Aquatic therapy programme

Buoyancy removes most joint load, so movement that is impossible on land becomes achievable. Water resistance strengthens in every direction. Hydrostatic pressure reduces swelling. Warm water lowers pain and muscle tone.

The practical effect is that meaningful exercise can start before land-based work is possible, which helps to limit the deconditioning that otherwise occurs during the wait.

Early rehabilitation after joint replacement and lower limb surgery, osteoarthritis where land exercise is too painful to begin, neurological rehabilitation where balance is impaired, rheumatological conditions, chronic pain and fibromyalgia, and obesity rehabilitation.

If you use a wheelchair or cannot manage steps, ask for pool access to be confirmed in your plan. Access is usually the practical barrier for the people who would benefit most.

Bone and muscle adapt to load, and water removes load. That is why it helps at the start and why staying in it stops producing gains. A programme that is entirely aquatic improves cardiovascular fitness and leaves the patient no readier to walk on land.

Land work is introduced as soon as it is tolerated, and the aquatic component reduces as it does. The pool is a bridge.

Open wounds, active infection, uncontrolled epilepsy, severe cardiac impairment, severe respiratory instability, unmanaged incontinence, significant swallowing impairment, and some skin conditions. Tracheostomy and open pressure injuries are also exclusions. These are checked before the first session rather than at the poolside, and where the pool is not appropriate, the programme is built on land. Sessions are conducted with a physiotherapist in the water.

Water temperature is set for therapy rather than for comfort swimming, and patients with multiple sclerosis in particular are assessed for heat sensitivity, which can temporarily worsen symptoms.

For knee and hip osteoarthritis, a Cochrane review of 13 trials with 1,190 participants found moderate-quality evidence that aquatic exercise brings small, short-term improvements in pain and disability 1. The gain was about five points on a 100-point scale compared with control groups such as usual care 1.

For fibromyalgia, a Cochrane review of 16 trials with 881 participants found low- to moderate-quality evidence that aquatic training improves symptoms and fitness compared with control groups 2. Where water and land exercise were compared directly, results for pain and function were similar, while muscle strength favoured land-based training, on very low-quality evidence 2. That fits the use of the pool as a starting point rather than a destination.

It can help with strength more than with pain. A meta-analysis of randomised trials after knee replacement found that hydrotherapy relieved pain no better than land-based exercise or usual care, but produced a moderate gain in leg muscle strength 3. The number of high-quality trials was limited and the treatments varied, so the authors drew no firm conclusions 3.

Starting sooner is not automatically better. In a randomised trial of 465 patients, beginning pool exercises 6 rather than 14 days after surgery made no statistically significant difference overall, and after hip replacement the results did not support the earlier start 4. An open wound rules out the pool in any case.