Water has been used for centuries as a medium for rehabilitation, relaxation, training during injury recovery and as an alternative training site. However, upper extremity rehab using aquatic therapy is often ignored due to the notion of shoulders and arms being out of the water while standing in a vertical position. The pool can be used to rehabilitate several upper extremity impairments and restore functional movement patterns using water resistance, buoyancy, hydrostatic pressure, various resistive and assistive equipment in different positions. Aquatic therapy makes possible to address all aspects of the rehabilitation program, including passive stretching, resistive exercise, functional movement patterns, and cardiovascular training in the same location.
Rehabilitation after shoulder injuries and shoulder surgeries can begin early in water. Water’s buoyancy and viscosity make it easier to perform resistive exercises in positions with the least amount of strain and risk of injuries to healing tissues and bones. Conditions putting restraints on the range of motion and weightlifting limits can start early with rehabilitation in an aquatic environment. Immersion in neck-deep water results in a natural depression on the rib cage and shoulder girdle, hence causing traction of shoulder, scapular, clavicle, and lower cervical joints, which ultimately helps in reducing pain, improving flexibility and mobility. The reversal of gravitational forces due to buoyancy results in increased activation of deep stabilizing muscles of the upper body which are extremely important for correct posture and movement pattern.
Athletes recovering from upper extremity injuries can begin high-intensity exercises in water, way earlier than land. Water also helps in identifying and correcting biomechanical deficits and impairments by slowing down the movements and challenging core stability. This results in excellent outcomes as the therapist can target core strength, posture, motor control, strength, and mobility all at once, which ensures the most functional training program for athletes as well as non-athletes. Even though performing overhead movements in vertical positions is difficult, the correct positions can be easily achieved using floatation devices and assistance from the therapist.
The warmth of water causes intentional relaxation which is highly beneficial for patients with tightness, spasticity, and rigidity. Proprioceptive input from water immersion is useful in training for body positioning and kinesthetic sense. Additionally, PNF patterns and neural tissue mobilization can be easily incorporated in therapy for patients with neuromuscular disorder. Aquatic therapy techniques of Watsu and Bad-Ragaz are excellent for brain and spinal cord injuries.
In Conclusion, the therapists can utilize the aquatic environment to treat patients with a wide range of upper extremity, cervical, and upper body issues by incorporating their knowledge of anatomy, biomechanics, and physiology of injuries along with Aqua therapy for effective rehabilitation. Aquatic therapy has been proven successful in theory as well as in practice.