Visit our store for Waterpower Workout Equipment and Land Therapy Supplies.
A Long View of Aquatic Therapy
by Lynda Huey, MS
In 1983, as elite athletes gathered in Los Angeles for pre-Olympic competitions, Kenyan distance runners, French pole vaulters, Greek javelin throwers, Cuban sprinters, hurdlers, and discus throwers, and a phalanx of American athletes came to the International Sportsmedicine Institute (ISI) for treatment of their injuries. There, in our pool, they found a new rehabilitative tool that helped them maintain their skill and their world-class fitness level while their injuries healed.
At first most coaches and athletes merely considered these Waterpower Workouts® an effective means for emergency cross-training – something to keep the athletes active and sane during rehabilitation. But soon some outstanding success stories began to emerge: Mary Decker Slaney set a world record at 2,000 meters after a month in the pool and only one surprisingly fast track workout prior to that race. Triple jumper Al Joyner took the wooden boot on his broken foot into the pool to train and retain his powerful jumping technique. A few months later, he won a gold medal in the 1984 Los Angeles Olympic Games. Joan Benoit Samuelson won a gold medal in the marathon after doing Waterpower Workouts to protect her postsurgical knee. UCLA sprinter Jeannette Bolden trained strictly in water because of a broken foot, raced in the 1984 Olympics on that broken foot, won a gold medal in the 400-meter relay, then had a cast placed on her foot after the race.
Athletes were being restored to their winning ways with the power of water, the magic of water. Needless to say, this was a heady time of discovery. Although an occasional coach or athlete had tried such pool-based workouts before, their success wasn’t making headlines as was this work with the world’s best athletes. Suddenly Waterpower sessions were crucial and very much in vogue for every injured athlete; then the wisest coaches began weaving them into their year-long planning scheme for prevention of injuries. Within a few years most university and professional teams had added pool workouts to their training programs.
What were the lessons we learned during the 1980’s that would set the stage for physical therapists jumping in with a splash in the 1990’s? First, we learned about using varying degrees of buoyancy depending upon the athlete’s weightbearing status. That was our primary focus: to let the runner run, the jumper jump, the hurdler hurdle even when that wasn’t a possibility on the track. Most of these resilient athletes could perform at high speed just by adding water; but whenever the stress fracture or the pain in the knee, tibia, or foot reappeared during a pool session, we learned to add a flotation belt to decrease further the trauma to their weightbearing joints, muscles, tendons, and bones. Once tethered to the side of the pool in chest-deep water they could perform their scheduled track workout for the day. Their workouts were based on time rather than distance, meaning that if, for instance, Florence Griffith Joyner’s workout should have been five times 300 meters, I would have her sprint on a tether for 33 seconds – the same time her coach Bobby Kersee would have wanted from her on the track. I would talk her through the first straightaway, the turn, the home stretch. She would strain to the finish line against various competitors that I mentally placed beside her. In that way she did the mental work that must accompany any high intensity workout. She pictured herself running each of those 300 meters on whichever track we chose. By the time “Flo-Jo” won her three gold medals and one silver medal at the 1988 Olympic Games, the strained hamstring that had caused her to spend a month in the pool with me had receded into distant memory.
But why did Florence emerge from the pool faster than she entered? She was one of many athletes who presented us with this paradox: that while they were crosstraining, they had become faster. My theory is that since the arms drive the running machine and since arm action has to be perfect in the water not to throw off the balance, sprinters particularly benefited from their time in the pool because their shoulders and biceps became so strong pushing powerfully through the water against resistance. Further, their arm action and overall symmetry improved causing superior overall running form. Thus we learned how water’s resistance serves as a functional workload to increase strength through a specific movement pattern.
It wasn’t until the late 1980’s that we eventually worked our way into a zero-gravity environment by taking athletes into the deep end of the pool (most of these athletes were non-swimmers and uncomfortable in deep water). But we had found that some injuries couldn’t tolerate any weightbearing at all. Thus the deep-water running and deep-water walking techniques evolved which would become the centerpiece of today’s program. As we coaches talked with physical therapists, massage therapists, athletic trainers, chiropractors, and athletes, we learned that the injuries were healing faster by working out in the pool. Why would this be? The amalgam theory we came to was that by keeping the body’s systems flowing, not letting them stagnate on the sidelines, tissue healing was being accelerated due to blood flow, lymph drainage, and increases in fitness.
The same held true for an eminent actor who was badly broken in a motorcycle accident: he could leave his wheelchair, then crutches, then walker, then cane behind each day as he entered the pool and could walk upright without assistance. His multiple fractures healed and he regained his abilities quickly enough to perform the London stage play on which he had his heart set.
Soon other athletes discovered Waterpower: basketball great Wilt Chamberlain, tennis player John Lloyd, long jumper Mike Powell, sprinter Valerie Brisco, ice hockey player Luc Robetaille, baseball player Bo Jackson, and many others. Water exercise no longer languished in obscurity, but was on the sports pages of The New York Times (November 16, 1991) and the Los Angeles Times (October 10, 1991). By the late 1980’s doctors and patients were calling to ask for “the same program Flo-Jo did,” or “Bo Jackson did,” or “Wilt Chamberlain did.” Dancer Paula Abdul yearned to recover more quickly from knee arthroscopy to get back on tour. To save her knees, actress Cybill Shepherd needed to do the karate moves she was learning for a TV movie in her pool instead of in contact with the heavy bag.
This group of athletes and entertainers helped lead to the next discovery: that sports and dance skills can be retained and enhanced in the water. The closer we could come to duplicating the land skill in the water, the more it helped the performer make a seamless transition back into action after weeks or even months in the pool. Duplicating skills needed on land in the pool led to today’s functional training such a stair climbing and squatting.
This ballet dancer’s story illustrates how we learned that we could take a difficult or impossible-to-do move on land into the pool to relearn it and make it possible again. Melissa Lesly had be unable to lift up onto point following ankle arthroscopy. For nearly a month we did twice weekly pool sessions to increase the musculoskeletal resiliency of her lower extremities, which had become deconditioned. Still, she couldn’t push up onto point. I asked her to bring her oldest pair of toe shoes to the pool, “a pair you don’t mind ruining.” She laced them up and began doing ten releves, echappes, and pas de bourrees. Soon she could to fifty then one hundred of each. In the pool, she regained her confidence while holding half her weight on point. Within three weeks, without thinking twice, she stepped out of the pool and easily raised up onto point.
Because water slows movements, it allows coaches, athletes, and therapists to find glitches in form. This first became evident working with a baseball player’s swing. The little bobble in his swing happened slowly enough in water that both his coach and he could identify and smooth it out; then he could carry the new, improved form with him into the game. Today, as we work with postsurgical knee, hip, and back patients, we use that same principle in locating the glitch in a patient’s gait. Walking slowly in water allows the therapist (and patient) to identify weaknesses, imbalances, and find corrections.
By asking the baseball player to switch-hit in the water, he was able to keep both sides of his body strong and symmetrical, not unbalanced as so many athletes are who compete in one-sided sports – javelin, bowling, tennis, golf, to name just a few. This led us to identify symmetry as a key goal during pool sessions. By keeping both halves of the body (front to back and side to side) functioning symmetrically, the weaker side begins to learn from the stronger side, begins to carry its fair share of the load in movements.
In 1993, when physical therapists began offering aquatic therapy, I partnered with a physical therapist who wished to add my pool program to his land program. By 1999, I opened my own business, CompletePT Pool & Land Physical Therapy with John Koegel, PT. From 1993 on, the therapists who joined my team began adding their body of knowledge and skill. We modified the exercises for the less capable, then made them easier, then made them easier again. Those patients who couldn’t balance for free-floating running and walking in deep water held the side of the pool and did lower body work only. One PT strapped ankle weights onto patients with arthritic hips for distraction to create enough joint space that we could perform pain-free internal and external hip rotation. Another used buoyancy cuffs around ankles to force post-TKR patients into increased flexion and extension. Yet another PT had a post-CVA (stroke) patient perform supine leg presses off the pool wall to simulate sit to stand. (This patient was too weak to stand independently on land.) And another PT placed a Speedo Step into the water to simulate steps, stairs, and obstacles routinely encountered on a daily basis during the performance of functional activities in the home and community.
What had begun as rehabilitation of the world’s most exceptional athletes has, over a twenty year period, become a full continuum of water exercises that serves patients of virtually any diagnosis. Today’s patients are given the same exercises (although performed more slowly), the same twenty to thirty minutes of total body fitness, the same correction of biomechanics to create symmetry, plus the specific rehabilitation exercises for their diagnoses. The past slides into the present when, in the same pool, we treat a UCLA sprinter trying to make the Olympic team, a badly-injured stuntman eager to return to work, a former NFL player after total hip surgery (now in his late sixties), and a 104-year-old man who wishes to move through the last days of his life with more dignity and strength. All of these patients reap the benefits of the lessons learned with the first generation of athletes, and as further generations of physical therapists add their ideas, it will only improve to further the entire field of aquatic therapy worldwide.
Lynda Huey, M.S., a former sprinter and track coach, has owned and operated CompletePT Pool & Land Physical Therapy with John Koegel, P.T., DPT in Los Angeles since 1999.