Physiotherapy and Water- A fluid mix ?

My Name is Chris Heywood and I am physiotherapist specialising in low back pain. Over the last six and a half years I have had a dual role working as a researcher for Mr Nick Birch (Consultant Spine Specialist) alongside running my own clinical list. One of the techniques we use to great effect with some of our low back pain clients is Aquatic Physiotherapy so David, at Away with Pain, has kindly asked me to write this short article regarding this.


The use of water based therapy can be seen in history dating as far back as Egyptian times so it is by no means a new type of intervention. It has however been a victim of funding cuts within the NHS and this has led to many permanent pools being removed from hospital sites over the last 2 decades. This reduction in front line services has meant that many people who may benefit from this form of rehabilitation are either not able to access the facility or are not even aware of its potential benefits.

Aquatic Physiotherapy has had many titles over the years with the most widely known being Hydrotherapy. In recent times however hydrotherapy has been increasingly used as an umbrella term to encompass many water based techniques including colonic irrigation so to avoid any professional ‘misunderstanding’ we now just use Aquatic Physiotherapy!!

The official definition of Aquatic Physiotherapy is: 

A therapy programme utilising the properties of water, specifically designed by a suitably qualified physiotherapist for an individual to maximise function which can be physical, Physiological or psychosocial.


Treatments should be carried out by appropriately trained personnel, ideally in a purpose built, and suitably heated Hydrotherapy pool” (HACP 2007).

Here in Northamptonshire we are very lucky to have the Chris Moody Centre that is based at Moulton College. This houses two Aquatic Therapy pools one of which boasts an underwater bike and electronic treadmill! Do not confuse this state of the art facility with the similarly impressive equine centre next door which also has water therapy on site – we do not share facilities – although it would be fun!  

I would like to highlight at this point that aquatic therapy is not a singular, miraculous cure for all things, nor is it used exclusively for back or joint problems. It is also used very effectively for complex neurological conditions and is the reason many of you when looking for facilities in your local region may find them in schools specialising in children with learning disabilities or extended needs. 

 How does it work?

Believe it or not there is a lot of science and physics underpinning what we do and how we do it in the pool environment. It is not, as some of my peers often state, a bit of wallowing about in water.

The two primary effects we need to appreciate when discussing Aquatic Physiotherapy are the physiological changes that simple immersion in water causes to your body (hydrostatic) and also the effects then on moving fluids (hydrodynamic) which can either help or hinder the body. In addition to this we add warmth, keeping the water at around 34 degrees as oppose to a ‘hopeful’ 28 at your local baths. It may not sound like a lot of difference but it is enough to change a sharp inspiration on entry to an outward sigh of relaxation!!

Immersion in this environment can have profound effects on many bodily systems with the most relevant in this case being of relief of pain and muscle spasm (warmth, suppression of sympathetic nervous system, activity and reduced gravity), increased joint range/mobility (support of water and warmth) and increased strength and endurance through functional activities (using properties such as buoyancy and resistance). There is a lot of evidence to support the rehabilitation of the person as a whole entity to encourage self-sufficiency, especially in longer term back pain presentations, and Aquatic Physiotherapy really promotes this. 

What Should I expect?

Aquatic Physiotherapy sessions can be run as either one to one sessions or in a class format. Both the client and the therapist will be in the pool as many techniques taught are undertaken initially with additional supports or guidance and direct facilitation aids this. Pools generally are very warm and humid so you should take a water bottle so that you can keep hydrated through the sessions. The type of rehabilitation undertaken will vary greatly depending on your presentation and the therapist involved.

It is common to feel achy and very tired following the first session and to a lesser degree thereafter. This should be borne in mind when making plans for the rest of the day following the Aquatic Physiotherapy. Many therapists will encourage you to continue or carry out some of your exercise in a local facility between sessions or after you are discharged. Although you will generally lose the warmth related benefits in this environment it will enable you to govern your rehabilitation and become increasing self-sufficient.

Are there any Dangers?

The hydrostatic properties of water, that is the effects that water has on an immersed object, are the cause of the majority of the potential dangers. My clients are always very surprised with the sheer volume of questions I ask them to ensure I do not put them at any unmeasured risk.  The primary reasons for discounting hydrotherapy on safety grounds would be:

·         Medical instability after acute stroke (within 3 months), deep vein thrombosis, pulmonary embolism, asthma attack or significant neurological event during the last 6 months

·         Uncontrolled heart failure, resting/unstable angina,

·         Acute renal failure, dialysis

·         Bromide or chlorine sensitivity

·         Undiagnosed chest pain

·         Chemotherapy in last 3 months or undergoing radiotherapy

·         Active fever/temperature /infection

·         Known aneurism

·         Poorly controlled epilepsy

·         Weight in excess of pool evacuation equipment

·         Broken skin/pressure sores

We use other precautions as well on individual merit but immersion in water certainly has more effects on the human body that you would think. If you have any of the above or have other medical comorbidities please ensure that you are clear to exercise in water before doing so.

Accessibility and Cost

Some NHS trusts still operate Aquatic Physiotherapy services so it is worth approaching your local GP regarding this. The other alternative is to seek private care which may be covered on a private health care scheme or can be self-funded.  One to one sessions of Aquatic Physiotherapy with a suitably qualified physiotherapist with 30 minutes of pool time will cost anywhere between £60-£80 depending on the location and practitioner. A majority of this increased cost compared to conventional land based physiotherapy is simply to cover the cost of pool rental which is comparatively significant. 

It is a medical requirement that all individuals undergoing Aquatic Physiotherapy must have a land based assessment prior to their pool based session so be aware that this will need to be factored in to any private costing and expect this to cost £40-£45. The number of sessions can vary from a single visit to a course of treatment depending on individual needs.


We have been aware for some time that there is a growing need for some client groups to access aquatic pools without the additional needs of a physiotherapist. This may be for clients that have completed, or are undertaking, rehabilitation and want access in their own time or perhaps for those who would like to use it for general fitness or self-rehabilitation sessions. In light of this East Midlands Spine Ltd are working with the Chris Moody Centre to set this up and have the first session planned in May 2015.

If you would like more information on Physiotherapeutic led Aquatic Therapy feel free to contact me via www.chrisheywood.rehab. For further information on the open access Hydro4Cardio sessions please call me at East Midlands Spine Ltd on 01604 215442 or visit www.thebackdoor.org.uk

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