Hi, I'm Doctor Jo, a licensed Physical Therapist and Doctor of Physical Therapy. I hope my physical therapy videos for common injuries and syndromes will help put you on the road to recovery. If you have a question, just ask! Be safe. Have fun. And I hope you feel better soon.

Aquatic Therapy

Advanced Walking Exercises in a Pool

Once you have mastered the standing exercises in the pool, you are now ready for the more advanced walking exercises. These are basically putting the standing exercises into a dynamic walking movement. It is important to keep proper posture while doing these.
 
First is what we call the soldier march. It is pretty much a straight leg raise while walking.  Keep your knee straight and locked out. Pull your toes up towards you into dorsiflexion to keep your knee from bending. Kick through the water only as high as you can go without leaning back. Next is the hamstring curl kick. Just like when standing, your hip should stay in a neutral or slightly extended position. If you bend your hip up, you are working different muscles. It's almost like you are clucking like a chicken! Then there are the Rockette kicks. Bend your knee up into a march position, then kick your leg straight out and step forward. If that is too much of a stretch, don't bring your knee quite as high.
 
Now you are going to walk on your toes, just like you are in high heels. Try to stay up on the toes the whole time without touching your heels to the ground. Then switch to walking on your heels. Try not to push your bottom back; you are lifting your toes, not leaning back. This really forces you to straighten your knees into extension, so be careful if you have a knee injury. Finally, you are going to squat sideways. Remember to keep your toes facing forward the whole time. As you are stepping out, that is when you want to squat, and as you are standing back up, bring your feet back together. It is one fluid motion; try to move the whole time.
 
Always use CAUTION with Exercising in a Pool:
If you can't swim, don't do these exercises unless there is a certified lifeguard on duty. Working out in a pool can be very deceiving. Many times you will feel great while in the pool because gravity is taken away. It feels easy and you want to do a lot, but always start at a baseline. If you have not performed aquatic exercises before, you have to let your body adapt to it no matter what your fitness level. Pool workouts should only start at about 40 minutes, and you shouldn't be in the pool longer than an hour especially if it is a heated pool. Don't let the water fool you!

 

Deep Water Cardio Exercises in a Pool

Now that you have done the exercises in the shallow end, you can move to the deep end. Some of you might have to stay in the deep end if you have a non-weight bearing precaution. With the cardio exercises, the best equipment to use is an aqua jogger, and no weights for these. Here you want to focus on proper technique and getting your heart rate up.
 
Try not to lean back or forward with these exercises. You need to be in a vertical position. Start of with the bike. Try to bring your knees up and kick forward making big circle motions with your legs, just like you are riding a bike. Then kick your legs out and in like a jumping jack, or hip abduction/adduction. Try to keep your feet forward so you are working the outer portion of your legs, and try to keep your knees straight and locked out. Next, is a scissor/Cross Country skiing movement.  Again, keep your knees straight and locked out to give you extra resistance kicking your legs front to back, or hip flexion/extension. Finally, for those of you runners out there, this is just a running motion. Bring your knees up and push them downward.
 
You probably only want to start off with 5 minutes of each of these, but once your body gets use to the aquatic exercises, you can do a whole cardio workout for about 30-45 minutes!
 
Always use CAUTION with Exercising in a Pool:
If you can't swim, don't do these exercises unless there is a certified lifeguard on duty. Working out in a pool can be very deceiving. Many times you will feel great while in the pool because gravity is taken away. It feels easy and you want to do a lot, but always start at a baseline. If you have not performed aquatic exercises before, you have to let your body adapt to it no matter what your fitness level. Pool workouts should only start at about 40 minutes, and you shouldn't be in the pool longer than an hour especially if it is a heated pool. Don't let the water fool you!
 

 

Core Exercises in a Pool with Toys

Aquatic therapy can be a great workout for your core. Many times with back pain, you just can't handle exercises on land. The water helps take gravity out of the picture so you can focus on your exercises.
 
It is really important to make sure you have good posture when you are in the pool. It is really easy to move your upper body a lot, but you want to try to keep your upper body straight and upright. Squeeze in your abdominals to help keep that upright position. Using ankle weights can be very beneficial.  Not only do they give you some extra resistance, but they also keep your feet on the ground while doing the exercises.
 
Pool equipment, or pool toys as I like to call them, can range from very simple and cheap to very elaborate and expensive. Today I am going to show you some simple toys that you can find at most pools and not have to purchase on your own. The first set of toys is called paddles. These work well because you can open and close the slits to make more or less resistance. The next set is dumbbells. These are not like land dumbbells. They are very light and made of foam. So they not only give you good resistance in the water, but they also make it hard to keep them down in the water. The final one is a kickboard. This can really give you resistance in the water by pushing and pulling it halfway in the water. The faster you push with all these toys, the more resistance you will get.
 
The first exercise shown with the paddles is a gait exercise. You want to push out with the opposite arm of the leg that goes forward. This is how we walk normally on land, and is only difficult when you think too hard! Try not to let the resistance push you around. If you cannot stay upright, then you are not ready for equipment yet.
 
The next exercise, shown with the dumbbells, is in a staggered stance position. This is with one foot in front of the other. It is almost like you are in a lunge position. Bend down a little into the water to help keep your position. Start by alternating one arm in front and one arm in back. Keep your arms straight and push and pull through the water. Don't bring the dumbbells out of the water. Then switch feet, and push and pull both arms together.  If you feel like the paddles or dumbbells are too much resistance, you can do these just using your hands. Try each of these 15 times, and then work your way up!
 
Finally, with the kickboard, put it about halfway in the water. Simply push and pull the board towards and away from you while you are walking forwards and backwards. Then turn to the side, and put your arm straight out in front of you. Put the kickboard out in front of you and step sideways. 
 
Always use CAUTION with Exercising in a Pool:
If you can't swim, don't do these exercises unless there is a certified lifeguard on duty. Working out in a pool can be very deceiving. Many times you will feel great while in the pool because gravity is taken away. It feels easy and you want to do a lot, but always start at a baseline. If you have not performed aquatic exercises before, you have to let your body adapt to it no matter what your fitness level. Pool workouts should only start at about 40 minutes, and you shouldn't be in the pool longer than an hour especially if it is a heated pool. Don't let the water fool you!
 

 

Basic Gait Exercises in a Pool

One of the best ways to get your walking or gait pattern back after an injury is aquatic gait exercises. Walking in the water not only takes away some of gravity, but it also allows you to concentrate on getting your correct pattern back. It is a great way to get a workout without a lot of impact on your joints. These gait exercises are a good warm-up before you do an aquatic therapy workout.
 
It is really important to make sure you have good posture when you are in the pool. It is really easy to move your upper body a lot, but you want to try to keep your upper body straight and upright. Squeeze in your abdominals to help keep that upright position. Using ankle weights can be very beneficial.  Not only do they give you some extra resistance, but they also keep your feet on the ground while doing the exercises.
 
To start off, simply walk forward. Concentrate on a heel to toe walking. When we walk on land, our heels hit first and we roll onto and push off with our toes. Exaggerate this movement while you walk while keeping that upright posture. Then reverse it and go backwards. Now your toes are going to hit first and roll back onto your heels. Try not to lean back when you are doing this, and keep your body upright. 
 
Next, turn sideways. When you step, it is important to keep your toes pointed forward. If you turn your foot out when you step, you are changing the muscles being worked. Finally, march by bringing your knee up toward the surface of the water getting a bend in your knee and hip. Really try to drive your knee upward to get a good stretch. Again, don't lean forward, try to keep your body upright. 
 
Depending on how fast you go, these should take you between 5-10 minutes and is used as a warm-up to your exercises.
 
Always use CAUTION with Exercising in a Pool:
If you can't swim, don't do these exercises unless there is a certified lifeguard on duty. Working out in a pool can be very deceiving. Many times you will feel great while in the pool because gravity is taken away. It feels easy and you want to do a lot, but always start at a baseline. If you have not performed aquatic exercises before, you have to let your body adapt to it no matter what your fitness level. Pool workouts should only start at about 40 minutes, and you shouldn't be in the pool longer than an hour especially if it is a heated pool. Don't let the water fool you!

 

Standing Exercises in a Pool

Sometimes you just can't do exercises on land because they are either too painful, or you just might not be strong enough to do them on land. Aquatic therapy with water exercise helps you get the exercise you need in a low impact environment. You can really concentrate on your technique because you don't have to worry about falling. After you do a warm-up in the pool of gait exercises, then you can work on some standing exercises.
 
It is really important to make sure you have good posture when you are in the pool. It is really easy to move your upper body a lot, but you want to try to keep your upper body straight and upright. Squeeze in your abdominals to help keep that upright position. Using ankle weights can be very beneficial.  Not only do they give you some extra resistance, but they also keep your feet on the ground while doing the exercises.
 
Hold onto the side or a bar to help keep your upright posture. Start off with a hip flexion/extension (front to back) exercise. Lock out your knee and try to keep it straight the whole time. Pulling your toes up or into dorsiflexion will help keep your knee straight. Bring your foot up as high as you can without leaning back, and then bring it back as far as you can without leaning forward. Then still keeping the knee locked out, perform hip abduction/adduction (side to side). Try not to turn your foot out when kicking out to the side. This will change the muscle you are trying to work. Start off with 10 on each side, and then work your way up.
 
Next is a hamstring curl. You are only bending your knee here. Try to keep your hip in a neutral position.  If you bend your hip up, you are working different muscles. If you have to hold your hip down, that is fine, but it should stay in alignment with the other hip. Then you are going to do a Rockette kick. Bend your knee up into a march position, then kick your leg straight out. If that is too much of a stretch, don't bring your knee quite as high. Make sure to do all these exercises on both sides. When you are standing on the leg, and moving the other, you are using your muscles as stabilizers so they are being worked in different ways.
 
The final two will be done with your feet about shoulder width apart, and again, make sure your feet are pointed forward. For the heel/toe raises, make sure to go as high up on your toes as you can to work the calf muscles. Then roll back onto the heels and pull your toes up to work the anterior tibialis muscle. Try not to stick your bottom back, just pull your toes up. Lastly, is a squat. Keep your feet flat on the ground the whole time. Stick your bottom back like you are going to sit in a chair to make sure your knees do not go in front of your toes. Bring your chest slightly forward, and keep your back straight.
 
If these become easy and you can do 20-25 without difficulty, try doing them without holding on to the side. If that is still easy, try holding on, but increase your speed. Make smaller, but quicker movements, and this will add resistance in the water.  If you can't hold your posture while doing these, then you are not quite ready yet!
 
Always use CAUTION with Exercising in a Pool:
If you can't swim, don't do these exercises unless there is a certified lifeguard on duty. Working out in a pool can be very deceiving. Many times you will feel great while in the pool because gravity is taken away. It feels easy and you want to do a lot, but always start at a baseline. If you have not performed aquatic exercises before, you have to let your body adapt to it no matter what your fitness level. Pool workouts should only start at about 40 minutes, and you shouldn't be in the pool longer than an hour especially if it is a heated pool. Don't let the water fool you!