Have you had an injury in which doing movement on land was too advanced? Or too painful? It may be worth considering hydrotherapy to assist with rehabilitation! Water has been associated with health and healing for a long time, making it a great modality for rehabilitation. From Roman baths to mineral hot springs, differing cultures around the world have used water to aid illness and health. Hydrotherapy (also known as Aquatic therapy) is a water-based activity to aid recovery from neurological or musculoskeletal injuries. The goals of exercising in warm water aim to enhance muscle relaxation, improve joint motion, reduce pain and improve fitness.

Hydrotherapy is often facilitated by physiotherapists, kinesiologists or rehabilitation assistants. Clients are often satisfied with their one-to-one sessions or in turn, the social dynamic of group settings.

The natural properties of water

Thinking back to science class, water is similar with other forms of matter in which it holds physical properties of mass, weight, density, buoyancy, hydrostatic pressure, surface tension, refraction and reflection. In relation to hydrotherapy, it is the hydrostatic pressure and buoyancy that is our focal point in therapy.


Through buoyancy, the water is able to support the client’s weight to help relieve pain. Buoyancy is defined as the force experienced as an upthrust that acts oppositely to the direction of the force of gravity. In water, the body’s equilibrium is achieved when; 1) the centers of buoyancy and gravity are in the same vertical line, and 2) the weight of a floating body equals the weight of the water displaced. If the centers are not in the same vertical line, then the two forces acting on the body will cause the body to roll until equilibrium is achieved.

Hydrostatic Pressure

At a given depth, Pascal’s law reveals that fluid pressure will be exerted equally on all surfaces of an immersed body at rest at a given depth. Pressure increases when there is an increase in depth and the density of the fluid. Thus, this is important because this means that swelling will be easily reduced if exercises are performed well below the surface of the water where the effects of increased pressure can be utilized.

The Effects on the Body

The combination of warm water and exercise are the contributors to the physiological effects. The effects are dependent on the temperature of the water, the duration of the session and the type of exercises performed. The mild heat of the water tends to reduce the sensitivity of sensory nerve endings and muscle tone will tend to reduce when the muscles are warmed. The warm water causes superficial blood vessels to dilate, which activates sweat glands and loosens joints to remove toxic wastes from tissues. Thus, by immersing the body n water, it is believed that joint and muscle pain may be relieved by counteracting gravity by reducing pressure on the joints as a whole. Below are examples of therapeutic effects:

  • Relief of pain and muscle spasm
  • Enhance relaxation
  • Water can help blood flow
  • To relieve joint pain in clients with rheumatoid or osteoarthritis
  • Re-education to paralyzed muscles or gait-re-education
  • To strengthen weak muscles and progress power and/or endurance by using the water as resistance
  • To provide confidence in carrying out exercises, balance and stability
  • The hydrostatic effect may relieve pain by reducing peripheral edema

Contraindications and Considerations

The hydrostatic pressure that is felt on the outside of one’s body leads to a decrease in blood pressure peripherally, and blood pressure increases around the heart. Thus, it is with great consideration and caution that clients with Chronic Heart Disease or Coronary Artery Disease are screened. As well, contagious diseases or open wounds are an absolute contraindication as these conditions safe hygiene protocol is of utmost importance.

Wrap Up

Hydrotherapy has the potential to improve function, strength, increase in community involvement and progress function to land based exercises. Wth participation, this enhances once’s confidence to be able to continue exercises independently to maintain strength and function. It is recommended to be used in conjunction with current rehabilitation and not used alone as a therapeutic technique. At Chipperfieldphysio, our staff has experience with working with adults and pediatrics in hydrotherapy across a variety of musculoskeletal and neurological conditions. Speak to your rehabilitation professional to discuss opportunities! 

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Kamioka H, Tsutani K, Okuizumi H, Mutoh Y, Ohta M, Handa S, Okada S, Kitayuguchi J, Kamada M, Shiozawa N, Honda T. Effectiveness of aquatic exercise and balneotherapy: a summary of systematic reviews based on randomized controlled trials of water immersion therapies. Journal of Epidemiology. 2010 Jan 5:0910270113-.

Bartels et al., Aquatic exercise for the treatment of knee and hip osteoarthritis (Review),The Cochrane Library 2007, Issue 4 (Level of evidence : 1A)

Canadian Aquatic Rehab Instructors (CARI) website: http://www.aquaticrehab.ca/

Diving deep into Hydrotherapy
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