Source: www.guardian.co.tt
Story by: Asha De Freitas-Moseley
As an athletic trainer, I use as many tools as I can to get the desired effect of healing on damaged tissues as well as to instigate proper movement on the road to full recovery, or in the case of athletes, return to training or competition. Truth be told, particularly in the case of post-surgical and chronic injury management, rehabilitation and muscle conditioning is a process that requires lengthy commitment and discipline by the individual. The purpose of rehabilitation is to facilitate the healing process while simultaneously re-educating particular muscles and/or muscle groups in order to restrict muscle atrophy in the early stages and create a strong foundation for strength training later on. The application of massage, cold, heat, ultrasound, electric stimulation, laser, kinesio tape, zinc oxide tape (the white tape used for ankle taping amongst other things), prescription exercises, flexibility training are all deeply engrained in the practice of physical and athlete therapy. Aquatherapy and hydrotherapy is another such tool and the focus of this week’s column.
The difference between the two (as defined in my world of athletic training) is in the way it is applied. Hydrotherapy is with reference to whirlpools, aquatherapy involves bigger spaces like swimming pools. The benefits of water therapy are vast, and understanding the applications dictates when and how it can be used. Whirlpools refer to a body of water contained in a smaller space that requires the athlete to emerse themselves and allow the water components to affect the tissue. Small movements might be incorporated but this depends on the goals of the therapy. For instance, an acute ankle sprain, swollen as big as a grapefruit, could be suspended in a cold whirlpool and the athlete made to move the toes back and forth. The purpose is to curb inflammation and facilitate circulation. The temperature of the water is a very important factor that must be managed. This is just one very simple example.
In the pool, the same can be done if it isn’t heated, but usually, aquatherapy in this setting has a different purpose, fully utilising the physical properties of water and should be heated. The hydrostatic component of water decompresses and relieves the stress in the joint and by extension, the pain. One very basic rule of therapy: relieve the pain and you increase the movement. The buoyancy of water provides security to individuals who would otherwise be more cautious in their movements due to the fear of falling or overexerting the injured area. Removing that gravitational element displaces the stress that would otherwise be placed on the joint and muscles. Having accomplished this, normal movement patterns can be reintroduced concurrently with improving body awareness. The resistance experienced in water while exercising in a pool or any body of water is directly related to the force exerted against it. Water is several hundred times denser than air and can provide up to twelve times the resistance. The more speed applied in aqua exercise, the more effort that is required to push against it.
The bigger the surface area of the moving part, the greater the required force as this will involve a greater displacement of water, hence the involvement of equipment such as webbed gloves and various floating devices such as noodles and hand buoys which make exercises more challenging. One great way to test strength progress in the pool is to count the number of reps that can be completed in a minute. Provided sound technique is applied throughout the minute, an increased number of reps indicate an increase in muscle strength and function. The body part’s full emersion in the water allows resistance application in all planes of movement. Unlike on land where gravity constantly provides a downward force towards the earth’s surface, further felt with the addition of weight (as is accomplished with dumbbells and machines) or therabands that provides resistance from a fixed point, water completely surrounds the joint creating an environment capable of challenging the agonistic, antagonistic and stabilising muscles of the joint concurrently.
The best part about aqua/pool therapy is the break in monotony to a rehabilitation programme that it brings. Rather than having to be in the clinic, it provides a different setting to the athlete and the clinician, introducing a different sort of challenge physically and a sort of psychological relief. Athletes usually welcome this change and enjoy the aqua session. Athletic trainers and physiotherapists alike apply this medium of rehabilitation. Aside from myself, physiotherapists like my co-columnist, Carla Rauseo at Total Rehabilitation Centre and Lisa Niles at Altus Health Services use this medium of therapy in their physiotherapy practices. Water therapy can assist any kind of client from the osteoarthritic patient to the back pain sufferers to the elite athlete. But whether you are injured or not, aquatherapy is something that anyone can benefit from.
Note: Asha De Freitas-Moseley is a certified athletic trainer. She works with the athletes of Trinidad and Tobago from recreational to elite level at Altus Health Services Ltd. (Port-of-Spain) and Total Rehabilitation Centre Ltd. (El Socorro).