Gym in a Swimming Pool

Water-based exercises provide excellent relief from joint-pain, and help in strengthening muscles

Exercises in swimming poolHydrotherapy refers to the therapeutic use of water at any temperature or form, including packs, vaporisers, baths, saunas, douches, wraps and pools.

Hydrotherapy exercise programmes consist of variety of water-based treatments and exercises that are designed for joint-pain relief, to condition and strengthen muscles. Hydrotherapy offers many of the same benefits associated with a land-based exercise programmes. However, it is especially helpful in cases where a land-based exercise programme is not possible due to pain, decreased bone density, disability or other factors. It also an effective approach for patients with rehabilitation needs or developmental disorders.

Hydrotherapy Exercise Techniques

Ai chi – Modelled after the principles of Thai Chi and yogic breathing techniques. The person stands in chest-deep water and performs a slow, rhythmic combination of therapeutic movements and deep breathing.

Aquatic PNF – Modelled after the principles and movement patterns of Proprioceptive Neuromuscular Facilitation [PNF]. The patient performs a series of functional, spiral and diagonal, mass-movement patterns while standing, sitting, kneeling or lying in water. The exercises may be performed actively, or with assistance or resistance provided by specialised equipments or a therapist.

Bad Ragaz Ring method – Based on the principles and movement patterns of Knupfer exercises and PNF. The person is made to do a series of exercise and relaxation patterns in horizontal position, supported by rings or floats in the water. The exercise is performed either passively or actively by the patient himself or with the help of therapist.

Fluid moves [aquatic feldenkrais] – Based on Feldenkrais Method. Exercises follow a sequence of movements based on the early developmental stages of the infant. The patient stands in chest-deep water, typically with his back to the pool and performs a slow, rhythmic combination of therapeutic movements and deep breathing.

Halliwick method – It is designed to teach balance and postural control. The patient is made to do series of activities which require more sophisticated rotational control in an attempt to teach him to control movement in unstable environment. The Halliwick Method combines the unique qualities of the water with rotational control patterns.

Swim stroke training and modification – It is a form of active hydrotherapy exercise, which makes use of swim-stroke patterns to rehabilitate.

Task-type training approach [TTTA] – It adopts ways to teach functional activities to stroke patients. The principles can be extended to include treatment of all patient disorders, particularly those involving neurological dysfunction. The TTTA is best described as a task-oriented approach because it emphasises on functional skills performed in functional positions.

Watsu – Based on the principles of Zen Shiatsu [massage]. The therapist stabilises or moves one segment of the body, resulting in a stretch of another segment due to the drag effect. The patient remains completely passive while the therapist combines the unique qualities of the water with rhythmic flow patterns.

Apart from various above techniques, simple exercises such as floating, general body movements, stretches, and walking in water is beneficial, as water’s natural buoyancy allows freedom of movement without jarring or straining the body. Its natural resistance encourages strengthening of the muscles, and its unique properties alleviate pain and facilitate ambulation skills.

Who benefits from hydrotherapy?

Hydrotherapy aids in pain reduction, muscle strength, joint flexibility, cardiovascular fitness and ambulation skills. Hence it is beneficial for those who have:

  • Chronic pain
  • Osteoarthritis and advanced osteoporosis [with susceptibility to and/or pain from fracture]
  • Muscle strain or tears
  • Low back pain
  • Spinal cord injuries
  • Post polio syndrome
  • Shoulder, neck, back and pelvic injuries
  • Cardiac conditions
  • Obesity
  • Bone, joint, or muscle disorders
  • Neurological Impairments
  • Cerebral Palsy and Stroke
  • Post operative ankle, knee, hip and spine surgeries

Hydrotherapy is also helpful to treat diabetics and high blood pressure patients. Both conditions can improve and become more manageable with water-based exercise. All of these conditions can make it uncomfortable or painful, for patients, to exercise on a hard/padded surface or while standing. Water provides a much gentler, welcoming environment. Moreover, the perception of pain may be diminished as a result of many factors including the relaxing sounds as well as the warmth of the water during water therapy exercise, making it a different and often very pleasurable experience.

The buoyancy of water permits a greater range of positions/motions due to the virtual elimination of gravitational forces.

Benefits of hydrotherapy exercises

The physical properties of water make it a highly desirable medium for exercising:

  • Water buoyancy eliminates the gravitational stress on the joints. This helps to improve balance and strength. Buoyancy is helps those who suffer from arthritis, injuries or obesity, who can get a cardiovascular workout without the risk of jarring/straining of joints or risk of falling.
  • Water viscosity provides resistance to movements by means of gentle friction, allowing easy regulation of movements, while reducing the risk of further injury due to loss of balance and over exercising.
  • The hydrostatic pressure of water enhances return of lymphatic fluid and venous blood, stimulating circulation and reducing swelling and inflammation in joints, making workouts easier and less painful. It also improves heart and lung functions and muscle blood flow.
  • Immersion in water reduces pain signal feedback.
  • The high specific heat of water carries heat to the tissues, further reducing inflammation and stimulating circulation, as well as increasing joint mobility and flexibility.
  • Water induces relaxations and provides a feeling of psychological well being.


Hydrotherapy exercises should only be performed under the guidance of qualified health professional.

It should be avoided if a person has

  • Fever.
  • Sever heart and respiratory failure.
  • Urinary or faecal Incontinence.
  • Active urinary infections.
  • Skin infections.
  • Excessive low, high or uncontrolled blood pressure.
  • Hydrophobia.
Roli Dave
Dr Roli Dave BPT, PG in Sports medicine and physiotherapy, is a consulting physiotherapist at Dr L H Hiranandani Hospital, Powai, Mumbai. She specialises in exercise physiology and manual therapy.



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