Last year, the practice led by Daniel J. O'Connor, PT, decided that it needed a new name—one that would better reflect its capabilities. And so, Sportho Physical Therapy became Sportho Physical and Aquatic Therapy, located in Chicago. It was a simple change, yet it had an immediate effect. "We discovered that we have been working with some people for 20 years who did not know we offer aquatic therapy," says O'Connor, president of the practice.

Yet aquatics are a major component of the practice's services. "With aquatic therapy, we can progress more quickly," O'Connor says. Aquatic therapy is often part of a larger program that includes land-based work as well as at-home exercises.

In addition to aquatic therapy, Sportho offers work conditioning (including back injury prevention programs), augmented soft tissue mobilization, sports rehabilitation, industrial functional testing, orthopedic physical therapy, and physical conditioning. O'Connor notes that one team member (Judith Polkow, PT, CFP, who, according to the practice's Web site, worked with Michael Jordan during the 1985-'86 NBA basketball season) is also a Certified Feldenkrais Practitioner.

The Sportho philosophy is tied strongly to function. "I strive for functional ability with everybody and try to be as aggressive as possible to get people to return to their previous functional ability," O'Connor says. To achieve this as quickly as possible, O'Connor turns to the pool.

Exercise Through It

"The water environment helps people feel safe and still be able to move," O'Connor says. Water can both assist and resist movement as well as enable the therapist to stress functionality. "You can get the patient to go through any motion you want them to do and have them not be afraid and realize it won't hurt them," O'Connor says.

This atmosphere permits patients to be pushed. "Most patients are leery and nervous after injury and don't want to exercise vigorously. But if we watch what's happening with their bodies while helping them to exercise to their tolerance, they realize they can do it," O'Connor says.

The intended benefit is more rapid healing. Greater vigorousness and longer periods of exercise are often achieved in the water than on land—the more movement the patient performs (properly and without damaging strain), the faster the healing. In addition, the water's buoyancy permits a patient to exercise the whole body while protecting any damaged parts.

"If the knee has been injured, we can still exercise the trunk and upper body to restore function more quickly or get a patient back to work sooner," O'Connor says. In addition, the mental benefit can be as great as the physical.

Sink or Swim

The patients most likely to benefit from the pool include those with multiple physical problems. "We can maximize treatment and be efficient with time," O'Connor says. Examples include back injuries ("working with underwater flexibility can lead to quick gains in function and comfort," O'Connor says) and total joint conditions ("water increases the feeling of security in these patients," O'Connor says). Patients with greater control can use the water's resistance as they move through a range of motions to gain strength.

Full range of motion activities can be enhanced by devices to increase the resistance of the water.

Though many exercises can be performed in a pool and therefore many conditions may have an aquatic therapy component, some patients will not be able to enjoy these benefits. Post-op patients, for instance, must stay out of the water. "Incisions typically need about 10 days to 2 weeks to heal," O'Connor says. Patients who are unable to safely enter and exit the pool should not be treated in it, nor should those who are excessively uncomfortable in the water. Some patients with limited mobility may be able to benefit from aquatic therapy with access to the water through pool lifts.

To screen patients, O'Connor completes a careful process that includes a questionnaire and tour of the pool.

Aquatic Accessories

During the tour of the pool, O'Connor will turn it on and show potential aquatic therapy patients what the water can do. "We turn the pool on from zero to full force, show what we'll be doing, and explain the entry and exit platforms to be sure they understand what they are getting into," O'Connor says.

Sportho occupies 4,000 square feet, which includes a pool, private changing room, a shower, and towel service. The pool is a SwimEx 600-T heated pool by SwimEx, Fall River, Mass, that holds 3,200 gallons of water at adjustable depths of 4 to 5 feet. The system can create a moving wall of water with multiple speeds and resistance up to 6.5 miles per hour. An integrated motorized treadmill provides a running platform for further therapeutic exercise options.

O'Connor finds its power to be a major benefit. "We can adjust it to a level patients can handle—up to 6.5 miles per hour, which can be so powerful that college swimmers can't keep up," O'Connor says.

Other pool equipment includes belts ("good for people who are uncomfortable in the water," O'Connor says); devices designed to increase resistance, such as paddles and fins; exercise equipment, including dumbbells; and items intended to help the patient resist the water and move quickly through it (such as boards).

O'Connor is not loyal to any one brand but does believe that there are some excellent catalogs online that address aquatic therapy needs. "The best tool for this is the Web," O'Connor says.

One-to-One

Various devices can be used to assist or to resist movement.

Each patient is supervised during his or her time in the pool by the therapist. One-to-one care has been a cornerstone of O'Connor's practice since his graduation from the University of Illinois at the Medical Center in Chicago in 1977. Working in a rehabilitation hospital, he delivered one-on-one care that he realized could be applied to outpatient orthopedic therapy. "I don't think treatment of multiple patients at once is the best way to go but rather that patients should be treated one-on-one," O'Connor says.

When he first opened Sportho in 1983, he established the singular patient-therapist method as a practice philosophy. "I realized I could provide that type of care given my own control of it," O'Connor says.

As a result, Sportho therapists manage any exercise a patient is performing on any particular day. Though not in the water, they guide patients through movements and exercises, making sure the patient is performing them properly and experiencing the right effect. "We stay with the patient, developing a relationship that permits us to monitor them closely," O'Connor says.

Though it can be a financial challenge to maintain this type of care, O'Connor cites volume as a benefit. "Therapists providing one-on-one care can help patients reach improvement more quickly and maintain it and get more patients as a result," O'Connor says.

Pool Programs

Sportho's four full-time PTs see approximately 250 patients per week with the help of one part-time PT assistant. Patients use the pool on a varying basis, but generally those who visit the clinic three times per week are in the pool once per week. The rest of the time, treatment takes place on land.

There is no typical treatment program, in part because treatments are customized to the patient and diagnosis. O'Connor suggests that the average back patient will undergo treatment for about 3 to 4 weeks; post-op patients will often require a longer-period treatment; and total joint replacements need a little bit more time than that.

The typical back patient will usually undergo a lot of underwater flexibility work. "The buoyancy lets them move their limbs and trunk through a greater range of motion," O'Connor says. Next, a kickboard exercise may be introduced to encourage the use of the back. "Most people swim with their arms," O'Connor says. Once patients are ready, the therapist can add current. "Just trying to stand provides excellent core strengthening," O'Connor says.

Dramatic improvements are not rare, and O'Connor finds that many patients who were leery of the water love it once in it. "Once they've tried it, they want to go back," O'Connor says.

Practice Swimmingly

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