By Barb Cacia, BS ED, and Elizabeth Grzeskowiak, PT
Chronic pain is a serious issue facing an estimated 100 million Americans, according to the Institute of Medicine of the National Academies. Many of the individuals who seek relief at Pieters Family Life Center, a program of Heritage Christian Services, are affected by chronic pain from arthritis, back pain, fibromyalgia, and a host of other diagnoses. These individuals have to find the best ways to manage their differing degrees of discomfort daily, and no matter what the underlying cause of their physical issues, their pain symptoms end up fully affecting them.
For some, pain management involves taking over-the-counter and prescription medicines, but many believe in a holistic approach that does not rely on pharmaceuticals to mask the pain. Those seeking a better way to keep their pain at tolerable levels using a minimum amount of drugs are finding relief through the benefits of warm-water physical therapy.
It is critical for individuals affected by pain symptoms to understand that when they are exercising a joint that has arthritis or a chronic muscle pain condition, the more muscle strength that person has, the lower the sensations of pain. The muscle is the shock absorber for movement, and when muscles are stronger, they take pressure off the joint. On land a person fights against gravity, but in the water a person has the opportunity to build muscle with the effects of gravity and pain minimized.
The Advent of the Aquatics Era
Aquatics has become a central focus for many physical therapy professionals, as well as facilities and clinics. This is because of its well-known advantages for populations experiencing chronic pain and limited mobility. Water-based therapy is well-tolerated by people at every pain level, and when performed in a specialized pool set at temperatures in the upper 80s or low 90s, it can help build lean muscle mass, improve strength, and increase flexibility. For an individual with chronic pain, these are all significant benefits, as the more freely they begin to move in the water, the more they will be able to do on land.
Clients at this facility have access to an advanced therapy pool with an integrated underwater treadmill, a variable-depth pool floor, resistance jets, massage hose, and more. The movable floor is particularly useful when it comes to promoting muscle gains, as water depths can be monitored and changed as muscles develop. The most important aspect of the pool, at least at the beginning of any therapy session, is just getting a patient started. Many chronic pain sufferers and those with limited movement have been led to think that moving equals pain; they are pleasantly surprised when they realize the water feels good. This helps them feel more confident in themselves and their abilities, creating a win-win situation.
Today’s therapy pools are offered with a wide range of options and accessories that allow therapists to flex their creativity in tailoring programs that meet the needs of patients and clients. HydroWorx, Middletown, Pa, offers a line of pools equipped with features such as underwater treadmills and viewing monitors that allow therapists to observe gait and balance below the waterline. The treadmill can also accelerate a user’s ability to achieve an upright posture as well as work on correct gait in preparation for ambulation on land. Endless Pools, headquartered in Aston, Pa, are designed with variable-speed swim current as well as underwater treadmills that are powered hydraulically. Nespa Tiled Spas, Oroville, Calif, offers a line of swim spas in standard and custom configurations for use in rehab settings.
Activities for Every Chronic Pain Patient
One of the more interesting—and exciting—facets of engaging in aquatic therapy is that there are multiple ways to help physical therapy patients as well as the general public. For example, this facility offers group fitness programs in addition to individualized therapy. Both patients and wellness clients perform a considerable amount of water walking, and because of its size, the therapy pool can accommodate several people on the underwater treadmill at the same time. Some people are cautious about entering a regular swimming pool. Knowing that the water level in the pool can be adjusted quickly and easily, however, helps instill a high degree of comfort among clients who use the pool.
Another option for some aquatic therapy to help clients feel safe entering or exiting the pool is the use of a pool lift. Several manufacturers offer such devices to the physical therapy market, including Louisville, Ky-headquartered Aquatic Access, which builds a line of ADA-compliant, water-powered pool and spa lifts. Aquatic Access lifts include accessories such as bariatric seats, wraparound contouring headrests, and seatbelts for hip and chest. Pine Island, NY-based SureHands Lift & Care Systems manufactures a motorized wheelchair-to-water lift designed to be compact and transportable.
Pieters Family Life Center incorporates special equipment for aquatic-based activities when appropriate. One example is kickboards, which are used not in the conventional sense but rather as resistance tool. For this application a patient holds the kickboard in front of the body and walk against the current that is created by using the resistance jets. The water dumbbells are used the same way; and various sizes are available to help users build strength. Water wings and noodles are also used to work the lower extremities.
The beauty of using flotation equipment is that it’s another way for us to help chronic pain patients establish core strength. Flotation tools cannot be moved around in the water without strengthening the trunk. The core has everything to do with balance, endurance, strength, and coordination. This means being able to better manage life from the morning coffee pot to a cozy bed.
Additionally, flotation devices help people learn to control their movements. Without the water, in strength training, people have to rely on momentum; but with the flotations in the pool, they go slowly, fine-tuning those muscles for control. This is something physical therapists have trouble encouraging chronic pain clients to do on land.
Accessories for water-based activity are available from several companies in the physical therapy market. Sprint Aquatics, San Luis Obispo, Calif, offers the water walking assistant, which is made of PVC and designed to improve balance and gait by supporting the user’s upper body. The company also makes floatable pool cuff weights for the ankle and wrist.
Danmar Products, Ann Arbor, Mich, provides the Head Float, constructed from marine flotation foam and built to allow the wearer’s head to rest without pressure on the spinal column. The Head Float encourages neutral position and may have particularly good utility among individuals with reflex domination. The Hygienic Corporation, Akron, Ohio, also provides exercise accessories that can be used in the pool, such as Thera-Band tubing, Hand Bars, Aquafins, Pull Buoys, and Swim Belts.
The following companies also provide products for aquatic therapy:
Hydro-Tone Fitness Systems Inc
Nespa Therapy Pools
StretchCordz by NZ Manufacturing Inc
SureHands Lift & Care Systems
Safety and Security for Maximum Outcomes
Safety measures are essential for all patients, and that includes those who can’t move easily outside of the pool. Of course, for patients who are wheelchair-bound, or who cannot get into or out of a regular swimming pool, the therapy pool with variable-depth floor can be brought up to meet them, becoming flush with the ground. This takes the fear out of getting into the water, and allows them to concentrate on the enjoyment of the experience, as well as the results. Once they are in the water, staff can submerge a step, which gives the ability to practice the motion of stepping up and down without the effects of gravity.
A fibromyalgia patient who was a client utilized the facility’s safety measures to get in and out of the pool so she could work on balance and dizziness without concerns about falling. She stuck with an aquatic therapy program twice a week, and in time regained her core strength. Today, she can shop, prepare meals, and carry on independently. She is more mobile than she has been in years; without complementary water-based therapy to her land-based physical therapy, she would likely have plateaued at a much lower level.
Of course, not all pain patients had the gradual onset of chronic pain. One patient had back surgery and a previous knee replacement. After her back surgery, she struggled with mobility and couldn’t get away from using the walker. Aquatic therapy was begun once she was strong enough. A couple of sessions were completed in the pool and built her core strength. That same client now hardly sits, participates in wellness classes, and continues to improve.
Reimbursement and Realistic Expectations
In a time when discussions about healthcare are prevalent, including concerns among those suffering with chronic pain and mobility problems, it is important to know clinics have the resources to help their clients and also benefit financially from their aquatic therapy pools. The secret to that is simply this: getting creative.
This facility uses its therapy pool in several different ways. Aside from having a traditional physical therapy program, the aquatics facility is open to the public. People are admitted as if they were going to any other pool; however, use is limited to four individuals at a time. The underwater treadmill is used for about 30 minutes so everyone can perform cardiovascular training. One-on-one sessions are available, and most group classes are filled to capacity.
Insurance-focused services are prevalent in this climate, but the facility has priced its physical therapy services at a point typically lower than any insurance co-pay. This allows clients to avoid going through the paperwork, yet obtain the care they need. In addition to the pool, the facility has a versatile staff of creative physical and occupational therapists who use music therapy, art therapy, and dance therapy to help people, in addition to aquatic therapy—all of which help provide a better quality of life for patients dealing with pain.
Seniors are living longer, and studies show that the stronger a person keeps their muscles, the more able that person is to be independent. Pain is reduced. The use of medication is reduced. The psyche is lifted. Overall health is enhanced. By offering aquatic therapy to people who thought they had limited options, a new world of possibilities opens. PTP
Barb Cacia, BS Ed, is the wellness coordinator at Pieter’s Family Life Center in Rochester, NY. She is a personal trainer and health and wellness educator with a focus on individuals with chronic health conditions. Cacia coordinates HealthyYou, an employee wellness program, and facilitates group and individual wellness programs.
Elizabeth Grzeskowiak, PT, helps individuals with developmental disabilities at Pieters Family Life Center and specializes in aquatic physical therapy as a method to help individuals increase and maintain their independence and enhance their quality of life. For more information, contact PTProductsEditor@allied360.com.