About Hydrotherapy: Why Exercise In Water?

In a previous blog post, we discussed how a conservative approach to osteoarthritic knee pain has been shown to be an effective and preferable alternative to arthroscopy or knee surgery.

In recent months, further research in rheumatology has found a crucial link between metabolism and osteoarthritis. While often put down to a natural part of the ageing-process or ‘wear and tear’, an expert review in Nature Reviews Rheumatology describes how the onset or progression of Osteoarthritis can potentially be delayed, slowed down or even prevented with a good diet and regular exercise.

We also know that regular exercise can reduce the risk of Dementia, Type 2 Diabetes, depression, some cancers, heart disease and other chronic conditions by at least 30%.

So if exercise can help Osteoarthritis, plus many other health conditions, what type of exercise should you do? One great option for many conditions is Hydrotherapy, where you undertake a specific exercise programme in water, under the guidance of a Physiotherapist.

The Benefits of Water

Philosophers and physicians like Plato and Hippocrates knew the value of warm water as a therapeutic medium. The ancient Romans and Greeks thought waters relieved conditions like Rheumatism, Arthritis and an over-indulgence in food and drink.

Over the years, water has continued to be used in the treatment of muscle spasm and various diseases by many – including an increasing number of allied health and medical professionals.

As it turns out, the Romans and Greeks weren’t far off the mark! Water-based exercise can provide a realistic and enjoyable alternative to exercising on land, and when done correctly can provide you with similar strength and conditioning outcomes.

Having to move against the resistance of the water (using it’s properties of drag and turbulence) promotes activation of deep stabilising and postural muscles, which are important in conditions like back pain and during pregnancy.

Hydrotherapy can help manage:

The hydrotherapy environment can also address balance issues in a way that is safe and supportive. With less pressure under our feet in the pool, because we are buoyant, the other parts of the body that help us balance get a chance to work harder. The water creates a secure environment to challenge balance and confidence without risk of falling.

Is Hydrotherapy Safe?

Modern pain science tells us that pain is an expression of perceived danger to the body.  The pool environment is one of the few places where we can be more active while also feeling safer. This has powerful benefits for both rehabilitation and chronic or persistent pain.

For the larger weight-bearing joints like your hips, knees and spine, exercising in water is proven to be safe and can actually be more comfortable, particularly if you are dealing with a painful flare up or recovering from early Orthopaedic surgery.

In water, there is less loading and compression of the joints which means less risk of injury.  Standing in water up to your neck equates to a reduction in body weight of up to 90%, and a 100% reduction of joint load can be achieved if engaging in flotation or exercise off your feet; a way to experience “weightlessness”!

Is Hydrotherapy Too Gentle?

While it feels great to be light on our feet, we shouldn’t underestimate the hidden cardiovascular effort of water pressure and the effect of resistance.

The heart and lungs work harder when exercising in water, largely owing to an increase in circulating blood volume of 20-40%. This can be influenced by water temperature, depth and body positioning and can have positive cardiovascular health benefits.

A recent study showed that high drag forces in water result in greater muscle activity up to 300% of body weight. By choosing the right activity, varying speed of movement and using additional equipment like paddles or floats, joint forces, muscle resistance and overall effort can be modulated individually to meet your rehabilitation or fitness goals.

Exercise for Osteoarthritis

If you are overweight, suffering from health problems or already with Osteoarthritis and painful inflammation of the joint cartilage, the prospect of starting an exercise programme may seem daunting.

If you have pain, swelling or reduced mobility owing to Osteoarthritis, exercise in water may be a preferable and safer alternative to help you get back on your feet. This is related to the unique properties of water including warmth, buoyancy and hydrostatic pressure.

How To Start Hydrotherapy

If you’d like to investigate whether Hydrotherapy would be appropriate for you, contact us on 8373 5655. You can find out more about our Hydrotherapy class or 1:1 options here.


Ali Mobasheri, Margaret P. Rayman, Oreste Gualillo, Jérémie Sellam, Peter van der Kraan, Ursula Fearon. The role of metabolism in the pathogenesis of osteoarthritis. Nature Reviews Rheumatology, 2017; 13 (5): 302 DOI: 10.1038/nrrheum.2017.50

Ines Kutzner, Anja Richter, Katharina Gordt, Jörn Dymke, Philipp Damm, Georg N. Duda, Reiner Günzl, Georg Bergmann. Does aquatic exercise reduce hip and knee joint loading? In vivo load measurements with instrumented implants. https://doi.org/10.1371/journal.pone.0171972 Published: March 20, 2017

Micah Dorfner. Aquatic exercise: Gentle on your bones, joints and muscles. http://newsnetwork.mayoclinic.org/discussion/aquatic-exercise-gentle-on-your-bones-joints-and-muscles/. Published: July 7, 2015

Paul Ingraham. Get in the Pool for Pain: Aquatic therapy, aquajogging, water yoga, floating and other water-based treatment and injury rehab options. https://www.painscience.com/articles/aquatic-therapy.php. Updated: Mar 8, 2017

Academy of Medical Royal Colleges. Exercise: The miracle cure and the role of the doctor in promoting it. AOMRC.org.uk. 2015 Feb. PainSci #53672.

Barker AL, Talevski J, Morello RT, et al. Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis. Arch Phys Med Rehabil. 2014 Sep;95(9):1776–86. PubMed #24769068.

Villalta EM, Peiris CL. Early aquatic physical therapy improves function and does not increase risk of wound-related adverse events for adults after orthopedic surgery: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2013 Jan;94(1):138–48. PubMed #22878230.


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