Dear Doctors: I had a total hip replacement. I also have arthritis. It has made it hard to get back on my feet. My doctor is wanting me to try aquatic physical therapy. Is it all that different from the regular physical therapy I’ve already been doing? Why would it be more helpful?
Dear Reader: For those who are not familiar, physical therapy is a health care practice designed to restore or improve strength, balance, flexibility, range of motion, coordination and mobility. It can also improve cardiovascular health and can help reduce inflammation. Physical therapy is often recommended for people recovering from an injury, surgery or illness. In addition to a wide range of exercises, it may also include the use of massage, heat treatments, electrical stimulation, manual therapy and visualization. Drug-free pain control and pain management are also important components of this practice.
Aquatic physical therapy and nonaquatic physical therapy share the same goals. The difference is that aquatic physical therapy harnesses the unique properties of water in order to achieve them. To that end, it takes place in warm water, typically a pool that has been heated to between 89 and 95 degrees. The warmth helps increase blood flow, and thus oxygen delivery, to the target areas. It often also has a soothing effect on the body and the mind.
Because water is dense, it creates steady resistance as you move through it. The degree of resistance can be adjusted by changing speed or direction, and with the use of equipment such as weights, floats, paddles or webs. And because water resistance is multidirectional, it engages the muscles and connective tissues more completely than the same land-based exercise would.
Another benefit of aquatic therapy is something known as hydrostatic pressure. That’s the gentle but steady force that water exerts on your body when you’re submerged in a tub or a pool. Hydrostatic pressure can boost lymphatic circulation and help ease swelling in the joints and tissues, and it adds an additional physical cue to track the position or trajectory of a limb. Perhaps most important is buoyancy, which lifts and supports the body during exercise. This allows the muscles to work without the stress and pressure of gravity on the joints and connective tissues.
Research has shown that aquatic physical therapy can be beneficial to people who are recovering from joint-replacement surgery. This is particularly true for those, like yourself, who have undergone a total hip replacement. Exercising in water provides the resistance needed to build and strengthen muscle. The warmth helps muscle to become more pliant, and the buoyancy of water eases pressure on the new joint. One interesting study compared the post-surgical recovery of hip-replacement patients who did only land-based physical therapy and those who also included the aquatic version. The researchers found that patients whose physical therapy regimens included both types of PT had a faster and more successful recovery.
Full recovery after total hip replacement can take from six months to a year. Regular physical therapy is crucial to a successful outcome. Whichever form of PT you choose, be sure to follow the complete treatment plan.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
