Water has long been valued for its healing properties, with spas and Roman baths the historical evidence for this. Physiotherapy has also looked to benefit from the reduced weight bearing nature of this medium to apply their range of manual techniques to effect healing. ntpages caught up with Belinda Sidrak, a physiotherapist who practices under the name of AquaPhys, to learn more about what can be achieved.
Is the field referred to as Hydrotherapy or Aqua Physiotherapy?
“Many people would traditionally know the treatment that Physiotherapists carry out in the water as Hydrotherapy. Hydrotherapy however, can mean a range of things including colonic irrigation, spa pools and hot and cold contrast bathing. The Physiotherapy profession uses the terminology 'Aquatic Physiotherapy' to help demarcate our role in using the medium of water as one of our treatment modalities and remove some of the confusion about other terms such as aqua aerobics, water exercise and swimming. The word Hydrotherapy is an umbrella term that covers many of the activities that occur in water but only Physiotherapists do Aquatic Physiotherapy.”
Tell us a little about yourself and how you came to practice Aquatic Physiotherapy?
“I commenced my professional education in 1996, undertaking a three year Bachelor of Applied Science in Exercise and Sport Science. Following this, I went on to study a four year Bachelor of Applied Science in Physiotherapy. During my early years of work, I was exposed to Aquatic Physiotherapy through various positions that I held, in both public and private sectors. My appreciation for this type of treatment modality grew, when I observed the outcomes I was achieving with patients, who had either plateaued with traditional forms of Physiotherapy, or who would otherwise find it too painful or difficult to attend treatment. I realised that Aquatic Physiotherapy allowed many patients the opportunity to commence their rehabilitation a lot earlier than they otherwise would (eg. orthopaedic patients in casts), or provide a more comprehensive rehabilitation (eg. mobility restricted patients, wheel chair patients).
In light of this, I created AquaPhys in 2006, as I felt there were too few Physiotherapists practicing this form of treatment, particularly in the Bankstown area.”
What training does an Aquatic Physiotherapist require?
“All Aquatic Physiotherapists are University qualified professionals. They require a four year Bachelors degree in Physiotherapy or Applied Science (Physiotherapy). Alternatively, they may complete a two year Master of Physiotherapy, for those with an appropriate undergraduate degree. All Physiotherapists are legally required to register with the Australian Health Practitioner Regulation Agency (AHPRA). They are also required to undertake continuing professional development programs, to keep themselves up to date and comply with the expected standards of professional conduct.
As a part of continuing professional development, Physiotherapists who practice Aquatic Physiotherapy will undertake courses specific to this role.”
What conditions is Aquatic Physiotherapy most effective at treating?
“Aquatic Physiotherapy is effective in treating an array of conditions, some of which include :
ORTHOPAEDIC (Fractures, Post plaster mobilisations, Arthroscopies)
The Physiotherapist can judge the exact amount of weight that is put through the injured limb. When the water is at neck level, the patient is taking 10% of their weight through their feet. Water to the hips is equal to 50% weight bearing. This allows for early mobilisation of joints with the support of the water, allowing for earlier recovery of function (eg. a patient who has been advised to partial weight bear by their orthopaedic surgeon can still comply with their weight bearing orders and safely exercise in waist deep water).
SPINAL (Acute back pain, Disc injuries)
Circumferential heating can ensure that pain and muscle spasm are addressed, allowing for simultaneous mobilisation and exercise to take place. Techniques (eg. mobilisation, traction) that are normally performed on land can also be performed in the water.
ARTHRITIS (Rheumatoid Arthritis, Osteoarthritis)
To maintain mobility, arthritic patients need to exercise but this is sometimes too difficult on land due to pain, age, deformity, etc. Water is often the best medium because the patient can exercise quite vigorously but with little stress on the joints.
NEUROLOGICAL (Cerebrovascular, Spinal cord injuries)
Neurological patients can exercise without the fear of falling, allowing them to improve balance and co-ordination, re-educate functional activities and patterns of movement, in a non threatening environment. This enables the patient to remain motivated and gain a sense of achievement.
RESPIRATORY/CARDIAC (Asthma, Chronic Obstructive Pulmonary Disease, Ischaemic Heart Disease)
Activity in the water can be progressed slowly to improve fitness, considering such patients usually have poor exercise tolerance.
LONG TERM DISABILITIES (Chronic pain)
These patients can be given an exercise program suitable for their disability, so they can continue to do physical activity for fitness, rehabilitation and enjoyment.
OBESITY
For those who are overweight, the water is often the only place they can exercise without great discomfort.”
What makes Aquatic Physiotherapy different from conventional Physiotherapy treatment?
“Aquatic Physiotherapy is different from conventional Physiotherapy treatment because of its use of the properties of water. There are various physics principles that act when a person goes from a stationary body (land treatment), to a person propelling themselves through the water (Aquatic Physiotherapy). Some of these properties include the density of an object in water, buoyancy, laminar flow of water and hydrostatic pressure. Put simply, these properties create a number of benefits including:
- Pain reduction
- Decreased muscle tone
- Decreased muscle spasm and guarding
- Decreased swelling and improved circulation
- Increased range of motion and flexibility
- Increased muscle strength
- Decreased weight bearing forces
- Improved co-ordination and movement initiation without the fear of falling
- Re-education of functional activities
- Improved cardiovascular/respiratory fitness
- Improved psychological well being and motivation.
Aquatic Physiotherapy is such an effective modality, that many of these benefits can be achieved at the one time. Unlike land treatment, where often only one aim can be addressed at the one time. This means the activity or body position needs to be totally changed to address a different goal, or the next stage of the rehabilitation process. Similarly, the properties of water allow the complexity of the task (eg. strengthening a muscle) to be varied in so many different ways including speed (turbulence), size and shape (streamlining), floats (buoyancy), lever length (distance of weight from the body) and force of gravity (weights). The added benefit of Aquatic Physiotherapy is that all of the manual techniques (eg. mobilisation, stretches, massage, traction) which are applied to the injured body part during traditional Physiotherapy sessions, can also be applied in the water, by lying patients down with the use of floatation devices. Despite all the science behind Aquatic Physiotherapy, many of our patients love it because quite simply, 'it is a lot of fun'!”
What can I expect from a typical session?
“Prior to attending the first Aquatic Physiotherapy session, the patient would be booked in the clinic for an initial assessment, in order to find out a little more about their injury. A typical Aquatic session lasts at least one hour. This comprises of specific hands on treatment, followed by the provision of a personalised exercise program tailored to the patient's needs. To achieve this, the Physiotherapist is in the water with the patient during every consultation and not on the side of the pool.”
Do I need a referral to see a Aquatic Physiotherapist?
“Private patients do not need a referral to start Aquatic Physiotherapy. DVA patients or those claiming under the Medicare Benefits Schedule (MBS) primary care items (previously known as EPC) will need a referral from their GP. All patients who have a Workers Compensation claim or Third Party claim will also need a referral.”
Do health funds generally cover Aquatic Physiotherapy?
“AquaPhys specialises in one on one or individualised Aquatic Physiotherapy and therefore, sessions are covered in exactly the same way as Physiotherapy by health funds. As long as the patient has Ancillary cover including Physiotherapy, then they are covered for Aquatic Physiotherapy. The benefit received however, depends on the patients level of cover.”
Originally published on Jul 31, 2012
