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Melanie Cole (Host):  If you’ve ever exercised in the water, you know how exhilarating it can be. And you actually get a great workout. But did you know that physical therapy can also be done in water? My guest is Neal Thomsen, he’s a physical therapist with Bryan Health. Neal I’m so glad to have you with us today. what is aquatic physical therapy?

Neal Thomsen, MPT, ATC (Guest):  It’s an exercise program designed to utilize a pool setting where it minimizes the pressure on your joints and depending on how you exercise, it can either make the movement in the water more fluid, more easy or if you go a little faster, give a little more drag to it, give it a little more resistance. But probably one of the best things about it is the water will push just as hard as you push against it.

Host:  Well what’s the difference then between aquatic physical therapy and aquatic exercise? We see the classes and aquatic exercise classes at clubs. What’s the difference between the two?

Neal:  With the aquatic therapy you are going to get an individualized program and it’s geared for what the goals are whether it’s pain reduction, improved gait, balance, improved strength, that type of thing. And again, because it’s more individualized, personalized, can hit those areas versus where you are in a big class and they are just kind of doing it for the whole group and not really tailoring it to that individual.

Host:  So, what have you seen Neal as far as outcomes? Is it effective and who is it mostly recommended for?

Neal:  Well in our case, we see a lot of orthopedic patients either postoperative patients, back surgeries, hips, knees, the like. And we also see just arthritis, fibromyalgia, that type of thing because at least with our facility, we have our warm therapy pools at 92 degrees so it’s a little warmer that your average pools that you would get at a fitness center and that type of thing. And because of that, that’s kind of the clientele we see although depending on the diagnoses with some patients, they have neurological involvement either they are post-stroke, traumatic brain injury, spinal cord injury, anything of that nature they will also benefit from being in the pool. Although we don’t see that near as much because of the way our facility is. But we still have seen them in the past. And they would actually benefit immensely because they may not be able to lift an extremity for instance, on land but they can do that with the help of the water just as an example.

Host:  Are there people for whom this is not indicated? Are there certain people that just should not participate in water physical therapy?

Neal:  Well depending upon several factors, one thing we’ve seen because we have that warm therapy pool; we also have a lap pool that is 82 degrees and the warm therapy pool is not indicated in the multiple sclerosis type of patients where they fatigue easily because of the heat. So, we have used the lap pool in that regard. Otherwise, if they have any sort of allergy say to chlorine, bromide, whatever the cleaning factor is or the chemicals in the pool itself; if they are allergic to that, that’s obviously a detriment. You have people that are not real comfortable in the water either they have had some issue in the past, when they were young, not being able to learn to swim, that type of thing. A lot of times, with ours, we’re not technically swimming if you will, but they are doing a lot of walking in either waist or chest high water. Anything where they run into like an open wounds, 

Host:  So, I think one of the questions because it sounds like a great way to do physical therapy especially in the warmer water. But I think one of the questions people have is when they are doing physical therapy, they go through their insurance companies. Do insurance companies recognize aquatic physical therapy?

Neal:  Yes, they do. What we found though it does help to have the physicians order it specifically. That way there’s no question I guess if you will, we are doing that as part of their treatment plan. We’ve had people come in just strictly aquatic therapy, we have had them do it where the physician will order both aquatic and land-based exercises or even like a coordinated or say a progression like they are in the water to kind of get – build up that strength and then as they do, then start doing stuff more on land. But, as far as the insurance companies, they have been recognizing that for quite some time now.

Host:  So, is someone is worried about getting in and out of the water; speak about how that works if somebody is very old or they’ve had knee replacement or hip replacement. Tell us a little bit also about some of the equipment that you might use in the water.

Neal:  In our particular facility, we do have a ramp, so a zero entry into the warm therapy pool. In the lap pool, itself, we do have a chair lift that will go down into it if they need to or stairs and with railing on wither side. So, it kind of depends on their level of functioning and ambulation. But generally, with the ramp, if some people, like I said, we’ve seen some people with either neurological issues or weightbearing restrictions if you will, that we have an aquatic wheelchair that they can transfer into and we can well them down on the ramp.

As far as equipment, we do have floating dumbbells, noodles where they can lay on or doing some kicks, ankle weights, kick boards. We also have specific things like say steps or they need to work on stair climbing. But they do it on land, they have a significant amount of knee pain. Well you put it in the water, you have the step and they are at say chest high water. There is significant amount of their weight is eliminated or decreased that they are able to do it without the discomfort or compression through the joint.

Host:  What great information. As we wrap up Neal, tell us what you’d like the listeners to know about aquatic physical therapy and some of the current trends or anything new and exciting that you are doing and what you’ve seen as great results from this.

Neal:  Well as far as new stuff like you were alluding to, is insurance is a real big proponent of it now. Probably seeing a little bit more of even – and this is just kind of a trend in general, is prehabbing. And it’s like say you’re developing core strength for instance for a patient that might be going in to have back surgery for instance. And you are trying to develop some good core strength, some improved mobility in the back and that type of thing. You are also just seeing not only the aquatic therapy but the continuation, having them going on and exercising on their own whether it be in that class setting like you were alluding to or just where they are doing it on their own.

And in our particular case, we have specials and offers as far as membership so they can come in and continue with their exercise program and it’s been very effective, and people have had a great response to that.

Host:  Well, it’s great information. Thank you so much. Do you have any final thoughts that you’d like to let the listeners know about aquatic physical therapy and how great it can be for the feeling and for the physical therapy aspect?

Neal:  It’s just a great adjunct especially if traditional therapy has not helped them in the past or if they’ve had some chronic pain issues like I said, fibromyalgia or they’ve had postoperative pain and this may even be a year out, two years out, that type of thing. They can go in, they can exercise and they can give a little bit more effort because it’s a little easier to do it in the pool so either you can extend the time or you can do more repetitions or push it as much as you can and the water is a great medium for them to develop mobility, strength and have less pain.

Host:  Well thank you so much Neal for joining us and telling us all about aquatic physical therapy. And thanks to our Foundation Partner, Lockton Companies. That wraps up this episode of Bryan Health Podcast. Head on over to our website at www.bryanhealth.org for more information and to get connected with one of our providers. If you found this podcast informative, please share on your social media. Share with friends and family. I’m sure you have some people that are curious about aquatic physical therapy and if it might be right for them. And be sure not to miss all the other interesting podcasts in our library. Until next time, I’m Melanie Cole.