Innovative Ways Of Incorporating Aquatic Therapy Into Functional Rehab

Protocols For Various Rehabilitation Progressions

The Jacksonville Jaguars and their associate athletic trainer, Rod Scott, have a HydroWorx 2000 Series and 1200 Series pool, both featuring a fully adjustable pool floor. This feature has become a very critical component of the rehabilitation protocols because it allows Scott and his staff to treat athletes of varying height and weight bearing status. In the photos above, Scott showed the variable water depth based on upon which stage of the rehabilitation program the athlete is in.

When developing an aquatic therapy rehabilitation protocol, it is important to follow the protocols set by the physician or surgeon as well as setting long-term and short-term goals.

Each aquatic rehabilitation program should be designed similar to land-based programs and include:

warm-up
mobility exercises
endurance and cardiovascular activities
cool down

Upper Extremity Injuries Protocol

Stage 1:
- The athlete is in chest deep water and utilizes the walls of the pool to support the scapular/thoracic area during aquatic therapy
- Exercises for Stage 1
  - push downs with kick bar
  - wall push-ups
  - shoulder internal/external rotation against wall
  - pendulum swings
  - forward flexion to 90 degrees
Stage 2:
- Upper extremity exercises can be progressed with the use of motion resistance equipment to increase difficulty and improve muscle strength
- Exercises for stage 2 (all of these exercises can be performed with resistance equipment).
  - push-pulls
  - diagonal push-pulls
  - punches
  - figure 8’s (with resistance equipment)
  - internal and external rotation
Stage 3:
- This stage incorporates high level functional strength and training with sport specific movement patterns. Repetitions and resistance is increased with the use of the resistance jets, resistance bands or flotation devices.
- Exercises for Stage 3
  - transition to land-based exercises
  - nerf ball toss and catch against the the jets
  - punches with resistance against the jets
  - figure 8’s with resistance equipment
  - forward flexion/extension (add resistance equipment and adjust water depth to increase difficulty)

It is important to always develop protocols with progression stages so athletes know they are making progress and are working toward their end goal of getting back on the playing field.

Common Questions

Talking about using pain as your guide, how much pain is typically tolerated for these exercises in the water?

It comes back to what stage you are in in the rehab protocol and exactly what the injury prognosis is. Pain is a guide. If there is pain with any of the exercises, we will make modifications- with any level of pain.

What do you look for to tell the athlete that it’s time to move back to land?

It’s not anything set in stone, but some of the things you are going to look for are how are they handling the progression. Is the progression a lot easier for the athlete? When they get to a point where you are really challenging them and they are handling it well- they should be transitioned to land.

Would you recommend using the pool to help increase proprioception?

Absolutely. There are a ton of proprioception exercises you can do in the pool. And just being in the pool alone, one has to figure out where they are in space (balance). If they are having a lot of trouble doing those exercises on land, simply take those exercises and put them in the pool and the buoyancy of the water is going to give them that support they need.