Aquatic physiotherapy is a specialised treatment that’s carried out while floating, partially submerged or fully submerged in a temperature-controlled pool, by a physiotherapist with specialist training in rehabilitation in water.

The therapeutic benefits of hydrotherapy are helping physiotherapists meet client needs, particularly those with severe mobility challenges on land, and improving physical function associated with pain, stiffness, weakness, and balance as a result of illness, injury or disability.

Paediatric Physiotherapist Emily Hayles of Move and Play Paediatric Therapy says aquatic physiotherapy has been an integral addition to the land-based services she offers her young clients.

The paediatric physiotherapy practice, based in Mackay, Queensland, assists children with developmental delays and disabilities, such as cerebral palsy, muscular dystrophy, Down Syndrome, autism, and a myriad of other genetic or developmental conditions, to achieve their full potential. 

“Being in the water has numerous various benefits for the children we work with,” said Ms Hayles. “Children who usually cannot sit or stand or walk by themselves are supported in the water and can practice doing things they normally can't do or find difficult.

“The warm water helps their muscles relax, and this means they can move more freely and easily,” she said.

The warm water in aquatic physiotherapy is especially useful for children who have recently had orthopaedic surgery, according to Ms Hayles, and hydrotherapy is routine as part of their early recovery.

Therapy in the aquatic environment can also help provide sensory feedback because it provides gentle pressure to the body and resistance when moving in the water, said Ms Hayles. 

“Kids also love being in the water, so it makes our therapy sessions fun!

“There is nothing more rewarding than seeing the smiles and look of pride on a child’s face when they do something in the water that they have never been able to do before.

“Last week we had one of our little girls stand up by herself in the water, and walk with some assistance across the pool - something she was so proud of and wouldn’t otherwise be able to do on land!”

It's crucial to assess clients on land initially to get an understanding of their abilities and difficulties in their daily life, and to be aware of their goals for therapy, said Hayles.

“If we then think hydrotherapy will be beneficial for that client and can help them work towards their goals, we can then book them in for it. 

The most significant benefit of aquatic physiotherapy for children with disabilities is that they can move more freely and independently when they are supported by water, said Ms Hayles. 

“This helps them to be able to practice movements that they would like to do better on land.

“We also see participating in hydrotherapy as a stepping stone for children of all abilities to be able to ‘go for a swim’ with their family and friends, something that is popular recreational activity here in Australia.”

It was crucial that her practice integrated aquatic therapy to meet clients' needs, said Ms Hayles, as some children struggle with the strength to perform functional activities on land. 

“Doing hydrotherapy and being in the pool provides clients with an opportunity to practice movements that are otherwise too hard on the land, and bridges that gap between what they are currently doing and what they want to be able to achieve,” said Hayles.

Hydrotherapy sessions are facilitated by ensuring clients arrive early for their session, so they are ready to enter the pool on time. It is also important to have a spotter (a person who can assist in an emergency), at the side of the pool in case of an incident. If the child has a complex disability, there must also be someone in the water to assist.

“The first session for any of our clients in the pool is always a safety session. We determine the best way for the child to safely get in and out of the pool, and assess their water awareness and safety so that we can then tailor the therapy activities safely.”

“We love the opportunity it provides for our clients to be challenged in a fun and engaging way.”

Hydrotherapy sessions are not without complications though, and finding a pool with appropriate access and facilities can be challenging.

“Many of our clients need to be hoisted into and out of the pool, and they need to be able to change into and out of their swimmers on an adult-sized change table.

“Unfortunately, these types of facilities are only available at one of the local pools in our town, which limits our clients being able to access hydrotherapy as much as we would ideally like.

“Most pools in most communities are not designed adequately to enable access for people with significant disabilities, which is frustrating to have a perfectly appropriate pool, but our clients cannot get into it," said Hayles.

Aquatic Physiotherapist, Judy Larsen, owner and operator of Hydrotherapy Brisbane, one of Australia’s largest independent privately-run hydrotherapy facilities, said specialised hydrotherapy pools are rare.

“Usually you would see pool like ours only in a hospital setting,” said Ms Larson.

"It’s hard work to run a pool at this level which is why they are usually in hospitals. Most practices offer an hour or two of hydrotherapy a week at a local pool, whereas we run a pool and specialise in the area.

“Our physiotherapists are in the pool most of the day in many cases,” said Ms Larson.

This is an essential adjunct to physiotherapy, said Ms Larson, as there are many health benefits associated with aquatic treatment.

“There is growing evidence across a range of areas for aquatic intervention including pulmonary rehab, heart failure, diabetes, mental health issues, pain management, particularly since the changes in codeine prescription, as well as more recognised areas such as arthritis, joint replacement rehab, neuro rehab, and antenatal care.

“We see patients from four months to 104, across all areas of medicine and health,” said Ms Larson.

The Australian Physiotherapy Association (APA) states that aquatic physiotherapy can be used as a treatment anywhere a pool is available and can be used to treat a multitude of conditions, including:

• Sports injuries
• Post-operative and orthopaedic conditions
• Spinal pain and/or injuries
• Neurological conditions
• Cardio-respiratory problems
• Balance dysfunction
• Women’s health complaints
• Arthritis and aged care

The challenge of offering aquatic physiotherapy and working in a pool, in warm water, includes tiring physically, more so than when treating clients on land, said Ms Hayles.

As a result, specialised training, including water and pool safety is essential for any physiotherapist looking to expand into aquatic services.

“You need to make sure your clients are safe because it is a more risky environment than working on the land. But otherwise it’s an excellent adjunct to what we provide in the clinic and the community, and it is worthwhile for our clients’ outcomes and satisfaction with their treatment,” said Ms Hayles.

Training to be an aquatic physiotherapist

Brisbane Hydrotherapy offers professional development training in aquatic physiotherapy for physiotherapists and hydrotherapy training for other allied health professionals and swim school staff.   

The APA’s aquatic group states that physiotherapists interested in treating clients in a unique environment should know the hydrodynamic and hydrostatic properties of water, the physiological effects of immersion, and all relevant water safety procedures.

The ACA’s aquatic group offers Level 1, 2 and 3 courses to educate aquatic physiotherapists who treat clients in the pool.

Also, a hydrotherapy rescue course, a program developed by the APA in conjunction with the Royal Life Saving Society Australia, is held annually in most states and territories.