A: I would recommend that when you first begin to utilize the HydroWorx pool that you work with a qualified health care professional to establish a program for you.  While unweighted envirionment of the pool will allow you to tolerate a significantly high level of activity without the increased pain, it is important that you establish what makes you better and what makes you worse.  This is very powerful in giving you control over your pain and giving you back the highest quality of life possible.  It is great that you have tried aquatic exercises but I agree that these classes are often much too aggressive for someone with a physical injury.  There may be a facility in your community that offers arthritis aquatic classes and those may be more appropriate for you.  

A: It sounds as though your already have the right idea in terms of your own exercise.  The elliptical machine allows you to do high repitition and low resistance exercises.   Research shows that performing high repitition/low resistance exercises increases the turnover of synovial fluid without increasing irritaion and inflammation within the joint.  This increases joint health and can help gain pain control in severely arthritic or degenerative joints.  The pool is the perfect environment in which to perform these types of exercises.  I recommend you perform normal strengthening exercises including hip and knee flexion and extension with or without resistance.  If you have access to a HydroWorx pool the treadmill is perfect for ambulating without increasing irritation or inflammation.  Another great option is to teather yourself to one end of the pool.  This will hold you in place so you can walk for an extended period of time without running out of space.  Utilizing resistance with your upper extermities while holding a squat stance will also help with increasing lower extremity and core strength.  Performing this in a single leg stance changes it to help strengthen hip muscles.  If your water is warm this is an exceptional environment in which to gain flexibility.    

A: The pool would be a wonderful environment in which to improve strength and balance. I can not briefly recommend specific exercises, so much of that depends on your specific needs.  If you are working on land, many of the exercises you would be doing can be performed in the pool with or without resistance (hydrotones, balance rings etc.).  A unique feature about working in water is that as you move through the water your create waves and thereby create more challenges to your balance.  So exercises that are very isolated on land become dynamic in the water.  Forcing you to utilize core and accessory muscles in addition to your lager muscle groups.  As you stregthen in the water remember the faster you move in the water the more resistance you create. I am hesitant to recommend that you walk in the pool independently at this time.  It is very likely that with guidance you may be able to establish a functional gait pattern.  The most important thing to remember is to do no harm. If you have a tendency to hyperextend with gait, it may help to have a professional analyze and correct your gait pattern in the pool.  Once you have a functional gait pattern or at the least a gait pattern that doesn't force you into hyperextension, you can utilize the pool to increase strength and balance with gait activitie - progressing to more advanced patterns to your tolerance.  The wonderful thing about the pool is that there is a huge margin for error.  If you misstep and fall the worst you get is very wet.

A: You can be creative with shoulder strengthening.  But first, you should be sure that pain is under control and that you have full range of motion.  The pool is a great environment to gain full range of motion. One way is using a kick board floating on the surface of the pool you can do figure eights, flexion/extension, horizontal ab/adduction.  Another great position for shoulder work in in prone and supine.  Laying on your stomach while utilizing a snorkel you can go through motion almost passively.  If you are working on a shoulder without pain here are some great strengthening ideas:
-Using hydrotones or some other form of resitance you can perform punch fronts, alternating shoulder flexion, shoulder abduction, triceps extension.  The faster you move the more resistance you will get from the water.  If you are in a HydroWorx pool you can turn on the jets and work against these.  If you keep yourself away fromt the side of the pool and hold a squat position while doing these exercises you will be forced to utilize your core to maintain your balance and gain core strength.

A: I am very blessed with the opportunity to work closely with two exceptional spine surgeons who perform some incredible surgeries.  We get our post op spine patients in the pool usually 2 weeks post surgical with special situations even sooner.  We continue to cover the patients wound with opsite until all of the steri-strips fall off.  We see an array of surgical patients ranging from the less involved Discectomy and Laminectomy, to single level fusions, multiple level fusions, anterior and/or posterior approaches, Artificial Disc Replacement, very involved scoliosis patients and 360 even 540 fusion.  We have established protocols as to when flexion, rotation and extension are allowed and follow these.  Initially we gain significant pain control and have a very gentle approach focusing on pelvic flexion to stretch the paraspinals enough to decrease muscle spasms but protecting the new fusion.  Then move on to hamstring, piriformis, calf stretches, normal flexibility activities for all extremities.  We work on isometric strengthening and focus on increasing activity by walking on the treadmill.  Slowly focusing on mechanics including normal gait and arm swing.  We eventually get very aggressive and creative with strengthening all extremities and core.  We very often utilize the massage jets to decrease muscle soreness.  

A: We are currently conducting a research study to validate our clinical experiences.  What we have discovered in our clinic is that by getting our surgical patients into the pool as soon as they are discharged from the hospital we accomplish 3 important things:  1.  Decreased swelling in operative extremity 2.  Decreased pain 3.  Increased motion.  Our orthopedic patients tolerate much greater activity and ROM in the pool.  Our study is not complete so these numbers are not yet proven.  Prior to our study we conducted our own unofficial research and found an increase in ROM from our pool patients to published reasearch on land based rehab by about 15%.  Our total knee replacement patients get to 115 or 120 degrees of flexion routinely with in 6 weeks of surgery.  Our spine surgery patients also begin core stabilization exercises very quickly only in the pool and therefore we believe they will have less incidence of post-brace injury due to the fact that there abdominal and paraspinal muscles were not allowed to atrophy and get as dependent on the brace.

A: Although I am primarily an orthopedic clinic, the surgeons I work with also work with trauma patients.  Because of this I had the great privilage of working with a 24 year old multi-systems trauma.  She had been accepted to Medical School and was driving home to very rural Kansas from a visit when she and her family were stopped in construction.  They were rear ended by a semi-trailer truck going highway speeds.  My patient suffered a severed carotid artery and a severe stroke as well as pelvic, femur, rib and shoulder fractures.  I entered into her care one year post injury after the removal of her femoral IM rod.  She was initially wheelchair bound.  My protocol was as follows: