‘HydroWorx Bubble Bursters’ Tackles Aquatic Therapy and Wounds
“Aquatic therapy can’t begin until a wound is completely healed…right?”
This statement is uttered on a regular basis, usually by well-meaning professionals who are unaware that it’s based on antiquated understandings and misconceptions about water therapy. To help us burst this pervasive myth, HydroWorx turned to Randy Cohen, ATC, DPT, who is the University of Arizona’s Associate Athletic Director for Medical Services.
Cohen is no stranger to physical therapy and athletic training, having received his degrees from Purdue University and the University of Illinois-Chicago. He’s been with the University of Arizona since 2001, and maintains an excellent reputation for using aquatic therapy as early as one week post-op to help the athletes under his supervision begin to actively heal. Not only are many of those athletes still on crutches when they begin to work with Cohen, but they also have wounds that haven’t scabbed over, and/or stitches that haven’t been removed.
How does Cohen make sure they are able to safely get in the water? His trick is hardly magic – it’s just a purely pragmatic, proven waterproofing technique.
- The process to waterproof a wound that has stopped draining (and isn’t infected) but isn’t completely healed takes only a few moments, surprisingly:
- Expose the wound and remove any current dressings.
- Make sure the area around the wound is completely dry.
- Cut a piece of gauze pad to fit over the wound. The gauze will be used later to document that the wound was kept dry throughout the aquatic therapy session.
- Spray the area around the wound with stick-it to provide stronger skin anchoring for the next step.
- Completely cover the wound and gauze with a bioclusive clear waterproof dressing, pushing and rubbing it down along the edges until it is smooth. The dressing should be big enough to seal the wound; some athletic trainers and physical therapists prefer to double-up by placing two dressings on the site for added security.
- If the area is not a joint Flex Wrap can be used around the extremity to create an extra waterproof barrier.
At this point, the dressing should be checked to make certain that it stays in place without hindering movement. For instance, if the wound is along a joint such as the knee, the athlete or patient should bend and extend the knee several times to ensure that the seal of the bioclusive dressing doesn’t break. As long as the wound can’t get wet, it’s fine to proceed with the aquatic therapy session!
Is it really that simple, and does this waterproofing technique work? YES!
In fact, Cohen has never – and we mean never – had one of his athletes get an infection or experience wound dehiscence (i.e., the rupturing of stitches) because of early aquatic therapy intervention.
Of course, physicians tend to be conservative by nature, so it may take a little convincing to assure them that a patient with an unhealed, but no longer draining, wound can start physical therapy in the pool. In Cohen’s experience, when doctors see the documentation that the gauze pad (in step three, above) always stays completely dry, they tend to become more comfortable with allowing aquatic therapy within the first few weeks post-op.
It is another bubble busted… and a great advantage for all those athletes who thought they had to wait “forever” to get moving again!
Do you have an aquatic therapy misconception you’d like to see us tackle as part of our Bubble Busters series? Let us know and you might see it addressed in a future post!
View this On-Demand Webinar: Functional Post-Op Rehab of Division I Swimmer Using Aquatic Therapy
View this FREE on-demand webinar, “Functional Post-Op Rehab of Division I Swimmer Using Aquatic Therapy.” The presenter, Collin Francis, MS, ATC, LAT, Assistant Athletic Trainer at Indiana University, will present the case study of the rehabilitation of a Division 1 swimmer who required arthroscopic surgery on both knees. He will review the athlete’s background prior to surgery as well as his subsequent differential diagnosis and eventual treatment plan. View this webinar here.