Lower Leg Injury Webinar Recap
We recently hosted a webinar presented by Deborah Werner from Penn State Hershey Medical Center on Aquatic Physical Therapy for Lower Leg Injuries. Deborah has a wide range of aquatic therapy experience and has recently been able to use her knowledge with the HydroWorx 2000 Series pool at Penn State Hershey Medical Center. In this webinar, she discussed the advantages of aquatic therapy for lower leg injuries in general, and additionally provided specific protocols and advantages for three common injuries.
Deborah pointed out the many benefits she has seen of aquatic therapy for some lower leg injuries, including:
- Decreased weight-bearing on the joint which is beneficial for post-surgery rehab, joint pain, traumatic or overuse injuries.
- Research shows that some degree of weight-bearing is important to reduce loss of function, scarring and to promote bone healing which can be done safely in the pool.
- No risk of falling which is ideal for pushing people beyond what they are capable of on land.
- Decreased stiffness, swelling and pain promotes earlier return to everyday activities and work.
Deborah discusses the value of aquatic therapy for three types of lower leg injuries:
- Traumatic injury – ankle sprain
- Overuse injury – shin splints
- Post-operative – tibial plateau fracture
- Ankle sprain. Once the swelling is reduced, aquatic therapy can be introduced. Be sure to keep the patient’s goal in mind. Aquatic therapy can help to keep the exercises challenging and variable. Initial exercises in the water are similar to what you would do on land, like ankle pumps, inversion, eversion, alphabet, hip strengthening exercises and walking without the treadmill. Deborah suggests playing it safe the first day; many patients, especially athletes, push themselves further because their ankle feels much better in the water, but find soreness the following day. When the patient is ready to progress, introduce walking at a comfortable pace on the treadmill with arm swing and correct gait, mini squats and balance exercises. For advanced progressions, introduce additional upper extremity resistance devices, step ups, lunges, unilateral exercises and eventually running or jogging on the treadmill.
- Shin splints. After the acute phase, aquatic therapy is a useful and safe transition. Many athletes are eager to get out running as soon as the pain begins to subside. Aquatic therapy offers a better method to keep athletes in cardiovascular shape while allowing shin splints to heal. Deborah suggests deep water jogging intervals with a flotation belt. When the athlete is ready for more movement, they can progress to waist deep water treadmill running, starting with a walk/run program and ramping up. Running drills like those done on land can be introduced. This includes exercises such as high knees, butt kicks, skips, grapevine, lateral shuffle, catch up drill (with treadmill at a faster speed and resistance jets on – athlete starts at back of treadmill and outruns it to the front of the pool, then lets jets and treadmill push them back). These exercises are also great for cross training during the season.
- Tibial plateau fracture. Aquatic therapy can begin once the incision is healed. Because of the minimal weight-bearing phase of recovery, aquatic therapy offers a great way to progress a patient within the restrictions with great carryover to land. This gives time to strengthen the leg and improve gait patterns before full weight-bearing can be done on land. It is best to begin the patient walking without the treadmill at first. Parallel bars can be used if needed for support. Work on walking in all planes of motion to begin strengthening. Progression can include mini-squats and walking with the underwater treadmill on. When it is time to transition to land, Deborah often will do one aquatic session and one land session per week until the patient is fully ready for land only. Timing will be determined by the surgeon.
Deborah provided specific protocol ideas for each case and examples of how she had seen them work. After her presentation, she took questions from webinar attendees.
Below are a few of the question and answers:
Q: What would you recommend as optimal water temp for athletes with these conditions?
A: The arthritis foundation suggests using high 80s to low 90 degrees. Our pool is around 90-92 degrees. That temperature might be a bit warm for higher level athletes, but it’s tough when you’re rotating through different types of patients.
Q: How long are the typical aquatic sessions and how many times per week?
A: A typical aquatic session is generally 45 minutes. Some lower level patients start at 30 minutes and work up to 45 minutes. For our lower level patients, we start at 1 session per week. Higher level athletes do 2 times per week for a few weeks depending on recovery.
Q: What are examples of additional equipment you use in the pool?
A: We use upper body resistance tools to help lower extremity and core strengthening. We will use equipment like aquatic paddles in hands or fins with velcro strap for arms or legs.