The Power of Water to Heal a Shoulder Replacement
Although we often discuss how aquatic therapy benefits patients with lower extremity injuries, it is also extremely effective for upper body injuries too!
Veronica Paquette, PT and Owner of Essex Aquatic Rehab Center in Vermont, discusses how the pool is an ideal environment for shoulder rehabilitation. Wally Stein had a total shoulder replacement in September and began his work in the pool with Veronica just one week following surgery. This case study was filmed in the beginning of January, just three short months after surgery and Wally is functioning at 100%. In fact he states that he has surpassed 100% and is able to do more than he could have 20 years ago!
Stories like Wally’s are certainly impressive, not to mention inspirational, especially to patients who are curious about the benefits of hydrotherapy after shoulder surgery. The goal of shoulder surgery is to repair the joint and improve the patient’s function, but it’s hard work and dedication during therapy sessions that can make the most difference. There’s a lot to gain following the surgery, but patients can also lose mobility — not to mention experience plenty of frustration — especially if they don’t follow a focused recovery plan after surgery. This is where hydrotherapy really has benefit, whether it’s done in just a few sessions or over an extended period of time.
The practice of hydrotherapy is not a novel concept. Water has a number of healing properties, especially when it comes to recovering from shoulder surgery or a similarly invasive procedure. Hydrotherapy helps reduce or relieve pain while ensuring that the patient remains comfortable during each movement. The temperature of the water is crucial, and many hydrotherapy pools offer warm water.
Warm water promotes relaxation and increases mobility. When getting started with hydrotherapy healing, it’s crucial to have access to the best possible hydrotherapy pools. Water promises a number of healing properties on its own, but it’s much easier for patients to make (and keep) gains when they are rehabbing their shoulders in the right pool. Among the most rewarding aspects of these therapy pools are the resistance therapy jets, which help patients increase their strength and range of motion in the surrounding joints and muscles. Following tougher rehabilitation sessions, or simply for a bit of much-needed pain relief, the deep penetrating massage system lets patients control the amount of massage they desire. Whether it’s a harder massage or a lighter one, the goal is to reduce soreness and pain while also reducing scar tissue. Some pools also have adjustable floor technology or ergonomic stairs, which is an added bonus for getting patients into the water quickly and safely without ladders. This is an essential component for anyone who’s in the early stages of recovery from shoulder surgery. From shoulder replacement recovery to shoulder arthroplasty rehabilitation, hydrotherapy pools cater to a wide range of post-surgical exercise and therapy demands.
Starting Hydrotherapy After Shoulder Surgery
Wally enjoyed using the warm water pool for therapy because it was pain-free. He states that he could barely stand doing any of his land rehabilitation early on, because of the level of discomfort he felt. Wally has attributed his fast recovery and increased shoulder and upper body strength to the HydroWorx pool. Using the aquatic therapy pool for rehabilitation allowed Wally to increase his range of motion just one week following surgery and perform exercises that he could not do on land. As Veronica describes in the video, Wally used the underwater treadmill and the massage hose to enhance his overall recovery as well as performing various shoulder exercises underwater. Using the underwater treadmill for shoulder rehabilitation seems irrelevant, however using the treadmill allows the patient to work on their gait, either walking or jogging, while using their arms to balance. When an individual walks or runs on land, the arms swing back and forth. Therefore Wally was swinging his arms back and forth in the water, working on his range of motion and stability. The massage hose was used on his scar to massage the scar tissue and decrease muscle soreness following an aquatic therapy session. As is the case with Wally, the goal for most patients should be to aim for the best possible range of motion early on in the healing process. After they can move the post-surgery shoulder a bit better, the next step is to slowly increase strength, coordination and endurance in the affected arm. This is often done through frequent gentle exercises rather than irregular forceful efforts. As a clinician, you want to encourage a slow, steady and smooth progression with a minimal amount of soreness. Water exercises are ideal for this, as they are often very well tolerated after shoulder surgery. By practicing gentle and deliberate arm movements in shoulder-deep water, patients can begin to feel more comfortable using their arm and shoulder. Over time, these movements should restore enough flexibility and coordination for steady progression in the water. Over time, these pool exercises will greatly help in restoring strength and coordination to the healing shoulder.
Water and Shoulder Recovery
The benefits of water exercise are seemingly endless. While patients recovering from shoulder surgery can enjoy a number of gains when working out in the water, the same is true for anyone with general shoulder problems along with nagging aches and pains. In fact, some individuals may notice a substantial amount of improvement when they exercise in warm water. That’s because heat can help with problems such as arthritis and shoulder stiffness. According to the University of Washington Orthopaedics and Sports Medicine department, those who benefit from heat find that the warmer water assists in relaxing their muscles while decreasing any lingering pain and stiffness. The source notes that these benefits are often seen in water temperatures between 83 and 88 degrees — higher temperatures can be too uncomfortable.
Pool vs. Land
Traditional recovery from shoulder surgery takes place on land, often in an outpatient facility or rehabilitation setting. Depending on the extent of the operation and the overall health of the patient, it’s often necessary to incorporate some form of land-based recovery into the person’s post-surgical routine. Successful rehabilitation is crucial for allowing individuals to resume their daily activities as quickly and pain-free as possible. According to the American Academy of Orthopaedic Surgeons, a solid exercise program will assist in regaining strength and motion in the affected shoulder. Most rehab plans are largely based on input from the surgeon as well as the type and extent of surgical procedures. More complicated surgeries may also require a physical therapist to help supervise a post-surgery exercise program. After surgery, the surgeon and physical therapist will determine when it’s safe to begin pool-based therapy. The exercises patients perform in the pool may be similar to those performed on land, but the benefits vary. For starters, there’s less pressure on your body — especially sore post-surgical joints — in the pool than on land. This removed pressure on the joint allows for increased mobility and also provides a natural form of joint mobilization that is sometimes difficult to achieve manually on land. According to the Hospital for Special Surgery, there is a 90 percent reduction in the amount of weight pressing down on one’s body when the individual is immersed up to his or her neck. Even if the water reaches a person’s waist, it can reduce pressure up to 50 percent. This overall weight reduction is particularly beneficial after surgery, especially in the early stages as the shoulder is just beginning to heal. Aside from noticeable weight reduction, pool-based therapy has other benefits as well. Decreased swelling is one common benefit, as hydrostatic pressure from the water aids in moving fluid away from the post-surgical site. Once the swelling has gone down, most people find it easier to regain the strength and range of motion they lost during surgery. Another benefit is that the gentle nature of the pool can encourage people to begin rehabilitation exercises a bit earlier than they typically would on land. Even if it’s too soon to start rehab, or the shoulder isn’t yet ready for the land, water-based therapy offers less impact on one’s joints along with the opportunity to improve core strength and balance. Pain is common after shoulder surgery, but too much pain can make certain exercises downright uncomfortable. Warm water helps to lessen the amount of pain. In some instances, this reduction in pain can be enough to convince the patient to use his or her arm in ways that the individual would not yet want to on land. Aside from helping to decrease the amount of pain, water-based recovery also promises ease of movement. That’s because water itself is great for assisting and supporting movement, providing a comfortable setting where patients can focus on regaining their strength and range of movement in the joint rather than their level of discomfort. A water-based setting can also be more exciting and stimulating — mentally and physically — than a traditional land-based one. Patients are often more motivated by the progress they see in the water and are hopeful they can regain motion on land.
Shoulder Problems and Recovery Solutions
Many surgical efforts may be utilized to repair a damaged or injured shoulder. While the general principle of recovery is the same — a focus on providing simple and deliberate motions at first, then working the patient up to more advanced ones — some conditions require more specific pool protocols. For example, a patient who has undergone a labral repair of the shoulder might begin with the basics such as noodle pushdowns or arm circles to regain motion and strength, along with underwater treadmill walking to work on natural arm swing. Pool therapy may evolve to include more difficult exercises, such as figure eights. For patients such as Wally who undergo a total shoulder replacement, pool therapy often starts with a simple goal of keeping the shoulder down and performing basic repetitive movements to regain strength and fitness. After a rotator cuff surgery, most therapists aim to relax and loosen up the muscles, which often become extremely tight after the operation. Simple exercises also boost strength and coordination in the affected shoulder.
Stages of Motion and Movement in Recovery
The first few days following shoulder surgery are often the toughest given the amount of swelling, general discomfort, stiffness and lack of motion. Although it can be difficult, rehabilitation should start as soon as possible to help patients regain the strength and coordination they’ve lost in the affected shoulder and reduce scar tissue. According to the University of Washington Orthopaedics & Sports Medicine department, slowly and steadily increasing range of motion early on leads to better strength coordination and endurance. Some patients may develop soreness, at which point it’s best to hold off on strengthening exercises. However, range of motion exercises should still be conducted as normal. Early on during recovery, when the patient is able, it’s best to start exercising as soon as it’s tolerable. Often starting exercise in the pool is easiest.
At this point in the rehabilitation, Wally is fairly advanced and has regained all of his strength. Veronica talks about his first sessions and the main focus in the beginning was working on the range of motion for the shoulder. It is important that following a major surgery that the range of motion is not completely lost. This can be as simple as standing against the pool wall keeping the shoulder underwater and moving the arm out laterally or forward, up and down. Wally does just this in the video; however he has the gloves on at this point for added resistance.In the video you will see the following shoulder exercises performed:
- Horizontal abduction and adduction
- Shoulder flexion and extensions
- Push-pull alternating
- Sideways arm raises
- Forward arm raises
- Push-pull with hydro-tone bells
- Figure eight arm rotations
- Diagonal arm movements
- Palm up and palm down- front and side
- Flexion and extension, lying face down with a snorkel
- Barbell push-downs
- Swimming motions
Additional Benefits of Hydrotherapy
Hydrotherapy has produced a number of well-documented results among participants. We certainly know that it plays a crucial role in helping speed up shoulder surgery recovery. Not only does it reduce muscle pain and tension, it also assists in slowly stretching and strengthening the injured arm. However, hydrotherapy offers additional benefits for patients as well.
For example, hydrotherapy is capable of:
Reducing and relieving stress: Warm water is a great stress-reducer. That’s because it can assist in lowering stress-related high blood pressure. In addition, hydrotherapy may also cut back on a patient’s overall levels of anxiety by releasing endorphins to help combat stress.
Fortifying the immune system: Another benefit of hydrotherapy is that it leads to better (and more efficient) circulation and blood flow of white blood cells throughout the body. This process ultimately aids in clearing any unnecessary materials from the body. The result is a stronger immune system, one that is better able to better ward off colds and other illnesses.
Promoting detoxification: Whether it’s through exercises, warmer water temperatures or both, detoxification is another added benefit of pool-based therapy.
Some people visit spas to obtain benefits from hydrotherapy, but patients who are recovering from shoulder surgery can enjoy these same benefits through their own programs. If someone seems hesitant to get into the water or is lagging a bit in terms of motivation, it’s well worth it to mention these additional hydrotherapy benefits.
Shoulder replacement is challenging, but having the proper recovery routine can make the process much easier. Hydrotherapy pools are a versatile solution, offering a stimulating environment and gentle yet effective force that works very well on various types of shoulder injuries and operations.
Aquatic therapy for shoulder replacement also helps relax the body and loosen up tight muscles — essential benefits for surgery recovery. Remember that for many patients, it may be easier to start the recovery process in the pool first rather than on land, which can greatly enhance recovery and minimize time spent in therapy.
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View our webcast, “Strategies to Perfect Upper Body Rehab Outcomes with Aquatic Therapy” presented by Barry Lippman, MS, ATC, NASM-PES, Associate Athletic Trainer/Rehab Coordinator for Coastal Carolina University
Page Updated on: July 17, 2020