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Using the Power of Water for Knee Rehabilitation

Using the Power of Water for Knee Rehabilitation

Rehabbing injuries following surgery can be a challenge for many reasons and for both the patient and the therapist. Therapists want nothing more than to help their patients heal and get healthy, but patients often experience pain and discomfort on a daily basis. The surgical incision area is very sore, the muscles surrounding the area have become weak and if the surgery was to repair a torn ligament or tendon, the tendons are very tight and do not want to be pushed to move. Despite a lot of reasons to wait to begin rehabilitation, it is important to begin a therapy program following surgery to increase the range of motion and strengthen the injured area as soon as possible.

knee rehabilitation in the HydroWorx pool

Below is a specific case study, one that is currently in progress (stay tuned for part two), about a young athlete recovering from a total knee reconstruction surgery. The patient, Meghan, suffered a severe knee injury while playing soccer where she tore her ACL, MCL, PCL and her medial meniscus. Needless to say, this was quite a unique and severe injury that required special attention. Meghan, a Vermont native, received surgery in Colorado from a specialist due to the complexity of the tears in her knee.

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Following the surgery, Meghan was referred to Essex Aquatic Rehab Center where she began her aquatic therapy outpatient rehab program with owner and head PT, Veronica Paquette. When Meghan first started at Essex, she had minimal range of motion. She was lacking 10 degrees of full extension and her knee flexion was only at about 90 degrees. After just one week in the warm water therapy pool, Meghan improved to minus 5 degrees and 100 degrees of knee flexion. Additionally, because of the progress Meghan made in the pool during her first week, she no longer needed her crutches when walking on land! She also discusses in the video that the level of discomfort is minimal to none when moving her knee underwater, compared to the pain she experienced on land.

Range of Motion Before Hydrotherapy After One Week of Hydrotherapy
Full Extension -10 Degrees -5 Degrees
Knee Flexion 90 Degrees 100 Degrees

Pool Protocol

The exciting thing is that this is a true time progression case study, which means that this rehabilitation is still in progress and we will all be able to see more of Meghan’s progress in a few weeks. Paquette (PT) demonstrates numerous exercises and activities she had Meghan do in the pool for the first three weeks of her therapy program. In just three weeks you will see that Meghan has made a lot of progress. Paquette incorporates different types of stretches, strengthening exercises and walking and jogging emphasizing the importance of strengthening her whole body rather than solely focusing on her knee. It is important to keep her entire body strong to enhance recovery and reduce the risk of re-injury.

In the video Veronica walks through a 3 week rehabilitation protocol with numerous exercises. Primarily she focuses on:

  1. Stretching
  2. Core Stabilization
  3. Active Motion, including cardiovascular exercises and walking/jogging on the underwater treadmill

Be sure to watch the video demonstrating a total knee rehabilitation protocol, where Veronica, the head PT discusses the exercises in detail. It is amazing what the power of water is capable of doing!

The HydroWorx Advantage

For Veronica, a HydroWorx pool is an essential ally for rehabbing patients with severe knee injuries like Meghan. With a HydroWorx pool, a physical therapist can take clients through a complete recovery program, starting slow and adding exercises to strengthen joints as they recover. A HydroWorx therapy pool features adjustable resistance therapy jets to gradually increase the intensity of the workout, building balance, range of motion and strength as rehab progresses. The underwater treadmill, a standard feature on all HydroWorx products, is another important tool for knee surgery patients.

It’s a long road to recovery after a knee surgery like Meghan’s, but with support from dedicated PT professionals such as Veronica and from water therapy, a successful rehab can be pain-free and fun.

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23 comments on “Using the Power of Water for Knee Rehabilitation”

  1. I am after a knee aquatic board to put your foot in and do strengthen exercises and would like to obtain one but don’t quite know where to get one.
    Appreciate your help.
    I’ve had a partial done.
    Thank you

  2. Had a injury on the military side. No surgery needed but is it possible to do this therapy to increase range of motion. I can barely bend my knee. Need a solution.

  3. I am a 67 yr old very active healthy mal that is contemplating bilateral knee replacement I intend to use my pool for therapy will it be ok if the water is on the cool side will that be ok ??

    1. It is important to discuss these matters specifically with your surgeon or Physical therapist as every patient is different.

  4. I’m 20 years old and 8 months ago I tore all 4 knee ligaments (acl,pcl,mcl,lcl) and a slight tear in my meniscus. I’ve had 3 surgeries, latest one being in April and I’m hitting around 105-degrees flexion. My doctors did not repair my acl or pcl because they scarred in enough to give me stability. I’m wondering if this will help improve my range of motion?

  5. Hi
    So I fractured my knee cap 8 months ago.It was a non displaced vertical fracture to the middle of the patella.
    Over time, its gotten better but its not at its best and I still can’t jog because my knee keeps buckling.I can do a straight leg raise but I can’t lift calf (knee to ankle area) because my knee hurts.Is this normal so late after the fracture?I know that I should have done some sort of physiotherapy but I never managed to get to it and let it recover by itself.
    I really want to go back to playing sports and I have this big tennis tournament coming up in 2 months.I really want to help myself but I just don’t know what to do.Please help me.

    1. Speaking with a physio is definitely your best route to get back to playing sports quickly. They will be able to assess your situation and get you the best program for your goals. Certainly warm water therapy could be a great help under a physio’s care. We wish you the best of luck getting back to tennis!

    1. There are many different factors that contribute to the ideal timing – we would suggest asking your surgeon or physical therapist.

  6. I broke my patella in 3 places and am wired and pinned as well as a wire attached to my tibia. Currently at 125-127 rom and my os says he only wants me to reach 130!!! This is not acceptable to me. I need 145 to match good leg. I asked him to refer me to aquatic therapy but has declined me. I’m 14 weeks post op. With this fracture will your pool therapy work?

    1. There are many factors that go into determining your rehabilitation potential. We are not orthopedic surgeons or physical therapists and suggest requesting a second opinion from an os or pt if this is something you would like to pursue.

    2. Hey Mini Christine,
      I smashed my patella in six pieces and didn’t know it was broken until a month later so there is alot of scar tissue now. I’m 10 weeks post op and still have a large pin and wires holding it together. I suffer from effusion but my surgeon has said that I can start using the pools and treading water and doing light swimming. Would really love to hear how your rehab has gone since you posted!!!

  7. Hi , I had Acl Surgery and meniscus repair about 6 month ago . now I can walk but i can’t run fast and when i walk long distant my knee become swollen . is it normal? should i walk or swim or i should stop my activities?

    1. Those are pretty major surgeries that likely take a long time to heal, but each individual is different. Please discuss limitations and expectations with your surgeon or physical therapist.

  8. Hi. I broke ankle and sprained MCL in
    Same leg. I’ve had previous nerve damage and a scope over 14 yrs ago. Before my fall, I could walk but not run. I did water therapy and it helped tremendously yrs ago. Now I am 7 wks in therapy, no surgery and how can I get in a pool if I am in a wheelchair/ crutches. Non weight bearing right now. Thanks

    1. Many physical therapy clinics or even public pools will have some way to get into the pool. Many will have a chair lift or a gradual decline. Customers with one of our HydroWorx 2000 or 1200 pools will have a moveable floor with zero-depth entry. You can see if there are any HydroWorx customers near you: https://www.hydroworx.com/contact/locations/

  9. I enjoyed your article, and thank you for sharing your case study.

    Some of us might not realise that when a knee injury occurs, structurally, emotionally and mentally, – a lots of things are changing.

    And one of the best knee specialist London insists that each knee rehab must be customised however, he said that the rehabilitation approach and length will depend on the severity of your injury.

    Whilst the injury is on the knee ligaments, it’s good to remember that knee pain and trauma affects the whole body.

    The surgery allows the surgeon to access the knee area.

    This means it will cut, penetrate, remove, rebuild, suture the wound etc.

    This way our surgeries become possible therefore by definition is an invasive procedure (most of the time required) and even though it’s successful – surgery itself is a trauma which must be dealt with separately.

    After suffering a meniscus or an ACL, MCL, PLC injury etc, any individual will develop compensatory movements.

    These compensatory new movement patterns must be assessed as fast as possible, & addressed very carefully during your knee rehabilitation process.

    A few things you must look out for.

    Look out at the in/outward ankle, foot positioning, knee and or hip rotation, foot/pelvis shortening and missalignments, lower back (including new lower back pain) and shoulder missalignments.

    Some muscles will become overactive therefore, they might attempt to take over the structure whilst other knee / leg muscles will become underdeveloped, lose significance, become weaker and even switch off.

    These are only a few critical areas your physical therapist will assess in order to help you rebalance your body and rehabilitate your knee.

    I personally love hydrotherapy, you can easily adjust the level of resistance to the patients needs but, do you provide in-house physical therapists?

    Your therapist will work to restore muscles, joints, ROM, abilities and neurological balance helping you to get rid of knee pain and customise all exercises to your needs.

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