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Osteoarthritis Warm Water Therapy

According to the Centers for Disease Control (CDC), almost 50 percent of the United States population will develop osteoarthritis in their knees by the time they are in their mid-80s. Not only is this an alarming statistic, but it illustrates a strong need for physical therapy professionals to treat this condition.

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Potential Symptoms of Osteoarthritis

Without treatment options, individuals suffering from osteoarthritis can experience osteoarthritis-related problems including:

  • The development of obesity due to inactivity. Many times pain causes individuals to slowly decrease their exercise routines. Along the same lines, if the individual with osteoarthritis is already obese, it is only likely to worsen as the condition progresses.
  • An inability to move without pain. This causes adults to rely on both over-the-counter and prescription pain killers which may cause other side effects.
  • A loss of freedom. For the person who has osteoarthritis, just getting out of the house can be a chore and difficult to do alone. If the person is living by him or herself, this can create a feeling of isolation and reluctance to do enjoyable activities.
  • An increase in depression. Many people who deal with the chronic pain of osteoarthritis are overcome by emotional feelings of intense loss.
  • An increased amount of emotional instability. Pain can easily cause kindhearted people to “lash out” at those they love. This can add strain to marriages and other relationships.
  • The inability to continue working. For many men and women, working after typical retirement age is desired or a financially needed activity. However, those with severe osteoarthritis may no longer be able to hold a job.
  • A need for surgeries. Surgery to address osteoarthritis may be prescribed by a physician. While this can be a positive development in the short-term, surgery always has risks. If surgery can be avoided without hurting a person’s health or wellness, finding alternative methods of treatment can be the best course of action.
  • An increase in the number of medical bills paid each year. Whether the individual with osteoarthritis is covered by private insurance or government-assisted insurance, or pays for osteoarthritis treatment out of pocket, there will be an increase in healthcare costs.

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Each of these problems can be detrimental to the health and lifestyle of many individuals. When combined, they can hinder the peace of mind and independence of the adult with osteoarthritis. This is why many physical therapy professionals are constantly seeking better ways to help their clients through natural osteoarthritis treatment remedies.

Pam Cook’s painful arthritis in her knees and hip forced her to take off work for over a year. She tried traditional physical therapy programs with no improvement and were particularly painful with her arthritis and extra weight. Pam decided to try aquatic therapy at ACCUA’s HydroWorx Pool. Watch this video about her case:

The Underlying Causes of Osteoarthritis

There are many reasons for the development of osteoarthritis in an aging population. Some reflect the lifestyle choices of those afflicted; others are related to medical or physical conditions that are out of the individual’s control. A few of the most common precipitators of osteoarthritis in adult populations are:

  • A tendency to be overweight or clinically obese. The CDC estimates that around 67 percent of all men and women who are obese will develop osteoarthritis during their lifetimes.
  • An inability to move without pain. This causes adults to rely on both over-the-counter and prescription pain killers which may cause other side effects.
  • A past injury. Often, athletes who are in otherwise good shape will deal with osteoarthritis as a result of injuries or accidents they experienced earlier in their lifetimes.
  • Getting older. Because osteoarthritis is due to some natural “wear and tear” on the body, the older someone gets, the more likely he is to be diagnosed with the condition.
  • Any removal or deterioration of cartilage in joints such as hips or knees.
  • Misalignment of the joint. If someone’s joints do not “fit together” in the right way, they may find themselves dealing with osteoarthritis at some point in their lifetime.
  • Having parents or other relatives with osteoarthritis. Heredity can and does play a factor in the development of osteoarthritis.

Of course, every osteoarthritis case is different. Sometimes, people with no underlying risks for the condition can find themselves in a doctor’s office learning that they have osteoarthritis.

Since Pam started aquatic therapy she has lost 40 pounds and is now back at work as a flight attendant. Her arthritis is manageable now that she is lighter and has her strength back. Watch this video of Pam in one of her aquatic therapy sessions at ACCUA to find out what kind of warm water workout exercises helped her get her life back.

Using Warm Water Osteoarthritis Therapy to Mitigate Problems

Physical therapists and doctors continue to actively seek methods to mitigate the problems inherent with osteoarthritis. One of the newest techniques they are employing is osteoarthritis pool therapy. Because most recreational swimming pools have a water temperature that is too cold to feel comfortable for patients with osteoarthritis, it’s best to perform rehabilitation exercises in a specialized fitness therapy pool where the water temperature can be adjusted.

A warm water osteoarthritis therapy pool with integrated technology can allow clinicians to change the depth of the water — they’ll have easy access to an underwater treadmill floor and resistance jets. These amenities give the physical therapist many options when it comes to working with clients suffering from osteoarthritis.

Osteoarthritis water therapy works for most clients because it provides an environment that is calming and less stressful than therapy that’s usually associated with land therapy. The advantages to working with patients in an advanced therapy pool include:

floor-icon The ability to raise or lower the height of the therapy pool floor as needed. A moveable floor makes hydrotherapy available to anyone, even those that have limited mobility and are unable to navigate ladders or even stairs.
sooth-icon A soothing atmosphere surrounding the patient’s body. Because pain is such a strong symptom of osteoarthritis, the patient who has this condition will likely find a warm water osteoarthritis therapy pool to be quite comforting. Warmth combined with hydrostatic pressure helps reduce pain and inflammation in the joints, alleviating some of the daily discomfort. Research shows that this reduction in discomfort lasts well beyond the aquatic physical therapy session.
flexibility-icon A place for increased mobility. On land, someone who is carrying too much weight may not have freedom to perform many exercises. In the water, that individual’s weight is offset by up to 90%. Raising arms and legs or general movement is not as difficult in a therapy and fitness pool, although it might be on land.
strength-icon Strength-building opportunities that are not overwhelming to the patient. Many people with osteoarthritis are surprised to discover that, after performing exercises in a warm water therapy pool, they feel refreshed and experience little exhaustion. This is due to the fact that the water serves as an agent to keep their inflammation under control. It also provides a “massaging” force that truly reduces their aches at the site of their osteoarthritis.
rx-icon The ability to address symptoms of osteoarthritis without the use of pharmaceuticals — or with minimal use of pharmaceutical products. Plenty of individuals are seeking natural osteoarthritis treatment options, and warm water therapy fits that description well. Not only is it all-natural, but it has been proven to work. This makes it ideal for people who want to reduce or eliminate the use of osteoarthritis medicines.
social-icon Camaraderie with other people. Whether the patient with osteoarthritis is working alone with a clinician or is exercising with a group, he is likely to feel more connected with society. This can help lift spirits and reduce the signs of depression. For many individuals, this frees them emotionally — a positive outcome that should never be overlooked when considering the important elements of aquatic therapy in osteoarthritis treatment.

After aquatic physical therapy exercises in a HydroWorx pool are complete, the clinician may even wish to use a specialized massage hose that attaches to resistance jets. The massage hose provides deep tissue massage to areas that are particularly sore. An osteoarthritis aqua therapy hot water massage can also be a nice “cool down” for clients who engage in warm water therapy on a regular basis.

Warm Water Fitness Options After Physical Therapy

To help osteoarthritis patients who are no longer eligible for physical therapy, but who have a strong desire to continue with their warm water exercise, many physical therapy clinics are now offering warm water classes outside of physical therapy treatment. These classes take place in the therapy pool when it’s not being used for patient treatment sessions. Generally, they cannot be underwritten by any kind of health insurance, although patients who feel strongly about osteoarthritis water therapy are often willing to use their own funds to continue their progress.

This type of entrepreneurial venture can be a source of profitability for many therapy clinics with one or more warm water therapy pools, as it provides an outlet for patients with osteoarthritis. It also gives those clients:

  • A way to continue to strengthen their bodies in a forgiving environment.
  • A method of reducing the pain they feel from their osteoarthritis symptoms.
  • A place to socialize and meet with other patients who have similar experiences and ailments.
  • A way to improve their balance so that when they are in non-aquatic environments they have a lowered chance of falling and injuring themselves.
  • A location to go for an aquatic therapy hot water massage.

As the Population Ages, More People Will Seek Ways to Lessen Osteoarthritis Symptoms


While osteoarthritis cannot always be prevented, its symptoms can be lessened. This will be especially important in the coming years, because the population of adults over the age of 50 is continuing to rise. In fact, the Population Reference Bureau estimates that in the next four decades, the population of persons 65 and up will almost double. At the same time, most of these individuals — many of whom are Baby Boomers — will want to remain in good health despite their age.

Because getting older is one of the biggest risk factors associated with osteoarthritis, the expectation of aging men and women to remain active should not be ignored by physical therapy professionals. They should be quite cognizant of the fact that individuals will become more knowledgeable about the inherent benefits of warm water therapy – and they’ll begin looking for clinics that offer this kind of treatment. Therefore, more warm water therapy pools will be needed across the nation.
The good news is that this is a positive “problem,” and it’s one that is imminently solvable. For clinicians and individuals managing physical therapy clinics or hospitals, the first step involves investigating the warm water therapy options available on the market today. In order to offer the best aquatic therapy possible, it’s recommended to invest in an advanced therapy pool that includes technology such as:

  • A variable-depth floor with embedded treadmill. The underwater treadmill should have many speeds so patients can safely increase or decrease intensity as required.
  • Resistance jets for balance training and variable intensities.
  • A massage hose for hot water massage opportunities.
  • Underwater video monitoring to correct gait mechanics and posture in real-time.
  • Removable handrails for support where needed.

Natural osteoarthritis treatment is becoming a rising trend, and it’s important for physical therapists to ensure their clinic is equipped to meet this up-and-coming need.

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Case Studies

OA Patient’s Pain Lessened Thanks To Water Power

Can water-based exercises and protocols make a serious dent in osteoarthritis sufferers’ pain levels?  According to results from a recent Utah State University study, they can by up to 24%.

Conducted by the University’s John Worley Sports Medicine Research Center, the 2010 study published in the International Journal of Aquatic Research and Education evaluated perceived pain levels in and objective physical abilities of senior-aged patients with knee, hip or ankle osteoarthritis (OA).  Each subject walked for prearranged periods on a HydroWorx underwater treadmill and a land-based treadmill.  Afterwards, they self-diagnosed perceived levels of discomfort. 

The results revealed that the individuals rated their pain levels (via visual analog pain scales) an average of 24% less after working out three sessions in one week in an aquatic environment as opposed to after working out on a land-based treadmill. The OA patients displayed greater mobility after underwater than land treadmill exercise when assessed with the Timed Up & Go test (TUG).

In an extension of that project, preliminary research published in abstract form in the journal Medicine and Science in Sports and Exercise (2011) revealed that patients with knee OA displayed improved knee kinematics following the week of aquatic versus land treadmill exercise.  Specifically, knee extension velocities in the involved knees increased by 23% after aquatic treadmill exercise and approached values reported for a healthy control population.

Eadric Bressel, PhD and Clinical Biomechanist for the Research Center, the principal investigator for the project, contends the mechanism for reduced pain and improved kinematics is unknown but may be related to aquatic factors such as buoyancy, hydrostatic pressure and temperature.  The observed improvements in mobility (TUG) may be similar to the acute neuromuscular gains observed after starting a land-based resistance training program but without load-elicited pain.  The results from these preliminary studies are encouraging and suggest the need for further investigation.

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