The “shape of water” for rehab
Do you remember that movie by the critically acclaimed Spanish director Guillermo del Toro?- a love story between a mute cleaner and an amphibian-human creature. It captivated audiences- it caught my attention. As has the advantages of using water in a rehabilitation process. A vital and crucial, usually under-valued missing link in the rehabilitation pathway is that of improving movement fluidity and neuromuscular control competency from start to finish with hydrotherapy as a key ingredient.
At the start of rehabilitation, there are many advantages of hydrotherapy, much more than just the obvious buoyancy factors, when an athlete bears certain percentages of bodyweight at certain water depths; water allows an athlete to support up to 90% of their body weight during the early stage. The warmth of the water relaxes joints and muscles promoting early range of motion, increased circulation and increased flexibility without exacerbating swelling. The natural properties of water naturally reduce swelling and inflammation, known as hydrostatic pressure. Water increases the kinesthetic awareness of the body to promote relaxation stimulating sensory nerve endings. Resistance and strength are increased when working against the added viscosity of the water without compromising joint integrity, which is a huge bonus.
There is a significant psychological effect with hydrotherapy in that early movement in the water may improve an athletes’ mental state, performing exercises in water well prior to performing them on-land. Furthermore, there is a better transition with functional return to play activities using the pool to reinforce neuromuscular recruitment patterns earlier.
Exercise in the gym naturally follows after or along with hydrotherapy. There are many different variables that are affected by moving to land from water but the support of the surrounding water and the buoyancy would be significant factors to take into account when transitioning to the gym. Strides made in the pool are progressed at this point when a greater emphasis on coordination and strength is focused upon.
Pool rehabilitation can also be applied in a different stage of the recovery process. Rather than solely during the early stages of rehabilitation when the focus is on fluidity of movement, there is scope to use hydrotherapy again in the latter phases. This is when sport-specific plyometric drills and retraining of vastly more complex motor movement schemas can be practiced without risk of adverse reactions such as
joint overload.
On the other hand let us not forget that blending hydro and gym rehab therapies together can be a winning combination for beginning or enhancing neuromuscular control competency. Neuroplasticity is a phenomenon prevalent in the present era of sports medicine and addressing motor control deficiencies can be seen clearly in the pool and gym.
Neuro-motor training (NMT) with a focus on movement patterns may be introduced early in the pool and continue in the gym thereby ensuring an optimal foundation of neuro-motor control to feed into the latter stages of a rehabilitation continuum. Contrary to popular belief NMT has a place in the early phases not solely in the late, as optimal movement is always important. The body learns to move in a path of least resistance but what may be metabolically efficient may not be correct for long-term stability and control; the introduction of motor control earlier in the process is important.
It is fair to say that hydrotherapy is a useful and safe adjunct to an accelerated gym-based rehabilitation and that it appears to help enhance the rehabilitation process. Firstly, it plays a pivotal role in a low-stress environment. Secondly, it contributes to improving motor control competency along with work on land. Thirdly, it is also advantageous in reference to sport-specific movements focusing on complex movement patterns.
It is justifiable to state that a bespoke programme of hydrotherapy and gym exercise is a winning combination throughout a rehabilitation pathway.