Aquatic Physical Therapy: What It Is, Who Provides It and What a Session Involves

What it is

Aquatic physical therapy (also called aquatic therapy, pool therapy or, in UK hospitals, hydrotherapy) is physical therapy exercise done in a warm pool. One NHS hospital describes it as using the properties of water to do therapy-based exercises in a pool. [2] A UK physiotherapy definition quoted by another NHS trust calls it "a physiotherapy programme utilising the properties of water, designed by a suitably qualified physiotherapist." [3]

It is not the same as a spa soak or a fitness class. The aim in these descriptions is rehabilitation: moving more easily, building strength, balance and confidence. For how the two differ, see wellness hydrotherapy and clinical aquatic rehabilitation.

Why water is used (proposed, not proven for every person)

NHS pages explain that water lessens the load on joints and that the warmth is meant to help you move in comfort. One trust says the aim is to improve joint movement, stability and muscle strength, and general mobility, balance and core stability. [3] Buoyancy aids can be used to assist or resist a movement, depending on your goals. [3] These are the services' own explanations. Whether they lead to better results than the same exercises on land depends on the condition; see aquatic therapy and land-based exercise compared and how water affects the body.

Who provides it

• Physical therapists (physiotherapists). In the NHS pages we read, a physiotherapist runs the pool sessions, and referrals come from a physiotherapist you have seen on dry land. [3] Another hospital says every patient needs a physiotherapist's assessment before starting. [1]
• Assistants. One hospital describes a physiotherapy assistant greeting patients and giving the introductory talk. [2]
• United States. The American Physical Therapy Association says physical therapists must earn a Doctor of Physical Therapy degree and pass a state licensure exam. [4] What extra aquatic training a therapist has is not described in the sources we read.
• United Kingdom. The Health and Care Professions Council says the titles "physiotherapist" and "physical therapist" are protected by law. [5]

Titles used in spas and fitness clubs, such as "hydrotherapist", are a different matter; see who is who among aquatic therapists and spa staff. Rules for other countries and states are not covered here. We do not list or recommend providers.

What a session usually involves

These details come from three English NHS hospital pages and will differ elsewhere.

• Referral and screening. The referring physiotherapist asks medical questions first, to check that pool rehabilitation is medically safe for you. [3]
• The pool. One trust says its pool is held at a constant 34 to 35 degrees (Celsius). [3] Entry is by steps with a handrail or by an electric hoist. [3] You do not have to swim, according to one hospital. [1]
• Length. One hospital says a first session lasts about 20 minutes and later ones up to 30 minutes. [2] Another says about 40 minutes, in a group of up to eight, with exercises tailored to each person. [1]
• Your exercises. The therapist gives you a personal exercise sheet. [2] At the end of a course patients usually have a set of pool exercises to continue independently in a local pool, and you can ask for a copy. [3][2]
• Afterwards. One hospital says it is normal to feel tired and achy after sessions. [2]

Our page on your first aquatic therapy or spa session covers what to bring and ask.

Who is told to check first or wait

NHS pages are specific. One lists problems that make hydrotherapy not appropriate, including open wounds or skin infections and angina, cardiac and respiratory conditions. [1] Another asks you to say if you have an open wound and not to wear plasters, and to tell staff about any change in health or if you are pregnant or trying to be. [2] Poolside floors are slippery, so non-slip waterproof shoes are required. [2] Lists differ between hospitals, so ask the service you are referred to. See preparing for hydrotherapy and pool safety for exercise and therapy.

Benefits and limits

Hospital pages describe the goals as relaxation, strengthening, joint movement and pain reduction. [1] They list conditions treated, such as recovery from joint replacement and osteoarthritis. [1] Those are service descriptions, not trial results. Evidence differs by condition: see osteoarthritis and joint replacement and low back pain. The same hospital says the exercise can aggravate symptoms, including worsening pain at times. [1]

Access, cost and cover

Not every area has a heated therapy pool. Prices and insurance rules vary and were not verified here. See costs, insurance and coverage and how to check a pool, spa or clinic.