Water Rehabilitation

Usually when you are up to your neck in something you’re in trouble, but research shows that being up to your neck in water may be just what you need. Dr. Bruce E.Becker, who has published, taught, and researched extensively on aquatics, wrote an article titled “Considering the Biologic Aspects of Water” which was published in April 1995 in Advance for Directors in Rehabilitation. His article included the latest information and research on the physiological changes that occur when the body is immersed in water. The following points are summarized from Dr. Becker’s article to provide you the benefit of his observations.

Although water is the oldest rehabilitation modality, few understand the magnitude, variety, and rapidity of its healing effects. Yet much research over the centuries validates these effects, and recent research adds further understanding:The aquatic environment produces physiologic changes that help remove metabolic waste, improve cardiac function, lower blood pressure, and assist the body in tissue healing.

In regard to the circulatory system, Dr. Becker stated that: “Immediately after a person is immersed, water begins to exert pressure on the body…Central venous pressure rises with immersion to the chest and increases until the body is completely immersed… Cardiac volume increases by nearly one-third with immersion to the neck…Since the ultimate purpose of the heart is to pump blood, its measure of performance is the amount of blood pumped per unit of time.” This is called cardiac output and “submersion in water to the neck depth increases cardiac output, 32% at rest.” “Therefore the claim that water exercise is not aerobically efficient is faulty. In fact, it may be the ideal cardiovascular conditioning medium.”

“Like the circulatory system, the pulmonary system is profoundly affected by immersing the body to the thorax. Part of the effect is due to blood shifting into the chest cavity, and part is due to compression of the chest wall. The combined effect alters pulmonary function, increases the work of breathing, and changes respiratory dynamics. In fact, expiratory reserve volumes decrease by 75 percent at neck immersion, with vital capacity decreasing only slightly …The combined effects of these changes increase the total work of breathing by 60 percent. Thus for an athlete used to land-based exercise, water-based exercise is a significant workload challenge to the respiratory apparatus. If water training time is sufficient, this challenge can improve the respiratory system’s efficiency.”

“Water immersion positively affects the musculo-skeletal system as well, particularly with vasoconstriction. On land, for instance, sympathetic vasoconstriction tightens the resistance vessels of the skeletal muscle to resist blood pooling. But in water, immersion pressure removes the biologic need for vasoconstriction, thus increasing muscle blood flow. In fact, resting muscle blood flow increases by 225 percent during neck immersion”

“Aquatic immersion creates many effects upon renal blood flow and the renal regulatory systems. For instance, the flow of blood to the kidneys increases immediately upon immersion, which produces an increase in urine production, as well as sodium and potassium excretion. Sodium excretion also increases as a function of depth due to the shifting of circulating central blood volume.”

Immersion up to the neck during deep water running is often utilized for its conditioning effect.” Although some controversy exists about the optimal training program for athletes who need joint off-loading during a recovery period, it is known that aquatic exercise can indeed increase conditioning in that population. In fact, water running equals land running in its effect upon maintaining VO2 max. When training intensities and frequencies are matched.”

“Similarly, when aquatic exercise is compared with land-based equivalent exercise in its effect upon maximum gains in VO2 in unfit individuals, aquatic exercise achieves equivalent results.”

“Water-based exercise programs may be used to sustain or increase aerobic conditioning in athletes who need joint offloading… Studies, have shown excellent cross-over benefits.”

Through understanding the principles and benefits of aquatic physics, coaches, trainers, athletes and rehabilitation clinicians can design aquatic programs that complement and enhance land-based programs to provide increased levels of fitness and function.

Dr. Bruce E. Becker, MD. became Medical Director of St. Luke’s Rehabilitation Institute in May 1999. A graduate of Tulane University School of Medicine, Dr.Becker completed his residency training in physical medicine and rehabilitation at the University of Washington. He was an associate professor at Wayne State University School of Medicine as well as Residency Program director for the Department of Physical Medicine and Rehabilitation there. He also served as vice president of Medical Affairs for the Rehabilitation Institute of Michigan, 1992-1998. Dr. Becker was in private practice with Rehabilitation Medicine Associates in Eugene, Oregon, where he founded the Oregon Rehabilitation Center, and served as its Medical Director for many years.

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