HYDROTHERAPY SPORTS MEDICINE

THE VISCOSITY OF THE WATER PROVIDES MUCH ADDED RESISTANCE WHEN COMPARED WITH THE SAME MOVEMENT IN THE AIR

that athletes return to sport as quickly and as safely as possible. To achieve this, the programme must include sports-specific activities using sporting equipment. The equipment, such as a racquet, has a large surface area and the water provides increased resistance and develops endurance. The viscosity of the water provides much added resistance when compared with the same movement in the air. In this example, the athlete swings the racquet through the water using a similar stroke to that used in the sport. This improves the neuromuscular facilitation, particularly of the upper limb, and the stability of the lower limb (6).

MAINTENANCE OF FITNESS DURING REHABILITATION FROM INJURY Athletes are often concerned that during injury their fitness will decrease and it will take a long time to return to active sport. This part of training should include cardiovascular conditioning as well as maintaining flexibility, strength and coordination of uninjured areas. Exercise in deep water results in weight relief for the lower limbs while providing an environment that increases the muscle strength of the whole body. Therefore, athletes may have an intensive and possibly competitive workout without stressing the injured area.

Deep-water running Deep-water running (DWR) is a form of aquatic exercise simulating running. Participants wear buoyancy jackets or a form of floatation and keep the body upright using arms and legs as in running. Three or four 45-minute sessions, three to four times per week, will increase fitness. The injured limb is exercised in a pain-free, safe environment that cannot be simulated on land. British marathon runner Sarah Rowell cites personal experience of the benefit gained from DWR while recovering from a fractured metatarsal, Mary Decker practised DWR for 3 weeks after injury and then did 3 days’ training on land before breaking the world 2000-m record (7). Circuit training Circuits in the pool can include star

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jumps, trunk rotation with bats held in both hands, running against a Theraband, running on the spot with high leg-lifts, push-ups on a pool bar, pushing a float down into the water, and touching opposite knee and elbow. These exercises may be customised for the athlete to include the skills required in their sport. Competitive acumen is maintained by recording the time taken for each task or the number of repetitions performed.

PREVENTION OF SPORT INJURIES Once the injured athlete has recovered, an important aim is to protect the athlete from stress and to prevent further injury. The athlete’s fitness programme should include flexibility and myofascial stretching exercises. Stretching exercises are performed slowly to the point of discomfort, held at the limit determined by the athlete, and then followed by relaxation and further stretching into more range. Ideally these exercises are performed with buoyancy assisting into the new range. This helps to reduce recurrent injuries related to overuse and stress. Such a programme interspersed with land training is also useful as part of pre-season training. Other aspects of prevention include circuit training (see above).

CONCLUSION Hydrotherapy can provide an adjunct or alternative to land-based rehabilitation programmes. In the early stages of rehabilitation, buoyancy can be utilised to assist in weight relief. At later stages it is used to provide resistance to movement. Water

THE AUTHOR

Alison Skinner trained as a physiotherapist in Glasgow. She gained the hydrotherapy certificate and the teaching diploma of the Chartered Society of Physiotherapists (CSP) at the Middlesex Hospital School of Physiotherapy, where she subsequently taught for many years. Recently she has been leader of the physiotherapy skills course for physiotherapists who qualified outside the UK at University College London. She is an external examiner for the Bath hydrotherapy course, an international lecturer in the Halliwick concept, and co-author of Duffield’s Exercises in Water and Tidy’s Physiotherapy. She has lectured and delivered courses in hydrotherapy both in the UK and abroad. She has been instrumental in moving the ATACP foundation course towards CSP endorsement and has served as ATACP treasurer for many years. She was awarded a fellowship of the CSP for services to physiotherapy, particularly hydrotherapy.

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provides an excellent medium in which to perform cardiovascular conditioning and to maintain flexibility, strength and coordination of uninjured areas.

References 1. Mano T, Satoshi I, Yamazaki Y, Saito M. Sympathetic nervous adjustments in man to simulated weightlessness induced by water immersion. 1985 2. Hall J, Bisson D, O’Hare P. The physiology of immersion. Physiotherapy 1990;76:517– 521 3. Genuairio SE, Vegso JJ. The use of a swimming pool on the rehabilitation and reconditioning of athletic injuries. Contemporary Orthopaedics 1990;20:381–387 4. Harrison R, Bulstrode S. Percentage weight bearing during partial immersion in the hydrotherapy pool. Physiotherapy Practice 1987;3:60–63 5. Tierney T. In: Ruoti RG, Morris DM, Cole AJ (eds) Aquatic Rehabilitation. Lippincott 1997. ISBN 0397551525 6. Tierney T. In: Ruoti RG, Morris DM, Cole AJ (eds) Aquatic Rehabilitation. Lippincott 1997. ISBN 0397551525 7. Rowell S. Deep water running. Coaching Focus 1992;19 A version of this article was first published in Aqualines 2007;19(2). Reprinted with permission of the Aquatic Therapy Association of Chartered Physiotherapists (ATACP).

WEIGHT RELIEF FOR THE LOWER LIMBS WHILE PROVIDING AN ENVIRONMENT THAT INCREASES THE MUSCLE STRENGTH OF THE WHOLE BODY

EXERCISE IN DEEP WATER RESULTS IN