Hydro therapy strengthens joints, reduces cardiovascular risks | Sunday Observer

Hydro therapy strengthens joints, reduces cardiovascular risks

26 January, 2020
Water exercises
Water exercises

While no national survey has been done on the number of people in Sri Lanka who have osteoarthritis (OA), specialists in the field believe a significant proportion of the population (mainly women) suffer from this crippling condition which hampers their movements. The recommended traditional treatment was weight balancing, and gym workouts with a few pain killers like paracetamol or panadene thrown in to relieve severe pain quickly. This changed when around 2003 a new study showed that both, land based exercises as well as water resistance exercises could definitely help to increase muscle strength and help people with osteoarthritis of the hip or knee to walk faster and longer, reduce risks of falls and increase cardiovascular health.

Researchers compared the effects of a six-week hydrotherapy or regular gym exercise program vs. no exercise at all in a group of about 100 people with osteoarthritis of the knee or hip. Both exercise programs focused on resistance exercises designed to build muscle strength around the affected joint, and participants worked out three times a week either in the pool or in the gym. They found that both programs provided valuable benefits in improving physical function. Walking speed and distance improved in both groups compared with the non-exercisers, while one advantage of hydrotherapy was that it increased cardiovascular fitness, allowing people with osteoarthritis to exercise to a greater degree of intensity without the harm they would experience with a gym-based program.

The Sunday Observer asked a long experienced Chartered Physiotherapist, Dr Gopi Kitnasamy, currently heading the Rehabilitation Services at MJF Charitable Foundation, how water therapy benefits OA.


Q. While Osteoarthritis is often talked about, not many people know what this condition is. Explain its meaning, how it occurs and which part of the body is affected.

A. Osteoarthritis ( OA) the most common form of arthritis, affect millions of people worldwide. It occurs when the protective cartilage on the ends of your bones wear down over time. Although osteoarthritis can damage any joint in your body, the disorder commonly affects joints in your hands, knees, hips and spine. In normal joints, a firm, rubbery material called cartilage covers the end of each bone. Cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. In OA, the cartilage breaks down causing pain, swelling and problems moving the joint.

Q. Symptoms? How are they initially identified?

A. Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

Pain. Your joint may hurt during or after movement.

Tenderness. Joint may feel tender when you apply light pressure to it.

Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity.

Loss of flexibility. You may not be able to move your joint through its full range of motion.

Grating sensation. You may hear or feel a grating sensation when you use the joint.

Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.

Q. What are the risk factors?

A. Factors that may increase your risk of osteoarthritis include:

Old age. The risk of osteoarthritis increases with age.

Sex. Women are more likely to develop osteoarthritis, though it isn’t clear why.

Obesity. Carrying extra body weight contributes to osteoarthritis in several ways, and the more you weigh, the greater the risk. Increased weight puts added stress on weight-bearing joints, such as, hips and knees. In addition, fat tissue produces proteins that may cause harmful inflammation in and around joints.

Joint injuries. Injuries, such as those that occur when engaging in sports or from an accident, may increase the risk of osteoarthritis. Even injuries that occurred many years ago and seemingly healed could increase your risk of osteoarthritis.

Certain occupations. If your job includes tasks that place repetitive stress on a particular joint, that joint may eventually develop osteoarthritis.

Genetics. Some people inherit a tendency to develop osteoarthritis.

Bone deformities. Some are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.

However, osteoarthritis symptoms can usually be effectively managed, although the underlying process cannot be reversed. Staying active, maintaining a healthy weight and other treatments may slow progression of the disease and help improve pain and joint function.

Q. What role does exercise play in relieving disabilities among people with OA?

A. Exercise is an integral part of any arthritis treatment program, as it helps to strengthen and stabilize the joints, preventing further damage. For patients suffering from osteoarthritis, the pain brought on by regular exercise could be unbearable. Water Exercise is an excellent option for patients with osteoarthritis of the knees, hip and spine due to the decreased pressure placed on the joints.

Q. In what way?

A. Water provides an ideal environment for patients to exercise because the buoyant force of water counteracts the downward pull of gravity, thus reducing the weight placed on the joints.

Studies have shown that up to 50% of body weight is supported in waist-deep water, while 90% of weight is supported in neck-deep water.

Patients suffering from osteoarthritis are often unable to perform traditional land-based exercises due to increased pain created by the impact. In a supportive medium such as water, patients can perform similar strengthening or endurance exercises with the benefit of gentle resistance, and also a reduction in pain. Water exercise is especially helpful in cases where a land-based exercise program is not possible due to the intensity of pain, decreased bone density, disability or other factors.

Water exercise is particularly good for people with conditions such as: Osteoarthritis, Advanced osteoporosis (with susceptibility to and/or pain from fracture), Muscle strain or tears, Physical disabilities and Neurological disorders.

In addition, water exercise is frequently recommended as a form of exercise therapy to treat those with diabetes as well as individuals with high blood pressure. Both conditions can improve and become more manageable with water exercise.

Q. What are its benefits?

A. The physical properties of water make it a highly desirable medium in which to exercise to treat arthritis, back pain and other musculoskeletal injuries. Some of the most important properties of water that make exercise easier are:

Buoyancy: water counteracts gravity and helps to support the weight of the patient in a controlled fashion as the patient is immersed. This can aid the development of improved balance and strength. The buoyancy of water also permits a greater range of positions due to the virtual elimination of gravitational forces, particularly, for exercises that require lifting the legs, the heaviest limb of the body for most people.

Viscosity: water provides resistance by means of gentle friction, allowing strengthening and conditioning of an injury, while reducing the risk of further injury due to loss of balance.

Hydrostatic pressure: there are powerful effects produced by hydrostatic pressure that improve heart and lung function, making aquatic exercise useful to maintain and strengthen heart and lung function. This pressure effect also aids in improving muscle blood flow. Water provides 12 times the resistance of air, which means walking in water requires more effort and ultimately burns more calories than walking on land. And still it’s a great workout, as you walk, you’re really strengthening and building muscle.

Q. Are there different types of water exercises?

A. Exercises often resemble those performed in traditional land-based exercise programs. They look similar to stretching or resistance exercises conducted on land, with the exception that they use the gentle resistance of water rather than gravity to exercise muscles or joints. A few of the more popular exercises are:

Stretching, including stretching the hamstrings and lower back by slowly raising knees to chest, or stretching the upper back and neck by standing away from the side of the pool and leaning forward with arms outstretched to grasp the pool edge.

Strengthening, including using foam barbells to complete bicep curls or lateral side raises that work against water resistance.

Water aerobics, including water walking or slow jogging in a shallow pool which loosens the lower back and hips.

Ai Chi, a hybrid form of Tai Chi developed specifically for water exercise that develops strength, balance, and joint flexibility through slow gentle movements while focusing on relaxation and controlled breathing.

Q. Is there something new being tried out now?

A. Water Walking is becoming popular. It is considered easy on the joints, according to the Arthritis Foundation. You can walk in the shallow end of the pool or walk in the deep end with a flotation belt. You can walk backwards and sideways, as well as frontwards in the pool, to tone different muscles. Sitting along the pool edge and doing kicks or squats also enhance your water workout.

Q. Will water exercise help those with obesity problems since obesity is one cause for OA?

A. Overweight and Obese adults may have functional limitations that result in difficulty performing traditional weight-bearing exercises and activities. Water exercise is a commonly recommended alternative due to the potential therapeutic qualities of water. Weight loss involves burning more calories than a person ingests. Understanding this one basic fact takes the magic and intimidation factor out of the weight-loss equation. Water exercise allows people to work out longer at lower intensities, thereby burning more calories than shorter duration, high-intensity exercise.

Q. Your message to the public?

A. Getting in and out of a pool will be difficult for patients with OA, after hip and knee surgeries, people with physical disabilities and obese patients. Disabled friendly or wheelchair accessible pools are the best solution to help these patients, but we don’t have many pools with accessibility in Sri Lanka. At NCCCPDD, which is a special school for children with Cerebral Palsy and other Developmental Disorders in Rajagiriya, we have a disabled friendly pool and Physiotherapists trained in hydrotherapy.