Rehabilitation in the water

Rehabilitation in the water (also called movement bath or hydrokinesitherapy) is a form of therapy in which physiotherapy exercises are carried out in a well-tempered swimming pool, whereby the physical properties of the water are used to rehabilitate numerous skeletal muscle complaints.


Advantages and disadvantages of the exercise pool

Due to the advantages of water: buoyancy, flow resistance and heat, the patient can achieve better results in many cases than on dry land.

The essence of the exercise bath is the low load on the body. In the gym, pressure is applied to the respective joints during any exercise that requires the active contraction of a muscle group against resistance. In the swimming pool, the movements are less stressful and painful for the joints due to the weight and gravity reduction.
Therefore, the patient also feels safer in the water; if he feels pain while performing a certain exercise, he only needs to interrupt it, the water will hold his weight. In the floating belt, the movement can be better controlled due to the slow execution and the patient can thus allow himself some mistakes without fear of serious consequences.

The main advantages of hydrokinesitherapy are the frictional resistance that water exerts on the human body, which has the following effects:

  • strengthening of muscles;
  • improved joint mobility;
  • Strengthening the cardiovascular system.

The flow resistance can be easily changed because it depends on the size of the surface and the speed of the movement applied. The resistance arises in all directions and in this way trains the entire body, which allows a better result for the whole organism to be achieved.

Immersion in pleasantly tempered water promotes the relaxation effect and thus rehabilitation.
In addition to the advantages of rehabilitation in the water, some disadvantages and minor problems should also be mentioned.
Hydrokinesitherapy alone is not sufficient, we recommend performing therapeutic gymnastics twice a week in the swimming pool and three times a week in the gym, because the promotion of the body’s sense of balance and self-perception (proprioception) in the water is missing.

The poor hygiene behaviour of patients and entering the pelvic edge area with shoes can lead to contamination of the water; in addition, the water temperature causes germs and pathogens to multiply; One hundred percent effective preventive measures are unfortunately illusory.
Skin infections (fungal infections, such as mycosis and candidiasis, warts on the soles of the feet), bronchial infections (sinus infections and bacterial or viral middle ear infections) and conjunctivitis occur frequently.

The following aspects must also be taken into account: can the patient swim, does the appearance in bathing uncomfortable (especially in overweight people)? Women may not be able to perform their exercise program regularly due to their menstrual period, which slows down the healing progress.

Indications and contraindications of rehabilitation in water


There are numerous indications for rehabilitation in the water; it helps after surgery to get back to its old form more quickly, especially after an anterior cruciate ligament transplant. In the orthopaedic field, it is not recommended as a postoperative measure after selective removal of the meniscus (meniscectomy), because 10 sessions in the sports hall are sufficient, as well as for other operations of an orthopedic nature. The exercises in the swimming pool can be helpful because of the effect of weightlessness in vertebral fractures, because the vertebrae in the water are relieved of body weight. For neurological problems, the exercise bath is useful in the following cases:

peripheral paralysis (poliomyelitis, neuritis, polyradiculoneuritis);

diseases of the central nervous system; (spinal cord injury, such as paraplegia and incomplete quadriplegia, impaired coordination (ataxia), hemiplegia (hemiplegia), sequelae of head injuries);

Multiple sclerosis (outside the evolutionary phase);

Muscle diseases (myopathies).

In the case of traumatic injuries, the exercise bath is helpful for the rehabilitation of patients with multiple trauma.


The contraindications are often not mandatory; if certain diseases are present, the doctor may initially advise against this form of therapy until the cure has taken place.
Hydrokinesitherapy is particularly discouraged if the following problems are present:

  • Skin infections
  • Conjunctivitis
  • Skin injuries caused by bedsores and ulcers
  • Epilepsy
  • Urinary incontinence

On the other hand, there is an absolute ban in the following cases:

  • Severe heart failure and unstable angina pectoris,
  • severe renal insufficiency,
  • uncontrolled epileptic seizures,
  • otitis media with secretion and tympanic membrane perforation,
  • Advanced cancers.

How is the exercise program in the water determined?

Hydrokinesitherapy helps the athlete to maintain his condition and to carry out a sport-specific rehabilitation.
Before the movement exercises can begin in the water, it must first be weighed up how well the patient can move in the water, whether he can swim and, above all, whether he is willing to tackle this form of rehabilitation. Aerobic activities should begin as soon as possible to strengthen the heart and circulation, but without overloading or damaging the injured tissue structures. Training in the water plays an important role and completes the exercise program on dry land.
In the water, an earlier education to an upright posture and load can take place than in the gym. In the case of traumatic injuries or operations on the lower extremities, Archimedes’ principle is used to reduce the burden of body weight.
The mobilization techniques are essentially active kinesitherapy exercises that take advantage of the static buoyancy of the water, the resistance to any movement and finally the beneficial effect of the water temperature.

Running underwater is an excellent exercise for injured athletes because running occurs in most sports.
The exercises in the deep pelvis are carried out until the joints can be fully loaded again; if this is the case, the exercises are performed gradually in increasingly shallow water, so that the body is slowly prepared for the normal state of the environment.

Finally, the focus is on closed kinetic chain exercises and on sport-specific exercises that prepare the athlete for a return to competition.
In rehabilitation after arthroscopic reconstruction of the anterior cruciate ligament, therapeutic gymnastics in the swimming pool begins after about 20 days after the stitches have been removed.

What are the benefits for the joints?

Subacute, chronic, dysmetabolic processes often take place in the joints, causing pain and restriction of movement.
Fango is recommended for arthrosis, sequelae of traumatic injuries, primary and secondary chronic rheumatic diseases.

THERAPIES: mud, bath therapy. The salt, bromine and iodine-containing water is particularly effective for alleviating chronic inflammation, has a disinfectant, relieving and stimulating effect. Stimulates thyroid, ovaries and increases basal metabolism. Prevents varicose veins and slows down their development process.

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