A dip in a nice, warm pool probably sounds pretty relaxing and restorative right now. Add in underwater exercises and you’re now performing hydrotherapy, a beneficial treatment for those with many kinds of arthritis, including osteoarthritis and inflammatory types, such as rheumatoid arthritis.
“When we talk about hydrotherapy or aquatic therapy, we’re referring to exercises performed in a pool where the level of the water has to be at least waist, chest, or shoulder height, ” says Soo Yeon Kim, MD, medical director of musculoskeletal medicine and assistant professor of physical medicine and rehabilitation at Johns Hopkins Medicine in Lutherville, Maryland.
That’s one thing that differentiates hydrotherapy from a spa therapy where you might float or sit in a pool and simply relax. Traditional hydrotherapy is not just soaking in warm water; it requires you to put in some work.
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In this treatment, you would see a physical therapist who has a specialized pool that contains exercise equipment, such as an exercise bike or treadmill. There may be bars you can hold to perform resistance exercises.
You can also take underwater aerobic exercise classes at your local community center or gym. These are usually not run by a physical therapist but a certified personal trainer or group fitness instructor. Learn more here about water exercises for arthritis.
Both can be effective, though randomized controlled trials examining hydrotherapy have been done in a physical therapy setting. Dr. Kim says that anecdotally, patients also respond well to aquatic classes in a community pool.
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If you’ve ever tried to walk underwater, you know it’s a tougher task than walking on land. “Water creates resistance, which is what builds strength in muscles, ” says Dr. Kim. The big plus, though, is the elimination of gravity. “Underwater, patients feel better. They have less pain and engage muscles more. They can activate muscles that they don’t typically use when doing land therapy, ” she says.
A wealth of research shows that regular exercise is very beneficial for people with arthritis. Regular physical activity improves joint functioning, reduces symptoms like fatigue, leads to a lower risk of being hospitalized, and decreases the likelihood of developing chronic disease associated with inflammatory arthritis, like heart disease, according to a review in Best Practice & Research Clinical Rheumatology.
However, many arthritis patients may skip exercise entirely, either out of the belief that certain types of movement will worsen symptoms or because workouts feel terrible. “We have a lot of evidence that land therapy is important for managing symptoms. But the problem is that patients say that their joints hurt, so exercise isn’t fun. It can almost be torture for them, ” says Dr. Kim.
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That analyzed six studies, RA patients who performed hydrotherapy felt less pain and joint tenderness, improved their mood, and reported liking the workout, too. Here are more details on why hydrotherapy is good for arthritis:
“Hydrotherapy affects disease activity in RA. Studies have found that certain inflammatory markers decrease with aquatic therapy, ” says Dr. Kim. Exactly why isn’t well understood, however.
Then, there’s the mental uplift from spending time free of pain. “Research shows that a sense of well-being — an ability to move the body as you want without pain — increases your quality of life. That is one of the most motivating factors for encouraging aquatic therapy, ” says Dr. Kim.
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Talk to your rheumatologist about what water therapy option might be best for you. If you’re grappling with a greater level of pain and need more supervision (or worry that you could hurt yourself if you attempt these exercises on your own), then a referral to a physical therapist who offers pool therapy is right for you. If you’re more functional and your disease activity is well controlled, you can try take classes in a community pool.
If you choose the community pool option, make sure that the pool has warm water. (It may not be.) “Any type of arthritis is marked by stiffness in the joints. Warm water is needed to relax the joint capsule and decrease stiffness to allow for better joint movement with less tenderness, ” says Dr. Kim.
Water should be well-monitored (in terms of pH and chlorine levels) to decrease infection risk, says Dr. Kim. Ask the front desk about pool inspection reports or what they do to monitor their water quality. That’s a legitimate question for anyone, but if you feel comfortable, you can explain that this information is critical for managing your disease.
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Sporting a bathing suit often makes patients think they will be swimming. With hydrotherapy, “you won’t swim. You’ll be doing the same exercises — walking, running, biking — that you would do on land but in the water in a controlled environment, ” says Dr. Kim.
If you’re taking a community class, tell your instructor that you have arthritis. Being aware of your health issues will help them understand any limitations you may have, modifications you need, or tips that will help you get the most benefit from class.
Check out PainSpot, our pain locator tool. Answer a few simple questions about what hurts and discover possible conditions that could be causing it. Start your PainSpot quiz.
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Interview with Soo Yeon Kim, MD, medical director of musculoskeletal medicine and assistant professor of physical medicine and rehabilitation at Johns Hopkins Medicine in Lutherville, Maryland
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The purpose of this study was to verify the effect of deep-sea water thalassotherapy (DSWTT) on recovery from fatigue and muscle damage. The same exercise program is conducted in general underwater and deep-sea water to confirm the characteristics of deep-sea water through fatigue recovery and muscle damage enzymes. A total of 30 male college students were studied, including 10 belonging to the control group (CG), 10 in the water exercise group (WEG), and 10 in the deep-sea water exercise group (DSWEG). The DSWTT treatment consists of three components—preheating, treatment, and cooling—and the DSWTT program stretches and massages the entire upper body, lower body, back, and the entire body for a total of 25 min in a deep-sea tank. After the DSWTT program, blood tests were conducted to confirm the level of fatigue-related parameters and muscle damage enzymes. Fatigue-related parameters including glucose, lactate, ammonia, and lactate dehydrogenase (LDH), and the levels of muscle damage enzymes such as creatinine kinase (CK) and aspartate aminotransferase (AST) were measured. The results revealed that fatigue had a primary effect (p < 0.001) and exhibited strongly significant interaction (p < 0.001) with lactate, ammonia, and LDH levels, whereas the glucose level remained unchanged. The post hoc results showed a significant decrease in these parameters among DSWEG compared to CG and WEG (p < 0.01). Muscle damage enzymes showed a main effect (p < 0.001) and significant interaction (p < 0.001) with CK and AST (p < 0.001). The post hoc results showed a significant decrease in DSWEG compared with CG and WEG (p < 0.01). In conclusion, the DSWTT program applied to this study showed significant effects on muscle fatigue and muscle damage recovery. When the DSWTT program is applied in hot springs, it can have a positive effect on muscle fatigue and muscle damage recovery and can contribute to improving national health and quality of life. Further studies are needed to investigate DSWTT programs with various research subjects at different program temperatures, exercise times, and frequencies of treatment and exercise.
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In recent years, both men and women have become interested in effective physical activity and healing while pursuing a healthy life. As a result of the increase in interest, studies on physical recovery programs
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