Aquatic therapy (Hydrotherapy)

What is aquatic therapy?

Aquatic therapy, or hydrotherapy as it's also known, involves special exercises that you do in a warm-water pool. The water temperature is usually 33–36ºC, which is warmer than a typical swimming pool.

Aquatic therapy is different to aqua-aerobics, which can be quite strenuous, as it’s generally more focused on slow, controlled movements and relaxation.

Aquatic therapy can be helpful however many of your joints are affected. It’s sometimes used if you’ve had joint replacement surgery or if you have back pain, ankylosing spondylitispsoriatic arthritis and osteoarthritis, but it can be used for other types of arthritis as well.

Is aquatic therapy similar to spa therapy?

Spa therapy is based on the theory that the mineral content of spa water has special health-giving properties. In many European countries, aquatic therapy often takes place in spa water. Although there’s some research that suggests the mineral content of the water may make a difference, other studies show that aquatic therapy has significant benefits regardless of the water used.


How does aquatic therapy help?

Aquatic therapy can help you in a number of different ways:

  • The warmth of the water allows your muscles to relax and eases the pain in your joints, helping you to exercise.
  • The water supports your weight, which helps to relieve pain and increase the range of movement in your joints.
  • The water can be used to provide resistance to moving your joints. By pushing your arms and legs against the water, you can also improve your muscle strength.

What to expect from aquatic therapy

Your physiotherapist may suggest a course of five or six 30-minute sessions of aquatic therapy. These may be group sessions – sometimes, but not always, with people who have similar conditions. However, the exercises suggested for you will still be personalised.

Not all hospitals have their own aquatic therapy pools so you may need to travel.

Check with your therapist what you'll need to take with you to the sessions, but this will usually include:

  • a swimming costume
  • your own towel
  • any medications that you may need – either for your arthritis or for any other conditions you may have.

You don't need to be able to swim to benefit from aquatic therapy – although swimming is also a good form of exercise for arthritis. The pool is usually quite shallow but may vary in depth so you can exercise at the depth that suits you.

There will be a few steps down into the pool, but if you have trouble with steps there’ll also be a mechanical hoist to get you in and out of the water. There will be a rail around the sides of the pool for extra support if you need it.

Once you're in the water, a physiotherapist, or sometimes a physiotherapy assistant with special training, will take you through a series of exercises that are suited to your needs, strength and mobility. Usually the focus is on slow, controlled movements and relaxation.

Because the water provides support you may feel that you can exercise more than you normally would, so be careful not to overdo it. However, it’s quite normal to feel tired after an aquatic therapy session.


Are there any reasons why aquatic therapy may not be suitable?

You must tell your physiotherapist if you have any of the following:

  • a wound or skin infection
  • a virus or stomach upset
  • a raised temperature
  • breathing difficulties, angina or heart problems
  • a kidney condition requiring dialysis
  • incontinence
  • a chlorine allergy
  • any conditions that aren't well controlled, such as diabetes, asthma or epilepsy.

In many cases, the therapist just needs to know in advance so they can make any special arrangements that may be needed. But sometimes the therapist may advise against aquatic therapy.

What happens at the end of a course of aquatic therapy?

One of the main aims of aquatic therapy is to give you confidence to continue and manage a programme of exercises on your own once the course has finished. Your physiotherapist will probably suggest that you carry on with your exercises in your local swimming pool.

Some swimming pools have special sessions when the water temperature may be increased and some sports centres offer water-based exercise classes. Ask your doctor or physiotherapist for advice before you join a class to make sure it’s suitable. You should also speak to the instructor about your arthritis and its effects so they can adapt some of the exercises for you if necessary.

It may also be possible to pay for further sessions without the physiotherapist in the hospital pool. And in some areas, local arthritis support groups (such as the National Ankylosing Spondylitis Society) hire a hospital or health club pool for aquatic therapy sessions.

If you can’t swim, it might be worth learning – swimming is an excellent form of exercise for improving your fitness and mobility without putting a lot of strain on your joints. Ask a healthcare professional for advice if you’re not sure whether it would be suitable for you.

How can I access aquatic therapy?

Aquatic therapy sessions are available on the NHS, and most hospitals have access to aquatic therapy pools. However, the nearest pool may not be at your usual hospital so you may need to travel.

Any member of the healthcare team should be able to refer you to an NHS physiotherapist if they think you might benefit from aquatic therapy. In some parts of the UK you can also refer yourself to a physiotherapist, who’ll assess whether aquatic therapy would be suitable for you. Check with your GP or call your local rheumatology department to find out if an NHS physiotherapist in your area will accept self-referrals.

You can also choose to use private healthcare. If you do, check before your treatment starts that you’re happy with the facility. A qualified physiotherapist will be registered with the Health and Care Professions Council (HCPC), and it’s recommended that you see someone who’s a member of the Chartered Society of Physiotherapists (CSP) and who’s accredited by the Aquatic Therapy of Chartered Physiotherapists (ATACP).