{"id":6,"date":"2020-08-12T13:13:16","date_gmt":"2020-08-12T13:13:16","guid":{"rendered":"http:\/\/ewachub.orgo.ee\/medical\/methods-in-aquatic-therapy\/"},"modified":"2026-08-03T16:56:17","modified_gmt":"2026-08-03T16:56:17","slug":"methods-in-aquatic-therapy","status":"publish","type":"page","link":"https:\/\/ewachub.orgo.ee\/medical\/methods-in-aquatic-therapy\/","title":{"rendered":"Methods in Aquatic Therapy or Hydrotherapy"},"content":{"rendered":"
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Written by:<\/h5>\r\n
\"Johan<\/a><\/h5>\r\n<\/div>\r\n
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Edited by:<\/h5>\r\n

\"drs.<\/a><\/h4>\r\n<\/div>\r\nAquatic Physical Therapy is primarily focused on exercise in water but also includes hands-on techniques. It can include some of the methods mentioned underneath, it can also include joint mobilizing or stretching techniques or other passive relaxation techniques, it can also include gait or postural re-education. \u00a0All techniques can be combined depending on the individual\u2019s goals.\r\n\r\nIn order to achieve specific physical or functional\u00a0 goals, aquatic physical therapists can choose a number of concepts (methods or techniques). Well-known concepts from Europe are Water Specific Therapy (WST) and the Bad Ragaz Ring Method (1955). The USA\u00a0 has given us Deep Water Running or Aquajogging (1970) and Watsu (early 1980s). More recently, Ai Chi has been developed in Japan (1993).\r\n\r\nThe reason for the choice to give a short description of these concepts is the availability of courses, information on the internet and the choice of editors of recent American textbooks on aquatic therapy to include these concepts in their books.\r\n

Water Specific Therapy (WST)<\/h4>\r\nWater Specific Therapy (WST) is THE aquatic therapy concept worldwide, included in more than 50 published articles. WST covers the entire ICF-spectrum including one of the most important topics in rehabilitation: fall prevention. It is an aquatic therapy with elements of the Halliwick 10 point-programme swimming method. Halliwick is used as pretraining for exercises that use the fluidmechanical properties of water. The Halliwick ten-point-programme was developed by the engineer James McMillan. The first 6 points were also described by him as pretraining, i.e. teaching a patient to dare to fall and be able to stand up. These points are related to aquatic self-efficay as basis for compliance to exercises and activities that address a patient specific problem, using the constraints of the aquatic environment. Some of these constraints are related to fluidmechanics: use of flow conditions (turbulence), waves of transmission and metacentric effects (using the change of gravity and buoyancy induced torques).\r\n\r\nWST started it\u2019s development in 1974 when McMillan was asked to found an aquatic research group in the medical centre of Bad Ragaz and the neighbouring rehabilitation centre \u201cKliniken Valens\u201d, in Switzerland. He and the physiotherapists in the group developed exercises that were described in the German book \u201cWasserspezifische Therapie und Training\u201d, written by Urs Gamper, one of the research group members. This book has been modernized to the present website: Water Specific Therapy<\/a><\/span> .\r\n\r\nAlready Noh (2008) used the pre-training to continue with Ai Chi and Kwon (2010) to continue with an obstacle course. Where swimming mostly is a continuation of the 10 point programme in paediatrics, in aquatic therapy for adults a focus on postural control (in fall prevention) is more logic. This is what the quoted literature shows. WST has been described in-depth in the book Comprehensive Aquatic Therapy by Lambeck & Gamper (2011) and this chapter, together with the publication by Noh in 2008 were the reason to include WST in the Dutch guidelines on stroke treatment.\r\n\r\nIn 2018, the German book \u201cWasserspezifische Therapie\u201d was published by Katharina Kastner. This book covers in-depth descriptions of all elements that belong to WST and Halliwick. See the book: \u201cWasserspezifische Therapie\u201d<\/a>\u00a0<\/span>\r\n\r\nThe choice for WST (exercises and activities) is the result of a clinical reasoning process in which, partly based on external evidence, aquatic therapy is chosen as the best intervention for a certain patient with (mostly) a certain neuromusculoskeletal problem.\r\n\r\nWhen the intervention requires activity of the patients and the goals are at the level of function of ICF: WST has proven to have clinical relevant results in e.g. neurological patients (Vivas 2011, Scarano 2012, Tripp 2013, Zhang 2016, Terrens 2020). A clinical question in WST could be : \u201ccan metacentric effects be used to train central stability in an ataxic patient\u201d? Perhaps more important is that the combined approach of WST and original Halliwick group activities fit perfectly in the contemporary framework of neuroprotective exercises: a combination of sustained physical activities and environmental enrichment in which e.g. executive functions are challenged and neuroinflammation is addressed. Also (an)aerobic principles can be included: muscle power training, sensorimotor agility, cardiovascular endurance\/health.\r\n\r\nFor more information about Water Specific Therapy <\/strong>(WST), visit the IATF website<\/a><\/span>.\r\n

The Bad Ragaz Ring Method<\/h4>\r\nThe Bad Ragaz Ring Method has a long history of adaptations to the state of art in aquatic proprioceptive neuromuscular facilitation. Originally based on PNF, fluidmechanical elements were added to adapt it for aquatic therapy. The key element is the activation of muscles in (myofascial) chains as a preparation for functional activities in water and on land. Recently, principles of muscular fine tuning, PNF techniques, training physiology have been included. Also concepts like functional kinetics and core stabilization are a part of contemporary BRRM, and applied to working with neurologic, orthopedic and rheumatic populations. See the bad Ragaz website<\/a><\/span> for more information.\r\n\r\nExamples of contemporary topics that are included in the course are:\r\n