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.
Types of Hydrotherapy for Arthritis
There are two general approaches that your doctor may recommend, says Dr. Kim:
Physical therapy hydrotherapy
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.
How Hydrotherapy Helps Treat Arthritis Pain
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.
For many people with arthritis, warm water therapy is the opposite of torture. In a 2013 review in the journal Musculoskeletal Care 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:
A heated pool is incredibly soothing for pain, delivering numerous physical and psychological benefits.
Improves cardiovascular health and muscular strength
Hydrotherapy provides a boost to cardiorespiratory fitness, which is important for good heart health. It also increases muscular strength.
Lowers disease activity
“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.
How to Get Started with Hydrotherapy
Get an expert opinion
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.
“Once I’m confident a patient can exercise without injury, they gradually decrease from supervision to independence,” says Dr. Kim.
Check for warm water
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.
Going once or twice per week is a good goal, she says.
Ask about water quality
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.
Don’t worry about your swimming skills
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.
Consider water therapy part of your overall treatment plan
Warm water therapy will not replace your drug therapy. “This is an adjunct treatment,” Dr. Kim says.
Tell your trainer about your condition
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.
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Al-Qubaeissy KY, et al. The effectiveness of hydrotherapy in the management of rheumatoid arthritis: a systematic review. Musculoskeletal Care. March 2013. doi: http://dx.doi.org/10.1002/msc.1028.
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
Metsios, GS. Physical activity, exercise and rheumatoid arthritis: Effectiveness, mechanisms and implementation. Best Practice & Research Clinical Rheumatology. October 2018. doi: https://doi.org/10.1016/j.berh.2019.03.013.
Water Therapy for Osteoarthritis. Arthritis-Health.com. https://www.arthritis-health.com/treatment/exercise/water-therapy-osteoarthritis.