When you work with some of the world’s best athletes, you learn a lot. A key lesson I learned was that we needed to protect the weak link in the chain while keeping the rest of the body strong and ready for action. That was fairly easy to do in the water, because the minute we entered the water, buoyancy reduced or eliminated gravity and trauma to weight-bearing joints.
That lesson applies to all aspects of rehabilitation, from the professional and Olympic athlete to the most disabled of patients. We must still protect the weak links as we keep people strong and exercising in the pool.
For post-stroke patients, the weak links are many: compromised cardiovascular systems, decreased strength, limited mobility, reduced trunk control, changes in muscle tone, and poor balance. Until recently, most post-stroke patients have followed the traditional land therapy route and struggled to sit upright, transfer from a bed to a chair, shift their weight, and walk. But in a pool, patients can walk without fear of falling, assume a vertical position without unsteadiness and perform aerobic work without overloading the cardiovascular system. By protecting and addressing the body’s weakest links in the pool, a post-stroke patient can become more confident and capable of performing tasks and skills that once seemed out of reach.
Below you will find some basic deep- and shallow-water exercises that lay the foundation to a successful recovery of the deficits observed in stroke patients. Once these pool skills are established, a patient can make an easier transition to a land-based program and eventually to an independent home program.
DEEP WATER TECHNIQUES
Deep water is an ideal environment in which post-stroke patients can train their cardiovascular systems. The water’s buoyancy lifts the patient’s body weight to allow upright positioning. A patient’s legs can move freely, since no impact is felt in the lower body. So the patient can do running, walking, and bicycling movements while floating upright. Water’s buoyancy allows a patient to lift his legs through a range of motions, so stretching is easier than on land.
Patients with poor trunk control can use small water-resistant weights on the ankles to pull the feet downward and maintain the vertical position. Core stability is improved as patients actively contract the core musculature to remain upright while floating and exercising in deep water. With practice, stroke patients can master these tasks.
SHALLOW WATER TECHNIQUES
In shallow water, a post-stroke patient can practice movements to gain strength and skill before attempting them on land. For example, balance training can begin in the pool. The water helps improve balance by supporting the body, and, because it offers a sense of security, decreases the fear of falling. For many patients who have been immobile since a stroke, walking in water for the first time can be revitalizing and inspiring. Once walking can be accomplished, weights and in-pool steps can be placed on the bottom of the pool so the patient can practice negotiating obstacles. All of this greatly improves a patient’s confidence.
Performing leg exercises while standing at the wall lets the patient continue to improve balance while he works on gaining strength. Water offers resistance in all directions of movement so both halves of muscle pairs are strengthened in the same exercise.
Regaining the ability to stand up from a seated position is easier in the water than on land, too. Patients sit on the pool steps then rise to a standing position. At first, some patients may need assistance with standing. But many patients can perform the sit-to-stand skill independently by using one or two upper extremities to hold a railing or a side of the pool for support.
If a pool isn’t readily available, I encourage you to do the work to find access to one. It opens so many options for recovery from any injury or condition. I have a basic rule of thumb that came from my work with elite athletes, and that rule applies to all patients who have goals they want to accomplish on land: Do it first in the water!
Lynda Huey, M.S., founder of CompletePT and Huey’s Athletic Network, is a former athlete and coach whose own injuries led her into the water to find fitness and healing. She was educated at San Jose State University where she starred on the track and field team during its golden years. Lynda is the author of four books on water exercise and water rehabilitation.