RPM – Spokane Clinical Director Julianne Alford imparts knowledge she’s learned from worldwide training on how to use the water environment to facilitate functional improvements and improve mobility.
Twenty years into Julianne Alford’s physical therapy career, an injury to her shoulder stopped her in her tracks. No longer would she be able to treat like she used to unless she adapted to a whole new medium: water.
“The first time I got into the water as a clinician, I had my arm back,” Alford shared. “I realized I could marry all the skills that I had on land with that of water and treat a whole new source of clientele in the water.”
Alford went on to train in world-renowned centers in key thought centers across Europe until she mastered aquatic rehabilitation practices. In this episode of Powering Health and Wellness with RPM Rehab, Alford shares her passion for aquatic therapy and explains all the ways in which water-based rehabilitation can increase support, strength and stamina in the pool.
The power of water
When you move your therapy practice into the pool, it opens up a new world with a whole new range of possibilities for improving physical health.
Whereas on land patients have to fight gravity, the pool offers them freedom from this sometimes limiting force. In water, people benefit from the effects of buoyancy which helps lift and support them while they work through their exercises.
“Everything you do, it’s unweighting those painful joints. It’s unweighting those painful spinal structures. It’s supporting your body. It’s alleviating that stress of that gravity. And it allows that person to be upright,” said Alford.
Water is also more viscous than air, meaning you face far more resistance to your movements when submerged, which Alford says can be used in numerous ways to build better mobility.
“I can take an individual and say, ‘I can use the viscosity to support you or I can use the viscosity to strengthen you.”
Another property that makes water such an invaluable resource is the hydrostatic pressure. When you stand in the pool, the pressure is greater on your feet than on your chest level – increasing the workload of your heart by 40%.
In this way, Alford says water is like a third partner, alongside you and your patient, assisting with the physical therapy.
“I’ll tell a patient when they first come in the water, you’re benefiting from being in the water and I haven’t even touched you,” Alford said. “And that’s the greatest gift water gives is hydrostatic pressure.”
The pools for physical therapy aren’t your average pool. Alford believes it’s important that pools be adjusted to assist rehabilitation efforts as much as possible.
That includes temperature. For aquatic physical therapy, you want water that is warmer than the average pool – at about 92 to 94 degrees Fahrenheit.
“The purpose of using that is to make sure when you get in, if you’re not moving, we don’t want you to shiver, but we also don’t want you to be too warm and relaxed,” she explained. “It’s to be comfortable enough to move around and exercise, but not to overheat your body.”
In Spokane, Alford runs a clinic with a pool designed specifically to meet the needs of her practice and her patients. The depth of the pool varies from 3 feet up to 7 feet in order to allow for a wide range of movement, both shallow and deep water.
“It’s a 20 by 30 foot pool, so it’s a very large area to treat,” said Alford. “You want to make sure that a person is exercising at the appropriate level for them. So I don’t want to take a 5”2’ lady and put her in 6” water.”
Lastly, the chemical makeup of the pool can determine a lot about who you can treat. Alford uses bromine, rather than chlorine, to treat her pool because she says it’s the least harsh option for her patients’ skin. She also recommends a strict routine on how much time they should spend in and out of the water.
“There’s a whole hygiene on how you get in the water, how you get out of the water and what you do with your bathing suits. And we explain that to all of our clients.”
Another amazing aspect of aquatic therapy is that it can be used not only for severely debilitated patients, but also for elite athletic training.
In fact, studies have shown that participation in aquatic therapy significantly strengthened athletes. Alford explains that sometimes patients can “out-endurance those athletes that were on land because their cardio-pulmonary function was so much stronger in the water.”
Alford has found this cross-training method very successful for athletes of all backgrounds, from high school athletes all the way to Gonzaga University basketball players.
“In a lot of ways, not only did we keep them on the field through their injury and protect them,” said Alford, “but then after they were done they continued because they liked the performance enhancement. They were stronger.”
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