Aquatic Physical Therapy and Pool-Based Exercise for Arthritis

Physical activity in the water is typically easier on joints than activity on land. Therapeutic exercise programs that take place in the water can be used to help reduce joint pain caused by osteoarthritis, rheumatoid arthritis, and other types of arthritis.

Aquatic Physical Therapy

Occasionally, a physician may recommend physical therapy that takes place in a pool. Just like for land-based physical therapy, the goals are to speed up healing, increase joint function, and improve quality of life.

Many exercises in the water are adapted from land-based activities. For example, a person who wants to walk unaided on land may practice walking in waist-deep water first.

Consider talking to a physical therapist who is trained in aquatic therapy if the aim is to:

• Make aquatic exercise part of a long-term routine
• Achieve specific functional goals, such as using stairs without pain or recovering from an injury

A trained physical therapist will be able to create a personalized pool exercise plan and teach good form.

Read more about Arthritis Treatment Specialists

Pools dedicated to physical therapy may be associated with a rehabilitation center, hospital, or clinic. If pool-based physical therapy is not available, a doctor or physical therapist may be able to recommend specific aquatic exercises that can be done independently.

Pool-Based Exercises

Done independently or as part of an organized class, exercising in a pool can help improve strength, heart health, and even balance. Community pools, YMCAs, and private gyms may offer aquatic exercise classes, such as water aerobics. Pool facilities may also designate certain hours for non-swimmers.

Below are examples of exercises that can be done in a pool.

Walking in water

In waist- or chest-deep water, walk the length or width of the pool. Turn around and repeat. As an alternative to walking, try slowly jogging or doing alternating leg-lunges.

These simple exercises work muscles in the core and lower body and can also help improve balance. Beginners may start with 5- to 10-minute sessions and increase time gradually. People looking for more of a challenge may add ankle weights.

Hip abduction and adduction

This exercise works the adductor and abductor muscles. These muscles are located on the inside and outside of the thighs and are essential for supporting the hip joint and balance.

• Stand in waist-deep water (or deeper) and hold on to the side of the pool, resting the body weight on the left leg
• Swing the right leg up and out to the side (away from the body)
• Swing the right leg back down and toward the body, crossing past the midline of the body and in front of the standing leg, if possible
• Try to keep the body upright and the leg in motion straight (a slight bend at the knee is okay

Repeat 10 to 20 times, then switch legs. Add ankle weights to make this exercise more challenging.

Arm push-pull

This exercise can help strengthen the muscles that support the shoulder, elbow, and hand joints. Muscles in the chest and back are also used.

• Stand in neck- or shoulder-deep water with feet planted on the pool bottom, about hip-width apart.
• Hold arms in front of the body, and try to flex the wrists to about 90° with palms facing forward.
• Pull the right arm back so that the elbow is bent at 90° and the arm grazes the side of the body.
• At the same time, keep the left arm out in front of the body, fully extending and straightening it (if possible).
• Alternate arms, pushing the right arm forward while pulling the left arm back.

Repeat 10 to 20 times. If this exercise puts too much pressure on the wrists or fingers, make adjustments. For example, relax the wrists for some or all of the repetitions.

Shoulder abduction and adduction

Daily activities, such as putting on a coat and closing a car door, require moving the arm out to the side and away from the body (abduction) and back toward the body (adduction). This exercise works the shoulder muscles that control abduction and adduction movements, including the supraspinatus, deltoid, trapezius, and serratus anterior muscles.

• Stand in neck- or shoulder-deep water with feet planted on the pool bottom, about hip-width apart.
• Hold arms in front of the body, at shoulder height with just a slight bend in the elbows.
• Focusing on the shoulders, chest, and back, sweep the arms outward and to the sides. If the shoulders have a healthy range of motion, it may be possible to sweep the arms slightly behind the body.
• Sweep arms back to the start position.
• Before each sweep, rotate hands so they are cupped in the direction of movement.

Repeat 10 to 20 times.

Shoulder flexion and extension

Daily activities, such as putting away groceries, require shoulder flexion and extension. These are movements that bring the arms out in front of the body.

• Stand in neck or shoulder-deep water with feet planted on the pool bottom, about hip-width apart.
• Hold arms straight in front of the body at shoulder height, with just a slight bend in the elbows
• Focusing on the shoulders, chest, and back, sweep arms down toward the sides of the body and continue past the body, if possible.
• Sweep the arms forward, returning to the start position.
• Before each sweep, rotate the hands so they are cupped in the direction of movement.

Repeat 10 to 20 times.

Tools that add resistance, such as hand paddles, webbed gloves, or foam barbells, can make these shoulder exercises more challenging. Webbed gloves made of neoprene and can also help keep hands warm.

Swimming

Like many other types of aerobic exercise, regular swimming can help improve heart health, develop muscle strength, and increase or maintain joint range of motion.

• Begin swimming in short intervals or use a kickboard to help build stamina and strength.
• If neck pain and stiffness make turning the head side-to-side difficult, try breaststroke or backstroke.

Experienced swimmers who have thumb or finger pain may consider using webbed gloves or swim paddles. These devices can take stress off individual finger joints while also improving stroke mechanics and increasing resistance strength in the shoulder, chest, and back muscles. Webbed gloves made of neoprene can also help keep hands warm in the water.

See Water Therapy for Osteoarthritis

When RA is moderate to severe, swimming may be too painful. In these cases, more gentle pool-based exercises or resting at home for a day or two may be a better choice.