How physical therapy leverages the properties of water to achieve remarkable therapeutic outcomes.
As the only existing Water/Swim/Sea Therapist, in Nigeria I feel it is my duty to break down the connection step-by-step to everyone that truly cares about the welfare of people living with Cerebral Palsy.
- The Problem on Land: Gravity and Weak Muscles
People with profound cerebral palsy (CP) especially face a significant challenge due to two interconnected factors:
High Tone and Spasticity: CP is a neurological disorder caused by damage to the developing brain. This damage disrupts the brain’s ability to send correct signals to the muscles, often leading to spasticity (a state of continuously increased muscle tone). Muscles are constantly “on,” tight, and stiff.
Weakness and Atrophy: Paradoxically, these same tight, spastic muscles are also very weak. Because the brain’s signals are imprecise, the muscles cannot contract efficiently or with full force. Furthermore, the inability to move freely leads to disuse atrophy, where muscle tissue wastes away from lack of use.
The Tyranny of Gravity: On land, gravity is a constant, unyielding force. To perform any movement, lifting an arm, taking a step, even sitting up straight; a person must generate enough muscular force to overcome gravity’s pull on their body weight. For someone with weak, uncoordinated muscles, this is often an impossible task. Gravity becomes a barrier to movement.
- The Solution in Water: Buoyancy and Support
Water has unique physical properties that directly counter the challenges posed by gravity and weakness. The two most important are low density (which leads to buoyancy) and resistance.
A. Buoyancy: The Gravity Counteractor
Buoyancy is the upward force exerted by water that counteracts gravity. It’s why you feel lighter in a pool.
How it helps: When submerged in water up to the chest or neck, buoyancy can support 70-90% of a person’s body weight. This is the game-changer with the “Naija Guru Magic” from SID Africa.
Completely removes the Fear of Falling: The water provides full-body support, eliminating the risk of falling and allowing for a feeling of safety, security and the weightlessness that gives the feeling of flying in water.
Enables Movement: With the crushing force of gravity drastically reduced, a person’s weak muscles no longer have to fight their entire body weight. Movements that are impossible on land, like standing, stepping, or kicking, suddenly become possible. A person who uses a wheelchair on land can often stand and even take steps with assistance in the water.
Decreases Spasticity: Hopefully in future after construction of our international Academy, we would have the luxury of the warmth of the therapy pool (usually kept around 91-95°F or 33-35°C) and the gentle hydrostatic pressure of the water that would help to relax tight, spastic muscles, allowing for a greater range of motion.
B. Resistance: The All-Direction Strengthener
Water provides a gentle, yet constant resistance in every direction of movement. This resistance is proportional to the effort exerted.
How it helps:
Builds Strength Safely: To move through the water, muscles must work. This resistance acts like natural weight-training equipment. The key difference is that in a gym, if you drop a weight, it can cause injury. In water, if a movement is too difficult, the water simply gives way, making it an extremely safe environment for strengthening.
Improves Coordination: The resistance provides constant sensory feedback to the brain and muscles, helping to improve motor control and coordination.
Equal Work for Opposing Muscles: On land, a spastic muscle (like a bicep) might be so tight it’s hard to strengthen its opposite muscle (the tricep). In water, both the push and the pull movement meet resistance, helping to strengthen muscle groups more evenly.
The Progression of Muscle Strengthening with Consistent Water Therapy Why we must keep the therapy ongoing for life.
The progression isn’t just about getting “stronger” in a general sense; it’s about neuromuscular re-education, teaching the brain and muscles to work together more effectively.
Phase 1: Foundational (Early Sessions)
Goal: Acclimation, relaxation, and assisted movement.
What Happens: The warmth generated and buoyancy of the water cause a significant decrease in muscle spasticity. With the therapist’s support, the individual experiences movements like standing, walking, and reaching for the first time, or with much greater ease. The focus is on range of motion and the sensation of movement without fighting gravity. This phase builds confidence and trust.
Phase 2: Active Movement and Initial Strengthening (Consistent Therapy)
Goal: Initiate voluntary movement and build foundational strength.
What Happens: As the person feels safer, they begin to initiate their own movements. The therapist guides them through exercises:
* Walking in chest-deep water.
* Kicking while holding the pool edge.
* Arm raises and circles.
* The water’s resistance ensures that every one of these movements is actively strengthening the muscles. The motor cortex in the brain starts to form new, more efficient pathways for these movements because they are now successful and rewarding.
Phase 3: Increased Strength and Functional Carry-Over (Long-Term Therapy)
Goal: Increase resistance, complexity, and translate gains to land.
What Happens:
Progressive Overload: The therapist increases the challenge by using water weights (cuffs), paddles, or faster movements to increase resistance, continuing to strengthen the muscles.
Functional Training: Exercises become more specific, practicing stepping over imaginary obstacles, sitting-to-standing motions in the water, or catching a ball.
Neurological Carry-Over: This is the most crucial part. The brain begins to “remember” the patterns of movement learned in the water. The strength and coordination gained are not confined to the pool.
On land, the individual may have:
A. Improved head and trunk control.
Stronger core muscles, leading to better sitting balance.
B. Increased leg strength, which might translate to better weight-bearing, standing posture in their stander, or even assisted stepping.
C. Reduced spasticity and pain, leading to improved overall well-being.
Summary
The connection is a perfect example of using physics to overcome a neurological and muscular challenge:
On Land: Gravity + Weak/Spastic Muscles = Inability to Move.
In Water: Buoyancy (reduces gravity) + Resistance (builds strength) + Warmth (reduces spasticity) = Ability to Move and Strengthen Muscles.
Consistent water therapy allows individuals with profound CP to break the cycle of disuse and weakness. By enabling successful movement, it forges new pathways in the brain, strengthens muscles in a safe environment, and provides functional benefits that genuinely improve quality of life on land.