Water Based “Aquatic” Physical Therapy

August 2015 Family Friendly Community Events
July 31, 2015
Traveling with Young Children
August 3, 2015
August 2015 Family Friendly Community Events
July 31, 2015
Traveling with Young Children
August 3, 2015
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Water Based “Aquatic” Physical Therapy

By Anna Romanosky, PT

Pools and water play are such important and fun family activities in the summer. If your child likes the bath and is motivated by water, aquatic therapy is a great way to build their skills and confidence. Even without easy access to a pool, you can still use the properties of water to help your child. Many pool-based activities can also be carried out in a kiddie pool or bathtub at home to aid in the advancement of gross motor skills, increase joint range of motion, improve strength, and decrease muscle pain and spasms while also promoting relaxation or increasing weight bearing in a fun way.

There are four key properties of water that make aquatic therapy unique and beneficial for your child.

  • Buoyancy: This is the feeling of weightlessness that you experience when immersed in water. The natural buoyancy of water decreases the effects of gravity allowing for easier, safer, and more comfortable movements during therapy. This upward force makes the water a perfect place to work on rehabilitating painful or stiff joints and weak or uncoordinated muscles.
  • Temperature: Water should be 86 degrees or warmer to relax muscles, decrease muscle spasms, relieve pain, or increase joint range of motion. Many facilities have warm water pools available or you can easily fill a kiddie pool or bathtub with warm water. Cooler water is also great for other kinds of aquatic therapy; it just might not be as effective with muscle relaxation.
  • Fluid Resistance: This is the pushback you feel when walking through the water. This property can be used to strengthen muscles or challenge walking balance.
  • Hydrostatic Pressure: Hydrostatic pressure is the fluid pressure that the water exerts equally on all submerged areas of the body at any given depth. This constant pressure can increase awareness of where body parts are as they move, reducing swelling, or stabilize joints, which can be beneficial to kids that have hypermobility or low muscle tone.


Whether you are at a community pool or using a bathtub at home, the following tools can be helpful but aren’t a necessity:

  • Pool noodle
  • Arm floaties
  • Swim vest or built in flotation device
  • Floating pool toys (mini rubber duckies work great!)
  • Pool rings
  • Kickboard
  • Bucket or watering can
  • Foam letters


Setting up the environment:

  • Depending on your child’s goals and age you may want an aquatic environment where they can touch the ground. This is especially helpful if they are working on independent walking or jumping skills. The higher the water level, the less weight bearing while standing. This can make walking, half kneel to stand, jumping, and stairs much easier for your child and allow them to feel success with a new skill.
  • Check to see what pools are available in your area and find out the water temperature provided.
  • If your child needs to practice stairs, ask if the pool has stairs or aerobic steps that you can use.


The following are some common positions that are used in aquatic therapy. These positions are helpful in carrying out specific aquatic exercises or activities.

  • Standing or kneeling
  • Reclined in one or more of the following: in parent’s arms, with a pool noodle, leaning against the edge of the pool, with a life vest or other flotation device
  • On the child’s belly, supported by one or more of the following: being held by the parent, pool noodles under the child’s chest, holding onto the edge of the pool, wearing a life vest or other flotation device
  • Suspended with support by one or more of the following: with pool noodles (under the arms or have the child straddle the noodle), flotation devices, or support from a parent/caregiver


Exercise Ideas:

  • Hold your child in a reclined position, preferably with their head and back resting against your chest. This will give them a lot of support. Encourage them to kick their legs; you can model or help them at first or even have them kick a floating toy. This can help strengthen their legs and abdominals. It can also increase endurance and work the cardiovascular system. The less support you give them, the harder they have to work!
  • Hold your child on their belly with support at either the upper chest or under their entire chest/belly. Encourage them to kick their legs and move them forwards to give them the feeling of swimming. If they are having difficulty, have your child hold onto the edge of the pool and help them kick their legs until they are able to kick on their own. You can also encourage your child to reach up for toys while on their belly; this will help strengthen their back muscles, neck and shoulders.
  • Have your child straddle a pool noodle like they are riding a “seahorse” and kick their legs like they are riding a bicycle. You can give them support at their trunk or hips. This can be a really fun activity to race with family members. It also works on trunk control and balance, coordination skills, and leg strength.
  • When setting up for your child’s bath, you can encourage them to squat and throw in the bath toys, and this is even more fun if there is already water in the tub! You can also place foam letters or toys high on the shower wall and encourage them to stand on their tiptoes in the bath water to reach the toys. This activity should be easier than on land because of the buoyancy of the water.
  • If your child is learning to walk you can find a community pool that has a shallow end or baby pool, or you can use your bathtub or a personal kiddie pool. Start in water that is waist to chest high. Remember that deeper water equals less weightbearing, which can allow your child to feel more success with an activity. You can give them support at their arms or waist. If they are able to walk at this level try having them hold a pool noodle or less stable surface to challenge their balance. As they improve, have your child try to walk in shallower water to increase the amount of weightbearing and resistance. You can also use this same progression with many other developmental skills such as jumping, transitioning from floor to stand, kneeling, squatting, or cruising.


Water based therapy can be a fun and unique addition to standard physical therapy. It is part of many families’ routines throughout the year but especially during the summertime. If you are interested in trying out aquatic physical therapy, ask your early intervention provider for more ideas that can help your child succeed.