Bringing new clients to your facility with aquatic therapy and rehab.

The pool is wonderful for a special population of conditions: Multiple Sclerosis, arthritis, fibromyalgia, older or sedentary adults, people with high blood pressure, prenatal women, people with asthma, back or knee pain, and people who have had hip or knee replacements. The water provides an excellent medium for the de-conditioned because of the buoyancy afforded to the exerciser.

Health clubs, Y's, Recreational Departments, and private spas are constantly competing for members. In the United States, surveys show that only 20% of the population participate in exercise on a regular basis. Everyone is battling for the same market, as exercise venues all want that 20%. Why not try some of the non-exercising population? Most special populations are in the 80% of our population that do not or cannot participate in group exercise.

Like most community pool facilities, you probably have SLOW time in the mid-morning and mid-afternoon. Moving into secondary, even primary, aquatic therapy can help fill that time, bring you profits and serve a market that needs you.

Aquatic therapy and rehabilitation is a growing field and an exciting opportunity. Throughout the continuum of therapy, there are many positions open for non-therapists, aquatic instructors, and personal trainers. The therapy industry is starting to move into more "active therapy," which is also called "prevention." Few therapists are trained in the "whole body" approach like most fitness practitioners. Likewise, aquatic fitness/swim practitioners are not trained in therapy. A partnership is ideal.

Instituting a program to fill your dead time can be as simple as leasing out your pool. This allows a rehab corporation to offer off-site outpatient therapy. Another option is sub-contracting with a therapy clinic, private practice, or independent therapist to provide some of their services at your facility. A third choice is hiring a therapist or rehab practitioner to offer onsite therapy. Finally, you can use some of your aquatic fitness instructors or personal trainers to offer secondary therapy. (Secondary therapy is provided after the client has already been released from primary therapy with a licensed therapist and is sometimes called post rehabilitation.)

The health care industry is experiencing drastic changes with managed care and capitation. Therapists are sometimes only allowed nine visits with their patients. This only gives them time to train the patient (and sometimes their family) to do therapy on their own. It would be ideal if aquatic therapists could release the patient and their program plan to your facility.

How To Offer Aquatic Therapy

You will need success in three areas to make it work: Location, personnel, and referrals.

First of all, your location. Is your parking lot easily accessible? Is your facility and your pool handicapped accessible? Are your locker rooms and showers spacious enough to move around with a wheelchair? Few clients will need wheelchairs but it is good to be prepared.

Assuming that your facility has the air and water quality mastered, your pool is handicapped accessible, and you have adequate depth markers and signage, you will need to review your pool for proper rehab, therapy depth, and temperature.

Choose a good water depth that matches your client and your technique. If your client is fearful of water, begin in the shallow end. As the client begins to get a feel for working in the water, they may want to move to deeper water to give themselves more buoyancy and less biomechanical stress. Begin in deep water if the client has orthopedic or weight bearing problems. Finding an adequate water depth can lessen the likelihood of new injuries. Be sure the water depth allows time to move in a controlled manner.

Find a good water temperature. You may need warmer than average water temperature to keep the instructor's and client's body core temperatures up while doing very basic therapeutic work. You will probably find 84 to 90 degrees F water ideal for the average clients, with 92 to 96 degrees F recommended for Watsu. Clients with MS, fibromyalgia, children, the obese, and prenatal women will often find water temperature in the 80 to 83 degrees F area ideal. These clients have poor thermal regulatory systems or a build up of heat can exacerbate their systems. You will need to decide what types of clients you will market before setting your pool temperatures.

Cooler water can be used for slow moving rehab if clients wear neoprene (Wet Wraps) vests, jackets and/or shorts. There are plenty of clients you can work with in a cooler (80 to 83 degrees F) pool.

Second for success is personnel. You may want to hire licensed therapists to work in your facility. If so, you can bill insurance companies directly. Personal trainers are often extremely knowledgeable about rehab because of their expertise in working one-on-one. They can, depending on their training and certification, perform secondary rehab alone. Because of the patient's continuum of care from primary therapy to secondary therapy to fitness, you can consider hiring a wide variety of personnel. They all have a part in client care. Consider Personal Trainers, PT assistants, Occupational Therapists, OT assistants, kinesiotherapists, exercise physiologists, RN's, adapted PE, adapted aquatics, massage therapists, aquatic exercise instructors, and swim teachers.

If you need to train staff, there are private individuals who teach different protocols (therapy programs) and the Aquatic Therapy and Rehab Institute (906-482-9500) has educational programs offered throughout the year in various locations.

Lastly, you need clients who require rehab. People are always getting hurt, needing surgery and experiencing aging symptoms. How do you get them to your facility? You can through referrals from doctors, therapists, and other medical field personnel. Let the doctors, nurses, therapists, clients, and hospitals know that you are willing to work with them and follow their treatment plans. Invite them to visit your facility, your pool and equipment, and your staff. You will need to show your staff professionalism (possibly using a potential case to discuss the course of action) and let them know that clients are always supervised and never left alone.

Who Can You "Treat"?

You may want to offer group classes or one-on-one programs for arthritis, MS, prenatal, obese, hip or knee replacements, back surgery or pain, stroke victims, fibromyalgia, asthma (of any COPD), diabetes, CAD, shoulder pain or surgery, or general aging (inactive) symptoms. People who have weakness, pain, decreased range of motion, limited mobility, swelling, loss of balance, or have recently undergone surgery or experienced an injury are ideal candidates. The water is an excellent medium for all those populations ... even it's cool!

Aquatic Therapy and Athletes

Trainers realize that water therapy can bring dramatic results in treating injuries. When athletes are sidelined they lose not only physical conditioning, but also mental acuteness. If they are unable to compete for an extended period of time, the physical loss is tremendous and they often experience depression. Reaction time diminishes, coordination and balance decline, muscular strength and tone decrease, cardiorespiratory conditioning decreases, and agility is diminished.

It is not necessary for these things to happen. Immediately after injury or surgery, athletes can begin aquatic training. They can protect the affected area and work the rest of the body vigorously in deep water.

Whether it is a pitching arm that has developed shoulder impingement problems, a pulled hamstring, or a knee surgery, the water can help. Wraps have been developing to protect open wounds from the water allowing athletes a training/rehabilitation option the day of surgery.

Athletes who have rehabilitated in the water have been shown to lose less physical conditioning, lose less mental acuteness, lose less competition time, and often return to competition with their personal best times.

Treatment techniques vary according to the athlete, the level of pain, the situation, and the necessary function. Since athletes are so good at perceived exertion, they can easily transfer their training effort to the water. Lynda Huey, who has trained Olympic runners, can ask them to run the 4/40 in their minds and they know exactly how much speed, force, and effort to give.

Benefits

Land-based therapy and rehab offer tremendous benefits but, too often, clients are unable to manage the load of their body weight during rehab. The water allows clients to achieve all the benefits of rehab while enjoying the buoyancy offered by the water. Clients who have had strokes and who are unable to walk on land can often walk in the water. Gait training, balance, coordination, reaction time, agility, trunk stabilization, and mobility are just a few benefits of water rehab. Plus, the resistance of the water gives clients a "weight" to work through to increase muscular endurance and strength. Not only does the client benefit, but you facility will benefit with a boost in membership, a boost for the bottom line, and a boost in image.

Ruth Soya, M.S., an internationally known speaker, author, and consultant, is founder of six businesses including the Aquatic Therapy and Rehab Institute, the Aquatic Exercise Association, Living Right Magazine, ACT, Armchair Aerobics Inc., and the Fitness Firm. She is on the Wisconsin Governor's Council on Physical Fitness, received the Governor's Entrepreneurial Award, was the recipient of the IDEA Outstanding Business Award, worked on the ACE certification committee, was awarded the first Presidential Sports Award in aquatic exercise, and received AEA's 1994 Contribution to the Industry Award. She is the author of numerous articles and nine books on her specialties of wellness, fitness, and business. Sova brings her knowledge and experience on the subject to her article "Bringing New Clients to Your Facility with Aquatic Therapy and Rehab" on page 74.