POOL SEASON IS RIGHT AROUND THE CORNER

Pool (aquatic) exercise provides many benefits, including an ideal environment to exercise throughout the year. The buoyancy of the water supports a portion of your body weight making it easier to move in the water and improve your flexibility. The water also provides resistance to movements, which helps to strengthen muscles. Pool exercises can also improve agility, balance, and cardiovascular fitness. Many types of conditions greatly benefit from pool exercise, including arthritis, fibromyalgia, back pain, joint replacements, neurological, and balance conditions. The pool environment also reduces the risk of falls when compared to exercise on land. Below are some tips and tricks provided by the APTA as suggestions to get you started in the right direction.

Preparing for the Pool

Before starting any pool exercise program, always check with your physical therapist or physician to make sure pool exercises are right for you. A wonderful option is asking your physical therapist to take your home exercise program and adapt it so that it's possible to do in the water. Here are some tips to get you started:

• Water shoes will help to provide traction on the pool floor.
• Water level can be waist or chest high.
• Use a Styrofoam noodle or floatation belt/vest to keep you afloat in deeper water.
• Slower movements in the water will provide less resistance than faster movements.
• You can use webbed water gloves, Styrofoam weights, inflated balls, or kickboards for increased resistance.
• Never push your body through pain during any exercise.
• Although you will not sweat with pool exercises, it is still important to drink plenty of water.

10 Excellent Exercises for the Pool

1. Water walking or jogging: Start with forward and backward walking in chest or waist high water. Walk about 10-20 steps forward, and then walk backward. Increase speed to make it more difficult. Also, increase intensity by jogging gently in place. Alternate jogging for 30 seconds with walking in place for 30 seconds. Continue for 5 minutes.

2. Forward and side lunges: Standing near a pool wall for support, if necessary, take an oversized lunge step in a forward direction. Do not let the forward knee advance past the toes. Return to the starting position and repeat with the other leg. For a side lunge, face the pool wall and take an oversized step to the side. Keep toes facing forward. Repeat on the other side. Try 3 sets of 10 lunge steps. For variation, lunge walk in a forward or sideways direction instead of staying in place.

3. One leg balance: Stand on 1 leg while raising the other knee to hip level. Place a pool noodle under the raised leg, so the noodle forms a “U” with your foot in the center of the U. Hold as long as you can up to 30 seconds and switch legs. Try 1-2 sets of 5 on each leg.

4. Sidestepping Face the pool wall. Take sideways steps with your body and toes facing the wall. Take 10-20 steps in 1 direction and then return. Repeat twice in each direction.

5. Hip kickers at pool wall: Stand with the pool wall to one side of your body for support. Move 1 leg in a forward direction with the knee straight, like you are kicking. Return to start. Then move the same leg to the side, and return to the start position. Lastly, move that same leg behind you. Repeat 3 sets of 10 and switch the kicking leg.

6. Pool planks: Hold the noodle in front of you. Lean forward into a plank position. The noodle will be submerged under the water, and your elbows should be straight downward toward the pool floor. Your feet should still be on the pool floor. Hold as long as comfortable, 15-60 seconds depending on your core strength. Repeat 3-5 times.

7. Deep water bicycle: In deeper water, loop 1-2 noodles around the back of your body and rest your arms on top of the noodle for support in the water. Move your legs as if you are riding a bicycle. Continue for 3-5 minutes.

8. Arm raises: Using arm paddles or webbed gloves for added resistance, hold arms at your sides. Bend your elbows to 90 degrees. Raise and lower elbows and arms toward the water surface, while the elbows remain bent to 90 degrees. Repeat for 3 sets of 10.

9. Push ups: While standing in the pool by the pool side, place arms shoulder width apart on pool edge. Press weight through your hands and raise your body up and half way out of the water, keeping elbows slightly bent. Hold 3 seconds and slowly lower back into pool. (Easier variation: Wall push up on side of pool: place hands on edge of pool shoulder width apart, bend elbows, and lean chest toward the pool wall.)

10. Standing knee lift: Stand against the pool wall with both feet on the floor. Lift 1 knee up like you are marching in place. While the knee is lifted even with your hip, straighten your knee. Continue to bend and straighten your knee 10 times, and then repeat on the other leg. Complete 3 sets of 10 on each leg. For more of a challenge, try this exercise without standing against the pool wall.

FAQ OF YOUR 'HEP'

So you come to therapy. You're given a folder with exercise pictures, and bands to complete your resistance training when you're not at therapy; these exercises are a part of your "Home Exercise Program." 

Here at Champion, we expect you to do your exercises for 30 minutes, twice per day throughout the duration of your treatment. On the days you come to therapy, it's only necessary to do them once more, as you'll do them with us, as well. We suggest using ice for 15 minutes after each exercise session (at home and in-clinic.)

What happens after you've had a few sessions and you can no longer fit all of your exercises in within 30 minutes?

Get through whatever you can in 30 minutes, and do everything you didn't have time for in the second session of 30 minutes. If you get through all of your exercises in 45 minutes worth of time, start them over. 

What if I'm so sore from doing new exercises during a treatment session that I'm having problems doing them at home?

First thing you need to recognize is the type of pain you're having. If it's muscle soreness, do your best to push through it. If it's joint pain or localized pain right on an incision site or bony prominence associated with your diagnosis, either reduce the repetitions/sets, or reduce the weight you're performing the exercise with. The best way to describe the bad kind of pain is relating it to the symptoms you started therapy with; the pain you originally started therapy with. If the movement causes pain like that, anything above a 1-2/10, discontinue the exercise for the day. 1-2/10 may cause some discomfort at most, but this will be uncomfortable, at least slightly. 

Second thing you need to do is understand that we are going to progress you, just slightly, each time you come into the clinic. You will have some residual soreness from the increased stress on the body, and this can make it difficult to wrap your mind around continuing with your HEP. Your soreness should be gone within a couple of days, but we have to force that hypertrophy in your muscles to improve your symptoms. It's not an easy process.  If it's an exercise that causes lingering or sharp pains, stop. Our rule of thumb is no greater than a 4-5/10 on a pain scale. We want you around a 1-2, as far as pain goes. Please keep in mind, this does not include muscle soreness.

What if I forget how to do an exercise?

First suggestion would be to read the description under the photo - sometimes the description includes alternative options to performing the exercise that we used with you, and that version may not be the one depicted on your HEP sheets. 

Second suggestion would be to do your best to do the exercise as you remember, and make a note to yourself to remind us to review it with you and make notes on your HEP sheets for next time. 

Third suggestion, we're always just a phone call away. If you're really frustrated by an exercise, give us a call and we'll do our best to walk you through what we'd like for you to do. 

What happens when my bands get too light, or weights get too light? Should I push myself without being told and increase?

If you've been doing an exercise that feels too easy for you, try to increase your resistance or weight for one set. Most of the time, you'll be required to do 2 sets of an exercise, or at least 20 repetitions of an exercise.  Split your reps or sets in half, and try one at a higher resistance. If you don't have an increase in symptoms the next day, you're welcome to try to increase to doing all of your reps/sets at that higher level. If you do have some increased soreness, it's okay. Make sure to tell us that you tried, so we can make a note of it.  This will not slow you down, as long as you performed the exercise with the correct form - you'll likely just have some muscle soreness for the next couple of days. 

What happens when I'm finished with therapy, what do I do with my exercises?

It depends on what you were in therapy for.

Say you're an athlete who is post-surgical, you'll likely only be anywhere from 75-85% back by the time you're discharged.  Why? Because legally, therapy is prescribed based on medical necessity, and medical necessity is equivalent to functionality. According to insurance policies, you're entitled to be able to perform all daily activities that are related to your functionality as a person.  In other words, being able to cook, clean, bathe yourself, dress yourself, etc. As an athlete, being back to 100% means being able to return to play AND not feel limited by a prior injury; as if the injury never happened. You'll be discharged from therapy once you've met the functionality limitations, and can clear the specialized tests that are required to be cleared by a physician to return to play. However, there will still be aspects of your game that will be slacking, because you have to progress back up to higher level activity. 

In this case, you'll want to keep up with your exercises for a couple months until you're more comfortable playing again. From that point on, doing your HEP 3x/week should be enough. 

However, say you're in physical therapy for shoulder pain due to tendonitis, or impingement. By the time you're discharged, you'll likely already be rid of all your symptoms with most all activity. At your time of discharge, you'll be able to immediately switch to doing your HEP only 3x/week. If your symptoms return, even slightly, try to increase the number of times you perform your HEP before decreasing that activity that's causing the symptoms. 

What if I just do my exercises in therapy, since I'm so busy or don't like to exercise?

Your symptoms will only have slight relief. Unfortunately, by the time you've had pain severe and for long enough that you've seen a physician and scheduled therapy, your injury, whatever it is, has caused modifications in your lifestyle. Your body will make changes that modify daily activities to protect that injured area from increased pain - examples can vary from secondary muscle group activations to compensate, all the way to using the other hand for activities that require overhead movement. 

This requires completing your HEP religiously until at least some relief is felt. If you only do your exercises when you're here in the clinic, you'll likely see little to no progress. The interesting thing about physical therapy is it only works if you're willing to put the work in.