When you’re in pain, even simple movements like walking, climbing stairs, or getting out of a chair can feel overwhelming. Traditional land-based exercises might seem too hard, too risky, or just too painful right now. That’s where aquatic therapy—structured, water-based exercise guided by a physical therapist—can make a huge difference.
Aquatic therapy, sometimes called hydrotherapy or aquatic physical therapy, uses the unique properties of water to support your body, reduce stress on joints, and provide gentle resistance so you can move, strengthen, and heal in a safer, more comfortable environment.
Research shows that aquatic exercise can reduce pain, improve function, and enhance quality of life in many musculoskeletal conditions, including chronic low back pain, osteoarthritis, and other chronic pain disorders. Studies also suggest that, after orthopedic surgery, early aquatic physical therapy can improve function without increasing wound-related complications.
At Cawley Physical Therapy & Rehabilitation, serving patients across Northeast Pennsylvania, aquatic therapy is one way we help people safely return to walking, working, and enjoying life after injury or surgery.
What Is Aquatic Therapy?
Aquatic therapy is not just “going to the pool” or doing a casual water aerobics class. In physical therapy, aquatic therapy:
- Is prescribed and supervised by a licensed physical therapist or assistant
- Uses a therapeutic pool (often warmer than a regular pool)
- Is built around an individualized plan of care with specific goals
- Includes exercises to address pain, strength, mobility, balance, or endurance
It’s especially useful when land-based exercise is too painful, too difficult, or too risky (for example, right after surgery, with significant arthritis, or when balance is a major concern).
Why Water Is So Helpful for Injury Recovery
The magic of aquatic therapy isn’t just “being in water”—it’s how water behaves around your body. Several physical properties of water make it ideal for rehabilitation.
Buoyancy: Less Weight, Less Pain
Buoyancy decreases the effect of gravity on your body. In chest-deep water, your joints bear only a fraction of your body weight.
That means:
- Less compression through the knees, hips, and spine
- Easier walking and standing
- Greater ability to practice movements that would be painful on land
For someone with knee arthritis or recovering from ankle surgery, walking in water can be the first step toward normal gait without overloading the injured area.
Viscosity and Resistance: Gentle Strength Training
Water is thicker than air. As you move through it, you feel gentle resistance in every direction, which:
- Helps build strength and endurance
- Allows you to control intensity by changing speed or surface area (e.g., using paddles or foam equipment)
- Provides resistance without the need for heavy weights or machines
This is especially helpful after surgery or injury when traditional strengthening may be too aggressive.
Hydrostatic Pressure: Swelling and Support
Hydrostatic pressure is the force water exerts on your body when you’re submerged. It can:
- Help reduce swelling in the legs or arms
- Improve circulation
- Provide constant support that enhances body awareness and joint stability
This is one reason aquatic therapy is often used in early post-operative care and for people with chronic edema.
Warmth and Relaxation
Therapeutic pools are often kept warmer than recreational pools, commonly in the 88–92°F range. Warm water can:
- Relax tight muscles
- Decrease pain and muscle guarding
- Make stretching and movement more comfortable
For many people with chronic pain, the combination of warmth and buoyancy makes movement feel possible again.
Conditions Aquatic Therapy Can Help
Aquatic therapy has been studied across a wide range of conditions. Evidence supports its use in musculoskeletal, neurological, and general deconditioning scenarios, often as part of a broader rehab plan.
Common reasons a physical therapist may recommend aquatic therapy include:
- After orthopedic surgery – such as knee replacement, hip replacement, ACL reconstruction, rotator cuff repair
- Arthritis and joint pain – osteoarthritis or rheumatoid arthritis in the knees, hips, spine, or shoulders
- Chronic low back pain – especially when land-based exercise is painful at first
- Sports injuries – sprains, strains, stress injuries where impact must be limited
- Balance and fall risk – older adults or those with neurologic conditions who need a safer environment to practice walking and balance
- Fibromyalgia and chronic pain syndromes – where warmth, buoyancy, and graded activity can help reduce pain and improve function
- General deconditioning – after illness, long hospitalization, or long periods of inactivity
Aquatic therapy can also be useful as a bridge: once you become stronger and more confident in the water, you gradually transition to more land-based exercise.
Evidence-Based Benefits of Aquatic Therapy
Pain Relief and Improved Function
Multiple systematic reviews and meta-analyses have found that aquatic exercise can reduce pain and improve physical function in people with chronic musculoskeletal conditions, including osteoarthritis and low back pain.
Because the water supports some of your body weight, you can move more freely and work on strength and mobility without aggravating pain as much as you might on land.
Early, Safe Movement After Surgery
Research indicates that early aquatic physical therapy after orthopedic surgery can:
- Improve function
- Be as effective as land-based therapy for pain, strength, swelling, and range of motion
- Not increase the risk of wound-related complications when appropriate precautions are followed
Early movement—done safely—is a big factor in regaining independence and preventing stiffness or muscle loss.
Better Quality of Life and Confidence
Moving in water often feels safer and more enjoyable, especially for people afraid of falling or frustrated by pain. Some studies suggest aquatic therapy can improve overall quality of life, mood, and fear of movement in people with chronic pain.
Feeling successful in the pool can help rebuild confidence and motivation, which carries over to land-based activities.
Wondering if water-based rehab might be right for your recovery?
Let us help you decide. Request an appointment with Cawley Physical Therapy today.
What Happens During an Aquatic Therapy Session?
If your Cawley PT clinician recommends aquatic therapy, here’s what you can generally expect.
Initial Evaluation (On Land)
Before ever stepping into the pool, your therapist will:
- Take a medical and injury history
- Review any surgical precautions or physician instructions
- Assess your strength, mobility, balance, and walking pattern
- Discuss your goals (e.g., walking without a cane, returning to work, playing with grandkids)
This evaluation helps determine whether aquatic therapy is appropriate and how to tailor your program.
Getting into the Pool
Safety is the top priority. Your therapist will:
- Make sure you can safely enter and exit the pool (using stairs or a lift if needed)
- Explain any pool rules or infection-control guidelines
- Check that water depth is appropriate for your goals and comfort
If you’re nervous in water, your therapist will start in shallower areas and may use flotation equipment for additional support.
Typical Components of a Session
A session might include:
- Warm-up walking in shallow water
- Range of motion exercises for knees, hips, shoulders, or spine
- Strengthening exercises using water resistance, foam dumbbells, or paddles
- Balance and coordination drills using the support and challenge of the water
- Gentle stretching and cool-down in the warm water environment
Your therapist may stay in the water with you or work from the pool deck, depending on the facility and your needs.
Examples of Water-Based Exercises for Injury Recovery
Every program is individualized, but here are some examples of common aquatic exercises:
1. Water Walking
- Forward, backward, and side-stepping in chest- or waist-deep water
- Focus on upright posture and smooth, controlled steps
- Great for early gait retraining after lower-extremity injury or surgery
2. Step-Ups and Sit-to-Stands
- Using a submerged step to practice stepping up/down with less joint load
- Practicing sit-to-stand motions from a pool bench or submerged platform
- Builds leg strength for daily activities like stairs and getting out of chairs
3. Lower-Body Strengthening
- Standing squats or mini-squats with support from the water
- Hip abduction (moving the leg out to the side) against water resistance
- Heel raises to strengthen calves and improve push-off in walking
4. Upper-Body and Core Work
- Pushing and pulling foam dumbbells under the water
- Core stability exercises like gentle trunk rotations or marching in place
- Wall push-offs or gentle “floating” positions to stretch the spine
5. Balance and Coordination
- Single-leg stance with fingertip support on the pool wall
- Controlled weight shifts in multiple directions
- Walking on different pool surfaces or through gentle currents
Your therapist will adjust difficulty by changing depth, adding equipment, increasing speed, or introducing dual-task activities.
Is Aquatic Therapy Right for You?
Aquatic therapy can be a great option if:
- Weight-bearing on your joints is very painful
- You feel unsteady or fearful of falling
- You’re early in your post-operative recovery
- You have chronic pain that hasn’t responded well to exercise on land
However, there are times when aquatic therapy is not appropriate or requires special precautions. Guidelines and good-practice standards for aquatic physiotherapy highlight considerations such as:
- Open wounds or unhealed surgical incisions
- Active infections or contagious skin conditions
- Uncontrolled seizures
- Certain cardiac or respiratory conditions
- Incontinence that cannot be managed
- Severe fear of water
Your therapist and medical team will review your history and, if needed, obtain clearance before you begin aquatic therapy.
Aquatic Therapy vs. Land-Based Physical Therapy
A common question is: “Is aquatic therapy better than regular PT?”
The answer is usually: it depends on timing and goals.
- For some chronic conditions (like low back pain), studies suggest aquatic exercise can be at least as effective as land-based programs, with some evidence of greater pain relief in certain groups.
- After orthopedic surgery, aquatic therapy appears to improve function and pain without increased complications, and can be an excellent early-phase option.
- In many cases, the best approach is a combination: starting in water when land is too painful, then transitioning to more land-based exercise as you heal and gain strength.
Your Cawley PT clinician will help you decide how and when to use aquatic therapy as part of your overall rehab plan.
If you think a warm pool might be a better starting point than the gym floor, you’re not alone.
To learn whether aquatic therapy fits your recovery plan, contact Cawley Physical Therapy today.
Aquatic Therapy at Cawley Physical Therapy in Northeast Pennsylvania
In NEPA, weather, terrain, and everyday demands can make traditional rehab challenging—icy sidewalks, hills, long days on your feet at work. Aquatic therapy offers a controlled, supportive environment where you can safely practice movement before taking it back to the real world.
At Cawley Physical Therapy & Rehabilitation, our approach to aquatic therapy includes:
- Comprehensive evaluation to identify your specific limitations and goals
- Evidence-informed programming, drawing from current guidelines and research on aquatic exercise for musculoskeletal conditions
- Collaboration with your surgeons and other healthcare providers, especially after orthopedic procedures
- Gradual progression from pool-based exercise to land-based training as your tolerance improves
- Education and home strategies so you can build on your progress outside the pool
Whether you’re recovering from surgery, managing chronic joint pain, or rebuilding confidence after injury, aquatic therapy can be a powerful stepping stone toward moving more freely and living more fully.
Frequently Asked Questions About Aquatic Therapy: Benefits of Water-Based Exercises for Injury Recovery
1. Do I need to know how to swim to do aquatic therapy?
No, you do not need to be a swimmer to participate in aquatic therapy. In fact, most therapeutic exercises are done in shallow water where you can comfortably stand with your head well above the surface. Your physical therapist will choose a water depth that feels safe and appropriate, and you’ll often have access to the pool wall, steps, or handrails for support. If you’re nervous about water, that’s important to share—your therapist can start with very simple, stable tasks and may use flotation devices or other equipment to help you feel secure. Over time, many people who start out anxious in the pool become more confident as they realize they can move safely and comfortably. The goal is not to teach you to swim; it’s to use water as a tool to support your recovery.
2. How quickly will I notice benefits from aquatic therapy?
Everyone responds differently, but many people notice some type of benefit within the first few sessions—often less joint pain during exercise, easier walking in the water, or simply the feeling of moving more freely. Because the water supports your body and reduces impact, you may be able to move in ways that were too painful on land, which can be encouraging early in rehab. Over several weeks, as you consistently attend sessions and follow your home program, you may see improvements in strength, balance, walking tolerance, or confidence. Chronic conditions or complex post-surgical recoveries may take longer, so we focus on gradual progress rather than overnight change. Your therapist will regularly re-check your pain levels, range of motion, and function so you can see how far you’ve come.
3. Is aquatic therapy only for people after surgery or with arthritis?
Aquatic therapy is great for people after surgery and those with arthritis, but it’s not limited to those groups. It can also help individuals with chronic low back pain, fibromyalgia, sports injuries, balance problems, general deconditioning, or neurological conditions. The common theme is that water makes movement easier and safer, especially when full weight-bearing on land is a challenge. For example, an athlete recovering from a lower-body injury might use the pool to maintain cardiovascular fitness and leg strength while impact is restricted. An older adult with a history of falls might use aquatic therapy to practice balance tasks in a lower-risk environment. Ultimately, the decision is based on your specific diagnosis, symptoms, and goals—not just a label like “post-op” or “arthritis.”
4. Are there any risks or downsides to aquatic therapy?
Like any therapy, aquatic programs must be tailored to your health status. People with open wounds, unhealed incisions, active infections, or certain heart and lung conditions may not be safe candidates for pool-based rehab until those issues are resolved. Some individuals with uncontrolled epilepsy or severe fear of water may also need alternative approaches. Even for appropriate candidates, it’s possible to overdo it—moving too vigorously or staying in the water too long can lead to fatigue or symptom flare-ups. That’s why sessions are supervised and progressed gradually by a therapist who monitors your response. In most cases, when guidelines are followed and medical clearance is obtained as needed, aquatic therapy is a low-risk, high-benefit environment for rehabilitation.
5. Will I have to do aquatic therapy forever, or will I eventually “graduate” to land exercises?
Aquatic therapy is usually a phase of rehab, not a permanent solution. The water environment is incredibly helpful early on because it reduces pain and allows you to begin moving sooner and more easily. Over time, however, you still need to function on land—walk on sidewalks, climb stairs, lift groceries, or return to your sport or job. A well-designed plan uses aquatic therapy to build strength, mobility, and confidence, then gradually transitions more of your work to land-based exercise as your body can handle it. Some people choose to continue water-based exercise long-term for fitness or joint comfort, but formal aquatic therapy sessions typically become less frequent as you progress. Your therapist will talk with you about goals and milestones so you understand when and how that transition will happen and what you can do on your own to maintain your gains.