Aquatic Physiotherapy – Australian Guidelines (2015) for aquatic physiotherapists working in and/or managing hydrotherapy pools

Introduction to Hydrotherapy Guidelines for Physiotherapists

Hydrotherapy, involving therapeutic exercises in water, is recognized for its benefits in rehabilitation, particularly for conditions like chronic low back pain (CLBP) and post-stroke recovery. The unique properties of water provide a supportive environment for muscle activity while minimizing pain, making it an effective medium for exercise and therapy. This summary synthesizes current guidelines and evidence-based practices for physiotherapists working in or managing hydrotherapy pools, aiming to uphold safety, professional standards, and the quality of care.

Evidence-Based Practices in Hydrotherapy

Research highlights the significance of specific aquatic exercises for enhancing muscle activity and alleviating pain in individuals with CLBP. Exercises such as hip abduction/adduction, extension/flexion, and variations of squats are noted for their effectiveness in activating gluteal and back extensor muscles. Moreover, certain exercises that utilize buoyancy equipment can significantly increase abdominal muscle activity, contributing to core stability (SG Psycharakis et al., link).

Comparing Hydrotherapy to Land-Based Therapy

In the context of stroke rehabilitation, the effectiveness of water-based therapy compared to land-based therapy has been explored. While land-based therapy shows favorable outcomes in improving balance and gait parameters, water-based therapy offers unique advantages, particularly in reducing anteroposterior and mediolateral sway. This suggests that hydrotherapy can be a viable alternative or complementary therapy for enhancing balance in stroke patients (N Zughbor et al., link).

The Role of Hydrotherapy in Enhancing Balance

A study comparing the impact of aquatic environment rehabilitation to gym-based exercises on patient balance revealed slight superiority in balance improvement for those participating in pool exercises. This underscores the potential of hydrotherapy in contributing more significantly to body balance enhancement, an essential aspect of rehabilitation for various conditions (M Pieniążek et al., link).

Safety and Feasibility of Aquatic Physiotherapy

The safety and feasibility of aquatic physiotherapy, including specific styles like the Halliwick concept that emphasizes trunk rotation and core stabilization, have been validated. A study focusing on individuals with Parkinson’s Disease found that aquatic physiotherapy is a safe treatment option, with promising results observed in balance improvement. This supports the inclusion of customized aquatic therapies in rehabilitation programs.


Hydrotherapy offers a versatile and effective medium for rehabilitation, with specific exercises and therapeutic approaches demonstrating significant benefits in muscle activation, pain reduction, and balance improvement. Physiotherapists managing or working in hydrotherapy pools must adhere to evidence-based practices and guidelines to ensure the safety and efficacy of therapy, catering to the diverse needs of individuals with various rehabilitation requirements.

Keywords: hydrotherapy, physiotherapy, aquatic exercises, rehabilitation, safety standards, balance improvement, muscle activity.

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