Hydrotherapy for Parkinson’s Disease

Hydrotherapy for Parkinson’s Disease

Here’s an article I had the privilege to write last year for Parkinson’s Victoria. Enjoy!

Hydrotherapy comes from the Greek word meaning ‘healing water’. For people with Parkinson’s, hydrotherapy can be a great way to exercise in a safer and more comfortable environment. The buoyancy of water is a significant help for balance difficulties, the warmth of the water helps with stiff and sore joints and muscles, and the impact on joints is reduced. Water also provides a resistance to movement, meaning you get a great workout. Research also indicates some very specific benefits to balance for people with Parkinson’s.

In a recent study, exercises were based around challenging muscles used in balance and strength. One group did the exercises on land and the second group in water.

Both groups undertook 1 hour of exercise each day and improved their balance scores but the water-based participants showed a greater improvement in their scores.

Why is this so?

First, we must understand what goes into balance. The way our body maintains balance is through an automatic feedback loop, which is linked via a series of pathways that sense where and what the ground is like, sending signals up through the nerves, through the spinal cord and up to the brain into the basal ganglia and cerebellum. In return, appropriate information is sent down to the body’s muscles to provide the appropriate activity for balance.

The authors of the trial suggest that when people with Parkinson’s enter the water, it is a different environment to what they are used to. Therefore, it may be that they must use a more conscious brain pathway to perform movements, which is normally a more effective pathway in people with Parkinson’s, so as a result perhaps a more effective experience of practice results.

The effect of water

Water, being more dense than air, provides a greater resistance against which the body must move, therefore each movement demands more muscle activity, and hence demand on postural stability. As water is constantly moving around us, muscles are used even when we are standing still. This partly explains why hydrotherapy can be very tiring even though the exercises can seem rather gentle.

It may be that people also receive an increased and constant sensory feedback on their body parts due to the resistance and pressure of the water. As water depth increases, so does the resistance.

Any movement in one body part will often result in another counterbalanced movement in another body part. This means the brain is constantly adjusting its sense of what the body is doing, which is known as proprioception. Proprioception is a key part of our balance systems.

Buoyancy in the water reduces the impact of gravity on limbs, and slows the rate at which they tend to move. This allows more time and more relaxation to occur in the water, and reducing fear associated with movement.

In my clinical experience, fear is the enemy of the basal ganglia, the part of the brain that Parkinson’s has the greatest effect on. The more fear there is, the more freezing tends to occur. That is why you often see people with Parkinson’s struggle with simple tasks when they are highly anxious.

What sort of exercises are ideal?

Rotational
e.g. Using hand paddles, make large sweeping movements across diagonals, in and out of the water to challenge your postural control.

Agility
e.g. High and fast stepping on the spot, then in zig-zag formations, using both arms and legs.

Speed
e.g. Perform a set of 10 star jumps in the water, and repeat 3-4 sets.

Boxing
e.g. With floats, turbulence apparatus or no equipment, box forwards and sideways while marching not the spot. Try this with one foot in front of the other as a progression.

Lunges
e.g. Holding a noodle, lunge forward as far as possible while pushing the noodle in front. You may like to try this first in the corner of the pool.

Aerobic
e.g. Walk briskly, or try and jog forwards, sideways and backwards in the water. This could made more difficult by changing directions rapidly.

Try and do these exercises with a friend or someone you trust, not only to ensure safety but also to increase the social factor. The happier and the more enjoyable you make the exercise, the more you will benefit, in more ways than one.

Resources:
Volpe D, Giantin M, Maestri R and Frazzitta G. (2014). Comparing the effects of hydrotherapy and land-based therapy on balance in patients with a Parkinson’s disease: randomized controlled pilot study. Clinical Rehabilitation 28 (7) DOI: 0269215514536060

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