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F E B R U A R Y 2 0 1 2 techniques 45

hroughout my career as a distance runnerand Olympic coach, I’ve heard about andsought after it. What athlete doesn’t want tounlock the key to breaking through barriersand reaching unbelievable success?

The problem in the running world withdeveloping a competitive edge, of course, is

the very real risk of injury. Sprains, strains, tears andbreaks can become annoying realities at best andcareer-enders at worst. So it’s imperative to avoid burn-ing out bodies while reaching for ever-greater success.That’s where I’ve found it’s essential to explore othermethods of cross-training that are as effective as but donot have the physical impact of miles upon miles ofland-based running.

In my current status as head trainer for the OregonProject, I train world-class athletes like Galen Rupp and

Mo Farah. In their quest for medals and records, theylog significant mileage each week, but it’s not their out-door running that has enabled them to continuouslyshatter records (both Rupp and Farah had incredibleyears in 2011 on the international stage). Instead, ithas really boiled down to one word: water.

H2O FOR RUNNING SUCCESSYears ago, I began investigating innovative methods

for runners to blast past their personal barriers andachieve personal and team advantages legally, ethicallyand, most importantly, safely. My search led me towhat might seem an unexpected place – the pool.

I discovered that a portable, submerged underwatertreadmill could be one of the most valuable pieces ofequipment for coaches and runners. Thanks to theinnate power of water to almost completely eliminate

By Alberto Salazar

T

WATER:A RUNNING COACH’S COMPETITIVE EDGE

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by Kim Eichinger, Executive Director of Fitness, Country Meadows Retirement Communities

Underwater Treadmills Woo Boomers

to Retirement Communities, Encourage Innovative

Fitness ProgramsUnderwater Treadmills Woo Boomers

to Retirement Communities, Encourage Innovative

Fitness Programs

There are more than 77 million “Baby

Boomers” in America, and reports show

that they inclined to live more active

lifestyles than those of previous generations.

This ultra-fascinating population is turning

65 at a rate of 10,000 a day…and will be

for the next 18 years! Yet they don’t want

to be slowed down by Mother Nature,

medical conditions or other factors.

The challenge for retirement

communities is to position their campuses

competitively to attract this bevy of adults

who wish to keep working out despite

any physical impediments they might face.

That’s why so many facilities like ours

have turned to offering unique, techno-

logically-advanced fitness options like the

HydroWorx X80 underwater treadmill

and jet machine. Not only does this type

of ground-breaking equipment afford

opportunities for instructors to “change

up” their regimens; it also enables mature

adults to enjoy outstanding, pain-free

workouts.

For example, one of our residents,

Kate, is 94 years young. As she has very

emphatically told people, she came to us

with back pain. After she started to work

in the water with our team of aquatics

experts, that pain disappeared in about a

month’s time. Kate’s remarks have been

echoed by others, including one of my

colleagues who noted that the underwater

treadmill is what our community members

want as a low-impact, high-return way to

challenge themselves.

Of course, investing in an X80

underwater treadmill and jet machine is

the easy part; learning how best to use it

to catch the attention of residents (and

prospective residents) takes a bit of

strategy. That’s why we’ve developed so

many water-based exercises that use the

treadmill as the crux of the workout.

I want to share with you a few

elements of some of my favorite routines.

These are easy to implement and each

of them utilizes the key advantages of the

HydroWorx X80 in a dynamic way.

Step One: The Warm-Up

As any fitness instructor knows, the

warm-up stage is integral to the overall

success of any training session. Even in

tepid water (we keep our pool at around

92 degrees Fahrenheit), the warm-up

is equally as important as in land-based

fitness routines.

I typically like to start the warm-up from

the bottom of the body and work upward.

Thus, the short warm-up typically includes:

Heel to Toe Raises — The rocking motion

encourages plantar flexion and dorsa

flexion essential for walking heel to toe.

This movement is important for forward

propulsion when walking and helps

prevent shuffling.

Side to Side Rocking — Helps to prepare

for weight shifting and side stepping

patterns. In addition to the heel-toe raises,

this is a great exercise for working the

sides of the feet. Often, this is one area

that’s ignored during warm-ups, but it’s

essential for a positive outcome on an un-

derwater treadmill. It also helps engage

the hips and legs.

Trunk Rotation and Posture Press Ups —

The handrails of the X80 work as a great

feature to assist

with exercises that

encourage upright

posture and trunk

movement. By lightly

pressing down on

the rails to extend the

spine and by reaching across the body

to grasp the rails, participants can perform

exercises to engage the core muscles.

Step Two: Walking Workout

Because of its intrinsic nature, the

underwater treadmill lends itself to walk-

ing. However, I try not to allow our com-

munity’s residents to simply walk as they

would normally do on land. By forcing

them to think about their posture, gait and

speed, I can help them have an extremely

comprehensive workout that leaves them

feeling refreshed but not uncomfortable.

During the walking workout, I employ

the following methods to get a solid calorie

burn:

Arm Swing Progressions — Reconnecting

arm swing with walking is important for

mobility. Participants

who ambulate with a

walker typically do not

swing their arm when

walking. With the

X80 we can gradually

connect arm swing

with walking and still have the safety of

the bars to assist the participant while

they progress from swinging one arm to

both arms.

Level 2 Arm Swing — As arm swing

coordination improves strength and

endurance can continue to be challenged

by extending the arms through a greater

range of motion or with more force

against the natural resistance of the water.

Interval training can also be performed

by alternating periods of walking while

grasping bars, swinging arms only with

treadmill not in motion (no walking), and

then walking and swinging arms.

Cross-Shoulder Swing — The motion of

the cross-shoulder swing also provides a

boost to the caloric “burn” of the

underwater treadmill walking routine.

When the arms are forced to move across

the body against the natural resistance

of the water, their flexibility and strength

are engaged.

Step Three: Range of Motion,

Strength and Balance

I feel it would be remiss to simply offer

walking on the X80; after all, there’s so

much more to do! For instance, range of

motion, strength and balance (all of which

are daily concerns of aging residents)

can all be improved during the underwater

treadmill workout.

Below are three of my favorite exercises

to introduce:

Sit Back Hip Stretch — Holding onto the

bars for balance (or doing so without

them, if possible), an individual can “sit

back” in the water, bending downward to

stretch the upper legs and hip area. To

emphasize balance and give the abdomi-

nals a workout, I ensure that the core is

engaged during this process.

Hip Abduction — Important for balance

and walking. The handrails and the resist-

ance jet allow for a number of options

for varying positions and resistance level

in performing these exercises. This is also

a great exercise to prepare participants

for the strength, range of motion and

coordination for side stepping on the un-

derwater treadmill..

Balance Exercises Using Jets — Because

the X80 comes with built-in jets, I use

them to build balance.

During the training,

I have persons stand

on both legs, then on

one at a time, while

the jets are on. Again,

the hand rails are

available for protection and comfort if

necessary.

Step Four: Massage

By adding the hose instrument to the

HydroWorx X80, my residents can get a

deep tissue massage along their legs,

arms and back. It’s a great way to cool

down, as it facilitates blood flow and

reduces edema. So

many of the Boomers

I work with rave

about how good it

feels…and how it

keeps them from

getting sore the next

day. Massage also enhances the social

component of the cool down phase of

the class. Participants love to relax and

chat and this makes a nice closure to

the workout.

Water as the Wave of the Future

Forging ahead, it’s evident that the

population of America is just going to

continue to reach retirement age in record

numbers. And retirement communities

have to be ready for what that means.

Competition will continue to be fierce

within the industry; that’s the reason

those involved have to constantly strive

to be cutting-edge. For us, part of our

mission has been and continues to be

fulfilled by our fitness and aquatics

programs, highlighted by our HydroWorx

X80 underwater treadmill workouts.

To watch Kim Eichinger’s

exercise video on the HydroWorx

X80 underwater treadmill, go to:

info.hydroworx.co

m/ICAA

“They can’t believe it — they

can’t believe the way their body

feels! They just love it!”

“Even people with back pain…

they get on this treadmill in the

water and go!”

“That’s what our residents

are wanting…they are wanting

to be challenged.”

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Instituting aquatic therapy programs can phenomenally change the shape and scope of any physical therapy clinic. For patients, walking on an underwater treadmill is an efficient and pain-free way to exercise, as it unloads the burden on the joints and allows

individuals to perform at exercise levels they normally would not be able to.

Research has shown that, following surgery, aquatic therapy increases a person’s mobility and endurance thanks to the water buoyancy that eliminates 20 to 90 percent (depending on the depth of the submersion) of an individual’s body weight. In brief, that translates to patients beginning rehabilitation protocols earlier than they could with land-based physical therapy alone.

Aquatics attract clientele who might otherwise be limited when it comes to land-based therapy options. Additionally, marketing a clinic as a locale for aquatic therapy can have a substantial impact on the bottom line.

However, there are numerous aspects to consider when imple-menting aquatic therapy in a clinical environment; diving into aquat-ics isn’t a cut-and-dry proposition. Considerations include whether or not aquatics is needed/wanted in the community, upfront and continuing financial investments, billing and reimbursement implica-tions and, of course, revenue generation. Such factors have stopped some clinics from even investigating aquatics. However, with careful planning, deliberation and examination, these issues don’t have to be deal-breakers.

Are Aquatics Really Necessary?It’s an excellent question to ask, and the only way to answer it is to go to current clients, referral sources and even the general pub-lic. Be aware that sometimes the community will say they want something but won’t actually use it; this is where it’s important

to back your findings with realistic numbers and geographical/competitor stats.

When our clinic conducted a needs assessment to determine if increased aquatic therapy options would be beneficial to us and our customer base, we started by examining our current clients. We discovered that most were between the ages of 50 to 85, gender was split evenly and the majority of diagnoses were orthopedic: knee and hip total joint replacements, spinal conditions (including post-operative care), generalized weakness, fibromyalgia, chronic pain and post-operative surgical knee conditions.

Before we installed our own pool, we were using aquatics in a lim-ited fashion in our orthopedic practice and seeing a profit. We knew that we wanted to diversify and expand our scope of services. When we realized both intuitively and statistically that we were receiving adequate reimbursement for our aquatic therapy offerings, we were confident that expansion was sensible and practical.

Aquatic services would be a natural addition to our business plan, ultimately enhancing the visibility of our therapy services. Plus, we had orthopedic surgeons and other health care professionals on our side, so we knew we would continue to receive referrals from that population of experts. For us, this progression took shape over months. It wasn’t an overnight decision; it was one made with careful reflection.

How Much Will Opening a Program Cost?The financial aspects of incorporating aquatics into a physical therapy operation will likely be the first questions on the mind of its owner and administrator. Certainly, aquatic therapy has its own set of needs, includ-ing a pool (or pools), peripheral aquatics equipment, upfront and continu-ing education for team members, and facility upgrades or changes.

Because the pool is the most critical piece of the puzzle, it’s neces-sary to do a serious amount of homework, spending time initially looking into different pools and companies. Not all are created equal, as our Montana-based facility discovered. There are nuances both big and small that make all the difference. Investing in the right therapeutic pool is essential.

We investigated all current therapeutic pool lines and visited sites to see them in action. We spoke at length with physical therapists, athletic trainers and physicians.

In the end, we chose a pool with a treadmill and underwater camera hooked to a television monitor. It is kept at a temperature of 91 to 93 degrees Fahrenheit, has a massage hose attachment that we use as an adjunct to our pool treatment protocols and incorporates water jets for increased workout intensity.

Our pool setup gave us a plethora of options; not only could our physical therapy staff members provide clients with traditional aquatic therapy, but they could also use the treadmill and massage hose for added benefits. We appreciate the added benefit of watching biomechanics with the underwater video.

Walking on an underwater treadmill is distinctly different than walking in a regular pool. Clinically, we have observed that patients enjoy their sessions, exercise for longer periods of time and have a very low no-show rate for appointments when compared to our other facilities.

Before we signed the contract (one year in advance of the breaking-ground date), we thoroughly examined our financial picture with accountants and bankers.

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No FloatingBefore you dive into an aquatics practice, ask some important questionsBy Keith Ori, BS, PT

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[AQUATIC THERAPY]

Shoulder injuries are a frequent occur-rence among people from all walks of life. In fact, statistics from the American Academy of Orthopaedic

Surgeons indicate that more than 7 million people experience shoulder problems, such as arthritis, shoulder impingement, rotator cuff issues and upper-arm sprains, each year. Yet nobody wants to be incapacitated for longer than they need to be.

Physical therapists are regularly brought in to direct shoulder rehabilitation, either before or after surgery or instead of it. As such, aquatic therapy presents itself as a viable option to get patients moving again to maximize their functional abilities. It is a great medium to use when people are in too much pain to move on land, or as an adjunct to their land-based program. I’ve also noticed that the addition of the aquatic medium expe-dites functional outcomes.

Of course, there are considerations to keep in mind prior to beginning water therapy on an individual with a shoulder injury. These include:

1. The need to assess the patient’s comfort level with the aquatic medium. It is ideal if

patients are willing to get their faces or hair wet in order to provide the most thorough aquatic physical therapy treatment. This allows for the ability to complete supine or prone activities that will assist in maximizing range of motion and strengthening capabilities for exercises.

Though this might seem a tiny concern, it can greatly affect whether or not aquatic ther-apy will be a perfect fit. If a patient is uncom-fortable in a warm-water therapy pool, the physical therapist must be able to modify the program as needed.

As most physical and occupational therapists know, creativity is a must when working with the unique needs of patients. Consequently, water therapy exercises can always be adjusted to minimize physical or psychological discomfort for patients as much as possible.

2. The necessity for the aquatic therapist and patient to be physically stable at all times. Solid foot placement is a must during all aquatic therapy sessions. This is one of the main reasons to invest in a therapy pool with an adjustable floor depth.

Gravitational pull versus buoyancy should always be evaluated, and an adjustable ther-apy pool will give maximum flexibility.

Other options include small ankle weights to counteract buoyancy and allow for more stable foot position for the therapist and patient.

Ankle weights are ideal for patients who are very buoyant or if water is too deep for participants to maintain a flat foot position.

Appropriate ExercisesAfter these considerations are addressed, the perfect types of aquatic therapy exercises for the shoulder-injury patient need to be planned. Below are several techniques that have worked well in the past; however, note that all can be modified or changed according to the patient’s unique requirements.

Standing exercises. During standing shoul-der exercises, the patient can, under the direc-tion of his physical therapist, methodically work on building muscle tone and repairing injured soft tissue. This is a good starting posi-tion for initial visits, as it allows patients to become accustomed to the physical proper-ties of water (i.e., buoyancy, hydrostatic pres-sure), as well as how they affect positioning and movement.

A few favorite exercises include push/pull down, ER/IR, flexion/extension, horizontal abduction/adduction, diagonals (with or without head rotation), figure eights and/or circles. Each exercise can be adapted as the patient’s shoulder becomes stronger.

Various types of resistive or buoyant equipment can be used during standing aquatic therapy. From gloves, noodles of various sizes, small buoyant barbells, resis-tive “aquacizers” and kickboards, to aquafins, snorkels, large barbells and buoyant hydrofit cuffs, it’s critical for physical therapists to use any peripherals they can.

Adjustable resistance jets can also be helpful for progressing the strengthening portion of a program. (Some of this equipment can be used to facilitate stretching as well, not just resistance for strengthening).

The one limitation to standing activities is the inability to work greater than 90 degrees of flexion or abduction; this is where a patient’s willingness to get his hair wet or face in the water is helpful.

Supine and prone exercises. Water therapy

Diving InA look at aquatic shoulder rehabilitationBy Veronica Paquette, PT, ATRIC, PRC

Aquatic therapy presents itself as a viable option to get patients moving again to maximize their functional abilities.

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ne of the biggest chal-lenges for adults who use an assistive device to ambulate is strug-gling to maintain pos-ture and balance. Due to their intrinsic designs,

walkers or walking aids (e.g., canes) force users’ bodies into a hunching or leaning position, thereby causing added stress and

strain to their necks, backs and torsos. As a result, individuals who use walkers do not get the physical benefits that come with perfect posture, including improved flex-ibility, easier breathing, better digestion and overall health.

To combat the undesirable postural impacts of walkers, it’s important to provide adults who use them with opportunities to practice good posture when standing, walk-

ing or even running. And for cutting-edge senior care facilities, that means offering residents a way to exercise safely.

NOT JUST A POOLUnderwater treadmills that submerge into an existing pool are a fitness director’s best weapon to help residents maintain and practice excellent posture. When residents return to using walkers, their bodies still retain the muscle memory of standing up straight and tall.

Although many facilities encourage pool walking or aquatics classes in an attempt to achieve these same results, they simply don’t have the benefits that come from working out on underwater treadmills.

I’ve noticed that when residents walk on a treadmill, there are key differences from simply walking in a pool. People have a more upright posture when walking on the treadmill.

They walk faster and with more of a natu-ral heel-to-toe fashion.

They walk with a more natural arm swing. Participants who use the underwater tread-mill regularly express confidence, thanks to learning a new skill that has increased their health and level of fitness.Additionally, an underwater treadmill

tends to complement existing aquatic pro-grams. For example, it can be used as an exciting station as part of aquatic circuit training. It’s also perfect for interval training, alternating bouts of other aquatic exercise with bouts on the underwater treadmill. Finally, from a training perspective, it gives trainers a unique tool.

THE RIGHT EQUIPMENTOf course, it’s essential to invest in an under-water treadmill that will have the most valuable features for your residents’ needs (and those of community members, if you allow them to have membership privileges as an added source of revenue and recruit-ment.) These features include removable handrails, variable-speed jets, adjustable

Better Posture Through AquaticsPromote posture and health with an underwater treadmill. BY KIM EICHINGER

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Aquatic Therapy

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