Knowledge Hub

A movable‑floor hydrotherapy pool is most valuable for patients who cannot yet tolerate full weight‑bearing, need finely graded loading, or require high safety and access: early post‑operative orthopedics, painful OA, neurological gait and balance problems, frail geriatric patients, and high‑level athletes needing low‑impact but specific gait and strength work. (https://www.ewacmedical.com/many-advantages-of-a-movable-pool-floor-with-underwater-treadmill/)

In practice

For therapists, the key advantage of a movable floor is precise control over effective body weight. You can start a patient in deeper water to reduce joint loading, then progressively raise the floor as pain, confidence, and strength improve. This makes it ideal for knee or hip OA, post‑TKA/THA, ACL reconstruction, and low‑back pain where land loading is initially poorly tolerated. (https://www.ewacmedical.com/benefits-of-the-aquatic-treadmill-exercise-in-orthopedic-patients-in-five-articles/)

In neurorehabilitation and geriatrics, adjustable depth allows early standing and stepping in a safer, slower, more buoyant environment, decreasing fall risk while still stimulating balance and postural control. The same system can later support higher‑intensity sports rehab in a shallower, more challenging setting, so one pool services multiple patient groups. (https://www.ewacmedical.com/wp-content/uploads/2024/12/Stanciu-2024-Evidence-of-Improvement-of-Lower-Limb-Functioning-Using-Hydrotherapy-on-Spinal-Cord-Injury-Patients.pdf)

EWAC Medical references

– “Many advantages of a movable pool floor with underwater treadmill” – advantages of tailoring depth to therapy needs; one pool serving several target groups. (https://www.ewacmedical.com/many-advantages-of-a-movable-pool-floor-with-underwater-treadmill/)]​

– EWAC knowledge summary “Scientific Evidence-Based Effects of Hydrotherapy on Various Systems of the Body” (Mooventhan 2014) – outlines broad systemic benefits that underpin use in multiple populations. (https://www.ewacmedical.com/knowledge/mooventhan-2014-scientific-evidence-based-effects-of-hydrotherapy-on-various-systems-of-the-body/)]​

– EWAC article on aquatic treadmill exercise for orthopedic patients – emphasizes depth control for joint‑load management. (https://www.ewacmedical.com/benefits-of-the-aquatic-treadmill-exercise-in-orthopedic-patients-in-five-articles/)]​

External scientific references

– Aquatic exercise meta‑analysis in osteoarthritis: moderate pain reduction and functional gains vs control and land exercise, supporting use where land loading is problematic. (https://pmc.ncbi.nlm.nih.gov/articles/PMC8955208/)]​

– Stanciu 2023 review on hydrotherapy in spinal cord injury: improved lower‑limb function and reduced spasticity, supporting neuro use. (https://www.ewacmedical.com/wp-content/uploads/2024/12/Stanciu-2024-Evidence-of-Improvement-of-Lower-Limb-Functioning-Using-Hydrotherapy-on-Spinal-Cord-Injury-Patients.pdf)]

– Mooventhan & Nivethitha 2014: systemic cardiovascular and musculoskeletal benefits of hydrotherapy across diagnoses. (https://www.ewacmedical.com/wp-content/uploads/2017/11/Mooventhan-2014-SR-AT-scientific-evidence.pdf)

Choose an underwater treadmill when you need task‑specific gait training with reduced joint load, adjustable depth, and tightly controlled speed, especially in painful, deconditioned, or early postoperative patients. Prefer over‑ground gait once the patient tolerates higher loading, needs environmental variability, or you are preparing for real‑world community ambulation. (https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1682&context=etd)

In practice

An underwater treadmill combines familiar walking with buoyancy, drag, and constant therapist visibility. Depth and belt speed can be finely adjusted to balance support and challenge. This is particularly helpful after ACL reconstruction, in knee or hip OA, or for athletes returning from lower‑limb injuries, where you want cyclical gait practice without full ground‑reaction forces. (https://pmc.ncbi.nlm.nih.gov/articles/PMC8955208/)

Over‑ground gait becomes preferable when pain and tolerance allow normal loading, and when you need to train obstacle negotiation, variable surfaces, and community speeds. Many clinicians use a staged approach: start on the underwater treadmill at greater depth, then progressively reduce depth, then transition to land while maintaining some aquatic sessions for conditioning and confidence. (https://www.ewacmedical.com/many-advantages-of-a-movable-pool-floor-with-underwater-treadmill/)

EWAC Medical references

– EWAC treadmill article: emphasizes safe, low‑impact environment, depth‑dependent load control, and precise gait monitoring via cameras. (https://www.ewacmedical.com/benefits-of-the-aquatic-treadmill-exercise-in-orthopedic-patients-in-five-articles/)

– EWAC link to Jung 2018: water depth effects on kinematic and spatiotemporal parameters during aquatic treadmill walking.[[ewacmedical](https://www.ewacmedical.com/many-advantages-of-a-movable-pool-floor-with-underwater-treadmill/)]​

– EWAC‑hosted thesis summary: aquatic treadmill improved joint angular velocity and arthritis‑related pain in knee OA. (https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1682&context=etd)

External scientific references

– Jung 2018: demonstrates systematic changes in gait parameters with depth on aquatic treadmill, supporting graded loading. (https://www.ewacmedical.com/many-advantages-of-a-movable-pool-floor-with-underwater-treadmill/)]​

– Focht and others (cited in the OA thesis): aquatic training improves pain and mobility compared with land training in knee OA. (https://pmc.ncbi.nlm.nih.gov/articles/PMC8955208/)

– Recent review on hydrotherapy and lower‑limb function (Stanciu 2023) supports aquatic gait for spasticity and mobility. (https://www.ewacmedical.com/wp-content/uploads/2024/12/Stanciu-2024-Evidence-of-Improvement-of-Lower-Limb-Functioning-Using-Hydrotherapy-on-Spinal-Cord-Injury-Patients.pdf)]

Progress depth when the patient demonstrates stable pain levels, good movement quality, and adequate balance at the current buoyancy, and can complete the target volume without undue fatigue or symptom flare. Use incremental floor adjustments, monitoring pain, perceived exertion, gait pattern, and post‑session recovery to avoid overload. (https://www.ewacmedical.com/knowledge/mooventhan-2014-scientific-evidence-based-effects-of-hydrotherapy-on-various-systems-of-the-body/)

In practice

On a movable‑floor pool, buoyancy is your “load dial.” Start with deeper water for patients with significant pain, weakness, or fear. As they can walk or exercise with controlled symptoms, symmetrical gait, and stable balance, raise the floor in small increments to increase effective body weight. (https://www.ewacmedical.com/benefits-of-the-aquatic-treadmill-exercise-in-orthopedic-patients-in-five-articles/)

Key criteria before each progression include: pain no worse than mild during and after sessions, no significant swelling increase, preserved gait quality on video or visual observation, and acceptable perceived exertion and recovery by the next day. In neuro or frail patients, also check step initiation, postural stability, and ability to recover from small perturbations before reducing buoyancy. (https://www.ewacmedical.com/knowledge/mooventhan-2014-scientific-evidence-based-effects-of-hydrotherapy-on-various-systems-of-the-body/)

EWAC Medical references

– EWAC article: “Being able to change the depth of the pool… increases treatment possibilities tremendously, as the therapist can determine the intensity of joint loading according to the needs of the patient.” (https://www.ewacmedical.com/benefits-of-the-aquatic-treadmill-exercise-in-orthopedic-patients-in-five-articles/)]​

– EWAC summary of Mooventhan 2014: discusses systemic responses to water immersion that influence dosing and recovery. (https://www.ewacmedical.com/knowledge/mooventhan-2014-scientific-evidence-based-effects-of-hydrotherapy-on-various-systems-of-the-body/)]​

– EWAC movable‑floor advantages page: highlights tailoring depth to therapy needs and safe multi‑group use. (https://www.ewacmedical.com/many-advantages-of-a-movable-pool-floor-with-underwater-treadmill/)]​

External scientific references

– Jung 2018: demonstrates that gait kinematics and spatiotemporal parameters change predictably with water depth, supporting depth‑based progression. (https://www.ewacmedical.com/many-advantages-of-a-movable-pool-floor-with-underwater-treadmill/)]​

– Aquatic exercise meta‑analysis in OA: clinically meaningful pain reduction suggests depth can be safely progressed while maintaining benefit. (https://pmc.ncbi.nlm.nih.gov/articles/PMC8955208/)]​

– Stanciu 2023: emphasizes careful dosing of hydrotherapy to improve gait and reduce spasticity in SCI without overloading. (https://www.ewacmedical.com/wp-content/uploads/2024/12/Stanciu-2024-Evidence-of-Improvement-of-Lower-Limb-Functioning-Using-Hydrotherapy-on-Spinal-Cord-Injury-Patients.pdf)]​

Use hydrotherapy equipment as primary early rehab when pain, weakness, or instability prevent meaningful land exercise (acute post‑op orthopedics, severe OA, SCI, complex neuro, high BMI with joint pain). Use it as an adjunct when land exercise is possible but suboptimal, for example to enhance gait quality, conditioning, or confidence. (https://www.ewacmedical.com/knowledge/mooventhan-2014-scientific-evidence-based-effects-of-hydrotherapy-on-various-systems-of-the-body/)

In practice

Movable floors and underwater treadmills are most powerful at the beginning of care when patients simply cannot load or move effectively on land. Examples include early ACL reconstruction, joint replacement, severe OA flares, spinal cord injury, and neurological patients with high fall risk. (https://pmc.ncbi.nlm.nih.gov/articles/PMC8955208/)

Once a patient can tolerate and meaningfully perform land‑based tasks, hydrotherapy shifts role. It becomes an adjunct for refining gait mechanics, increasing training volume at lower impact, or providing variety and confidence building—particularly in athletes, chronic pain, and deconditioned patients. This primary‑to‑adjunct shift should be planned in the pathway, not accidental. (https://www.ewacmedical.com/benefits-of-the-aquatic-treadmill-exercise-in-orthopedic-patients-in-five-articles/)

EWAC Medical references

– EWAC treadmill article: describes underwater treadmill as an additive therapy that can even outperform stationary cycling after ACL reconstruction for muscle preservation and function. (https://www.ewacmedical.com/benefits-of-the-aquatic-treadmill-exercise-in-orthopedic-patients-in-five-articles/)]​

– EWAC knowledge content (Mooventhan 2014): justifies broad systemic benefits that make hydrotherapy suitable as a primary modality in early stages. (https://www.ewacmedical.com/knowledge/mooventhan-2014-scientific-evidence-based-effects-of-hydrotherapy-on-various-systems-of-the-body/)]​

– EWAC documentation of SCI hydrotherapy evidence (Stanciu 2023) – supports early, equipment‑based functional training. (https://www.ewacmedical.com/wp-content/uploads/2024/12/Stanciu-2024-Evidence-of-Improvement-of-Lower-Limb-Functioning-Using-Hydrotherapy-on-Spinal-Cord-Injury-Patients.pdf)]

External scientific references

– OA aquatic exercise meta‑analysis: aquatic exercise improves pain and function versus control and land, supporting primary use when land is limited. (https://pmc.ncbi.nlm.nih.gov/articles/PMC8955208/)]​

– SCI hydrotherapy evidence (Stanciu 2023): improvements in spasticity, gait kinematics, and underwater function support primary use in this group. (https://www.ewacmedical.com/wp-content/uploads/2024/12/Stanciu-2024-Evidence-of-Improvement-of-Lower-Limb-Functioning-Using-Hydrotherapy-on-Spinal-Cord-Injury-Patients.pdf)]​

– Evidence review on systemic effects of hydrotherapy (Mooventhan & Nivethitha 2014) backs its use as a central modality in multi‑system conditions. (https://www.ewacmedical.com/wp-content/uploads/2017/11/Mooventhan-2014-SR-AT-scientific-evidence.pdf)

Main red flags include unstable cardiac disease, uncontrolled hypertension, severe respiratory compromise, open or infected wounds, incontinence, uncontrolled epilepsy, severe orthostatic problems, and inability to follow safety instructions. Exercise‑specific cautions include acute joint infection, unstable fractures, and any condition where immersion‑induced volume shifts may overload the heart or lungs. (https://www.ewacmedical.com/wp-content/uploads/2017/11/Mooventhan-2014-SR-AT-scientific-evidence.pdf)

In practice

Underwater treadmills add the demands of immersion, belt motion, and sometimes higher water pressure. Screen for cardiac disease, heart failure, and uncontrolled arrhythmias because immersion shifts blood centrally and can increase preload. Also assess respiratory status, as hydrostatic pressure can increase breathing work. (https://www.ewacmedical.com/wp-content/uploads/2017/11/Mooventhan-2014-SR-AT-scientific-evidence.pdf)

Contraindications common to pools still apply: untreated infections, open wounds, recent surgery with unprotected incisions, incontinence, uncontrolled epilepsy, severe autonomic dysfunction, and severe fear of water without adequate safeguards. From a musculoskeletal perspective, avoid underwater treadmill in unstable fractures, acute joint infections, or when weight‑bearing is medically prohibited; in such cases static buoyancy exercises may be safer. (https://www.ewacmedical.com/wp-content/uploads/2017/11/Mooventhan-2014-SR-AT-scientific-evidence.pdf)

EWAC Medical references

– EWAC knowledge summary of Mooventhan 2014: details cardiovascular and respiratory effects of hydrotherapy, highlighting why cardiac and respiratory screening is critical. (https://www.ewacmedical.com/knowledge/mooventhan-2014-scientific-evidence-based-effects-of-hydrotherapy-on-various-systems-of-the-body/)]​

– EWAC orthopedic treadmill article: emphasizes low‑impact loading but implies that joint loading still exists, requiring standard orthopedic precautions. (https://www.ewacmedical.com/benefits-of-the-aquatic-treadmill-exercise-in-orthopedic-patients-in-five-articles/)]​

– EWAC‑hosted Stanciu 2023 review: discusses cardiopulmonary and thermoregulatory issues in SCI during hydrotherapy. (https://www.ewacmedical.com/wp-content/uploads/2024/12/Stanciu-2024-Evidence-of-Improvement-of-Lower-Limb-Functioning-Using-Hydrotherapy-on-Spinal-Cord-Injury-Patients.pdf)]​

External scientific references

– Mooventhan & Nivethitha 2014 review: documents changes in heart rate, blood pressure, and respiratory parameters with immersion, guiding cardiac/respiratory precautions. (https://www.ewacmedical.com/wp-content/uploads/2017/11/Mooventhan-2014-SR-AT-scientific-evidence.pdf)

– Hydrotherapy reviews in neurologic and SCI populations highlight thermoregulation, autonomic dysreflexia, and cardiorespiratory considerations as key safety issues. (https://www.ewacmedical.com/wp-content/uploads/2025/04/Peng-2024The-glamor-of-and-insights-regarding-hydrotherapy-from-simple-immersion-to-advanced-computer-assisted-exercises-A-narrative-review.pdf)

– General aquatic‑exercise safety guidelines in OA and other cohorts stress screening for cardiovascular instability and open wounds before immersion. (https://pmc.ncbi.nlm.nih.gov/articles/PMC8955208/)]​

Modular pools particularly benefit clinics treating diverse populations: pediatric and geriatric clients, mixed neuro and orthopedic caseloads, and sports medicine. Separate zones with different depths and features allow simultaneous, goal‑specific sessions—deep, calm zones for early support; shallower, more dynamic zones with currents or treadmills for advanced balance and performance. (https://nl.linkedin.com/company/ewacmedical)

In practice

Modular pools allow therapists to “design” spaces around clinical needs. A deeper, quiet bay can host supported gait, early standing, or group sessions for frail or anxious patients. A shallower, equipment‑rich bay with an underwater treadmill and counter current can serve athletes or higher‑functioning orthopedic patients. (https://www.antisel-physio.gr/en/modular-pool/)

For neurorehab, you can use one segment for basic postural control and another for more challenging balance tasks, reducing collisions and distractions. Paediatric and geriatric therapies can share the same physical structure but use different depths, entry systems, and environmental stimuli, optimizing safety and engagement for each group. (https://nl.linkedin.com/company/ewacmedical)

EWAC Medical references

– EWAC modular pool descriptions (e.g., fully featured modular hydrotherapy pool with underwater treadmill and movable floor): highlight separate functional zones in one structure. (https://www.youtube.com/watch?v=vsMG9O5gnj4)

(https://www.antisel-physio.gr/en/modular-pool/)

– EWAC content on movable floors and multi‑group versatility: “Because the pool is more versatile, you can do with a smaller pool… Several target groups simultaneously.(https://www.ewacmedical.com/many-advantages-of-a-movable-pool-floor-with-underwater-treadmill/)

– LinkedIn description: discusses using adjustable depth for pediatric to geriatric care and sports recovery.(https://nl.linkedin.com/company/ewacmedical)

External scientific references

– Hydrotherapy reviews in MS, SCI, and OA show benefits across highly heterogeneous patient groups; modular design supports parallel treatment tailored to each.(https://www.ewacmedical.com/wp-content/uploads/2025/04/Peng-2024The-glamor-of-and-insights-regarding-hydrotherapy-from-simple-immersion-to-advanced-computer-assisted-exercises-A-narrative-review.pdf)

– Evidence on aquatic balance and gait training in neuro populations supports dedicated zones for balance‑challenging tasks to manage risk. (https://www.ewacmedical.com/wp-content/uploads/2024/12/Stanciu-2024-Evidence-of-Improvement-of-Lower-Limb-Functioning-Using-Hydrotherapy-on-Spinal-Cord-Injury-Patients.pdf)

Justify equipment by linking it to measurable gains: reduced pain, faster functional recovery, improved gait parameters, and efficient multi‑group scheduling. Present published evidence for aquatic and underwater treadmill outcomes, connect these to your own KPIs and case‑mix, and highlight space, safety, and energy efficiencies of movable floors and modular pools.(https://www.ewacmedical.com/knowledge/mooventhan-2014-scientific-evidence-based-effects-of-hydrotherapy-on-various-systems-of-the-body/)

In practice

Decision‑makers want outcomes, efficiency, and safety. For underwater treadmills and movable floors, emphasize evidence showing reduced joint pain, better function, and improved gait mechanics in orthopedic and neurologic patients. Show how adjustable depth and modular zones allow several therapists and patient groups to use one compact pool, maximizing occupancy and reducing the need for multiple facilities. (https://www.antisel-physio.gr/en/modular-pool/)

Collect local data: changes in pain scores, gait speed, length of stay, and return‑to‑sport timelines in programs that use hydrotherapy equipment. Combine this with external evidence and EWAC‑provided summaries to build a concise business case that covers clinical benefit, patient satisfaction, safety, and operational efficiency.(https://pmc.ncbi.nlm.nih.gov/articles/PMC8955208/)

EWAC Medical references

– EWAC article on movable floor and underwater treadmill advantages: highlights versatility, smaller required pool size, energy savings, and reduced fall risk when the floor is at deck level.(https://www.ewacmedical.com/many-advantages-of-a-movable-pool-floor-with-underwater-treadmill/)]​

– EWAC aquatic treadmill orthopedic article: synthesizes five studies demonstrating benefits after ACL reconstruction and in joint pathology. (https://www.ewacmedical.com/benefits-of-the-aquatic-treadmill-exercise-in-orthopedic-patients-in-five-articles/)]​

– EWAC knowledge articles (Mooventhan 2014; Stanciu 2023): summarize systemic and lower‑limb functional benefits of hydrotherapy. (https://www.ewacmedical.com/knowledge/mooventhan-2014-scientific-evidence-based-effects-of-hydrotherapy-on-various-systems-of-the-body/)

External scientific references

– Systematic review and meta‑analysis of aquatic exercise in osteoarthritis: demonstrates significant reductions in pain and improvements in function vs control and land exercise, supporting cost‑justification. (https://pmc.ncbi.nlm.nih.gov/articles/PMC8955208/)]

– Underwater treadmill OA thesis: acute aquatic treadmill training improved gait kinematics and reduced arthritis pain.(https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1682&context=etd)]

– SCI hydrotherapy review (Stanciu 2023): shows improved lower‑limb function and reduced spasticity, justifying investment for neurorehab programs. (https://www.ewacmedical.com/wp-content/uploads/2024/12/Stanciu-2024-Evidence-of-Improvement-of-Lower-Limb-Functioning-Using-Hydrotherapy-on-Spinal-Cord-Injury-Patients.pdf)