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)]