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)]