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)