Uncharted Waters

Christian Brix, DC
January 03, 2008
Written by Christian Brix, DC
Calgary chiropractor takes the plunge into aquatic adjusting.
16It was the spring of 2003 when Judy Doyle, the owner of Water Moves Aqua Therapy, approached me with a question that I was totally unprepared to answer.  Was it possible, she asked, for a chiropractor to help her patients right in the swimming pool where they were currently responding so well to care from massage therapists, kinesiologists, physiotherapists, and exercise therapists?

My first visual was a shallow swimming pool with an unfortunate patient struggling to hold her breath on top of a submerged chiropractic table.  But I agreed to come visit and see if there was some way I could be therapeutically involved.

Especially in the cases of severe obesity, trauma, and even paralysis, it is most beneficial for some patients to be able to combine exercise, massage, and chiropractic in one aquatherapy visit.

An extensive and hopeful search on the Internet showed nothing of the sort having been done before.  We were moving into uncharted waters.

Water Moves is a fantastic program that brings multiple types of care to one facility.  The patients range from the elderly to fibromyalgia sufferers to disabled stroke patients with residual difficulties to motor vehicle accident victims.  Patients benefit from in-pool massage, stretching and exercise classes, one-on-one rehabilitation, and, as necessary, programs that are customized based on age, ability, strength, motivation, and the specific health challenge.  The 90- to 92-degree Fahrenheit water temperature, among other factors, creates an environment that is ideal for relaxation, inducing a positive response to care.

Most of the patients wear a floating waist-belt or use a pool noodle to perform their exercises and stretching, which further decreases the effects of gravity on the body.  The warm water helps to naturally release soft tissue tension so that therapeutic interventions have a greater effect in a shorter period of time. With patients, we focus on increasing their mobility, strength and function, especially in the core muscles, as well as reducing their pain and tension.  The warm water and the buoyancy allow for a low-impact, pain-free and soothing experience.

My intention in joining Water Moves was to provide chiropractic care to people who would otherwise not be able get it, especially in a setting where they would benefit from the convenience and efficacy of a multidisciplinary setting.  But it became clear right away that many challenges would present with respect to finding a way to do the actual adjustments.

WATERY EXPERIMENTATION
After experimenting with multiple positions and configurations – and after a few dunking incidents with my colleagues! – it became evident that an aquatic technique could be developed.  However, each patient would require a different specific adjusting protocol.  The goal was to determine positioning for each adjustment to be given while the patient relaxed or simply floated.

I discovered that cervical spine adjustments can be performed in the pool in any of three ways.  A manual diversified adjustment is done most commonly as the patient is seated in the water below the doctor.  Otherwise, the neck can be adjusted while the patient lies supine on a flotation mat, or with a mechanical adjusting instrument (in my case, the Activator) while the patient “hangs” or kneels facing the pool wall.  The tool is safely sealed in a double layer of latex gloves.  Thoracic spine adjusting is often carried out with this instrument, but a manual “anterior” adjustment against the pool wall has proven to be very effective for some. The Activator, used outside its protocols, provides me with the best approach for lumbar spine and pelvic adjustments, which are the most difficult.  There are times when I would have been so much happier to be able to get patients onto a table in the clinic, but, for them, Water Moves was really the only option. Especially in the cases of severe obesity, trauma, and even paralysis, it is most beneficial for some patients to be able to combine exercise, massage, and chiropractic in one aquatherapy visit.

With aquatic adjusting, as in conventional adjusting, the intention is to change the alignment or motion capabilities of a given bone or joint.  From observation, patients’ bodies in warm water are more receptive to these attempts to make a helpful change. We hypothesize that  proprioceptive inputs (afferents) to the cerebellum are significantly different than with similar activities done on land because of the added and less familiar stabilizing and sensory inputs while in water. The altered cerebellar input, producing an unfamiliar state, essentially seems to increase the body’s amenability to adjustment without too much resistance.

FUTURE CASE STUDIES
There have been some phenomenal results, and two future case studies with current patients are in the works. One involves a patient who suffered a stroke more than 20 years ago. He has been burdened with severe right side pain in both extremities, vision loss, and severe spastic paralysis of the flexor musculature of both the right arm and leg.  It is only in the pool that he can relax enough to benefit from massage, stretching and chiropractic care.  From severe depression and suicidal thoughts, he has in the past few years come to enjoy significant increases in range of motion, elimination of daily headaches, lowered blood pressure, decreased pain, and an optimism that is inspiring.  He is one of many patients who had, in the eyes of traditional medicine, reached a plateau and been cast aside. These are the people welcomed to Water Moves, where they usually show dramatic improvement.

It is a privilege to treat patients at Water Moves.  Many of them would not otherwise gain access to chiropractic care. Similar aquatic programs throughout the country would benefit from including a chiropractor since patients in such settings should be given the chance to experience the freedom of a healthy spine and nervous system.

THE AQUATHERAPEUTIC APPROACH
—Contributing authors: Rob Duncan, CALA (Canadian Aquafitness Leadership Alliance Inc.), CanFitPro, and Charlene Kopansky, Hons BSc (Human Kinetics), BEd, CALA founder and president

Adam was a champion speed skater, who at age 15 experienced inflammation of the patellar ligament, and the patella was found to be tracking incorrectly against the condylar surface of the femur.  The problem was identified as medial knee strain, likely developed through stress on the medial collateral ligaments as a result of intense training.  With a goal of going to the Olympics in a couple of years, Adam required speedy rehabilitation.  His physiotherapist recommended a course of water training therapy in conjunction with curtailing weightbearing training activities in order to allow the inflammation to subside.  Since water allows for the simulation of dynamic functional movement patterns, skating and cross-country skiing movements were incorporated into Adam’s water exercises.

Water therapy, one of the oldest rehabilitation modalities, dates back to as early as 800 BC in England.

Still today, however, not many understand water’s healing properties and just how it can facilitate repair.  How aquatic therapy might fit into a client’s treatment strategy is contingent on the practitioner’s knowledge of how that individual might benefit.

High-performance athletes can ill afford significant periods of inactivity while recovering from injury.  Water works well to maintain function and cardio fitness without the torsion and compressive forces experienced during movement on land.  The muscles and joints above and below the injury can be trained effectively in water, which is a low- or no-pain environment.

To learn more about the healing powers of water, and lower body exercises that can be effectively performed in a pool, read the full article at www.canadianchiropractor.ca.

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