The Benefits of Aqua Therapy

Exercise performed in water does not only refer to swimming lengths using the four traditional strokes. Various forms of exercise and therapy techniques can be performed in water for injury rehabilitation, chronic disease management or the improvement of cardiovascular fitness.

Water provides resistance without putting stress on the joints. Individuals who have experienced an acute orthopaedic injury, such as a torn ligament or strained muscle, need to strengthen the surrounding muscles to support the joint, without putting too much stress on the joint. Due to buoyancy, this is possible in water. The water supports the body, while providing resistance to movement which can be controlled by the individual – the faster you move a limb through the water, the greater the resistance will be. This individual, who is likely to be apprehensive to exercise after the injury, feels in control of the resistance and thus more comfortable with performing the exercise. Water also assists movement, thus contributing to greater joint mobility, which is important following injury. The hydrostatic pressure created by the water assists in reducing swelling around the injured area and promoting increased circulation, thus assisting in the healing process.

Aqua therapy is particularly effective in individuals with arthritis, as the reduced impact on the joints means less inflammation of the joints and therefore less pain. These individuals are thus able to perform a greater range of exercises without suffering pain or causing further degeneration in the joints.

Individuals who have chronic neurological conditions, such as Parkinson’s Disease or Multiple Sclerosis, benefit from the relaxation associated with being in the water. Fluid movements are more easily performed in water. The risk of injury due to falls is eliminated, although balance is constantly challenged due to the water constantly moving around the individual. Often, in these cases and with acute back injuries, the therapist will manually move an individual through the water, while s/he is completely relaxed, using flotation devices to assist the therapist. In this way, range of motion of the spine and other areas is improved while the individual is completely relaxed.

In more agile people, water can be used to improve cardiovascular fitness and increase muscle strength. Here, individuals actively perform exercise in the water. Additional resistance can be added using various pieces of aquatic equipment, such as pool noodles and special weights. Aerobics is performed in the water, where individuals feel safe and the risk of injury is reduced. Water aerobics can be very intense; therefore individuals with cardiovascular disease or similar risks must be cleared by the doctor before starting exercise.

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Traditional swimming strokes are also hugely beneficial. Again, the water provides resistance, thereby increasing muscular strength and endurance. Heart rate increases with the intensity, contributing to improved cardiovascular fitness.

The temperature of the water needs to be carefully monitored. The water must be warmer when doing manual therapy in which the individual is completely relaxed. If the water is too cold, the individual will be unable to relax. Cooler temperatures are appropriate when doing water aerobics or traditional swimming strokes.

An aquatic exercise programme is hugely beneficial for those individuals who cannot perform land-based exercises and the same benefits are achieved. There is reduced stress on the body, often making the exercises more enjoyable and more appropriate for those who struggle with impact exercises.

So, if you think you have an excuse not to exercise, think again! There is always some form of exercise that can be adapted to suit your specific needs.

World Diabetes Day - 14 November

Diabetes is a fairly dreaded word, as many people just think of pricking and injecting oneself numerous times a day. However, this is not always the case. Being World Diabetes Day today, as well as Diabetes Awareness Week this week, I thought I would provide some insight into this common, yet often misunderstood, condition.

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What is Diabetes?

Diabetes is defined by ACSM as: “a chronic metabolic disease characterized by an absolute or relative deficiency of insulin that results in hyperglycaemia”. More simply put, diabetes is a condition resulting in prolonged high blood glucose (sugar) levels, as a result of little or no insulin production.

Various types of diabetes exist. I will discuss the two most common types – type 1 and type 2 diabetes. The first distinction to make is the difference between Type 1 and Type 2 diabetes mellitus. Type 1, or insulin-dependent, diabetes is usually present from a young age, although late onset type 1 diabetes may also occur later in life. Type 1 diabetes is an autoimmune disease, in which there is destruction of the beta cells in the pancreas – the cells responsible for producing insulin. The result of this is a complete insulin deficiency; therefore, these people immediately start insulin injections.

Type 2, or non-insulin dependent, diabetes usually presents itself later in life and occurs as a result of a combination of insulin resistance and decreased insulin secretion by the pancreas. Various factors increase the risk for developing type 2 diabetes. These include obesity (especially a large waist circumference), physical inactivity, family history, smoking, high blood pressure, high cholesterol, and stress. Individuals with type 2 diabetes usually start with oral medication to improve insulin sensitivity and will possibly start insulin injections later on if necessary, to accommodate for the decreased insulin secretion. Thus, it is possible to have type 2 diabetes and be insulin-dependent; this does not mean you have type 1 diabetes.

Why is exercise so important in managing diabetes?

There are many complications associated with diabetes, including cardiovascular (heart), renal (kidney), and neuropathies (nerve system damage). Physical activity is essential in managing these complications. Both type 1 and type 2 diabetes put individuals at increased risk for heart disease. Therefore, exercise is important to reduce the risk of heart disease, as has been discussed in previous blogs. Exercise also improves insulin sensitivity and glucose tolerance, thereby decreasing insulin requirements. Individuals with type 2 diabetes also often have high blood pressure and high cholesterol and are often overweight. Exercise is particularly important for these individuals to manage these conditions, as well as to reduce body fat percent.

Individuals who are on insulin therapy (injections) must be carefully monitored, especially when starting an exercise programme, as they tend to respond very quickly to exercise. During exercise, the body uses glucose as an energy source. Different types of insulin have different peak onset times. If the insulin peaks at the same time as the individual is exercising, then too much glucose may be used up, resulting in the individual experiencing a hypoglycaemic incident – the glucose dropping too low to keep the body functioning. The individual may faint and lose consciousness. Usually, one will have other symptoms first, such as sweating, shaking and nausea. Individuals will generally start to learn how their bodies react to hypoglycaemia.

On the other hand, individuals with type 1 diabetes are at risk of developing ketoacidosis if they exercise with very high sugar levels. If the blood glucose levels are not controlled and are too high, then there is no glucose in the cells, which means that fat must be broken down and used as an energy source. During this process, ketones, which are acids, are produced. This causes the body to become acidic and a coma may result if this state is prolonged.

An individual with diabetes will benefit from any exercise regimen. It is recommended that these individuals do at least 150 minutes of aerobic activity per week, to reap the cardiovascular benefits of exercise. They must also do light resistance training at least 2 to 3 times per week to improve muscle strength, decrease body fat percent and increase glucose metabolism. Stretching is also important to maintain flexibility and joint mobility and to reduce stress.

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So, if you have diabetes, don’t pretend it is not there and that it can’t cause any harm because you don’t have any visible symptoms. It is crucial to check your blood glucose levels regularly, follow a healthy diet and exercise on a regular basis. When exercising, be aware of how you are feeling and check your blood glucose levels whenever necessary if you are not feeling quite right. Always have a snack or some fruit juice nearby in case your glucose levels drop too low.

Diabetes is not something to be afraid of. If it is carefully monitored and correctly managed, one can live a reasonably hassle-free, long and healthy life. Educate yourself on how it works, so that you can be proactive and look after your body.

Neck Pain and Stiffness

I recently did some corporate wellness testing and one of the most common complaints was that of neck and mid back pain and stiffness. The main complaint was a dull ache in the neck and mid back region with a sharp pain at the base of the skull, often resulting in headaches. One of my earlier blogs spoke of correct ergonomics when sitting at your desk, as poor seated posture is very closely related to back and neck pain. Besides correct seated posture, remember to get up from your desk and walk around the room at least every hour.

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Other factors also contribute to this very debilitating neck and mid back pain. An x-ray should be done to rule out the possibility of any disc disorder. Then one must look at muscle spasm and tightness. Weakness of the deep neck stabilizing muscles, mid back muscles, shoulder and arm muscles, and tightness of the chest and superficial neck muscles may contribute to neck and mid back pain. In other words, a muscle imbalance exists, which causes certain muscles to go into spasm, resulting in pain and stiffness in the neck and mid back region.

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Numerous deep muscles stabilize the neck, as can be seen in the image below. If these muscles are weak, the superficial muscles, predominantly the trapezius muscles, compensate, often causing them to be tight and possibly to go into spasm because they are permanently working.

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The muscles in the mid back region help to stabilize the scapulae (shoulder blades). If these muscles are weak, it creates a pulling sensation on the neck muscles, as the scapulae pull downwards with gravity and the muscles are not strong enough to hold them in place. This constant pulling puts enormous strain on the neck, resulting in pain.

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If the shoulder and arm muscles are weak, the neck muscles, predominantly the trapezius muscle (shown above) tends to take over, especially when lifting heavy objects, such as shopping bags in and out of the boot of your car. Again, this overworked portion of the trapezius muscle results in pain and stiffness of the neck and mid back region.

Tightness in a muscle results in limited range of motion (ROM) of the joint it surrounds. When the trapezius muscle is overworked, it becomes very tight and may even go into spasm, resulting in pain. The chest muscles are often tight because of sitting in front of a computer all day with a poor seated posture – shoulders forward and rounded back. Add a phone tucked in between your ear and shoulder and you’re headed for disaster! These tight muscles must be stretched regularly before any strengthening can begin, because full (ROM) needs to be achieved and then the muscles strengthened throughout that range. Stretching also generally provides immediate relief of symptoms. If the neck is in spasm, see a Physiotherapist to break down the spasm before starting a specialized stretching and strengthening programme with a Biokineticist.