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Aquatic Therapy: Come on in, the Water's Fine

by Ryann Cacciotti

When I was in physical therapy school, I wanted to keep my options open as to which setting I would work in after I graduated. Having worked as a physical therapist assistant, I wanted to make sure to have a well-rounded experience when it came to my internships, but specifically wanted to make sure that my outpatient internship offered a special niche since my experience thus far was primarily in outpatient orthopedics.

When I was offered an internship at a facility that specialized in aquatic therapy, I was intrigued, but there was also a level of anxiety because it was out of my comfort zone.

Maybe I had the same misconception that a lot of our patients, as well as many physical therapy students, have about aquatic therapy. Is aquatic therapy just exercise in water? Does everyone go in the pool? Will I still be able to use my manual skills that I learned in school if I treat patients in the pool?

Aquatic therapy runs deep

The first and most important lesson I learned was that aquatic therapy is so much more than exercising in the pool. I now work at the same facility where I completed my internship, and I am fortunate to be able to work with physical therapy students at our pool during their aquatic therapy lab.

I often find I have to get into the pool to try different exercises so that I can feel what muscle group is being targeted with a specific exercise, to problem solve what might be an appropriate exercise or intensity for certain patients, or to learn better cues that I can give to patients so that they can properly perform an exercise.

Aquatic therapy is versatile

Not every patient will benefit from the same exercise or aquatic therapy program, but I now know that there is some mode of aquatic therapy that would likely benefit almost every patient at some point in his/her rehabilitation. From pain relief and decompression of a painful joint(s), to balance or gait training, to return to sports conditioning and more, aquatic therapy is a very versatile tool in the physical therapist’s bag of tricks.

But this does not mean that every patient I treat will end up in the pool. Unfortunately, there can be limiting factors when it comes to adding aquatic therapy to your plan of care.

  • Some insurances may not cover aquatic therapy without a special authorization.
  • Some patients may be unwilling to go into the pool, despite being advised of the possible benefits.
  • As our pool is outdoors, we are exposed to the elements and this can limit the patient’s desire to participate in aquatic therapy, potentially limiting their treatment outcomes as well as affecting your clinic’s productivity.

Physical therapy in the pool

Another thing to consider when you are an aquatic physical therapist is that there will be times when you also have to get into the water. Many of our patients only need us to guide them through their program in the pool while we stand on deck, but others require our assistance in the pool.

As a Certified Manual Therapist (MTC) through the University of St. Augustine for Health Sciences, manual therapy is a large component of my treatment plans. I have been able to continue to use manual therapy techniques with my patients in the pool, often finding increased tolerance for these techniques due to the relaxing and supportive nature of the water.

Gaining experience in aquatic physical therapy

While there are therapists who specialize in aquatic physical therapy, there are no special certifications or credentials required to work in aquatic therapy. However, solely relying on what you learned about aquatic therapy in school will likely not allow you to utilize aquatic therapy to its fullest potential. An internship is an excellent way to gain practical experience in aquatic physical therapy, but if you are unable to have an aquatic therapy internship, there are other options available to you, some of which include:

  • Continuing education courses such as those offered by Aquatic Therapy and Rehab Institute ( or the Aquatic Therapy section of APTA (
  • Volunteering or observing in a clinic that offers aquatic therapy as a student. Perhaps if a full internship is not available, arrangements can be made to shadow a clinician on a more informal basis so that you can increase your exposure to aquatic therapy.
  • Shadowing a clinician once you have graduated. By contacting a clinic and observing aquatic therapy, you are increasing your practical experience as well as demonstrating real interest to prospective employers.

Jumping into aquatic therapy

Aquatic therapy is like any other setting in physical therapy, you can always learn more. I think every therapist had the experience of taking a continuing education course and instantly thinking of patients they have either treated in the past or are currently treating who would benefit from the new skill they are learning in the course. The same holds true for aquatic therapy.

If you think you know all there is to know about physical therapy, it is time you move on to something new. As physical therapists, we should always be striving to stay knowledgeable about the latest techniques and research, and this applies to aquatic therapy just as it does to any land-based therapy. Don’t let your lack of experience hold you back from jumping into aquatic therapy. Just make sure you get out there and learn whatever you can so that you are the most beneficial therapist for your patients.


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