Aquatic Therapy and CRPS: Should you fear to tread…water?

by Melanie E. Swan, OTR/L

What is aquatic therapy?

Aquatic therapy is therapeutic exercise performed in a body of water-generally a lap pool or a deep water pool. Aquatic therapy often occurs in a group/class setting, though it may also be part of an individual treatment session with a therapist. Aquatic therapy may be used for people with RSD/ CRPS who have limited movement and/or have low tolerance for resistive therapeutic activities.

Why do you use water for therapy?

Water provides a combination of buoyancy and resistance/challenge. The buoyancy of the water supports your body weight differently, making you feel lighter and taking some of the pressure off joints so you can move more freely. The movement of the water during exercise challenges balance, helping to strengthen core/abdominal muscles. Moving faster or slower changes the resistance of the water, making it harder or easier to complete the exercises. Aquatic equipment, such as kickboards, foam noodles, webbed gloves, or aqua fins, can also increase the resistance of exercises.

What is an aquatic therapy session like?

An occupational therapist or physical therapist designs a series of exercises to promote increased strength, balance, and range of motion or weight bearing. Some programs may even involve floatation for relaxation of muscles. These exercises are tailored to meet the needs of the patient and the aquatic environment available.

What should the temperature of the water be?

There is no specific water temperature that is ideal for everyone. Most indoor pools are kept between 78 to 82° if they are used for vigorous swimming or exercise. Temperatures of 83 to 88° are optimal for moderate exercise. Temperatures warmer than 88° promote increased relaxation and circulation but can increase muscle fatigue more rapidly during exercise.

Will the water harm my CRPS if it feels cold?

Many people with RSD/CRPS prefer slightly warmer water during exercise, as often they are more sensitive to cold. Cooler water may initially produce some constriction of blood vessels; however, this is not harmful as it is your body’s natural mechanism to conserve body heat. This response can be reduced by performing a few minutes of vigorous exercise to increase muscle activity and circulation. Neither heat nor cold has proven to be more effective in the progression of aquatic exercise. Varying water temperatures during exercise is also an excellent way to work on temperature desensitization.

Is there a difference between aquatic therapy in a lap pool or deep water pool?

Lap pools are relatively shallow (approximately 3.5 to 4.5 feet deep) but offer a greater ability for patients to work on weight bearing and balance exercises during ambulation activity-walking, side-stepping, running, hopping, etc. Deep water pools offer greater ability to perform exercises while treading water or wearing a floatation device. This allows a greater amount of the body to be submerged below the water surface and provides greater resistance to upper body activity. However, most exercises can be completed in either setting with the use of aquatic equipment and modification or creativity.

Is there a difference between aquatic exercises and therapeutic activities outside of the water?

The water provides a place to try new activities, to improve ease of movement, to decrease muscle guarding and begin working on strength and balance. However, these activities need to be transitioned into a land-based exercise program to improve daily function. Aquatic therapy may be a good place to start therapeutic exercise; however, it should not be the only therapeutic exercise used during the treatment of RSD/CRPS as the buoyancy of the water prevents full weight bearing or loading of the affected area. Should I have aquatic therapy for my CRPS?

You should consult your physician before beginning any exercise program. Your physician or your Physical Therapist/Occupational Therapist can help determine if aquatic therapy is the right intervention for you.

Melanie E. Swan, OTR/L is a Resource Clinician at the Rehabilitation Institute of Chicago , Chronic Pain Care Center, 1030 N. Clark Street, Suite 647, Chicago, IL 60610.


Here we have two video submissions showing how Aqua Therapy can be used to help CRPS patients from H3O Aquatics . The keys are movement and warm water pool. You don’t have to go to a physical therapist to do exercise in a pool, but you do need to do the exercises in a warm water pool, the water needs to be over 83 degrees and usually no warmer than 88 degrees or fatigue can set in too quickly. For more on the temperature aspect and how cold affects CRPS you can refer to Melanie Swan’s article and/or the article regarding Ice and CRPS.

1)AQUA THERAPY – This link takes you to a number of other aqua therapy videos, some geared specifically towards adolescents. There are some excellent videos here describing a great variety of water exercises. 

2)AQUA THERAPY – This is yet another link to many more videos on RSD/CRPS and Aqua Therapy. Some courageous people and their struggles/battles and success stories!