Swinging in the Pool
Lynda Huey, MS, is the author of The Complete Waterpower Workout Book and has trained and rehabbed many professional and Olympic athletes with aquatic therapy. She operates Huey's Athletic Network in Santa Monica, Calif.
Imagine a world where athletes with lower-back pain can rehab without the forces of gravity pushing down on them, where baseball players with compartment syndrome can passively stretch out their shoulders, where uninjured athletes can go to train in an environment that provides resistance from all angles. Stop imagining and get in the pool!
Working out in the water allows injured athletes to rehab without concerns of weight-bearing too early--while retaining their strength and cardiovascular conditioning. In the early 1980s, track and field athletes began to widely use the pool to rehab various injuries, and time after time they surprised their coaches with faster times when they returned to the track. Athletes increased strength, retained neuromuscular coordination, and corrected biomechanics--all leading to improved performance. Over the years, athletes from virtually every sport have used pool programs not only in times of crisis due to injury, but also as part of a wise cross-training/injury-prevention program.
A HOST OF BENEFITS
Aerobic and anaerobic fitness. Some sports require predominantly aerobic fitness while others require mostly anaerobic fitness. Most sports, however, demand a combination of the two. While an hour or two of aerobic exercise on land will usually fatigue an athlete, that same time spent in water exercise usually leaves the athlete feeling refreshed. Anaerobic work on land is often accompanied by impact to the muscles, connective tissues, and weight-bearing joints, but most compressive forces are removed when that same work is accomplished in water.
Most importantly, aerobic and anaerobic work performed in water can continue for most athletes even after injury. Athletes who don't have a water rehab program available to them will often be sidelined while their pool-training counterparts retain top levels of fitness.
Balanced strength in muscle pairs. Every exercise in water's three-dimensional resistance forces athletes to work both halves of each muscle pair. For every thrust forward against water's resistance, there must be a backward thrust; for every upward push, a downward push also encounters water resistance. Unlike exercises on land where gravity prevails, in the pool you can't train only one half of a muscle pair. Therefore, symmetry is built in. Keep in mind, however, that the athlete must work with equal speed and force in both directions of the movement to keep balance in the muscle pairs.
Increased flexibility. Getting student-athletes to stretch can be like getting them to do their homework. They'd rather be out hitting or kicking a ball, running or jumping. However, nearly everyone will find stretching in the water comfortable and even enjoyable, especially after a high-intensity workout. The buoyancy of water makes it easier to get into and out of stretching positions, increases joint space, and allows athletes to stretch more rhythmically. Enjoying stretching means doing it more often, which adds up to improved flexibility.
Faster recovery. The rest period between exercises will be shorter in the pool than that required on land, because the coolness of the water helps speed recovery. Further, the water's hydrostatic pressure and massaging quality help prevent tissue swelling that results from waste-product build-up.
Athletic hopefulness. One of the worst things that happens to injured athletes is their loss of hope. They lose hope that they'll be able to take part in an important upcoming competition. They lose hope that they'll be ready to perform in time to earn a college scholarship or gain recognition to be drafted by the pros. When they lose hope, they lose mental focus. But by participating in a strenuous water rehab program that incorporates visualizing the performance of their skills in the actual area of competition, they not only retain their athletic skills and fitness, but their competitive edge (see "Visualization is Key"). They can "see" themselves racing, shooting hoops, or kicking field goals again, and they don't lose hope.
SHALLOW WATER vs. DEEP WATER
One of the most commonly asked questions is whether injured athletes should train in deep water wearing flotation devices with their feet not touching the bottom of the pool, or in chest-deep water. Use these guidelines in making that determination:
Use deep water when athletes have weight-bearing injuries (lower-extremity, back). By removing all impact to the injury site, athletes can continue to work out and retain their high level of fitness. Stay deep when athletes' joints and muscles are sore, stiff, and tired. Since distance runners and endurance athletes tend to "pound the pavement" a lot, they can often benefit most from deep-water cross training programs that take the weight off.
Use shallow water when athletes can't swim or are afraid of deep water. Also, make the transition from deep water to shallow water to prepare healing athletes for the return to land. In this way, gravity is gradually reintroduced to the program. Sprinters do best in shallow water, because it allows them to retain their exquisite proprioception as their feet push off from the pool bottom.
COMPONENTS OF A WATER REHAB SESSION
Water rehab sessions typically last 45 to 90 minutes, depending on the fitness level of the athlete and the sports skill techniques that must be practiced. Build the session from the components below.
Warm-up, three to five minutes. This can be in either deep water or in shallow water. A deep-water warm-up consists of running, walking, and "flies," a movement similar to a jumping jack, but with the arms underneath the water. A shallow-water warm-up includes jogging and bouncing back and forth across the pool (on both legs, like squat jumps, with a rhythmic pushing off and moving from one end of the pool to the other).
Stretch. Athletes can grasp a ladder, gutter, railing, or skimmer box. If the pool has none of these, they can hold the lip of the pool while performing a series of stretches for the back, gluteals, hamstrings, quads, and hip flexors. Upper-body stretches can be done standing anywhere in the shallow end of the pool.
Total-body-fitness exercises. There are 20 to 30 exercises that can be performed at either the shallow or deep end of the pool to help develop total-body fitness in both the cross-training or the injured athlete (see Figure One).
Interval training. This is the heart of the workout. Depending on what's appropriate for the athlete's sport, spend 20 to 40 minutes doing intervals. In deep water, this consists of running, power walking, speed walking, and recovery periods. In shallow water, athletes sprint for their work bouts and jog during the recovery periods.
Make the intervals match the athlete's normal land training by basing the work on time rather than distance. For example, soccer players can sprint, side-step, kick, and sprint for one to two minutes as they might on the field, then jog until recovered, then repeat. Four-hundred-meter runners can perform repeated controlled sprints at approximately race pace for 45 to 60 seconds.
Specific rehab exercises. Athletes with acute injuries may not be able to exercise in the pool right away. However, with proper preparation, most athletes can ease their way into performing specific rehab exercises in the water. For example, sprained ankles should always be taped tightly before the athlete enters the pool. Otherwise, water resistance will force the foot into passive, involuntary movements that cause undue pain. Keep the ankle taped in the pool for at least a week after you think it's no longer necessary.
Most other injuries, especially chronic ones, can be addressed immediately. If the injury doesn't require taping, or after the tape is off, ask the athlete to move the injured area through all possible ranges of motion. If undue pain results, slow the movement, and if pain continues, narrow the range of motion.
Resistance training. As healing progresses, athletes can add resistance equipment to increase the workload. For upper-body work, this includes webbed gloves, paddles, or ultra-resistant "bells." For lower-body work, this includes ankle and shin cuffs and resistance boots.
Technique work. Runners need to continue running, jumpers need to jump, and athletes of all sports need to keep their sports skills sharp even while injured. Old basketballs, baseball bats, and tennis rackets can go into the pool for practice. As an added benefit, because movements in water are slower than on land, athletes will be able to sense "freeze frames" of their skills, and smooth out erratic moves. For example, a baseball player can swing a bat through the water and eliminate any glitches in his or her swing. Water's buoyancy also allows athletes to assume their sports' key positions more easily; for example, allowing a shot putter with a back, groin, or lower-extremity injury to lower into the starting half-crouch. All it takes is a little imagination to simulate a sport's skill drills in the water.
SPORT-SPECIFIC WATER REHAB PROGRAMS
Baseball and softball. To increase range of motion in an injured shoulder, athletes can slowly walk from the shallow end of the pool to the deep end, allowing their arms to passively rise with the buoyancy of the water. Then, they can slowly work on strengthening the area with progressively faster movements of their arms through the water. Various "wings" and resistance cuffs can be used to increase resistance. An old bat can also be used to mimic the batting motion and work the muscles of the arms and lower back.
Basketball and volleyball. Ankle sprains can go into the water the day after injury. With a tightly taped, immobile ankle, the athlete can perform a full deep-water training program without losing even a day's conditioning. Depending on the severity of the sprain, tape can be removed at the end of the workout so the athlete can begin doing gentle foot circles as well as dorsiflexion and plantar flexion within three to seven days.
As the ankle begins to heal, let the athlete move to chest-deep water and begin running while still wearing a flotation belt. Over time, gradually increase weightbearing as tolerated by first removing the flotation belt, then having the athlete run faster and then having him or her perform various jumping exercises. Once the basketball player can shoot, rebound, and sprint in the pool, he or she can return to the court for easy practice.
Football. Knee problems that are so frequent in football can be addressed easily in a pool. If the knee condition is severe, start in deep water wearing flotation devices and perform straight-leg exercises (walking, flies, deep kicks) until the knee can bend without undue pain. A waterproof brace or tape can be worn to stabilize a particularly injured knee. As healing progresses, gradually add running and bent-knee exercises in deep water. If the injury is mild, athletes can often begin in shallow water while wearing a flotation belt to increase their buoyancy. Have the athlete simulate some of the game's specific moves in the pool. Repeat at least three different skills for 10 to 20 minutes.
Tennis. Shoulder and elbow strains and tendinitis are common overuse injuries for tennis players. These injuries should be stretched, strengthened, and iced while the athletes retain top fitness levels doing shallow-water exercises and an interval training program. Then, when most of the inflammation has been alleviated, have the injured athletes take their oldest tennis racquets into the pool. They can walk through the exact motion of the swing, preparing the healing tissues for the movement to come when they return to the tennis court.
In this way, injured muscles and tendons regain function, but they don't have to withstand full speed nor the impact with the ball. Do 25 strokes with the dominant arm, then 25 with the non-dominant arm to help keep the body's musculature symmetrical.
Sprinting, hurdling, and jumping. Strained hamstrings are by far the most common complaint of track and field athletes. These temperamental muscles often take weeks or even months to heal before a full effort can again by tried. In the meantime, use elastic tape to support the hamstring muscles and have athletes begin with a deep-water program while keeping the knees slightly bent to avoid aggravating the injury.
Quickly move to shallow water when gentle impact can be tolerated and have athletes run in place, leaning forward into sprint position against a tether. In this way, coordination between the arms and legs is retained, yet the hamstrings don't have to exert fully--they neither have to push off nor reach for full extension. As the knees pump up and down, the hamstrings have little to do but lift the heel toward the buttocks, then lengthen as the foot hits the pool bottom. Most athletes with hamstring injuries can sprint at top speed while running in place on a tether within a remarkably short time, even if they're barely able to jog on land.
VISUALIZATION IS KEY
Adding a mental visualization component to a pool workout gives injured athletes the opportunity to feel that they're still in the game, not stuck over in the pool while their teammates are doing a "real" workout. Visualization can also "work" their concentration skills to keep them training harder and more like actual game or event conditions.
For example, have a sprinter run 200 meters based on a 30-second clock and talk him or her through the distance while watching the clock. Mentally place other competitors in inside and outside lanes. Challenge the athlete to "catch" his or her top rival just before the finish line.
Another example: ask a field-goal kicker to go through his full mental preparation before a big field-goal attempt. Set the stage of a big game, naming where the ball is placed, the score, and how much time is left on the clock.
The key thing is to mimic specific sports as closely as possible, in both physical movement patterns and, through mental visualization, the setting in which athletes practice and perform in actual event situations.
Rehabbing athletes in the pool provides a unique opportunity to continue training without stressing injured muscles and joints. At the same time, they're receiving the benefits of a total-body aquatic workout, which noninjured athletes can exploit for improving biomechanics and overall performance.