Physical conditioning is an important aspect of injury rehabilitation and achieving positive return to work outcomes. However, it can be difficult to ascertain which of the many services available should be engaged. One of those dilemmas can include which type of rehabilitation/strengthening program is appropriate: Hydrotherapy (water) or Gym-Based (land).

Below are a few notes to help determine:

1. What service is suitable, and;

2. When the service is suitable.

Hydrotherapy preferred when:

• Client is also receiving physiotherapy, to compliment treatment modalities, and provide multiple services.
• A gym-based program has been trialled and the client was not comfortable or experienced constant aggravation of symptoms.
• Client cannot participate in a graduated return to work due to severity of symptoms.
• There are multiple injuries which may make a gym or home based program unsafe or difficult.
• There are other, non-injury related, conditions which affect balance or proprioception e.g. inner ear problems, vertigo, deafness, blindness.
• Avoidance behaviour of using affected limb due to pain.
• Improvement in injury pain is aided by heat or warmth (e.g. wheat packs, heat gel, or sleeve/compression bandage).
• Limb cannot be actively held up against gravity (leg or arms).
• No full range of motion of affected joint.
• Lower body (foot/ankle, knee, hip, lumbar spine)
  • Client has difficulty weight bearing due to pain or discomfort.
  • Injury has caused improper gait pattern.
  • Client is mobilising with aid of assistance device (walking stick, wheelie walker, crutches, or wheel chair).
  • There is swelling of the joint, or oedema.
• Upper body (thoracic and cervical spine, shoulder, elbow, wrist/hand)
  • Client requires part time use of sling due to decreased strength against gravity.
  • Pain or discomfort is caused by weight bearing (thoracic spine), or lifting items.

Gym preferred when:

• Client has no or minimal pain weight bearing, but pain is increased by activity or specific movements.
• Affected limb can be held up against gravity, however becomes fatigued quickly.
• Range of motion is within or close to normal parameters, however there is minimal strength in the muscles to move or carry additional weight.
• Strength is decreased at injury area/joint.
• Endurance is decreased at injury/joint area.
• Following and progressing from a hydrotherapy program.
• Specific requirements are needed prior to return to original employment (e.g. from job description or task analysis).
• Client is already participating in a graduated return to work to assist with weights and movements which may not be available at the work environment.
• Client has ceased physiotherapy, and needs an upgrade from body weight exercises, OR depending on specific injury, when client is ALSO receiving physiotherapy, to compliment treatment modalities, and provide multiple services.
• Client has a psychological injury.

Blog – Tara Optland (Exercise Physiologist)