H2O Fitness for ACL Rehabilitation



H20 Fitness Cooperative provides cutting-edge rehabilitation for Anterior Cruciate Ligament (ACL) injuries. Specifically, therapists take advantage of a new, Endless Fitness Pool that includes resistance current and underwater treadmill with data monitoring and camera capability. The properties of water, including its density, buoyancy, and viscosity allow individuals to begin movement earlier and in a safer environment than traditional therapies. Water immersion enhances rehabilitation and allows athletes to maintain and build fitness while recovering from injury.


The ACL is one of a pair of cruciate ligaments that runs diagonally inside the knee helping control back and forth motion as well as rotational stability. It is a ligament with a high incidence of injury. A 2016 study published in the American Journal of Sports Medicine performed a 21-year population study and determined the overall incidence of ACL tears was 68.6 per 100,000 people per year, making them a common orthopedic injury. Surgical repair is often indicated.


Making a strong case for aquatic therapy after ACL reconstruction, a 2019 study, Benefits and Use of Aquatic Therapy During Rehabilitation after ACL Reconstruction concluded that utilization of a water-based environment during ACL rehab allows activities or exercises to be “introduced earlier than on land potentially accelerating recovery process and reducing overall recovery time.”


Aquatic therapy at H2O Fitness accomplishes this— assisting with pain and swelling, improving range of motion of the knee, supporting gait recovery, promoting maintenance and development of cardiovascular fitness, helping rebuild movement patterns, and allowing session recovery and optimal load management, especially during the later stage rehabilitation process.


Reduced Pain and Swelling and Restored Joint Range of Motion


Early joint motion helps reduce swelling and pain. At H2O Fitness, an individual can be submerged in water early in the rehab process. Water pressure in the therapy pool allows for a force on the body that is slightly higher than normal diastolic blood pressure. Studies show this can help with fluid moving away from the injured joint through optimized venous return. Consequently, reduced swelling results in an increase in joint range of motion and the ability to move with less impairment. Additionally, pain perception is diminished in the water, allowing for more comfortable motion overall.


Improved Gait Mechanics and Recovery


Following ACL repair a patient generally has weight bearing restrictions and in an immobilizer for a period of time. During this time, it’s possible to develop incorrect, potentially detrimental gait patterns. These abnormal gait patterns have been associated with decreased functional performance and potential complications.


In the H2O Fitness therapy pool, patients can begin to normalize gait thanks to the reduced effects of gravity, allowing lower overall weight-bearing. A person submerged to just above the waistline has effectively lost close to 50% of body weight. Because H20 Fitness also uses an underwater treadmill, walking can safely begin early, with retraining exercises that support the development and maintenance of healthy movement patterns.


Maintain and Even Gain Cardiovascular Fitness During Rehabilitation


Preserving fitness, such as lactate threshold and aerobic capacity, is important for most athletes. Deepwater running has been shown to assist in maintaining all forms of cardiovascular fitness thanks to the resistance of water. H20 Fitness therapists can utilize heart rate monitors to ensure athletes or anyone looking to maintain fitness and health can bridge the gap during recovery.


More Rapid Return to Movement Patterns and Coordination


Because altered movement biomechanics are associated with a heightened risk of re-injury upon return to sport, conventional rehab practices often aren’t enough. Re-training muscle imbalances and neuromuscular responses through movement are a superior way to continue rebuilding coordination and can happen sooner in the therapy pool. Strength and movement can be combined to optimize movement quality.


H2O Fitness uses underwater cameras that allow careful monitoring of movement while it is happening. Therapists can use a systematic and combined approach with the pool and gym. Earlier motor control work in the pool can be combined with muscle strengthening in the gym. Also, earlier introduction of running, jumping and other plyometrics can all start with lower load and risk in the water. Ideally, this allows for faster and fuller progress and performance.


Improve Between Session Recovery and Maintain an Optimal Training Load


Late-stage rehab can include recovery sessions in the therapy pool that allow added training and reduced soreness. It is also useful for increasing training load safely with supplementary exercise on recovery or lighter days. This is very helpful for the athlete looking to continue building fitness in order to get back to sports competition as quickly as possible.


H2O Fitness offers everyone the ability to utilize the pool during or after therapy with the addition of individual memberships for pool access. Beyond therapy sessions, athletes can continue training, building training load, and enhancing recovery while returning from ACL injury.


About the Author

Carrie McCusker is an endurance athlete and coach who enjoys bringing detailed, individual attention to her clients. She is also a writer and student, tapping a love of deep research to explore all aspects of human performance, nature, and the interplay between the two. You can find her on Strava and Instagram or check out her coach profile at TrainingPeaks.