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Introduction to Aquatic Therapy: Summary
CASE STUDY: COMPREHENSIVE AQUATIC THERAPY FOR POST-SURGICAL ANKLE REHABILITATION Background : A 45-year-old female competitive tennis player presented for aquatic therapy following internal fixation surgery for a complex ankle fracture. Prior to injury, she participated in regional tennis tournaments and maintained an active lifestyle. Her primary goal was to return to competitive tennis within a safe timeframe. The patient demonstrated significant post-surgical limitations including reduced range of motion, decreased weight-bearing tolerance, and impaired proprioception. Initial Assessment: Upon evaluation, the patient exhibited moderate edema around the surgical site, pain levels ranging from 4 to 7 of 10 during weight-bearing activities, and significant gait deviations. Active range of motion was limited to 5 degrees dorsiflexion and 15 degrees plantarflexion. Weight-bearing was restricted to 50% on the affected limb, making land-based therapy challenging in the early phases of rehabilitation. Treatment Approach: The rehabilitation program was structured in three distinct phases, utilizing the unique properties of water to facilitate recovery. The initial phase focused on pain management and gentle range of motion exercises in 92° (thermoneutral) water. Soft swim fins were incorporated to provide gentle resistance during ankle mobilization exercises, while the buoyancy of water reduced stress on the healing structures. The patient began with shallow-water walking exercises, utilizing kickboards for balance support and proprioceptive training. Progressive Phase: As healing progressed, the program advanced to include more challenging exercises. The combination of hydrostatic pressure and controlled movement patterns helped reduce residual edema while improving joint mobility. Diagonal movement patterns were introduced, incorporating principles from the Bad Ragaz Ring Method to enhance neuromuscular control. The Burdenko Method’s progressive approach was implemented, gradually increasing the complexity of exercises while maintaining focus on the six essential qualities: balance, coordination, flexibility, endurance, speed, and strength. Advanced Rehabilitation: The final phase emphasized sport-specific movement patterns and power development. Water turbulence and resistance equipment were utilized to challenge balance and agility. The program incorporated multidirectional movements, plyometric exercises, and sport-specific drills adapted for the aquatic environment. Land-based exercises were gradually integrated following the Burdenko Method’s principle of transitioning from 80% water/20% land to 40% water/60% land. Outcomes: After 12 weeks of aquatic therapy combined with land-based rehabilitation, the patient demonstrated significant improvements: • Full ankle range of motion restored • Pain levels decreased to 0 to 1 of 10 during activity • Normal gait pattern achieved • Return to competitive tennis accomplished • Enhanced proprioception and stability during dynamic movements This case demonstrates the effectiveness of a comprehensive aquatic therapy program in facilitating return to high-level athletic activity following ankle surgery. The progressive nature of the program, combined with the therapeutic properties of water, allowed for earlier intervention and optimal functional outcomes.
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