For those struggling with inflammation and muscle and joint tightness, the pool can be a game-changer.
The natural buoyancy of water helps people move in ways they might not be able to on land, says Carol Stillman, a physical therapist specialising in aquatics at Sutton Place Physical and Aquatic Therapy in New York.
Standing in water reduces the impact of body weight, taking pressure off joints and lessening discomfort, all of which make postsurgical movement more tolerable.
The viscosity of the water also provides natural resistance, which helps build endurance.
“You can work on strengthening, walking and reacquiring skills after surgery, even if you have significant restrictions,” Karamitopoulos says.
And it can be done without breaking a sweat.
Beyond that, water feels protective – it’s difficult to take a hard fall in a pool, so it’s a great way to practise exercising before moving to a gym or workout room.
And, for those who get to a therapeutic pool, where the water ideally is kept at temperatures of 30 to 33C, there’s an additional benefit because warm water reduces swelling, also known as edema.
“The pool is like a wraparound compressive wrap, or a giant Spanx, that slashes edema, one of the biggest post-op symptoms after surgery,” says Stillman.
It can also improve your circulation and decrease postsurgical pain, according to a study involving some 190 patients undergoing rotator cuff repair surgery.
Mental health boost
After major surgery, it’s common to experience residual anxiety. You can’t do the things you once did, and your body may look different. In a 2022 meta-analysis, water exercise was correlated with significantly reduced symptoms of anxiety, depression and stress.
In a 2023 study, 12 months of aquatic therapy relieved fatigue, tension, depression and anger in 60 breast cancer patients and improved the overall wellbeing of the women after treatment. It was also found to be more effective than yoga or Pilates, researchers said.
Like most physical activity, aquatic exercise can increase dopamine – the feel-good hormone – allowing you to relax and have fun.
“You can hang from a pool noodle or put dumbbells under your arms, and all of a sudden, you release tension in the body that the land exercises wouldn’t allow you to do,” says Shea Andreone, a certified water fitness instructor at the YMCA in Culver City, California.
If that’s not enough incentive, Andreone says, moving in the water engages muscles most people don’t ordinarily use, but it doesn’t feel as challenging.
“You’re getting quite a workout, and you’ll sleep really well, too,” she adds.
Unfortunately, Karamitopoulos says, even though aquatics is beneficial, not enough doctors are prescribing it, and it’s difficult to find certified licensed therapists who offer the service.
“There are many people who can’t do an aerobics class, either from a bone and joint perspective, from a cardiac perspective or from a balance perspective, but they may be able to do a program that’s modified in the water,” she explains.
If you can’t find aquatic physical therapy, she suggests checking out aqua aerobics classes once you get clearance from your doctor.
How to choose
Choosing the right water exercise will depend on your surgery and requires a conversation between you and your doctor.
“For some people, depending on their baseline, they’ll be working on stretching, being upright or their posture. For other people, it can include walking. Then you can work up to resisted running in the water,” Karamitopoulos says.
Stillman adds that participants should plan on aquatic therapy twice a week for six to eight weeks and then graduate to aqua aerobics classes in a group setting to maintain strength. Don’t worry, she adds, you don’t have to be a great swimmer to join a class.
Five tips before taking the plunge
- Get your doctor’s go-ahead: Always talk to your doctor before beginning any kind of exercise post-surgery. Make sure your wounds are allowed to get wet and find out how soon you can get in the water after your operation.
- Be pool-ready: If you have open wounds, experience seizures or have incontinence, you might have to avoid water, though urinary incontinence is often acceptable in therapeutic pool settings, Stillman says.
- Take a tour: Before your first session, tour the facilities to make sure you can get in and out of the pool. Some aquatic therapists have a chair that will lift you, but many aqua aerobics classes only have pool ladders that can be difficult to navigate post-surgery.
- Talk to the instructor or therapist: Let the person you’re working with know your limitations. If you’re in a group setting, ask for modifications.
- Take it slow: Put your competitive nature aside and enjoy the water. Remember, any movement is good movement, Andreone says.
