Underwater Treadmill: Pitfalls and How to Avoid Them
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In a podcast interview with Francisco Maia from the K9PT Academy about?minimising our practices, the topic of the underwater treadmill came up. For Francisco, better results can be achieved without the use of an?underwater treadmill. I thought we could dive into this thinking a little deeper.
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There are multiple pitfalls associated with underwater treadmill treatment, including reaching an early plateau in the ability to provide progressive loading, the inability to target specific tissue structures, the possibility of strengthening incorrect gait patterns, and social and financial pressures. These pitfalls can be circumnavigated when we understand our modality well, use a multimodal treatment approach, and put the needs of our patients first.
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The pitfalls
According to?Francisco, the two primary pitfalls of using the underwater treadmill are the inability to provide progressive loading and the dangers of strengthening an abnormal gait pattern.
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Progressive loading
In order for tissue to strengthen and achieve a return to normal function, we must be able to?progressively?load tissues, based on an in-depth knowledge of biomechanics and an understanding of the healing timelines of the specific tissue affected.
While the underwater treadmill can reduce tissue loading in the initial phases of healing by providing buoyancy and reducing body weight loading, we are limited in the degree to which we can progress the tissue loading. We can only increase the load to normal weight bearing, and the effects gained from walking on an incline, as well as increasing speed. These loading progressions may not be ideal for all cases,? and it remains cyclical in nature which is an additional disadvantage.?
An often discussed benefit of the underwater treadmill is the resistance added by the water. Certainly, this is a way for us to increase loading on the cardiovascular system and components of the muscular system,? but we are limited in how specifically we can target one or a group of tissues, and are rather loading the system as a whole.?
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In essence, the value of the underwater treadmill in achieving the goal of strengthening a tissue will be?limited, and will plateau early in the rehabilitation process.
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Abnormal gait pattern
For the majority of our patients, a gait abnormality is present when they first come to see us, whatever the cause may be. Retraining a normal gait pattern is one of the important goals we strive for during a rehabilitation programme.
Repetitive walking, especially in water where there is added resistance, can strengthen an abnormal gait pattern instead of helping to restore it to normal; the very opposite of what we want to achieve.
Understanding the cause of the gait abnormality, and how it can be restored, is essential to any successful plan. Retraining will probably combine multiple manual therapy and?exercise modalities, and will require a hands-on, corrective approach in the underwater treadmill.
To avoid the pitfall of strengthening an abnormal gait pattern, we must be aware of the cause, work to restore?normal mobility and function?through manual therapy interventions, and be hands-on in the water treadmill – assuming, that is, that this is an appropriate modality for the patient to use in the first place.
On the other hand, the water treadmill?can?help us to restore and retrain normal gait. To achieve this, it needs to be seen as?a modality forming one part of an overall treatment plan, to be used in conjunction with other interventions. In addition, it’s efficacy and role need to be constantly re-evaluated and assessed to ensure that we are achieving optimal results for that specific patient.