Pain and resistive underwater exercise

Pain in paediatric rheumatic diseases is common place, with a prevalence of 86% in children with Juvenile Idiopathic Arthritis (JIA).

Resistive underwater exercise can be effective in treating JIA pain, especially when combined with traditional physiotherapy. Sadly, most children and young people will not have access to hydrotherapy pools so we have listed some exercises you can do in a regular swimming pool. Please check with your physio/specialist nurse that these exercises are suitable for your child.

Many types of conditions greatly benefit from pool exercise, including arthritis and it can be a fun and sociable way to exercise. The pool environment also reduces the risk of falls when compared to exercise on land. The buoyancy of the water supports a portion of your body weight making it easier to move in the water and improve your flexibility. The water also provides resistance to movements, which helps to strengthen muscles.

10 Excellent Exercises for the Pool

  1. Water walking or jogging 
    In chest or waist high water walk about 10-20 steps forward, and then walk 10-20 steps backwards. Increase speed to make it more difficult. Also, increase intensity by jogging gently on the spot. Alternate jogging for 30 seconds with walking on the spot for 30 seconds. Continue for up to 2 minutes.
  2. Forward and side lunges
    With the pool wall beside you for support if necessary, take an oversized lunge step in a forward direction. Do not let the forward knee advance past the toes. Return to the starting position and repeat with the other leg. For a side lunge, face the pool wall and take an oversized step to the side. Keep toes facing forward. Repeat on the other side. Try 3 sets of 10 lunge steps. For variation, lunge walk in a forward or sideways direction instead of staying in one place.
  3. Front crawl kicking
    Hold onto poolside with both hands, on your front and with a small knee bend and floppy feet, kick from the hips. Do this for no more than 5 seconds.
  4. Sidestepping
    Take sideways steps with your body and toes facing the wall. Take 10-20 steps in one direction and then return. Repeat twice in each direction.
  5. Hip kickers at pool wall
    Stand with the pool wall to one side of your body for support. Move one leg in a forward direction with the knee straight, like you are kicking and then bring the leg back to the standing position. Then move the same leg out to the side by about 45 degrees and return to the standing position. Lastly, move that same leg behind you. Repeat 3 sets of 10 and switch the kicking leg.
  6. Pool scissors
    Lie on your back with a noodle either under your shoulders or under your mid-back (dependent on where support is needed) and move your legs in and out like a pair of scissors opening and closing for 10 repetitions only.
  7. Deep water bicycle
    In deeper water, loop 1-2 noodles around the back of your body and rest your arms on top of the noodle for support in the water. Move your legs as if you are riding a bicycle. Continue for up to 1 minute.
  8. Forearm raises
    Hold arms at your sides in shoulder deep water. Bend your elbows to 90 degrees with your palms facing upwards and raise and lower forearms toward the water surface, while the elbows remain bent to 90 degrees. Repeat for 3 sets of 10.
  9. Push ups
    While standing in the pool by the pool side, place arms shoulder width apart on pool edge. Press weight through your hands and raise your body up and half way out of the water, keeping elbows slightly bent. Hold 3 seconds and slowly lower back into pool. (Easier variation: Wall push up on side of pool: place hands on edge of pool shoulder width apart, bend elbows, and lean chest toward the pool wall).
  10. Standing knee lift
    Stand against the pool wall with both feet on the floor. Lift one knee up like you are marching on the spot. While the knee is lifted to hip height, extend and straighten ten times and then repeat on the other leg. Complete 3 sets of 10 on each leg.

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Disclaimer: To reduce the risk of injury, before beginning any of these or any exercise program, please consult a healthcare provider for appropriate exercise prescription and safety precautions. The exercise instruction and advice presented are in no way intended as a substitute for medical consultation.

Written: 08/01/2019