DALLAS -- West Valley Hospital's physical therapists use every tool the can think of to get people up and moving after surgery or an accident.
Often, if the injury is debilitating enough or if the person has other medical conditions that limit movement or balance, water therapy is a necessary start.
"If someone can't exercise on land because of pain, they find that they are able to get some sort of exercise in the pool," said Caryl Nicol, WVH physical therapist. "Often times we try to progress them gradually into a land-based program, if that's their goal. But not everyone wants to return to working out on land, and that's OK."
Water therapy has unique benefits for people with joint and muscle pain. Perhaps foremost, there is no impact. The water makes a person almost weightless, so that each step in a pool doesn't transfer body weight onto already-stressed joints.
"Joyce (Finegan) here has an ankle fracture," said Nancy Wilson, another WVH therapist. "We are using resistance training to strengthen the muscles in her foot."
When the women are done with resistance training, they start doing underwater squats. This movement is the same in the water as it is on land, but in water the person has support on all sides and doesn't risk falling. A fall while exercising could be disastrous to recovery, and many of Wilson and Nicol's patients have balance issues.
What they have found is balance skills learned in the pool transfer to land with little adjustment.
In Joyce's case she is learning to do squats, and in doing so is learning that her large toe is the beginning point of balance. Her body is creating muscle memory in the water so that when she tries to do the same exercise on land in a few more weeks her body will know what to do.
Not all therapy programs have access to the types of facilities enjoyed by the West Valley Hospital staff. However, when the City of Dallas built its Aquatic Center about six years ago, it added a heated therapy pool and "river current" to the shallow pools.
These two features are luxuries for the therapists and allow them to tailor water-based, long-term programs for their patients.
"The big thing is the river," Nicol said.
"We can use the current's resistance to ad an extra layer of strength training to a water-based walking program. This makes it even easier for people wanting to get back on land to fulfill that goal. Not many programs have that; if they do it's because they have contracted out with a community pool of some kind."
Nicol said that about 60 percent of the patients she sees continue in some kind of water-based exercise program after they have left therapy.
"Before I started I had very little low self esteem. I just thought I was worthless as a person because I could do anything, patient Cathy Markworth said. "The physical therapists helped me out of that. They never looked down on me and were always supportive, and the exercise has eased my pain and helps me live my life," she added.
Note: A physician's referral is necessary for physical therapy.