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Aquatic training programs benefit injured athletes

This is an excerpt from Aquatic Exercise for Rehabilitation and Training by Lori Brody & Paula Geigle.

Injured Athletes

Some form of rest is often the treatment recommendation for an injured athlete. The rest may be relative rest, in which the athlete reduces the intensity of training or activity, or it may be absolute rest, during which the athlete performs no activity. In either case, rest for an athlete can be problematic. The research of Coyle et al. (1986 and 1984) showed that a significant decline in cardiovascular fitness can result from as little as 3 wk of inactivity. A 14 to 16% decline in maximal oxygen consumption has been documented after 6 wk of rest (Coyle et al., 1986 and 1984). Given that 3 to 6 wk is not an inordinately long period and certainly within the realm of the time needed for recovery from a musculoskeletal injury, the loss of cardiovascular fitness needs to be considered. An athlete may rehabilitate an acute injury only to find that he or she returns to the sport with a significant loss of conditioning. Fortunately, the aquatic environment can help to mitigate some, if not all, of the potential fitness loss.

A study by Michaud, Brennan, Wilder, and Sherman (1995) demonstrated that a progressive, 8 wk deep-water running program can successfully increase V.O2max. Exercise sessions performed three times per week at an intensity of 63 to 82% of maximal HR on land for 16 to 36 min per session were sufficient to produce a training stimulus. For the athlete, specificity of training is an important element to maximizing the application of fitness. Athletes who participate in sports that involve running could benefit from either shallow- or deep-water running, depending on weight-bearing limitations. When they are able to do so, athletes should “run off the shallow end” into the deep water to maintain proper running form (Thein and Brody 1998). They should include a slight forward lean and take the leg through to the horizontal position in a swing, avoiding circular motions (see figure 11.8). The elbows should be at 90° with the hands open, avoiding a dog paddling motion (Chu and Rhodes, 2001). As previously stated, HR, running cadence (with a metronome), and RPE (respiratory and leg musculature) are all useful tools to ensure that the cardiorespiratory system is challenged.

The cross-country skiing motion is an effective way to challenge both the upper and lower extremities. The reciprocal motion also recruits the oblique muscles to contribute to trunk stabilization. Swimming can be incorporated into a cardiovascular program in many ways. Although the front crawl and backstroke utilize a variety of large-muscle groups, many athletes are not accomplished swimmers and may not be able to achieve an adequate cardiovascular workout. Modifications such as flutter kicks or dolphin kicks with flippers or holding a kickboard with the hands can provide a conditioning effect to the unskilled swimmer. The athlete can perform any of these tasks exclusively or in combination to achieve a sustained workout in the range of 60 to 90% of maximal HR reserve or an RPE of 13 or 14 (somewhat hard or harder).

In addition, using interval training or circuit training can add variety to a program and reduce the risk of boredom. Interval training consists of alternating bouts of high-intensity and low-intensity (recovery) periods. Work periods should last for 2 to 8 min, and HR should be in the 80 to 90% range for the high-intensity periods and in the 60 to 70% range for the low-intensity periods. Total workout duration should be 20 to 50 min (Bates and Hanson 1996). A lower-extremity sample program is displayed in table 11.10, and an upper-extremity program is shown in table 11.11.

Table 11.10

Lower-Extremity Aquatic Exercises for Athletes
Exercise	Duration	Intensity
Water running	3-5 min	High
Scissor kicks	2-3 min	Low
Cross-country skiing	3-5 min	High
Trunk rotations	2-3 min	Low
High knee running	3-5 min	High
Leg figure-eights	2-3 min	Low
Water running	3-5 min	High
Double knee to chest	2-3 min	Low
Cross-country skiing	3-5 min	High
Butt kicks	2-3 min	Low
Total time	25-40 min

Table 11.11

Uper-Extremity Aquatic Exercises for Athletes
Exercise	Duration	Intensity
Reciprocal arm swings	3-5 min	High
Sagittal elbow flexion and extension	2-3 min	Low
Rowing with a float board	3-5 min	High
Trunk rotations holding a ball	2-3 min	Low
Arm jumping jacks	3-5 min	High
Ball press-downs	2-3 min	Low
Reciprocal arm swings	3-5 min	High
Horizontal elbow flexion and extension	2-3 min	Low
Arm figure-eights	3-5 min	High
Arm press-outs (serratus)	2-3 min	Low
Shoulder internal and external rotation	3-5 min	High
Total time	25-40 min

In circuit training the athlete uses a series of exercises that alternates the use of muscle groups. Again, the workload of each activity in the circuit should be 50 to 70% of functional capacity (Bates and Hanson 1996). By alternating muscle groups, the athlete can mitigate muscle fatigue to achieve the objective of continuous movement with the HR in the target training zone. Each activity may be performed for 2 to 3 min or for 30 to 50 repetitions. Some suggestions of sport-specific tasks are displayed in table 11.12. Increasing the speed of movement increases turbulence, which in turn increases resistance. Increasing the surface area of the moving body part with flippers, floats, boots, mitts, water wings, or paddles will also increase resistance to movement. Flotation devices such as float boards, AquaJoggers, and Aqua-Belts can allow a person to work in a non-weight-bearing situation. Thus, individual muscles and the cardiovascular system can be challenged without the joint compression forces experienced on land.

Table 11.12

Sport-Specific Aquatic Exercises for Athletes
Sport	Aquatic exercise
Tennis Baseball Softball	• Swinging a tennis racket (forehand and backhand) or baseball bat in the water • Lower-extremity braiding • Forward, backward, and side-to-side ricochets • Scissor kicks • Shoulder IR and ER with paddles
Football	• Plowing through the water with a kickboard • High-knee running • Forward and backward running • Ball push-downs
Soccer Field Hockey Lacrosse	• Forward, backward, and side-to-side ricochets • Lower-extremity braiding • Upper-body wall push-ups • Walking lunges • Leg figure-eights • Reciprocal rowing with paddle
Gymnastics Track and Field Jumpers Basketball Volleyball	• Floating squats* • Tuck jumps • High-knee skipping • Straddle jumps • Box drops • Ball push-downs • Upper-body wall push-ups
Sprinters	• Floating squats • Tuck jumps • High-knee skipping • Straight-leg kicks • Split jumps • Horizontal squats with push-offs from the side • Box drops • Reciprocal rowing with paddles
Skating Ice hockey	• Plowing through the water with a kickboard • Lower-extremity striding • Floating squats • Tuck jumps • Lower-extremity braiding • Diagonal scissor kicks • Reciprocal rowing with paddles
Cycling	• Bicycle motion with a flotation device • Floating squats • Walking lunges • Flutter kicks with a float board • Box drops • Deep-water high-knee jogging
Wrestling	• Floating squats • Walking lunges • Tuck jumps • Plowing through the water with a kickboard • Resisted trunk rotation • Ball push-downs • Upper-body wall push-ups

*Floating squats=perform a leg press motion while standing on a float board.

This is an excerpt from Aquatic Exercise for Rehabilitation and Training.

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