Why is Swimming and/or Hydrotherapy Often a Popular Choice for Physical Therapy?

Swimming is, undoubtedly, one of the most popular activities in the United States (and, in my humble opinion, quite possibly, globally). 

Whether it be for fun/leisure, sport, or rehab/recovery, swimming is a suitable activity for nearly everyone regardless of age or ability (of course, as with most anything, there are potential exceptions).

This in conjunction with the many general health and wellness benefits of water-based physical activity as well as the benefits from the natural, inherent properties of water itself makes swimming and/or hydrotherapy an excellent choice for physical therapy (and general physical fitness/wellness for that matter). 

One does not have to be a skilled swimmer to benefit from swimming and/or hydrotherapy- as stated it is a suitable activity for nearly all ages and abilities. Most of us are familiar with what swimming is; so, we will skip an explanation.

However, if you are not familiar with the term hydrotherapy and/or what it is it is also known as aquatic/aqua, pool, or water therapy, and is defined as the practice of using water as therapy and/or using water in different ways to affect the body positively.

Hydrotherapy can include anything from running- whether it be with a weight belt or on an underwater treadmill- to stretching (and more).

The inherent properties of water (buoyancy, viscosity, hydrostatic pressure, and temperature) add to the physical benefits of swimming and hydrotherapy- making either an excellent choice for the management of conditions such as arthritis, muscle/nervous system conditions, general fitness, or for rehab/recovery post-injury/surgery.

Both activities are not only beneficial in general for the aforementioned areas/conditions, but are also specifically beneficial for soft tissue injuries such as strains, sprains, and tears- after proper healing and once cleared for such activities, of course.

Furthermore, swimming (or walking in water) is recommended by The American College of Sports Medicine (ACSM) among the four preferred rehab exercises for injuries to soft tissue (i.e. ligaments, muscles, and/or tendons). We will dive deeper into this particular topic- soft tissue injuries/sprains and swimming/hydrotherapy- a bit later in the article (so, keep on reading… or, skip ahead and come back-either way). 

While swimming and hydrotherapy have many physical wellness and rehab benefits, they aren’t just beneficial physically, studies have also shown that swimming and hydrotherapy both have positive effects on mental and overall health & well-being too.

The Centers for Disease Control and Prevention (CDC) concurs with these findings stating that the benefits of swimming extend to improving mood and reducing anxiety. 

The natural, inherent properties of water provide light resistance and support for the body and also make for a low-impact environment. This low-impact environment, in turn, provides a safe and comfortable way for one to increase their range of motion and strength. This provides further reasoning as to why swimming and/or hydrotherapy are often popular choices for physical therapy. 

Generally, the pool (or open water) is a great starting point after injury/surgery/[severe] illness (after proper healing time and clearance from your physician and/or physical therapist to return to physical activity). 

Also, check out our post titled Can Swimming Make You Taller (or Shorter)? What Does Swimming Do To Your Body!

Another benefit to swimming and/or hydrotherapy, making either an appealing option for physical therapy, is that most insurances will cover such therapies, and (even for recreational purposes) it is relatively easy to start and maintain either activity. All you need is a swimsuit, goggles, swim cap, towel, and access to water -whether it be a pool or open water. 

Whether it is part of your rehab/recovery or your general fitness/well-being routine, remember to start slow and build over time (as with running or cycling, or pretty much any physical activity). (Source A) (Source B

What Is the Therapeutic Value of Water Swimming / Hydrotherapy?

Water is essential to everyday life from drinking it to using it for bathing. It’s also a large part of our recreational life whether it be swimming in it and/or participating in hydrotherapy. Water helps keep us healthy and treat disease/sickness.

The therapeutic value of water lies within its natural, inherent properties- buoyancy, viscosity, hydrostatic pressure, and temperature. 

There are many different uses for and ways to use hydrotherapy (and swimming)- both warm and cold water- particularly concerning therapeutic value. All of which is accomplished not only by the physical activity itself in the water but via the natural, inherent properties of water as well. 

From ice on a sprained ankle to group water aerobics for general fitness and/or rehab & recovery, there are many forms of hydrotherapy and applications for its therapeutic value. Some of the most common forms of hydrotherapy include aquatic exercise (water aerobics, swimming, yoga- yes, water yoga is a thing.

Check out the YouTube video and other links below and/or look it up for yourself-whatever you prefer), aquatic physical therapy (with a licensed/certified therapist and/or personal trainer), warm water bath, sitz bath (ideal for the treatment of/pain management for hemorrhoids and anal fissures),  saunas, and immersion therapy (cold water; much like an ice bath). 

Hydrotherapy and swimming are not only exercises performed in the water, but they use the inherent physical properties of water to aid in the healing process(es) & exercise performance.

Both activities can aid things as simple as stress or acne to more complex/serious conditions such as obesity, joint problems, and muscle/nervous system disorders. Both can also have a positive effect on mental health (as has been mentioned). 

Let’s take a look at each of the inherent properties of water that contribute to its amazing benefits and the therapeutic value of swimming and/or hydrotherapy: 

1- Buoyancy

The buoyancy of the water helps to support weight thereby decreasing the amount of weight one is bearing. This reduction in weight-bearing, in turn, reduces the force stress placed on joints. This is especially beneficial to those with arthritis, who are healing a fracture/soft tissue injury, or who are overweight. 

2- Viscosity

The viscosity of water refers to the magnitude of the water’s internal friction.  Water’s viscosity provides a light resistance that can easily be incorporated into one’s exercise and/or therapy program.

This light resistance allows one to build muscle strength without the need for weights (though they do make weights specifically for the water for those that could benefit from the added resistance- be sure to check with your therapist first) and with decreased joint stress that one can not achieve on land. 

3- Hydrostatic pressure

Hydrostatic pressure- the pressure that any fluid in a confined space exerts- of water is utilized to decrease swelling and improve joint position awareness. The pressure forces of water are perpendicular to the body surface which allows for improved joint position awareness.

Improved joint position awareness results in improved proprioception (improving proprioception is important to those recovering from a soft tissue injury-again, more on that later in the article).  Hydrostatic pressure also decreases joint/soft tissue swelling that results from injury and/or arthritic conditions. 

4- Temperature

Swimming and hydrotherapy can be done in either warm (heated) or cold (natural temperature/manually cooled) water. Warm/heated water is good for reducing pain, relaxing muscles, promoting better blood flow (vasodilation of blood vessels)- especially to injured areas, flushing out toxins, and relieving constipation.

Cold (whether naturally or manually made so)  water is good for reducing pain and inflammation, decreasing soreness in muscles (i.e. decreasing the likelihood of Delayed Onset Muscle Soreness- also known as DOMS), decreasing body temperature, and boosting the immune system. 

Also, check out our post on why Is Swimming Good for Hamstring Injury?

These inherent properties work together to create a low-impact environment well suited to do work on and improve strength, balance, and other functional skills. 

Other, more specific, therapeutic benefits (value/values) of swimming and/or hydrotherapy include (respectively) that it is low-impact on joints, increases cardiovascular endurance, offers whole-body sensory input, buoyancy & resistance of the water are used to enhance and/or facilitate exercise(s), a whole-body workout, improves motor planning/functioning & coordination, and improves muscle tone. 

Though water overall is beneficial and can provide therapeutic value for nearly everyone, it does pose some limitations, and there are some exceptions.

For example, one can make gains in the water, but those gains made in the water don’t always translate to land/to gains on land (i.e. you may be able to walk in the water with ease, but on land still have difficulty walking).  Also, it may not be the best modality for the functional and strength improvements desired/goals that you have for yourself/your rehab & recovery. 

Be sure to know and understand your desired improvements and goals (overall outcome) and whether or not swimming and/or hydrotherapy would move you toward those or hinder them.

Because hydrotherapy is generally beneficial for just about anyone, but not necessarily for everyone, always discuss with your physician and/or physical therapist before deciding whether or not it is the right/a viable option for you.

Also, be sure to work with a physical therapist or certified personal trainer with specialized training for such programming/programming that includes hydrotherapy exercises and/or swimming versus trying to go at it on your own. (Source A)  (Source B) (Source C) (Source D

Also, check out our post on Is Swimming Good for A Frozen Shoulder? Great Workouts To Try!


Does Swimming Help with Recovery?

Swimming, as was mentioned in the intro,  is a popular activity around the globe (particularly in the United States) and amongst all ages and abilities. Due to its low risk of musculoskeletal injuries, it is a safe exercise for most people (though there are always potential exceptions; so, be sure to check with your physician/therapist/coach first). 

Whether you are dealing with muscle pain/soreness, coming back from an injury, or are new to the gym/working out and looking for a fun activity, swimming and/or hydrotherapy are great options.

Both provide great cardio (benefits) while using nearly every major muscle group. So, it’s truly a whole-body workout, but it’s low-impact (which means it’s more joint-health friendly). 

According to studies, swimming is one of the best recovery modalities/techniques. Some studies show that athletes can improve times/scores in other sports via incorporating a recovery swim/swimming into their training routine (e.g. one study showed run times of triathletes were considerably better when a recovery swim was incorporated into their training). 

Other, studies show swimming has cardiovascular and muscular benefits as well as the ability to lower the risk of early death and keep people mentally and physically fit. Those same studies also indicate positive benefits to those dealing with joint/muscle problems/ailments.

A recovery swim/swimming doesn’t have to be just swimming laps. It can include water aerobics, water biking, water running, diving, or water yoga. Swimming and/or hydrotherapy are great recovery activities after a hard strength day and/or for some fat-burning cardio (HIIT) as both build cardiovascular fitness, improve muscle strength & endurance with little impact and no weight-bearing, and overall tone the body.

Additionally, due to their low-impact nature and being non-weight-bearing, both activities are safe for joints. 

To further clarify, swimming and/or hydrotherapy are good for active recovery and recovery from an injury/surgery/illness. With regard to active and passive recovery, active recovery is performing lighter activity/activities than your usual workout (with the aim being to enhance recovery) whereas passive recovery is complete, total rest.

 Active recovery is important for several reasons including decreasing fatigue, preventing

Overtraining, and improved blood flow to muscles and joints resulting in better recovery. (We will dive into the benefits of recovery from an injury/surgery/illness more in the next section)

Swimming and/or hydrotherapy are optimal activities for active recovery as well as recovery from injury/surgery/[severe] illness. Either can be used immediately after a workout as a cool-down, as an active recovery “off”/cross-training day activity, or as part of their rehab/recovery post-injury/surgery/[severe] illness. (Source A) (Source B) (Source C)

Also, we recommend that you check out our post titled ” Swim or Gym – Which Is Better? Should You Swim Before or After a Workout!

Is Swimming Good for Ankle Rehab?

An ankle sprain stretches or tears the soft tissue(s) (ligaments, tendons, muscles) of the lower leg and foot depending on the severity of the sprain. Proper healing is critical to a complete and successful recovery.

It is always best to check with your physician and/or physical therapist before getting into the pool/open water to swim or take part in hydrotherapy after a soft tissue injury-particularly to the ankle. 

While the recommended protocol for an ankle sprain is RICE (Rest Ice Compression Elevation) and a mild ankle sprain needs at least one week to heal before easing back into activity, with precautions one may still be able to swim.

Because sprains vary in severity and returning to physical activity, including (but certainly not limited to) swimming, could prolong or even prevent the healing process, it is best to follow the instructions of your physician and/or physical therapist. However, once cleared for physical activity, swimming is an excellent choice for rehab/recovery. 

On a side note, we also have written an article on tennis elbow titled “Is Swimming Good for Tennis Elbow? The Do’s and Don’ts !“. The recommendation in this post could be used for ankles as well.

It is important to note that severe ankle sprains may require more healing time and/or specific physical therapy before returning to normal physical activity such as swimming. 

The kicking motion- regardless of stroke- puts the ankle in plantar flexion (the foot/toes are pointed) and slightly inverted (the toes pointing in slightly) which places more direct pressure on the soft tissue of the ankle that was sprained. This direct pressure will continue to stress and aggravate the sprained ankle, and, ultimately, delay or even prevent proper healing. 

Once one has been cleared for physical activity and specifically returning to swimming (or hydrotherapy), it is not a bad idea to utilize a pull buoy to minimize the amount of kicking/need to kick initially.

Additionally, the first 2 to 4 weeks of your rehab/recovery should focus on strengthening the ankle and assuring a full range of motion without discomfort.  As one gains back full range of motion/mobility and strength in the ankle without discomfort/pain, one can lose the pull buoy and start incorporating kicking again. 

Propulsion through water relies greatly on ankle mobility/flexibility, stability, and strength (as well as general strength of arms/shoulders and lower body). Ankle,  strength, mobility/flexibility, and stability are key to effective form when it comes to swimming.

The ankle is a complex joint and as such recovery from an ankle injury requires one to focus on certain types of exercises to regain ankle strength, stability, and mobility/flexibility.

Types of exercises to focus on for regaining strength, mobility/flexibility, and stability in the ankle include range of motion (ROM) exercises, stretching exercises, strengthening exercises, and balance & control exercises. (Source A) (Source B)( Source C)(Source D)

Also check out Can You Swim with A Broken, Sprained, or Stubbed Toe? (Complete Guide)

How Does Swimming Prevent Injury?

Swimming is recognized as one of the best whole-body workouts,  has proved to be a beneficial cross-training and recovery workout for athletes (particularly runners), and has proven benefits for rehab/recovery post-injury/surgery/illness. It has proven, positive benefits to the body and mind for people of all ages. 

As an exercise, swimming gets the heart rate up (cardio) and builds muscle/muscle endurance (strength). Because it is a low-impact, non-weight-bearing activity, one can reap the benefits of heart health and/or core & overall strength while maintaining joint health. Plus, as has been mentioned,  it is quite literally a whole-body workout. 

Not only is swimming a fun activity with several physical and mental health benefits, but it can also help heal (and even prevent) injuries. Swimming is great for exercise and rehab/recovery alike. 

Also find out How Far Can the Average Person Swim? 1 mile, 10 miles, 30 min & Underwater ?!

Some reasons swimming is  great for rehab/recovery and injury prevention (as well as general exercise) include that it is 

  1. Low impact 
  2. Non-weight-bearing
  3. A form of active stretching/recovery
  4. A good cardio workout 
  5. May promote and/or assist in regenerating damaged nerves
  6. Increases bone strength 
  7. Builds muscles used in other activities (such as running) 
  8. Allows one to stay fit while maintaining joint health (even during rehab/recovery post-injury/surgery/illness) (Source A) (Source B) (Source C)(Source D)

Check out this post to find out if “Swimming Can Help In Running/Marathon Training?

Melissa Frank

My passion, outside of animals, is helping people and adding value to their lives…I strive to leave the world a little better than I woke to it each day. The first part of my career, for a total of about 15 years, was spent in the public safety field as a Volunteer Firefighter/EMT-B and 9-1-1 Operator. In 2019 I obtained my personal trainer certification (ACE certified) as well as many group fitness certifications and certification as a Corrective Exercise Specialist.

Recent Posts