Senior Physiotherapist, Ms Lindsey Jean Ross Weller, helps eight-year-old Garren with hydrotherapy exercises to improve muscle strength and joint mobility.
At KK Women’s and Children’s Hospital (KKH), hydrotherapy is being used to enhance and complement conventional land- and gym-based therapy for women and children with conditions such as neurodevelopmental delay, cerebral palsy, muscle dystrophy, chronic pain, osteoarthritis and sports injuries.
Hydrotherapy is the use of water as a medium to carry out therapeutic exercises to reduce pain, improve physical strength and function, and enhance quality of life after sustaining an injury or disability. Studies have observed better compliance and adherence to hydrotherapy compared to land therapy, as patients tend to experience less pain and more ease of movement1.
“The buoyancy and resistance of the water provides a unique environment for rehabilitation,” explains KKH Senior Physiotherapist, Ms Lindsey Jean Ross Weller.
“In the water, patients with physical restrictions – such as low muscle tone or weakness, disabilities, injuries and even paralysis – are able to safely and comfortably perform exercises that are not achievable while on land. This enhances their rehabilitation, improving their strength and cardiovascular fitness, as well as flexibility, balance, coordination and mobility.”
The hydrotherapy pool at KKH is equipped with a ramp and a commode wheelchair for easy access into the water for patients who are unable to stand. Three different pool depths also allow patients to experience therapy at different body weight loads.
Hydrotherapy for pain management
Hydrotherapy is conducted in heated water, 32 to 34 degree Celsius, as warmth helps to ease tight muscles and enhance relaxation, which reduces pain. Hydrostatic pressure also increases venous return and circulation, which can also help to ease oedema and further reduce pain.
These can help to increase range of motion, and bring relief to patients who suffer from chronic and acute pain. “We have patients of all ages who struggle to walk or do any land-based therapy, and are also unable to visit the public pool independently. Some suffer from chronic pain due to neuromuscular conditions such as fibromyalgia and osteoarthritis.
Hydrotherapy provides a healthy and sustainable way to manage their pain and maintain strength and fitness, as it gives them the benefits of rehabilitation and exercise while reducing the pressure and body weight loading on their limbs,” adds Ms Weller.
At KKH, hydrotherapy is provided by certified physiotherapists; all patients will be assessed to ensure there are no contraindications prior to commencing hydrotherapy, and regularly monitored to determine their goals and suitability.
Hydrotherapy is particularly beneficial for children with gross motor delay and global developmental delay, enabling them to build and maintain muscle strength and tone, and improve limb functionality and walking ability.
For children who are unable to walk or crawl due to neuromuscular conditions, hydrotherapy may be their only opportunity to experience freedom and independence of movement. The child can learn how to swim, stand and walk in the water with the appropriate flotation device.
Hydrotherapy can even be used to maintain lung function and inspiratory muscle strength through games which encourage them to blow bubbles or blow objects in the water.
Moreover, water provides a tactile, auditory and visually stimulating environment that can be especially beneficial for children with sensory integration disorders. Therapy conducted using this medium can enhance their ability to perceive their surroundings through their senses, and coordinate their limbs to respond more effectively to the stimulus.
Case study: Hydrotherapy for an eight-year-old child with hypotonia and a tracheostomy
Eight-year-old Garren has hypotonia and hypermobile ligaments, in addition to a tracheostomy to help with his breathing. He also has global developmental delay. Garren’s parents experienced difficulty carrying out water-based therapy for him at a public pool due to a fear of the public not being accustomed to children with special needs, and water being accidentally splashed into his tracheostomy by other pool users, which would cause him to experience breathing difficulties and expose him to possible infection.
Garren has been undergoing regular hydrotherapy at KKH for nearly two years. Each 30-minute session comprises exercises to strengthen the muscles of his trunk and limbs, and enhance his joint stability, flexibility and range of motion – all of which are crucial in enabling him to sit upright and walk with less assistance.
Hydrotherapy also provides sensory stimulation to improve his body awareness. This is beneficial for his overall strength and mobility, and to improve his sitting or standing balance. Hydrotherapy is also a source of enjoyment for Garren, as it provides freedom of movement and pleasant stimulation for his senses.
Antenatal aqua workout
“The benefits of hydrotherapy can also be applied through antenatal aqua workout to relieve pregnancy-related aches and pains, and help women maintain and even improve cardiovascular fitness during pregnancy,” says Ms Weller.
“Maintaining a regular and moderate exercise routine during pregnancy helps to prepare them for labour. It also improves insulin sensitivity, which can have a beneficial effect on blood sugar levels and help to reduce blood pressure.”
The Rehabilitation Centre at KKH conducts the only antenatal aqua classes in Singapore that are run by physiotherapists. The physiotherapist is able to modify exercises to suit the physical condition of each participant, ensuring that they do not strain their muscles or injure themselves.
“The effect of warm water helps to reduce stiffness, spasm and pain caused by tight or aching muscles during pregnancy. The buoyancy of the water also reduces the effect of gravity, allowing the woman to exercise more freely and easily in the water even with a big tummy,” Ms Weller added.
Under the supervision of a physiotherapist, pregnant women, even those who are not able to swim, can safely engage in exercises to improve strength in specific muscles, such as pelvic floor control, and reduce pain due to muscle strain, such as in the lower back.
Refer a patient:
Polyclinics and community healthcare practitioners can contact KKH at
+65 6294 4050 to refer patients for consultation and assessment on their suitability to commence hydrotherapy.
Antenatal aqua classes at KKH are open to the public. For more information, please contact the KKH Patient Education Centre at
+65 6294 4050 or email
- Declerck, M., Verheul, M., Daly, D and Sanders, R (2016) Benefits and enjoyment of a swimming intervention for youth with cerebral palsy: an RCT Study, Pediatr Phys Ther, 28:162-169.
This article acknowledges the inputs of the Physiotherapy Department, KKH.