Deemed more effective than gym exercises, hydrotherapy stands out as a distinctive method in both its substantial effects and the quality experience it provides

Hydrotherapy, or aquatic exercising, is very popular in European countries and the United States. Famous athletes, including NBA giant Yao Ming, Olympic marathon runner Budd Coates, FA Premier League soccer player Antonio Valencia, have benefitted from aquatic rehabilitation, prolonging their athletic careers and expediting their healing. They unanimously applaud hydrotherapy. In the UK and the US, professional athletes include aquatic rehabilitation in their weekly raining schedules.

Up to now, aquatic rehabilitation technologies remain foreign to the Chinese SPA industry. We introduce to you the basics here.

Just like martial arts, aquatic rehabilitation is divided into different schools, including Ai Chi, which emphasizes relaxation and balance in the water, Watsu, a type of soothing aquatic ballet with the assistance of therapists, Halliwick, group training with game themes and Bad Ragaz Ring Method, which focuses on buoyant and resistant forces. The above are some of the more known and systematic water therapies, aiming at different aspects depending on the recipients.



The Halliwick concept is a set of technologies and ideas that teach everyone, especially those with athletic or learning disabilities to do water sports, and eventually enable them to exercise independently and swim in the water. The modern Halliwick concept is made up by two main systems, the “Ten-Point-Program” and “Water Specific Therapy (WST)”, also referred to as the basic and advanced courses of Halliwick.

The former are primarily used for teaching swimming, the latter for further exploration, focusing on treating body structure deficiencies and functional obstacles. There is no strict border between the two, which complement each other in their application. As an important concept in aquatic sports rehabilitation, Halliwick has profound influence over it.

Today, the Halliwick concept has formed a distinctive set of analysis, judgment, treatment, recording and review process, widely applied to children’s rehabilitation, neurological rehabilitation and orthopedic rehabilitation. Clinical research has shown that the interesting water sports adopted by the Halliwick concept have positive influence on multiple aspects of the patient’s recovery, including body functions, mental state, personality, entertainment and socialization.


Bad Ragaz Ring Method

Bad Ragaz Ring Method (BRRM) is a type of hydrotherapy used for aquatic rehabilitation and improvement of sensory, neural and PNF systems. Originally developed by physical therapists in Switzerland, it uses the water’s physical properties to intensify and utilize water buoyancy and resistance, on grounds of human body movements. The “ring” in BRRM refers to a unique auxiliary instrument, used for supporting recipients’ floating and exercising in the water.

German doctor Knupfer first developed the BRRM spa in the 1930s. In the 1950s and 1960s, American neurologists Herman Kabat and his assistant joined in the study of PNF technologies. The method takes advantage of the multiple properties of water, especially buoyancy, turbulence and resistance, in order to fix functional problems in joints and muscles, combining anatomy, biology and kinesiology.

Normally, BRRM provides extra buoyancy for the neck, the pelvis, the arms and the legs, supplying a more stable support for patients to maintain a supine position in the water. Therapists stand in the pools, slightly bending their pelvises and knees, to instruct patients to practice certain moves. The key to such a method is increasing movement of the joints and sensitivity of nerves and muscle tissues, as well as enhancing muscular functions.


Clinical Ai Chi

Ai Chi is a type of spa technology that combines multiple elements: entertainment, relaxation, fitness and wellness. Compared to other spa technologies, Ai Chi is more malleable. Essentially, Ai Chi utilizes aquatic breathing skills and resistance training to achieve rehabilitation, incorporating elements of relaxation, meditation and Tai Chi.

In general, Ai Chi relies on aquatic relaxation and stretching to achieve rehabilitative effects. It first emerged as an exercise at a hydrodynamic research institute in Yokohama, Japan in 1993, and later became a serious and scientific independent therapy. Usually, practicing Ai Chi requires standing in shoulder-level water and one-on-one instruction from therapists to patients. The initial Ai Chi focuses on the use of deep breathing, and such focus remains in its later development. In the process of performing Ai Chi, one utilizes breathing skills when performing gentle movements, which are slow and continuous. Ai Chi provokes positive mentality often, exactly because of such calmness.



Watsu is a form of passive aquatic therapy used for deep relaxation and exercising, combining elements of muscle stretching, joint mobilization, massage, Shiatsu, and dance, performed in chest-deep warm water (around 35°C or 95°F). Watsu is characterized by one-on-one sessions in which the recipient remains supported by a practitioner or therapist while being back floated, rhythmically cradled, moved, stretched, and massaged.


History and Origins

In the early 1980s Harold Dull adapted Zen Shiatsu for use in warm water pools at Harbin Hot Springs in northern California, with emphasis on connecting with the breathing patterns of the recipient and establishing a meditative state during sessions. Dull observed that people receiving Watsu treatments entered a deep relaxation state, with strong physical and emotional effects. In the early years, massage therapists were the main practitioners of Watsu, offering sessions as a new category of hydrotherapy called aquatic bodywork. By the late 1980s and early 1990s, physical therapists and other healthcare providers began applying Watsu to treat various orthopedic and neurologic conditions. While Watsu's roots in Shiatsu and the close physical contact led to some early resistance among those trained in conventional healthcare, Watsu is now practiced in spas, clinics, and hospitals, and utilized as an aquatic rehabilitation technique.

Aquatic exercises differ from those on land. Recipients are more confident doing them. The multiple benefits of aquatic rehabilitation mentioned above are ascribed to the following reasons:



It is common knowledge that water has buoyancy. Different depths of water create different levels of buoyancy; people of different weights experience different senses of buoyancy. When in water, part of the body weight is supported by buoyancy, enabling the muscles to relax. This characteristic is useful for reducing fatigue and pain.

Aquatic buoyancy is especially useful and important for the injured. Scientists have confirmed the indubitable effects of buoyancy to maintain one’s energy, relieve muscle and joint pain, and increase mobilization of injured limbs through testing on the electromyographic response of human nerves immersed in water.

Aquatic training improves the performance of professional athletes. For instance, marathon runners endure greater stress on their knees as the miles they run accumulate. If they just keep running, their knees would get injured from excessive pressure, but if they stop running, their performance would not be raised. Aquatic rehabilitation, which takes advantage of water’s buoyancy, strengthens the stamina and power of muscles and relieves the pressure of joints, saving the energy while training the muscles to keep their strength, so that the athlete’s training plans can be performed. Although aquatic training for marathon runners is different from that on land, it still improves cardiovascular efficiency, as well as muscular strength.



When immersed in water, the human body experiences a kind of pressure from water, water pressure, which prompts liquids in the limbs to flow towards the heart, quickening nutrition supply and excretion, increasing cardio output, and fighting circumambient water resistance.

The human body reacts to an aquatic environment whether it is still or moving. The physiological reactions in a still state is caused by water pressure. Receptors in human body cause blood redistribution. Venous pressure in right atrial is raised, resulting in the Frank Starling Reflex and an increase in stroke volume. In a still state, the heart rate remains constant or decreases despite an increase in stroke volume or cardiac output; the degree of change in the heart rate correlates with the water depth, the body position and the means of exercising. The change of heart rate in water differs from that on land to a certain degree. Generally speaking, the heart rate in water is 17 beats slower than it is on land.



As an ancient Chinese saying goes, “water can float a boat, but it can also sink it.” Water provides assistance as well as resistance, training one’s body with unexpected force. Water has interesting properties related to resistance. It causes the muscles to perform isokinetic contraction, where the speed of one’s movement remains constant regardless or his strength, since the more powerful the move, the stronger the resistance. Theoretically, practicing to use different levels of power (such as 100%, 75%, 50%) effectively improves muscle stamina or strength. Compared with strength training in gyms, which requires constant readjustment of the weight of the instrument, aquatic training is indeed more efficient. In addition, when in water, resistant forces enclose one from all directions. Resistant forces incorporated with movement in sports (for example, jumping and dashing in basketball) enable one to effectively transfer the training effects into performance on the field.

Human movement slows down in water. With all three dimensions under resistance, the human body responds more readily to its proprioception, causing recipients to slow down in their moves and enter the early stage of rehabilitation, where a higher level of dynamic stability is achieved, with less pain in muscle and joints. Some aquatic exercises use swimming shoes or web to increase resistance against feet and legs, effectively improving muscular kinesthesia.

The range and speed of aquatic movement is decided by the purpose of the program. In general, the greater the range and speed of the movement, the greater resistance it causes, and the resistance exerts pressure to the cardiovascular system. Therefore, beginners should take it easy with the range and speed of their movement and wait until they master their coordination and skills to increase the intensity.


Water Temperature and Effective Elements in Water

Another characteristic of aquatic movement is the water temperature. Many rehabilitative hydrotherapy pools are between 32°C 35°C, because this temperature is suitable for all kinds of stretching and enhances blood circulation, inducing muscles to further relax. Exercising in the pools can also relax muscles with significant effects in amelioration of swelling.

Speaking of the beneficial elements in water, most would think of hot springs, where assorted minerals heal the human body. They are not to be further discussed here. In many foreign countries, sea water is the top choice for hydrotherapy: the content of sea water is very close to that of human blood and lymph fluid; there are iodine, potassium, calcium, magnesium, sulfur and other elements or mineral catalysts, which improve metabolism and coordinate activities of endocrine organs; sea water contains a large amount of biological stimulants, which aids activities of endocrine glands; elements in sea water enter the skin as crystalized substances, making the skin elastic and smooth; when touching sea water, the human body creates negative ions on the surface, which sedates the mind and soothes pain. A sea water bath after onerous physical labor or intense intellectual activities can erase fatigue, reduce work pressure, increase stamina, and enhance immunity of the organism. Last but not least, salts in sea water increases water buoyancy, creating the conditions for some aquatic exercises.

Modern technology permits artificial creation of some beneficial elements in sea water with saltwater pools, which are a good substitution for spa and rehabilitation centers away from the sea.



Aquatic treatments and exercises improve muscle strength, relieve pain, maintain the balance, accelerate the rehabilitation process, promotes proprioception, benefits physical and mental health, realizes deep relaxation, refreshes the organism, enhances blood circulation, increases joint mobilization and boosts self-confidence.

However, in the application of hydrotherapy, it is important that:

       Recipients perform sufficient warm-up before exercising and relax afterwards

       The processes of rehabilitation treatments need to be reasonably arranged by professionals

       The method should not be applied for open sports injuries

       The method should not be applied to patients with contagious diseases

       Treatments should be monitored by professionals and stopped to be readjusted if recipients sense discomfort.