In a recent discussion with Francisco Maia from the K9PT Academy about minimising our practices, the topic of the underwater treadmill came up. For Francisco, better results can be achieved without the use of an underwater treadmill. As we sign off our series of webinars with Angela Griffiths on introductions to the water treadmill, I thought we could dive into this thinking a little deeper.

There are multiple pitfalls associated with underwater treadmill treatment, including reaching an early plateau in the ability to provide progressive loading, the inability to target specific tissue structures, the possibility of strengthening incorrect gait patterns, and social and financial pressures. These pitfalls can be circumnavigated when we understand our modality well, use a multimodal treatment approach, and put the needs of our patients first.

The pitfalls

According to Francisco, the two primary pitfalls of using the underwater treadmill are the inability to provide progressive loading and the dangers of strengthening an abnormal gait pattern.

 

Progressive loading

In order for tissue to strengthen and achieve a return to normal function, we must be able to progressively load tissues, based on an in-depth knowledge of biomechanics and an understanding of the healing timelines of the specific tissue affected.

While the underwater treadmill can reduce tissue loading in the initial phases of healing by providing buoyancy and reducing body weight loading, we are limited in the degree to which we can progress the tissue loading. We can only increase the load to normal weight bearing, and the effects gained from walking on an incline, as well as increasing speed. These loading progressions may not be ideal for all cases,  and it remains cyclical in nature which is an additional disadvantage. 

An often discussed benefit of the underwater treadmill is the resistance added by the water. Certainly, this is a way for us to increase loading on the cardiovascular system and components of the muscular system,  but we are limited in how specifically we can target one or a group of tissues, and are rather loading the system as a whole. 

In essence, the value of the underwater treadmill in achieving the goal of strengthening a tissue will be limited, and will plateau early in the rehabilitation process.

 

Abnormal gait pattern

For the majority of our patients, a gait abnormality is present when they first come to see us, whatever the cause may be. Retraining a normal gait pattern is one of the important goals we strive for during a rehabilitation programme.

Repetitive walking, especially in water where there is added resistance, can strengthen an abnormal gait pattern instead of helping to restore it to normal; the very opposite of what we want to achieve.

Understanding the cause of the gait abnormality, and how it can be restored, is essential to any successful plan. Retraining will probably combine multiple manual therapy and exercise modalities, and will require a hands-on, corrective approach in the underwater treadmill.

To avoid the pitfall of strengthening an abnormal gait pattern, we must be aware of the cause, work to restore normal mobility and function through manual therapy interventions, and be hands-on in the water treadmill – assuming, that is, that this is an appropriate modality for the patient to use in the first place.

On the other hand, the water treadmill can help us to restore and retrain normal gait. To achieve this, it needs to be seen as a modality forming one part of an overall treatment plan, to be used in conjunction with other interventions. In addition, it’s efficacy and role need to be constantly re-evaluated and assessed to ensure that we are achieving optimal results for that specific patient.

 

The sausage machine

 In an interview with Dr Marta Sanchez Emden (in an upcoming episode on the Veterinary Rehabilitation Podcast), she shares that owners often want to tell her what modalities their pets should get, with the underwater treadmill being near the top of that list. Francisco has had similar experiences, as have many rehabilitation therapists. A request for underwater treadmill treatment may come from the owner, or even the referring veterinarian, when it isn’t the most appropriate treatment for that patient at that time.

It can be easy to fall into the trap of giving the owner (and the referring vet) what they’re asking for.  This path may seem and feel good to us, and pretty soon everyone is going on the treadmill. The underwater treadmill becomes a bit of a sausage machine – patient in, patient out, patient in, patient out. This is great for our business, but is it the best thing for our patients?

The answer is no. Just as we cannot use a set protocol or recipe for every patient, we also cannot slip into using one modality for every patient. Especially not in the same way. This applies to every modality, not only the water treadmill.

The use of rehabilitation modalities must always be based on patient presentation and goals and their response to the modality, and the process must remain subject to continual reassessment throughout treatment. In addition, the modality must be operated by someone who is skilled at clinical reasoning, familiar with the science behind the modality, and the best ways to use the modality in different situations and with different patients. Ideally, they have the support of a multi-disciplinary team behind them, so that they can seek advice and make clinical decisions when things veer away from the norm, and the patient is not responding as expected.

 

Conclusion

Yes, there are pitfalls to using the underwater treadmill, just as there are with any modality. Without an in-depth knowledge of the science behind a modality, an understanding of the biomechanics of our patient, a comprehensive multi-modal, patient-centric treatment approach, accountability, and a skilled operator, the water treadmill can be detrimental to our patients.

It is not a one-size-fits-all modality, and we should not view it in that light.

 

Resources

If you would like to learn more about this modality and its correct use in your practice, look up three webinars on the underwater treadmill by Angela Griffiths on our Hydro Members’ Portal:

  1. Basic use and equipment
  2. Are you ready?
  3. Patients and our treatment choices

These webinars are a great place to start if you are thinking about purchasing an underwater treadmill, or want to ensure that you have a sound foundation in its use. After all, you don’t know what you don’t know!  Unless you seek the knowledge, you will not know if there are gaps in your foundation.

In addition to the above webinars, there are many more webinars in the Hydro Members’ portal that can help you take your hydrotherapy to the next level.

You can also read some of our most popular Hydro blogs for more information! 

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