We Are Currently Offering Telehealth

Your Physical Therapist Can Help You Keep Your Resolution

As one year comes to a close and another begins, people begin to set goals and make
resolutions. Losing weight, getting to the gym more often or getting into “better shape” are all
common. These all require increasing your amount of physical activity. More activity is great for
your health, energy levels, sleep, and mood. However, ramping up your activity level too quickly
after a holiday season of eating, drinking and being merry can lead to pain, injury and
disappointment if your body isn’t ready for it.

Your physical therapist is an expert in human movement, and can help you safely reach your
fitness goals. People think of PTs as the person to see after an injury, but a visit before you
change your activity level could prevent injury in the first place. An evaluation by your PT will
include assessment of your strength, range of motion, and functional movement patterns – think
jumping, running, squatting, carrying. Some PTs even like to use a standardized assessment,
such as the Functional Movement Screen.

Most common injuries from new fitness routines are caused by underlying weakness, range of
motion deficits, or compensatory movement patterns. Your PT will find these during your
assessment. They can then prescribe exercises or movements to address the issues found and
get you safely moving into the new year!

The other common way people get injured working towards their resolution is with over-training,
or doing too much too soon. Physical therapists are also experts in exercise prescription and
program design. Your PT can help you create a routine specific to your needs and goals that will
progress appropriately and keep you out of trouble.

So stop only thinking of your PT after you’re injured. In this case, it’s true that an ounce of
prevention is worth a pound of cure. Seeing your physical therapist before you start on your
resolution can keep you on track, injury free, and help you reach your goals for the new year!

#Get PT 1st For Back Pain

Chances are, you or someone you know has had back pain. Each year 15% of the population has their first episode of back pain, and over the course of our lives, 80% of us will have back pain. Even though back pain is common, the medical community does a poor job managing it.  Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common.

Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:
Medication Low back pain is the #1 reason for opioid prescription in the US, however in 2106, the CDC recommended against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.”

Imaging

Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful.
Research has NEVER demonstrated a link between imaging and symptoms. As we age,
degenerative changes on imaging is common.
● 90% of people age 50 to 55 have disc degeneration when imaged, whether they have
symptoms or not
● In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6%
had a disc bulge
● Just getting an image increases the chances that you’ll have surgery by 34%

Surgery

The US has sky high rates for back surgeries – 40% higher than any other country and 5x higher
than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the
outcomes are terrible!

A worker’s comp study looked at 725 people who had spinal fusions VS 725 people who didn’t.
The surgical group had:
● A 1 in 4 chance of a repeat surgery
● A 1 in 3 chance of a major complication
● A 1 in 3 chance of never returning to work again

Physical Therapy

● Current clinical practice guidelines support manual therapy and exercise
● Research proves that early PT lead to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids
● A study of 122,723 people with low back pain who started PT within 14 days found that it decreased the cost to treat back pain by 60%
● Unfortunately only 2% of people with back pain start with PT, and only 7% get to PT within 90 days.

Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. Almost every state has direct access, meaning that you can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!

“The Power of Aquatic Physical Therapy!”

 Myths and Facts about Aquatic Physical Therapy:

Myth #1: You have to be a good swimmer to do aquatic therapy

Fact #1: Aquatic therapy pools are between 4 – 4 ½  feet deep, which allows individuals to stand comfortably in the water without the need to tread water.

 

Myth #2: Aquatic therapy cannot help me translate to improved function on land.

Fact #2: Peer-reviewed research has demonstrated long term functional improvements in the ability to complete daily activities for individuals who have completed an aquatic therapy program. (See research article below!)

 

Myth #3: Aquatic therapy is only done in large group classes and you don’t get individualized attention.

Fact #3: At Breakthru we offer one-on-one treatment sessions under the supervision of a Doctor of Physical Therapy, who performs a comprehensive examination on day-one to learn your individuals needs and create a program that is appropriate for you.

Schedule Your FREE Screen Today!


Peer Reviewed Research on the Effectiveness of Aquatic Physical Therapy:

Article Title: Effects of high intensity resistance aquatic training on body composition and walking speed in women with mild knee osteoarthritis: a 4-month RCT with 12-month follow-up

Date of Publication: August 2017

Journal: Osteoarthritis and Cartilage

Link: https://www.oarsijournal.com/article/S1063-4584(17)30869-5/fulltext

Main Take Home/ Implications:

  • There were 87 female participants aged 60-69 with history of knee osteoarthritis. Treatment program consisted of high intensity aquatic exercises at a frequency of 3 times per week for 16 weeks.
  • Aquatic resistance training resulted in improvements in decreased fat mass and increased walking speed.
  • Participants experienced a gradual decrease in pain symptoms over the course of treatment and in conjunction with increased intensity of exercise.
  • Results were maintained at 12 months post, demonstrating the lasting effects of aquatic therapy.
  • Participants finished the course of treatment with the ability to exercise at a higher intensity of resistance and with less pain in their affected knee!

Quotations from the research:

  • “Pain experienced in affected knee during the intervention was mild…”
  • “At 12-months follow-up, walking speed in the intervention group remained significantly faster compared to the control group.“
  • “…indicates that an intensive aquatic resistance training program is effective at decreasing fat mass as well as improving walking speed in post-menopausal women with mild knee OA.”

Disclaimer: This information is intended for educational purposes only. Individuals should seek consultation in person with a licensed physical therapist or physician prior to attempting aquatic therapy.

The Underutilized Muscle Contraction

Spend a week at any gym and you will see hundreds of different exercises, workouts, and program types.  Most of these workouts have very similar concepts sprinkled throughout them; in my opinion a large majority neglect eccentric muscle contractions.

There are three different types of muscle contractions that our body utilizes to function with every task we perform. These three muscle contractions include concentric, eccentric, and isometric contractions.3

  • Concentric- Muscle contraction that occurs as the muscle length is shortening
  • Eccentric- Muscle contraction that occurs while the muscle length is lengthening
  • Isometric- Muscle contraction that occurs while the muscle length remains the same

A good well-balanced exercise routine combines all three types of muscle contractions. Whether it be athletic performance or everyday life, all three of these contractions occur frequently, and that is why it is important to prepare the body.  Proper preparation will allow a decreased risk of injury, both during training and everyday life.

Eccentric muscle contractions are very frequently overlooked or not used properly in resistance training programs. I know that a lot of you are probably thinking, “But Justin, every single rep has an eccentric phase”.  While that statement is totally accurate and true, that is not enough force or time to truly be training eccentrically.

One main benefit of eccentric training is that it allows the muscle to withstand a supramaximal load.  What this means is that you will be able to eccentrically handle more load than you can concentrically lift.  A study by Doan et al. showed increases in 1RM bench press through the use of supramaximal loads during eccentric training. 1

Even if you do not plan on using supramaximal loads, there are benefits to adding eccentric training to your program.  Adding a slow eccentric phase to your normal strengthening exercises have been shown to boost metabolism and increase resting energy expenditure post workout in both trained and untrained individuals.2

Adding eccentric training to your current program could also be an effective way to decrease soreness a couple days post session.  I am sure that at some point we have all been super sore following a rigorous workout. This is because of delayed onset muscle soreness (DOMS).  DOMS is commonly associated with the eccentric phase of movement.  However, a study by Petetit et al showed that a second eccentric workout, a week or two following the first, would result in significant amounts of decreased soreness.4  

If you have any questions regarding how to implement eccentric training into your program please do not hesitate to reach out and ask one of our professionals.

References:

  1. Doan, B.K., Newton, R.U., Marsit, J.L., Triplett-McBride, N., Koziris, L.P., Fry, A.C., and Kraemer, W.J. (2002). Effects of increased eccentric loading on bench press 1RM. Journal of Strength & Conditioning Research, 16(1), 9-13.
  1. Hackney, K.J., Engels, H.J., and Gretebeck, R.J. (2008). Resting energy expenditure and delayed-onset muscle soreness after full-body resistance training with an eccentric concentration. Journal of Strength and Conditioning Research. 22(5):1602-1609.
  1. Norkin, Cynthia C, and Levangie, Pamela K. Joint Structure and Function. 5th Ed. Philadelphia, PA. F. A. Davis, 2003.
  1. Pettitt, R. W., Symons, D. J., Eisenman, P.A., Taylor, J. E., White, Andrea, T. (2005). Repetitive eccentric strain at long muscle length evokes the repeated bout effect. Journal of Strength and Conditioning Research, 19(4), 918-924.

Tips To Start Running Injury Free

The temperature is rising and days are getting longer. Spring is here and it’s always nice to be able to spend some time outside. While running can be a great way to get in shape while spending time outside, it is important to slowly build up those miles to prevent injury.

Here are some tips to start running injury free:

 

  • Strength Train/Cross Train

 

      1. It is important to continue with strength training in order to avoid injury with running.  Including preventative hip and glute strengthening can increase your stability while running and decrease risk of injury. Taking some days off of running to cross train is also important to give your body a break and prevent overuse injuries. Biking, elliptical, and swimming are great ways to cross train.

 

  • Stick to a gradual increase in running, don’t overdo it.

 

      1. Following a training plan can be an easy way to make sure you are appropriately increasing your running time/mileage. Increasing running too quickly can increase your risk of overuse injuries.

 

  • Wear Supportive Footwear

 

    1. Take a minute to stop by your local running store to see what shoes are best for you. The correct shoes can make a big difference in preventing aches and pains while running.

Below is a “Couch to 5K” training plan that is a good way to get started this spring.

Week Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
1 5 min walk
2 min jog
5 min walk
Relax! 5 min walk
2 min jog
5 min walk
Relax! 5 min walk
3 min jog
5 min walk
Relax! Relax!
2 5 min walk
3 min jog
5 min walk
Relax! 5 min walk
4 min jog
5 min walk
Relax! 5 min walk
5 min jog
5 min walk
Relax! Relax!
3 5 min walk
6 min jog
5 min walk
Relax! 4 min jog
5 min walk
4 min jog
5 min walk
Relax! 5 min walk
7 min jog
5 min walk
Relax! Relax!
4 5 min walk
7 min jog
5 min walk
Relax! 5 min walk
8 min jog
5 min walk
Relax! 5 min walk
9 min jog
5 min walk
Relax! Relax!
5 5 min walk
9 min jog
5 min walk
Relax! 6 min jog
5 min walk
6 min jog
5 min walk
Relax! 5 min walk
10 min jog
5 min walk
Relax! 5 min walk
11 min jog
5 min walk
6 5 min walk
11 min jog
5 min walk
Relax! 13 min jog
5 min walk
Relax! 15 min jog
5 min walk
Relax! Relax!
7 15 min jog
5 min walk
Relax! 8 min jog
5 min walk
8 min jog
5 min walk
Relax! 16 min jog
5 min walk
Relax! 17 min jog
5 min walk
8 17 min jog
5 min walk
Relax! 18 min jog
5 min walk
Relax! 20 min jog
5 min walk
Relax! Relax!
9 20 min jog Relax! 12 min jog
5 min walk
12 min jog
Relax! 24 min jog Relax! 25 min jog
10 25 min jog Relax! 27 min jog Relax! 30 min jog Relax! Race Day!

 

Concussion… now what?

Your son, daughter, athlete, or friend is in the middle of an intense game and they take a hard hit.  You see them stumble off the field looking unsteady, you can tell something is wrong.  What happens next?

The initial recognition of a concussion is critical to proper management. If the initial detection of a concussion is missed, and a player goes back in too early, they are at increased risk of cerebral edema or second impact syndrome which can have catastrophic implications.  Players don’t always mention when they’ve “had their bell rung,” so it is often up to the coaches and athletic trainers to notice when something isn’t right.  They will perform some sort of screening on the field to determine if there is a possibility of a concussion.  If it is determined that there might be a concussion, the player should be out of the game and not cleared to return to any athletic activity within the same day.

 

After a concussion, there should be a follow up with a physician skilled in managing concussion symptoms, you usually a sports medicine doctor.  Usually this happens relatively soon after the initial injury, within a few days. If there are more severe symptoms, such as worsening headaches, weakness or loss of coordination, slurred speech, repeated vomiting, or loss of consciousness a trip to the emergency room is needed for more urgent evaluation to reduce the risk of brain damage.  If these symptoms are not present imaging is usually not needed.  

Once the athlete is cleared from serious pathology a treatment plan is determined based on the level of symptoms and evaluation findings.  Cognitive rest is important as it will allow the brain to reduce its activity and start to heal.  Some people require complete cessation of all activity including school, reading, TV, phones, video games etc which is usually only a few days.  Others may be able to continue functioning, but at a lower level as in half days or limited homework.  Symptoms usually resolve mostly within 7-10 days.  When symptoms have not resolved in 3 weeks, further evaluation may be needed by a physical therapist or other professional depending on the type of symptoms to determine what additional interventions may be needed as the concussion is not resolving on its own.  Interventions may include further medical management, vestibular treatment, vision exercises, manual therapy, or graded exercise.      

As symptoms resolve, the athlete will want to start getting back to activity.  Although we want to get them back quickly, we also want this to be done safely.  Athletes can only return to athletic activity after being cleared by a physician.  If there is no physical testing done by the physician, it is up to you to pursue testing.  There is a systematic process of increasing the exertional load and monitoring symptoms that can be performed to assess readiness to return to sports.  Usually this occurs over the course of 5 days and gradually increases the intensity of exercises as long as there are no increases in symptoms and ends with activities simulating play.  Then the athlete will resume play with practice, simulated play, then competitive play.  Most athletes make a full recovery, but remember the history, as repeated concussions are more likely to lead to long term disability.

Postpartum and Physical Therapy

Pregnancy is a long and beautiful process with each step a critical component to proper fetal development. Your body, which you have gotten used to for the past 20-30 years has now suddenly changed within a very short period. After pregnancy, during the postpartum period, it can sometimes be discouraging and exhausting to return to your pre-pregnancy body.  Let’s face it; taking care of a newborn is tough and difficult, no matter how many times you’ve been through it. Your body has gone through a traumatic event and every second is a new experience.  Taking care of yourself can be extremely difficult with a newborn, but it is during this time that your body is most vulnerable and susceptible to acute and chronic injuries.  With everything happening for your newborn, it can be easy to forget to take care of yourself!

Common problems postpartum

  • If you had a natural delivery, you may have had stitches and it is normal to have some discomfort with urination or sitting. If you had a c-section, the recovery process will generally take longer and you may have more precautions that your doctor will instruct you in. However, with either type of deliveries, you should not have to tolerate long term pain! Your physical therapist can help reduce any pain you may have and help you return to your normal lifestyle pre-pregnancy.
  • Back pain is a common problem as your center of mass has drastically changed in a very short amount of time. This gives your body less time to prepare for the shift in weight. Your body will move differently than it has in the past 9 months and it is vital to have proper guidance to return to activities.
  • Hip pain may also occur as natural delivery requires you to create extremely high pressure in an unfavorable position for your hips. In therapy, you can benefit from strengthening your hips, as well as decreasing pain.
  • Weakness in your core can be expected as your abdominals have been stretched. Again, this is common, but you should not have long term pain.
    • You may also have diastatis recti, which is a fancy term for increased gap between your middle abdominal muscles, called the rectus abdominus. This may be painful and you can see your physical therapist to help you with this.
    • Weakness in the pelvic floor can lead to urinary or bowel incontinence. If you have a uterine prolapse or rectocele, it is very important that you learn how to strengthen to muscles properly. A therapist specialized in pelvic floor can you regain proper control of these important muscles.
    • Postpartum depression – it took 9 months for hormones to develop in your body to have a healthy baby and in 2-3 days postpartum, the levels of hormones will reduce to pre-pregnancy base lines! Postpartum depression is a serious complication. Be sure to communicate with your doctor if you feel you have postpartum depression.
    • Joint pain is common because during pregnancy, your ligaments become lax to create space for the baby to come out of the birth canal. However, the hormones do not limit to only pelvic ligaments and will stretch out ligaments in your entire body. It is important to see a therapist to learn how to strengthen your muscles and avoid certain positions that could place your body at risk for further injury.

Choose PT first!

  • Your body changes drastically during pregnancy and you may benefit from the help of a physical therapist to get you back to the way you were prior to pregnancy
  • Don’t be okay with postpartum pain or body aches and think that is “normal.”
  • Don’t be scared to get back into physical activity
  • Taking care of yourself can be extremely difficult with a newborn but it is during this time that your body is most vulnerable and most susceptible to acute and chronic injuries

 

Physical therapy can benefit you!

  • Teach you about your body so you understand how to use muscles that have been overstretched or overused from changes in your body
  • Strengthen muscles to create proper stability in your body and core
  • Relieve pain

 

Taking Care of yourself while taking care of your child

  • When you carry your child, be careful of your posture. Try not to hike your hip up and use both arms.
  • When picking up your child, go into a proper squat and use your legs to lift. Your newborn might be a few pounds now, but they gain weight quickly!
  • If you are breastfeeding, try to use a pillow to prop your newborn instead of using your arms to keep him lifted

In the States, new mothers will meet with their doctors after 6 weeks to clear them for activities. Many times, mothers will be nervous about returning to exercises or think they will not have the time to exercise. Meeting with a physical therapist will allow proper guidance to return to you lifestyle, worry-free.

References:   Simonds, A. (2015, June 29). Evaluation and Management of Prenatal and Postpartum Clients in Physical Therapy. Lecture presented at Prenatal and Postpartum Lecture in Rutgers University , Stratford, NJ.

Schroth Method

Although onset typically occurs in adolescence, patients of ALL AGES can benefit from this method of treatment. The exact strategy and approach is dictated by the unique curve patterns as well as levels of skeletal maturity; however The Schroth Method can be beneficial for patients in all stages of scoliosis. This includes patients who have not yet begun bracing, patient who are currently being braced, as well as pre-operative or post-operative treatment when surgery is indicated.

In addition, research on the Schroth Method and similar treatment strategies is also developing to evaluate the benefits and effectiveness on postural related spinal deformities for people of all ages.

Click here for more information.

Make a SPLASH into Recovery

Spring is around the corner! With it comes the opportunity to participate in all of the exciting activities the season affords. Unfortunately, many individuals are unable to take full advantage of this warm weather due to chronic pain or other injuries that causes difficulty with movement and activity.  Being unable to engage in hobbies or activities you are accustomed to can lead to a decreased quality of life.

Thankfully, it is not too late to get back to performing the activities you, or someone you know, once loved. Aquatic Physical Therapy can aid in improving movement, decreasing pain, and restoring function for all daily activities. In this article, we will discuss how there is no better time to dip your toe in and try aquatic therapy at BREAKTHRU.

  • What is Aquatic Physical Therapy? 

Many individuals feel as if they have exhausted all options including physical therapy and must live with their pain.  This is simply not true. Aquatic physical therapy is distinctly different from land based physical therapy. In the water, buoyant forces push the body upwards, effectively causing you to “weigh” less. This results in less impact during activity and a decreased load on the joints, muscles, and bones.  Movement is easier and less painful than on land, and patients are able to perform exercises not possible out of the pool. Additionally, our pools have multiple massaging jets and are kept at a warm 90°F which provides relief to tight muscles, spasms, as well as decreasing pain.  

At BREAKTHRU, exercise programs are constructed individually for each patient to ensure the highest levels of success. The exercise program will be challenging, but manageable for you, and will work specifically to increase your endurance, strength, and flexibility. Most exercises that are performed on land can also be performed in the pool. Our aquatics facility has a plethora of water based exercise equipment including use of dumb bells and flotation devices.

Most notably, we uniquely offer an underwater treadmill that can be remotely controlled to reach the perfect, most comfortable speed for you. The treadmill allows individuals to walk, jog, or run in the water where they “weigh less.” Additionally, we also have the ability to provide gentle resistance through water based currents in the pool.  

At BREAKTHRU, our goal is to provide the highest quality care to patient’s during their path to recovery and fitness. To us, this means one-on-one care with a Doctor of Physical Therapy (DPT) is the utmost importance.  

You will be scheduled with the same PT at every visit which will allow him or her to get to know you and your health condition personally. The entire staff will make sure you are performing exercises correctly with proper form at the right dosage (reps, sets, and durations), as well as taking recommended breaks throughout.  

  • How can I get started?

FREE Screen: If you are unsure if aquatic therapy is right for you, it all starts with your FREE consultation with a Doctor of Physical Therapy. You can set up this FREE meeting at our Mt. Laurel location (Near the Whole Foods and LA Fitness) by calling (856) 722-1044 OR our Medford Fitness location by calling (609) 451-6582

Initial Evaluation: If you or someone you know could benefit from decreasing pain and moving better, you can see a Doctor of Physical Therapy by scheduling an initial evaluation. At the evaluation, your PT will take a detailed history of your condition by asking questions and listening to your story. He or she will then take a look at what impairments you may have (strength, flexibility, pain, motor control).  The process typically takes between 30-45 minute.  You will then meet the friendly staff, be given a tour of the facility, and scheduled for the first session.  

First session: will consist of becoming familiar with the pool, getting to know your physical therapist, and beginning your exercise program. A typical treatment session is around 1 hour in length and allows time for warm up on our underwater treadmill or massaging jets, as well as your exercise program and a cool-down.  At following sessions, your exercise program will be progressed appropriately in accordance with your plan of care and include more exercises that will benefit you.  

  • Who can benefit from skilled aquatic physical therapy?

Arthritis:Arthritis of the hip and knee are one of the most common diagnoses seen for aquatic therapy at BREAKTHRU.  Our patients are able to walk for longer distances on the underwater treadmill without pain. Additionally, physical therapy will strengthen the muscles of the lower leg, thigh, and glutes in order to decrease pain and improve strength. This will help take some of the stress off of your arthritic joint by allowing the muscles to stabilize and absorb force. Osteoarthritis is the most common form seen at our clinic, however water based therapy will improve function in RA as well.

Low Back Pain: Low back pain is the most common diagnosis seen in physical therapy and can cause patient’s difficulty in walking, bending, and lifting items. Additionally, some low back pain may even be felt in the legs and feet.  In the pool, the water can relax the low back muscles and the jets can help de-sensitize an area by providing gentle stimulus to the nerves.  Stretching can be performed in the pool. Additionally, we will work to strengthen the core in the water which will act as a “natural back brace” to strengthen your spine’s support.

 

 

Post Joint Replacement: A large amount of evidence exists through research studies supporting using pool based therapy following total knee arthroplasty (TKA) or total hip arthroplasty (THA). These patients can benefit from water based therapy when cleared by a surgeon. Walking can be performed for longer periods of time with less rests. Most exercises can be performed with decreased pain in the pool, which can provide relief to patient’s looking to get moving sooner. These patients will eventually progressed to land based exercises.

Sports related surgeries:  Athletes who suffer ACL, PCL, or Meniscal injuries requiring surgery are often braced for several weeks. Afterwards, they typically follow a protocol in place by a physician in order to return them to sport safely. Many protocols recommend water based jogging in order to begin loading the joint before beginning these activities on land, however most physical therapy centers do not have access to pools. At BREAKTHRU, we can begin jogging activities early in the pool, which allows the athlete to return to running and sport sooner. Additionally, jogging in the pool will keep the athlete at a high level of conditioning during their recovery.

 

General Deconditioning: The pool is a great way to begin physical therapy for individuals who lack strength or endurance in their legs or core.  These individuals may report getting tired with walking after a short distance, having difficulty going up or down stairs, or feel “weak” in the legs. Exercises can be initiated in the pool and progressed to improve strength. Water-safe weights can be incorporated into programs to challenge the patient. Once the patient has gained sufficient strength, physical therapy can begin on land. This is a great “stepping stone” to begin land-based physical therapy.

References:Waller B, Ogonowska-Slodownik A, Vitor M, et al. Effect of Therapeutic Aquatic Exercise on Symptoms and Function Associated With Lower Limb Osteoarthritis: Systematic Review With Meta-Analysis. Physical Therapy. 2014;94(10):1383-1395. doi:10.2522/ptj.20130417.
Barker A, Talevski J, Morello R, Brand C, Rahmann A, Urquhart D. Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis. Physiotherapy. 2015;101. doi:10.1016/j.physio.2015.03.250.
Prins J, Cutner D. Aquatic Therapy In The Rehabilitation Of Athletic Injuries. Clinics in Sports Medicine. 1999;18(2):447-461. doi:10.1016/s0278-5919(05)70158-7.
Schonewill A, Rogers K, Spear A, Weinberg D, Pitt R. Combined Effects of Aquatic and Land-Based Rehabilitation in Female Soccer Players Post ACL Reconstruction: An Overview of Current Evidence. Journal of Physical Therapy and Health Promotion. 2015;3(2):11-19. doi:10.18005/pthp0302001.
Villalta EM, Peiris CL. Early Aquatic Physical Therapy Improves Function and Does Not Increase Risk of Wound-Related Adverse Events for Adults After Orthopedic Surgery: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation. 2013;94(1):138-148. doi:10.1016/j.apmr.2012.07.020.