Aquatic Therapy Guides

Start here: what aquatic therapy is and who provides it

The basics: definitions, scope of practice, and how to judge training. Current Procedural Terminology (CPT) code 97113 is the billing code for aquatic therapy with therapeutic exercises.

• What Is Aquatic Therapy? Who Can Bill for Aquatic Therapy under CPT 97113?

  What laws, government payers and current research say aquatic therapy is, and who can bill for it.

• Aquatic Therapy vs. Aquatic Fitness: What’s the Difference?

  Who provides each, how each is regulated, and why the difference matters.

• Aquatic Therapy: Procedure or Profession?Part 1 · Part 2

  Part 1: how aquatic therapy differs from adapted aquatics and aquatic fitness. Part 2: how state practice acts and certifications decide who may perform it.

• Any Legal Issues if PT or OT Providers Offer Aquatic Fitness Instruction?

  The duty of care a physical therapist owes when teaching an aquatic fitness class instead of treating a patient.

• Assessing Aquatic Merit

  Five questions to ask before you pay for an aquatic therapy certification.

• Water Is the Classroom: Speech-Language Therapy in the Pool

  What the water changes for speech-language pathologists, what safety takes, and what the research shows so far.

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Pools and water: choosing, renting, depth and temperature

Choosing a pool, renting time in someone else's, and setting depth and temperature for your patients.

• Coming soon Renting a Pool for Therapy

  A planning guide, with checklists, for renting time in an existing pool.

• Coming soon Building a Therapy Pool

  A planning guide with checklists for the key decisions and cost questions before you build.

• How to Select a Pool for an Aquatic Therapy Program

  What makes a pool truly therapeutic, from depth and temperature to entry and accessibility.

• How Deep Should the Water Be for Different Aquatic Therapy Goals?

  How depth changes buoyancy, loading and resistance, with depth guidance for common rehab goals.

• What Pool Water Temperature Best Supports Aquatic Therapy?

  Water temperatures matched to diagnosis and treatment goals, with links to published guidelines.

• Aquatic Therapist Occupational Hazard... Your Pool is HOW Warm?

  Why a pool kept near body temperature can be a hazard for the therapist, and how to bring it down safely.

• Before You Take that Dip: Renting a Community Pool for Aquatic Therapy

  What to sort out before you rent a community pool: liability, access, equipment, water and air quality, and privacy.

• Ask Andrea: Renting a community pool for aquatic therapy

  Starting a program in a hotel pool? The rules on closing versus roping off the pool, therapist presence and billing.

• Guest Post: Renting a Therapy Pool

  What the Centers for Disease Control and Prevention (CDC) found in more than 121,000 routine pool inspections, including therapy pools.

• Guest Post: Regulation & Inspection of Your Pool

  Who sets the rules for pools, what those rules cover, and where to find the Model Aquatic Health Code and your state's guidance.

• The Decision Matrix: Costs of Building & Maintaining a Therapy Pool

  Budgeting to build and run a therapy pool, with a design matrix to help you plan it right the first time.

Planning a pool program for your clinic or facility? We can bring a live class to your pool, or teach it online, customized to your staff. Ask about private training.

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Running a program: billing, documentation and referrals

Getting paid, keeping notes audit-ready, and filling your schedule.

• How to Justify Aquatic Therapy Versus Land-Based Therapy

  How to document and defend why you chose the pool over land-based treatment.

• How Should Aquatic Therapy Be Documented for Reimbursement?

  What payers expect in your notes and what auditors look for.

• Common Billing Pitfalls in Aquatic Therapy — and How to Avoid Them

  The billing errors that lead to audits and denials, and how to avoid them.

• Ask Andrea: To bill for Medicare, does the therapist have to be in the water?

  Must the therapist be in the water to bill Medicare? Examples from local coverage policies.

• How to Market an Aquatic Therapy Program to Referral Sources

  How to build referrals from physicians and rehab directors.

• Sample Business Plan for Swim School

  A free, thesis-based business plan with market research that can serve as a template for an aquatic therapy practice.

Want your whole staff documenting the same way? See private training for teams.

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Safety, precautions and medically complex patients

Infection questions, access rights under the Americans with Disabilities Act (ADA), and planning for patients with human immunodeficiency virus (HIV), hepatitis or metabolic conditions.

• Ask Andrea: Does Hepatitis C transmit in the pool?

  Can a patient with hepatitis C safely join aquatic therapy? What the CDC says about bloodborne germs and treated pool water.

• Refusing access for HIV? ADA Complaints

  A 2008 settlement shows what can happen when a clinic refuses aquatic therapy to a person with HIV.

• Careful Planning: Taking the systemic or metabolically challenged patient into the water

  How to screen, set goals and design a safe program for patients with systemic or metabolic conditions.

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Techniques and methods

Where the classic aquatic methods came from and how to use them, including proprioceptive neuromuscular facilitation (PNF), Halliwick and Water Specific Therapy (WST).

• Find Your Zen: Watsu

  Where Watsu came from, how a passive warm-water session works, and what equipment you need.

• Pattern Treatments: Aquatic PNF

  How PNF patterns, first built for polio patients, led to the Bad Ragaz Ring Method and freer aquatic PNF patterns.

• The Bad Ragaz Ring Method (BRRM)Part 1 · Part 2 · Part 3

  A three-part series: the method's history, matching it to a client's goals, and an exam case.

• Finding Balance: The Halliwick Concept

  How the Halliwick Concept began in 1950s London and how it uses balance and rotational control in water.

• Integration of Halliwick Principles into WST: Combining Elements of the Halliwick Ten-Point-Programme with WST to Enhance Postural Control and Functional Activities in Aquatic Therapy

  How Halliwick grew into WST, and how WST uses buoyancy, drag and waves to build skills.

• Ai Chi: Safety and EffectivenessPart 1 · Part 2

  Part 1: what Ai Chi and Clinical Ai Chi are and how they train balance. Part 2: the research by patient group.

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Orthopedics, sports and spine

Back pain, hip surgery, total knee replacement (TKR), plyometrics and return to sport.

• Back in the Game: Aquatic Spinal Stabilization

  Why buoyancy makes core and spinal stabilization training easier to start for people with back pain.

• Top 8 Reasons the Pool Rules for TKR

  Eight research-backed reasons to add the pool to TKR rehab, from pain and function to strength and mood.

• Hope After Hip Surgery

  How buoyancy, pressure, viscosity and warmth help patients stand and walk after hip surgery, plus precautions.

• Weight Bearing during Immersion: Start to Move and All Bets are Off

  What the research measured about joint loading once people start moving in water.

• Aquatic Plyometric Training: Safety and EffectivenessPart 1 · Part 2

  Part 1: why water suits plyometric training and why depth matters. Part 2: jumps, landing, arm position and progression.

• Research on Aquatic Plyometrics

  A reading list of studies comparing water and land plyometric training.

• Pool Power: Aquatic Training & Rehab for the Elite Athlete

  How a college coach and a sports physical therapist use the pool to train, rehab and decide when an athlete is ready.

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Heart and lung conditions

Cardiac patients, chronic obstructive pulmonary disease (COPD) and Postural Orthostatic Tachycardia Syndrome (POTS) in the pool.

• Heart Warming: Aquatic Cardiac Therapy

  Why upright water exercise is often a safer choice than swimming for heart and lung patients, with temperature and depth guidance.

• Aquatic Exercise: Dangerous waters for the cardiopulmonary patient?

  Four common myths that keep cardiac and respiratory patients out of the pool, and steps for a safe environment.

• Five most common aquatic therapy myths for cardiopulmonary patients (Part 2 of 2)

  More myths about heart and lung patients in the pool, and what the evidence says. (Part 1 is coming soon.)

• Aquatic Therapy for the COPD Client?

  Is the pool safe for people with COPD? Why upright water exercise can fit, with advice from two therapists who treat COPD.

• Evidence-Based Case for Aquatic Therapy in Postural Orthostatic Tachycardia Syndrome (POTS)

  How hydrostatic pressure and immersion support circulation, and what that means for POTS.

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Rheumatology, fibromyalgia and chronic pain

Aerobic training, warm water, balance and documentation for rheumatologic disorders and fibromyalgia.

• Crushing Pain

  Why the pool lets people with rheumatic disease do real aerobic training without pounding their joints.

• Therapeutic Spectrum: Treatment of Rheumatologic Disorders with Aquatic Physical Therapy

  Testing the case that warm water eases pain, spasm and stiffness, from heat physiology to the clinic.

• Balance and Sensory Awareness for Rheumatologic Disorders

  Why viscosity and turbulence make the pool a safe place to train balance.

• Building a Case for Treating Rheumatologic Patients with Aquatic Therapy

  The physics and research behind aerobic aquatic exercise for rheumatologic disorders.

• Rheumatological Disorders: Joint, Tissue, and Motor PainPart 1 · Part 2

  A two-part look at stiffness, pain and weakness, and how water helps.

• Fibromyalgia Is (or Should Be) All WetPart 1 · Part 2

  Part 1: a patient story, the exercise research and sample documentation language. Part 2: precautions to weigh first.

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Brain, balance and mental health

Mental health, Parkinson disease, and balance training for older adults.

• Making Waves: The Mental Health Benefits of Aquatic Therapy

  What the research says about mood, anxiety, stroke recovery, fibromyalgia and children with neurodevelopmental conditions.

• Aquatic Therapy & Parkinson's: Systematic Reviews & Practice Documents

  A reading list of systematic reviews and practice documents on balance, gait, motor function and quality of life.

• Trust Falls

  How the Aquatic Berg turns the 14 Berg Balance tasks into safe balance practice, with depths, equipment and temperatures.

• Balance training with a cognitive twist

  Why the pool suits balance training that adds a thinking task.

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Children, autism and water safety

Pediatric precautions and goals, autism, reflexes, the neonatal intensive care unit (NICU), and building water safety into therapy.

• For the Children: Taking your pediatric patient into the therapy pool

  Precautions, techniques and goals for bringing a child into the pool, plus how to explain it in plain language.

• 10 Evidence-Based Aquatic Therapy Applications for Autism from Aquatic Therapy University

  Ten practical, research-backed recommendations, from session structure and cues to dosing.

• Using Aquatic Therapy to Promote Social Interaction

  How water activities help autistic children socialize and form attachments.

• Reflex Integration

  Primitive reflexes, assessment tools and aquatic therapy protocols for neurodevelopmental conditions.

• Neonatal Hydrotherapy on the NICU

  The history, goals, candidates and techniques of warm-water therapy for infants in the NICU.

• Reimagining Aquatic Therapy, Part 3: FAST Skills™, Functional Aquatic Safety Threshold Skills

  A framework of basic water safety skills that can be built into skilled aquatic therapy.

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