February 5, 2023

Health Mettler Institute

Healthy LifeStyle & Education

6 Water Physical Therapy Benefits for Multiple Sclerosis

While there is currently no cure, there may be some things you can do to manage your
multiple sclerosis (MS) symptoms. Water therapy can help deal with the pain, mobility issues, and mental health challenges that people with MS face.

This article discusses water physical therapy for MS, the benefits of aquatic therapy, and what to expect if you seek treatment.

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What Happens During Water Physical Therapy?

Water physical therapy, or aquatic therapy, is one treatment people with MS can use to improve their health. For people with MS, the pools used for this exercise program must be carefully temperature controlled.

A physical therapist or other healthcare team member will design and assist you in an individualized program you complete in the pool, tub, or natural body of water. This type of therapy may help with your MS, including:

  • Buoyancy: Water helps support your body weight, so there is less stress on your joints, making it is easier to move (better flexibility).
  • Resistance: Moving through the water helps to strengthen muscles.
  • Hydrostatic pressure: The gentle pressure of the water helps decrease swelling and improve awareness of the position of your joints (proprioception).

At gentle warm temperatures, hydrotherapy (another name for water therapy) can improve blood flow to muscles and help relax tight muscles.

6 Benefits for MS

Exercise programs may be helpful for people living with MS by increasing strength, decreasing fatigue, slowing the progression of symptoms, and improving quality of life. Aquatic therapy can provide many benefits, according to research studies.

Mobility 

Up to 80% of people with MS are expected to develop problems walking. Other common mobility issues are loss of balance, difficulty getting dressed, and trouble climbing stairs. Exercise, including aquatic therapy, can help slow or even reverse these challenges.

Water therapy is helpful for improving muscular strength in people with MS. Strength is an important part of overall mobility (the ability to complete functional movements).

One study found people with MS who participated in three aquatic therapy sessions per week improved mobility in several areas, including a six-minute walk test and Berg balance scale score (measuring balance).

Other studies have shown water therapy for people with MS can help improve balance and walking speed. However, more research is needed to understand how long the benefits continue to last.

Fatigue

Fatigue is a common MS symptom and can cause significant disability. Fatigue is more than just being tired; it includes a lack of energy and motivation to get started on tasks. Memory or thinking issues can also occur with fatigue.

Although it initially takes energy to complete water physical therapy, it has often been shown to decrease fatigue and improve activity levels for people with MS. One study found people with MS who participated in three aquatic therapy sessions per week improved their scores on the modified fatigue impact scale (MFIS), which measures the impact of fatigue.

Another study found that water exercise was the most effective intervention for improving fatigue.

Mental Health

People with MS may face mental health challenges. The loss of mobility can affect social interactions, their ability to work, and their quality of life. Hydrotherapy and exercise can decrease depression and improve mood in people with MS.

In one study, women in an aquatic exercise group improved their quality of life over eight weeks compared to a group without exercise interventions. More research is needed to learn the exact mechanism that improves mental health in people with MS during aquatic exercise. Still, reasonable levels of activity may be safe and even provide benefits.

Pain Management

Acute and chronic pain can be symptoms of MS. Research shows aquatic therapy may help reduce pain in people with MS. However, the way hydrotherapy works to decrease pain is not fully understood.

Exercises that improve flexibility help to reduce muscle spasms and keep joints mobile, which may help with pain. More research is needed to understand how to incorporate this into an aquatic therapy exercise program.

Cooling

Water therapy for people with MS is often provided in pools with temperatures between 80 and 88 degrees F. This temperature range helps keep the body cool and can reduce MS symptoms that often appear when the body gets too hot. Water pulls heat away from the body 25 times faster than in the air, promoting optimal body temperature for people with MS.

Increased Body Heat

Increased body heat can cause a relapse of MS symptoms (Uhthoff’s sign). Fever, exercise, increased environmental temperature, and hot beverages or foods can worsen symptoms. Check the temperature of the pool before entering to help prevent triggering a relapse.

Overall Health

Water therapy provides many of the benefits of other exercise programs, including:

  • Cardiovascular health
  • Activity tolerance
  • Weight maintenance/weight loss
  • Stress reduction

Finding a Water PT Specialist

Your healthcare team may be able to recommend a local physical therapist specializing in water therapy. Your provider and physical therapist may ask questions to confirm that water therapy is a safe and appropriate treatment option for you. Check with your insurance provider to discuss the coverage available for this treatment based on your policy.

High temperatures can worsen MS symptoms in many people. Check with your healthcare provider to see what pool temperatures are recommended for your health.

MS Water Therapy Exercises

A specialist will tailor physical therapy to your condition, including water therapy. PT begins with an evaluation of your symptoms.

Depending on your goals and current mobility, you will be prescribed a specific exercise program. You may perform exercises that focus on the following:

  • Strength (arm and leg exercises against the water or holding a floating dumbbell)
  • Walking (gait training)
  • Balance
  • Flexibility
  • Aerobic exercise
  • Cycling (on an underwater bike)

You may benefit from beginning with a specialist to learn MS-friendly exercises you can work on in a pool. After your training, speak with your provider to see if you can continue using the pool independently. Be sure you understand the risks and benefits of working out on your own.

Risks and Safety Tips

Your healthcare provider will discuss the risks and benefits of water therapy with you before you start. Be sure to share any concerns about being in a pool—especially if you cannot swim.

Pool therapy may not be appropriate for you if you have open wounds on your skin, are incontinent of bowel or bladder (have bathroom accidents), or have an active fever or infection. Also, aqua therapy is not recommended for people with heart disease or abnormal blood pressure.

Depending on your mobility limitations, you may want to inquire how you can enter and exit the pool (zero entry, lift chair, stairs). You and your physical therapist may choose to have you stay in a depth where you can fully stand and be near a wall or grab bar for safety.

Summary

Water physical therapy has multiple benefits for people with MS, such as improving balance, mobility, and mental health. However, it is not suitable for every person. Ask your provider for a referral to a physical therapist who specializes in aquatic therapy. You will receive an assessment and an individualized program focused on your goals.

A Word From Verywell

If you find water soothing and relaxing, you may benefit from water therapy for your MS symptoms. However, if you are unable to swim or afraid of the water, there are still many treatments to help you live with MS. Reach out to your healthcare team and share any questions or concerns about your condition.

Frequently Asked Questions

  • Are hot tubs safe for people with multiple sclerosis?

    Warm environments, like hot tubs, can rapidly worsen symptoms of MS for many people. Your healthcare provider may recommend avoiding warm temperatures like hot tubs, saunas, and the outdoors during the hot seasons of the year. Never enter the water alone; consider seeking a pool with a lifeguard.

  • What temperatures make MS worse?

    Even a slight (less than 1 degree) increase in your core body temperature can worsen MS symptoms. Exercise, fevers, hot tubs, being outdoors in warm temperatures, and other things that raise body temperature may affect you.

  • Is shallow water better for pool therapy?

    You may practice movements in different pool depths if you are working with a physical therapist for your pool therapy. Water levels between waist and chest height are common. Deeper water provides more support for your body weight.