Is Aquatic Therapy Helping the Patients with Knee OA?


Many patients entering the PT clinic with an age group of 40 years and above, complains of knee pain and has been diagnosed with Knee OA. GUESS WHAT?? even their diagnostic tests conclude the same. Firstly, recommending a 60-year-old for an X-ray and diagnosing with arthritis does not make sense to me. But Well, today the discussion is not about that.

As we know arthritis is a chronic degenerative disease with pain, joint stiffness, instability and weakness causing functional limitations and difficulties. Various studies have supported the fact that, apart from drug therapy; manual therapy and exercise is the best conservative treatment, which has an easy application, is low cost and have minimal to no adverse effects. The types of exercises most recommended are those causing a low impact on the joints for muscle strengthening, aerobics or combination.

But here’s the biggest Catch:

Knee OA is generally followed by obesity (approx. 40% population). In order to control the pain and condition, it is necessary to reduce weight and be active. Let’s not forget reducing weight itself is a tough job and exercising to reduce weight causes more knee pain as it puts a lot of pressure on your knees which causes further damage.

Thus Aquatic exercise or exercising in water has become a trend nowadays. The question here is

Are they really helping with reducing pain and increasing function in patients with knee OA?

A systematic review (2016) was conducted in which they include 12 reviews (RCT + Experimental studies). The objective of this review was to evaluate and compare the effect of aquatic exercise programs on muscle strength and function of people with hip or knee osteoarthritis. This review study suggests that well-designed and controlled interventions with aquatic exercise lasting at least six weeks, contemplating muscle strengthening exercises and aerobic exercises, can be effective in increasing muscle strength of lower limbs and in improving the functionality of patients with OA

What is the reason behind it?

The aquatic exercise may have advantages compared to land-based exercise, because, due to the physical properties of water, the execution of the movements can become easier, decreasing also the sensation of pain. Strengthening the muscles surrounding the affected joint is an important part of the treatment of OA. Therefore, the resistance of the water is used as an overloading factor for muscle strengthening exercises. The use of resistive materials promotes an increased area of contact with water, and will also increase the exercise overload.


1. Lu M, Su Y, Zhang Y, Wang W, He Z, Liu F, et al. Effectiveness of aquatic exercise for treatment of knee osteoarthritis: Systematic review and meta-analysis. Z Rheumatol. 2015;74:543–52.

2. Yázigi F, Espanha M, Vieira F, Messier SP, Monteiro C, Veloso AP. The PICO project: aquatic exercise for knee osteoarthritis in overweight and obese individuals. BMC Musculoskelet Disord. 2013;14:320.

3. Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport. 2011;14:4–9.

4. Fernanda de Mattos,∗, Neiva Leite, Arthur Pittab, Paulo Cesar Barauce Bento. Effects of aquatic exercise on muscle strength and functional performance of individuals with osteoarthritis: a systematic review. rev bras reumatol . 2 0 1 6;56(6):530–542

Dr. Mansi Parikh,

Co-Founder EndoRush App

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