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Hydrogymnastics
Hydrogymnastics is a water-based therapeutic exercise. As its name suggests, this form of aquatic therapy or aquatic rehabilitation is performed in water, which can take place in swimming pool s at Aquatic Leisure centres and/or in home pools. Being a form of aquatic therapy, hydrogymnastics aims to improve the physical and psychological health and well being of an individual. Hydrogymnastics is able to be performed by anyone, including youths (children, teenagers, young adults), middle-aged people, the elderly, athletes and those with disabilities. Hydrogymnastics is often assisted by a qualified aquatic therapist and/or exercise physiologist. Although the effects of hydrogymnastics may vary between individuals belonging to different age groups and genders, hydrogymnastics mainly improves one’s cardiovascular fitness, strength, balance and mobility.

History
Over time many different terms and names have been used to describe hydrogymnastics however, each are categorised a form of aquatic or water rehabilitation. This practice of water rehabilitation began in the 24th century BC in Ancient Greece and Asia, where people used the therapeutic benefits of water as both a remedy for illnesses and for religious reasons. However, hydrogymnastics (in a less modern form) began in Ancient Greece in the year 460 BC where it simply involved a person transitioning between hot and cold water in order to treat diseases, muscle aches and pains and bring high fever temperatures down. This form of treatment continued over the years but in the 6th century, peoples fear of water meant hydrogymnastics was not performed as often and as a result, bathing (in general) also declined. But in the 1700's (decade), water and hydrogymnastics was used once again to treat illnesses; one of which was Smallpox and this was a very common disease during this period of time.

Therefore, as time passed more and more people began to see the benefits of water rehabilitation, and as a result people all over the world adopted hydrogymnastics into their lives. Consequently, new names, methods, techniques, styles, equipment and principles have been introduced into aquatic rehabilitation, one of which is hydrogymnastics. Today, hydrogymnastics helps people of all ages, genders and even those with disabilities to improve their balance, strength, endurance and movement. At the present time, almost every local aquatic centre has hydrogymnastics classes available.

Hydrogymnastics is also performed by athletes. Athletes use hydrogymnastics as a form of recovery which can help them heal from injuries at a faster rate. Depending on the athlete and which sport that participate in, these injuries can range from serious back, shoulder injuries to hip and knee problems; such as an ACL ligament tear or rupture. The severity of the injury will also determine if the participant is assisted by the therapist, uses specific equipment and/or a form of resistance, how long they spend in the water and the intensity of the activity. These are all also determined by the participants pain levels.

Bad Ragaz Ring Method (BRRM)
One technique of hydrogymnastics is the Bad Ragaz Ring Method. In 1957, BRRM was created in the “therapeutic thermal pools of Bad Ragaz in Switzerland” by Dr. Knupfer. BRRM involves a participant and three ring floaties which are located around their neck, pelvis, keens and/or ankles. These floaties help the participant to stay afloat in a horizontal position. The therapist is located at the participants head, side or feet and hence is able to effectively perform movement (e.g swaying, rocking, rolling, etc.). In order to be beneficial, this method requires warm water.

The are many benefits associated with BRRM, and these include; spinal alignment and elongation, stability, better range of joint motion and ability to activate pre-weight bearing. However, people who would benefit from the Bad Ragaz Ring Method include those who suffer from pain while moving (e.g walking, lifting, etc.), those who have poor range of motion and coordination, those who have “proprioceptive or sensory deficits” and those who are unable to use their full weight bearing. By using a particular form of equipment (floaties), BRRM is simultaneously a method for learning to activate different muscles and a form of body relaxation.

Watsu
Another hydrogymnastics technique is Watsu. In 1980, in the Hot Springs of Northern California, Watsu was created by Harold Dull. Essentially, Watsu combines both the Bad Ragaz Ring Method and Shiatsu massage - a type of massage that only uses hand pressure from a therapist. And like BRRM, this method is also performed in warm water in order for it to be completely beneficial.

In order for Watsu to work, the therapist should be situated at the centre of the participants back, not too low that they are near their lumbar spine and not too high that they are near their cervical vertebrates. Watsu is heavily dependent on the therapist as no floaties are used. By using the “supine position”, the therapist literally holds or cradles the participant and glides him/her through the water. In Watsu, it is extremely important that while the body is moving, rhythmical breathing occurs.

The benefits of Watsu include; reduced pain, freer range of motion and movement, more energy, development of even breathing, better sleeping and rest patterns and a higher body awareness (the ability to feel when something in their body does not feel right). People who will benefit from Watsu include those who experience pain while moving, those who have suffered from a traumatic brain injury, those who suffer from a neuromuscular disorder, soft tissue dysfunction, fatigue or hyperactivity, depression, stress, and anxiety.

Ai Chi
In 1990, Jun Knoon created another hydrogymnastics technique; Ai Chi which incorporates both Tai chi and Qigong. Unlike the other methods, the participant who takes part in Ai Chi is alone and does not use any assistance from a therapist. The only commonality Ai Chi shares with the other methods is that it too is performed shoulder level in warm water. To perform Ai Chi, the participant stands with his/her feet shoulder-width apart with their knees slightly bent (to prevent strain on their lower back). While they coordinate deep breaths and rhythmical inhaling and exhaling, they slowly move their body to stretch out muscles. By engaging their core/abdominal muscles to shift their body weight, the participant is able to lift their arms and legs to perform various stretches. The benefits of Ai Chi include; better flexibility and balance, improved range of motion and mobility, increased blood circulation and higher energy levels. As a result, Ai Chi reduces one’s stress, anxiety, fatigue, anger and depression.

AquaStretch
AquaStretch is the most recent hydrogymnastics technique. In 2010, George Eversaul introduced AquaStretch- a technique that involves resistance (e.g wearing weights) in order to restore one’s range of motion. Also like the other techniques, AquaStretch takes place in warm water. In order to perform AquaStretch, it is essential both the therapist and participant abide by the “basic procedure” which incorporates four steps. The first step is ‘play’ and this means the participants freely moves around in water to find the exact location where they are experiencing pain. They then ‘freeze’ when they have found the spot where the have pain and/or are prevented from moving. The therapist then applies ‘pressure’ (with fingers, hand and/or elbow) to the muscle the participant is experiencing the pain. The final step is ‘move’, however this step is not always performed. Depending on the participant and if “they feel the need to move”, this step aims to release muscle or body tension.

The benefits of AquaStretch include; decreased pain or soreness and improved flexibility, which suggests that the people who are most likely to benefit from AquaStretch are those who suffer from muscle strains, aches and pains. It is also important that therapist sheds a light on the differences between “good” and “bad” pains, where if the participant is experiencing “bad” or sharp pains, they must stop immediately.

Health Benefits
There are many health benefits associated with hydrogymnastics and these benefits are evidently found in a variety of people who suffer from physical health issues (e.g. arthritis, muscle pain, etc.), mental health issues (e.g. depression, low self-esteem, anxiety, etc.), injuries (e.g. ACL tears) and disabilities (e.g. Cerebral palsy, Parkinson's disease, etc.). However, the overall benefits of hydrogymnastics (on the participant/patient) include; better coordination, balance and strength, improved endurance (muscular and cardiovascular), better range of joint and muscle motion, ability to manage pain, increased hydro-static pressure and improved motor skill s and locomotion skills. It is also important to note that hydrogymnastics also has benefits on the therapists as the water buoyancy means the participant has a lighter body weight, which thus allows them to lift, hold and move the participant more easily.

As alluded to earlier, buoyancy plays a large role in ensuring the participants benefits from performing hydrogymnastics. Buoyancy means that when one is “submerged” in water, their body will float and this is mainly due to the fact that water has an anti-gravitational effect. In hydrogymnastics, the deeper a person is immersed in water, the less body weight they are carrying and therefore, this results in less pressure on one’s joints, ligaments, bones and muscles, better flexibility and increased range of motion. Because resistance activities are also incorporated into hydrogymnastics, this means that the participant will experience other health benefits such as muscle toning (especially around the legs, buttocks and arms) and reduced swelling (e.g. around the lower legs and feet).

Benefits on the elderly
When elderly people participate in hydrogymnastics they gain the ability to freely move their body without the fear or risk of severely injuring themselves. This fear derives from them being prone to falling over because their weak, frail and fragile bodies simply cannot bear their body weight. In addition, hydrogymnastics will benefit the elderly because it is a way for them to keep active, move their body, stay physically healthy and interact with others which will ultimately benefit their mental, emotional and social well-being.

Benefits on the middle-aged
As one enters the middle-aged stage of life, it is common from them to lose strength and as a result, they are prone to injuries. By performing hydrogymnastics during this age group, the benefits can include; improved upper and lower body strength and endurance. One of the most beneficial hydrogymnastics activities would be “large muscle activities” such as walking in water, as this explicitly uses arm and leg movements and will increase their muscular strength, endurance and range of motion.

Benefits on youths
In regards to the youth age group, hydrogymnastics is mainly used to help support children or young adults who have disabilities or developmental delays. To positively affect children’s functional mobility without causing excessive fatigue, therapists lead and assist activities such as; floating, walking, resistance activities (e.g using weights), sitting on floating mats and performing in different water heights and water currents. Consequently, this increases their functional mobility.

Doing hydrogymnastics in a group or with other participants also improves their socialisation skills as interacting with others encourages them to engage with people belonging to their environment; a key characteristic necessary for individuals to function within society. Having an improved functional mobility has important implications on the overall health and development of young children with disabilities. This has the power to promote participation in other physical activities which will improve their mental, physical, emotional and spiritual well being.

Benefits on athletes
Hydrogymnastics can also be performed by any level of athlete including; professionals (Olympians, world champions, etc.), elite athletes and international, national, state and local stream athletes. To these athletes, hydrogymnastics is a different way of training and moving in water means they are carrying a lighter body weight and therefore, not putting extra strain on their bodies, muscles, bones and joints. If they are recovering from an injury or going through their recovery, building back their strength and endurance in water is a very effective method and can potentially result in them returning to their land-based sport more speedily. Applying motor skills in water can potentially increase their confidence because in water, they can do things they can't or are unable to do on land.

Health Risks
There are not many health risks associated with hydrogymnastics however, it is important therapists and participants (regardless of their age, gender and/or ability level) take precautions in order to prevent injuries or internal damage. These precautions include; being aware of potential ear infections, especially because hydrogymnastics is performed in water and understanding that overuse can cause muscles strains, cramps, soreness and even tears. Because hydrogymnastics is a physical activity that involves movement, motion sickness can be quite common. This can cause a participant to feel dizzy, lightheaded and/or nauseous[1]. Also, if a severe injury (that is in its early stages) already exists, such as broken bones, soft tissue or fractures, it is strongly recommended that the participant does not perform hydrogymnastics until the injury has sufficiently healed or until the therapist advises to do so[2].