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Hydrotherapy, Sports Therapy
Hydrotherapy for knee & hip replacements
December 21, 2018 | by Erin Bussin, Fortius Hydrotherapy Lead & Performance Rehabilitation Coach

Whether it’s due to a sports injury or simply wear over time, most of us know at least one family member or friend whose undergone knee or hip joint replacement.

The up side, these surgeries help individuals manage pain, and get back to exercises or activities they could no longer do. The down side, they are intensive surgeries which require a lengthy rehabilitation process.

At Fortius, our Hydroworx™ 2000 Underwater Treadmill​ is a powerful tool to help optimize the recovery process from joint replacement surgery. Here are three ways our Performance Rehabilitation Coaches (PRC) can help.


Squats underwater in the hydrotherapy pool

In the Vancouver Coastal Health system, the average wait time for a joint replacement after a scheduled appointment is 9 months2. However, the entire process can take up to 2 years! Many people with arthritic hips and knees are in pain and fearful of further damaging their affected joint, and unsure how they can prepare for surgery.

During this time, it’s important to stay active, manage your weight, focus on joint mobility, and improve your strength, so you can prepare your body for the demands of the recovery process.

The biggest mistake a person can make is to stop moving all together. This can lead to gaining weight and stiffening the joint, in-turn increasing the pain, and injuring the joint further.

The underwater treadmill is a great way to slowly build the capacity of the workout in order to strengthen a knee or hip in preparation for surgery. The buoyancy, hydrostatic pressure, and temperature of the water helps to reduce the load on your joints, increase the joint range of motion and decrease inflammation, subsequently meaning less pain.

This also helps to manage your weight, or improve your mobility, and to strengthen your joints to better preparing the body for the impactful activities like walking after surgery.

This is especially relevant if your surgery is related to osteoarthritis:

“A study published in Journal of Strength and Conditioning Research showed patients with osteoarthritis (OA) had improved balance, function, mobility, and reduced joint pain after participating in a 6-week aquatic treadmill exercise program.” 1


Man holder onto a bar and squatting in the underwater treadmill

After being discharged from the hospital, it’s difficult to know when you should start doing specific movements and if you are doing them properly. It has been a long time since you first learned how to walk! Doing a movement like walking, incorrectly, can cause muscle imbalances throughout your body and increase the impact on the unaffected joints. Without proper guidance and instruction, joint mobilization can be delayed resulting in a slower recovery and a loss in the integrity of the surrounding soft tissues.

Gait and movement retraining should be an important part of your recovery. This can be done in the underwater treadmill under the supervision of a Performance Rehabilitation Coach (PRC).

As soon as the wound heals following surgery (approx. 2.5 – 3 weeks) you can enter into the pool. Due to the buoyant and hydrostatic characteristics of water, you are able to perform movements, walk, and practice balance with reduced or no pain, discomfort, or assistance.

The underwater treadmill is also equipped with six cameras, allowing the PRC to analyze movements from each direction and plane. They are able to outline all the proper mechanics and risk factors that commonly occur after surgery, giving you instructions to correct movements in real-time.

As you master the art of walking, step ups, and squatting, they can progress movements to help you regain all the range of motion and strength you had prior to your joint injury.

And don’t forget about the mental side of recovery! Fear of falling can be enough to prevent many patients from getting their joints moving after surgery.4 Being in the water provides a more comfortable environment to build your confidence walking and moving before progressing to land.


After joint replacement, many people are told that they may never run again.

You can run in the Fortius underwater treadmill! After a joint replacement, the impact of running on land can cause the new hip or knee to deteriorate quickly, which is why surgeons recommend against it. There is significantly less force on you joints when underwater, which means…YOU CAN RUN AGAIN.

The comfort of running on an underwater treadmill is incomparable to anything else. The treadmill can allow you to work on your aerobic fitness, joint strength, and mental health without further damaging your new hip or knee.

In 2015, the University of Wisconsin conducted a five-week study on the impact of the underwater treadmill on injury recovery.

“Adults with a history of orthopedic limitations and discomfort exercised on an underwater treadmill two days a week for forty minutes performing both aerobic exercise and aquatic resistance training. Results showed improve flexibility, sleep patterns, and reduce muscle, and joint pain.” 5


Are you, or do you know someone, preparing for a joint replacement surgery? Talk to them about the Fortius underwater treadmill. Note: Hydrotherapy requires a referral from your doctor, physiotherapist or health care provider.


I recently gave an online lecture on the current scientific literature on aquatic therapy and hip replacements, the major focuses at each stage of rehabilitation, and which exercises to perform during these stages. This will give you a more in-depth look at the benefits of hydrotherapy for hip replacements. View it here >>

Article References:

  1. Bressel, E., Wing, J., Miller, A., Dolny, D. “High-Intensity Interval Training on an Aquatic Treadmill in Adults with Osteoarthritis: Effects on Pain, Balance, Function, and Mobility”. Journal of Strength and Conditioning Research. (2014) 28:2088-2096
  2. Retrieved from https://swt.hlth.gov.bc.ca/Home.xhtml
  3. Brown, C., Williams, B., Woodby, L., Davis, L., Allman, R. “Barriers to mobility during hospitalization from the perspectives of older patients and their nurses and physicians.” Journal of Hospital Medicine(2007) 2:305-313
  4. Damar, H., Bilik, O., Karayurt, O., Ursavas, F. “Factors related to older patients’ fear of falling during the first mobilization after total knee replacement and total hip replacement”. Geriatric Nursing (2018)39: 382-387
  5. Desmond, A., Bayliss, A., Jacobson, H., Hardy, H., Jarvey., Bredle, D. “Health Benefits of Underwater Treadmill Exercise for Active Adults” Department of Kinesiology, University of Wisconsin. Retrieved from https://www.hydroworx.com/content/uploads/2015/07/Active-Aging.pdf