Ai Chi improves movement efficiency in patients
Ai Chi movements can be used to improve movement efficiency of clients who have chronic pain, arthritis, fibromyalgia, chronic obstructive pulmonary disease, balance deficits, diabetes, multiple sclerosis, or other neurological and orthopedic problems.
Ai Chi movements can be used to improve movement efficiency of clients who have chronic pain, arthritis, fibromyalgia, chronic obstructive pulmonary disease, balance deficits, diabetes, multiple sclerosis, or other neurological and orthopedic problems. Ai Chi can be used in groups or individually, requires no equipment, and allows the hair and face to stay dry. This head-out position is important for nonswimmers who would benefit from exercise in the water. Additionally, because the philosophy and breathing in Ai Chi are similar to those of land-based tai chi, many of the benefits seen in tai chi are applicable to Ai Chi.
Many of the benefits of Ai Chi come from breathing and relaxation. These benefits include those of exercise and the effects related to the relaxed contemplative state (Berger and Owen 1992; Taylor-Piliae and Froelicher 2004). The expanded range and cardiovascular benefits that arise from Ai Chi training have proved beneficial for patients with chronic pain, arthritis, chronic obstructive pulmonary disease, diabetes, and balance impairments. Ai Chi can also promote relaxation with clients who are coping with high stress levels (Courtney 2000; Jerath 2006; Vargas 2006).
Practicing slow movement techniques and diaphragmatic breathing increases relaxation; decreases muscular tension; improves symptom management (Arpita 1982; Monroe, Ghosh and Kalish 1989; Koh 1982; Sancier 1996; Courtney 2000); and facilitates recovery from problems associated with low back pain (Bhatti 1998), scoliosis, carpal tunnel syndrome, musculoskeletal injury or surgery, and sports injuries. These techniques have also been used successfully to improve balance (Queiroz et al. 2007) and improve symptoms associated with chronic disorders such as rheumatologic diseases, fibromyalgia (Berman and Singh 1997), and arthritis. Tai chi has been show to improve osteoarthritis symptoms, self-efficacy, tension levels, and satisfaction with general health status (Hartman et al. 2000). Tai chi has also been shown to increase lower-extremity muscle strength and endurance (Lan 2000).
Tai chi and Ai Chi follow the same precepts of slow, fluid, rhythmic movement with controlled breathing that can positively affect postural stability and falls in the elderly. Several studies have examined the effects of tai chi on balance and on the risk of falls in older people. In one survey of people age 70 and older, those who participated in tai chi training reported improvements in their daily activities, whereas others who participated in balance training alone reported no such improvements (Natural Standard). A 2004 study clearly demonstrated that tai chi training could lead to statistically significant improvements in functional balance in older persons (Li 2004). In another study, researchers observed that tai chi practice is valuable for improving physical balance (Tsang and Hui-Chan 2005).
Long-term practice of tai chi can improve muscular strength in the lower body, particularly around the knees and ankles, as much as long-term jogging, according to another published study (Xu 2006). Another study found that tai chi participants had stronger feelings of self-efficacy and less fear of falling than did older adults who did not practice tai chi (Fuzhong et al. 2005). These findings are good news for older adults who are looking for gentle movement alternatives that provide powerful conditioning benefits.
Dynamic balance ability is an independent predictor of quality of life (Karinkanta et al. 2005), so if older-adult practitioners of tai chi are stronger, feel more confident, and experience less fear than their peers do, they are likely to experience a higher quality of life than those who do not have the same level of conditioning.
Ai Chi creates musculoskeletal benefits that are derived from the effects of buoyancy, gentle and controlled movement, and coordinated breathing. Clients who experience back, neck, or shoulder pain unresponsive to other interventions may find respiration to be the missing link. A key component of many head, neck, and shoulder pain syndromes may be secondary inspiratory muscle overuse (Gallagher 2005). Diaphragmatic breathing can cultivate relaxation, myofascial function, and lumbopelvic stabilization (Gallagher 2005). The stress response to pain traditionally increases muscle tension, which usually leads to more pain (Turner, Ersek, and Kemp 2005). Diaphragmatic breathing can decrease the stress response.
The Ai Chi coordination of breathing and movement allows muscles to produce graceful, flowing movements of the trunk and extremities. This activity can lead to development of core control and alignment for all movement, not only Ai Chi movements (Queiroz et al. 2007), if properly cued and trained (see figure 7.14). Alignment, balance, and stabilization skills can be improved with properly trained slow movement techniques (Tsang and Hui-Chan 2003, Yan 1998, Wolfson 1996, Wolf 1996). Balance learned in the water (an unstable medium) translates well to land.
Along with arthrokinematic effects, the active Ai Chi motions recruit specific muscle groups and preserve the contractile property of soft tissues. Relaxation done before range of motion will minimize or eliminate monosynaptic spinal reflex (Pal, Velkumary, and Madanmohan 2004). Submerging the joints lessens the joint compression and edema (Cole and Becker 2004). The properties of water combined with the Ai Chi movements can improve range of motion and overall mobility. From a musculoskeletal viewpoint, range of motion is an effective means of maintaining the integrity of connective and soft-tissue structures.
Positive cardiovascular effects have been found in studies of tai chi training (Lai et al. 1995). Studies of physiological measures during cycle ergometry have shown that oxygen uptake and work rate in the tai chi group were significantly higher than in the control group. Other studies have shown increased cardiorespiratory function, soft-tissue flexibility, and increased strength in community-dwelling older persons who participated in tai chi one to four times per week (Schneider and Leung 1991).
Practice of the slow movement techniques and diaphragmatic breathing has been shown to activate the parasympathetic inhibitory nervous system, decrease heart rate, decrease blood pressure, improve respiratory and cardiovascular function, decrease oxygen consumption (Lai et al. 1995; Jerath 2006; Bowler, Green, and Mitchell 1998; Fried 1993; Pal, Velkumary, and Madanmohan 2004), create a neutral respiratory quotient, and decrease blood lactate and blood lipid levels (Chopra 1989; LaForge 1997; Moyers 1993). Diaphragmatic breathing has been shown to decrease autonomic instability and improve heart rate variability (Pal, Velkumary, and Madanmohan 2004).
A stress response produces increased respiratory rate, decreased tidal volume, and a shift to thoracic breathing. Ai Chi breathing can inhibit neural responses (Gatti 2003). Eliciting a parasympathetic or inhibitory response will enhance vagal modulation, decrease heart rate, and improve respiratory synkinesis (Courtney 2000), thus improving breath function. Clients with respiratory impairments that affect their ventilation can benefit significantly from the synchronized Ai Chi breathing cycle (Vargas 2006). Research has shown that implementation of diaphragmatic breathing exercises decreased postoperative complications in patients who underwent cardiac or pulmonary surgery (Chumillas et al. 1998; Vraciu and Vraciu 1977).
Decreased blood pressure and anxiety are a result of the relaxation that accompanies diaphragmatic breathing (Cheung 2005; Gatti 2003). Essential hypertension (high blood pressure of unknown cause) is common in our society. The Ai Chi breathing mode of treatment is beneficial in decreasing essential hypertension. Research has shown that blood pressure decreases by 3 to 15 mm Hg in studies of regular diaphragmatic breathing exercises (Grossman et al. 2001; Schein et al. 2001). The breathing, however, must flow and be continuous. Breath holding creates detrimental effects on the heart and overall health, including elevated blood pressure and a decrease in blood oxygen levels.
The practice of slow movement techniques with diaphragmatic breathing increases alpha electroencephalogram activity; produces right hemispheric activation; decreases sympathetic nervous system arousal and increases awareness; decreases hypothalamic-pituitary-adrenal activation (Martinsen 1993; Miller, Fletcher, and Kabat-Zinn 1995; Wang et al. 1993; Dychtwald 1986; Courtney 2000; Singh 1998; Ross 2001); and improves the psychological state associated with chronic diseases, anxiety and depressive disorders, anger management, and stress-related dysrhythmias. Stress can contribute to problems such as back pain, neck tension, headaches, fibrocystic nodules, muscle spasms, indigestion, heartburn, stomach ulcers, palpitations, shoulder and upper-chest pain, insomnia, disturbed sleep patterns, anxiety, depression, breathlessness, nausea, and fatigue (Rakel and Mercado 2007). Diaphragmatic breathing has been shown to decrease the stress response and alleviate depression, anxiety, and insomnia (Rakel and Mercado 2007; Tweddale, Rowbottom, and McHardy 1994; Cholz 1995). Stress increases muscular tension and vasoconstriction, thus decreasing blood flow throughout the body (Rakel and Mercado 2007). Tension in the neck causes muscular neck pain and headaches, tension in the stomach affects digestion, and tension in the body increases blood pressure. Relaxation through diaphragmatic breathing reduces blood pressure and the workload on the heart and decreases muscular tension.
Researchers attribute gains in brain function to the amount of oxygen that the brain receives during movement. The brain uses the glucose that it receives (delivered by the oxygen) as fuel for thought. Movement increases production of a brain chemical called brain-derived neurotrophic factor (BDNF), which stimulates the growth of nerve cells in the brain and curbs the development of Alzheimer's disease as well as other age-related brain degeneration (Astin et al. 2003). Water, movement, and music are used to encourage a state of relaxed awareness. With increased awareness, the breathing and relaxation learned in Ai Chi can be transferred to other life situations. If the breathing and relaxation associated with Ai Chi can be used to aid healing when they are simply remembered, the actual Ai Chi session is doubly valuable.
Practicing slow movements with diaphragmatic breathing has been shown to decrease epinephrine, cortisol, serum growth hormone, thyroid-stimulating hormone, prolactin, adrenocorticotropic hormone, and beta-endorphin (Arpita 1982; Monroe, Ghosh, and Kalish 1989; Morales 1994; Keleman 1989; Gallagher 2005; Sancier 1996). An endogenous opioid is an endorphin that is a product of the endocrine system (Farrell 1986). It is a hormone that has a biochemical similarity to drugs like morphine. The endorphins are best known for their analgesic qualities and their assistance with mood control. Other effects that are more widespread include the regulation of appetite, temperature, and respiration (Hoffmann 1997; Rama 2007). Improvements in immune system functioning, weight maintenance, and overall disposition because of hormone regulation can be side benefits from the practice of Ai Chi.
This is an excerpt from Aquatic Exercise for Rehabilitation and Training.
Aquatic training programs benefit injured athletes
The aquatic environment can help to mitigate some of the potential fitness loss in injured athletes.
Some form of rest is often the treatment recommendation for an injured athlete. The rest may be relative rest, in which the athlete reduces the intensity of training or activity, or it may be absolute rest, during which the athlete performs no activity. In either case, rest for an athlete can be problematic. The research of Coyle et al. (1986 and 1984) showed that a significant decline in cardiovascular fitness can result from as little as 3 wk of inactivity. A 14 to 16% decline in maximal oxygen consumption has been documented after 6 wk of rest (Coyle et al., 1986 and 1984). Given that 3 to 6 wk is not an inordinately long period and certainly within the realm of the time needed for recovery from a musculoskeletal injury, the loss of cardiovascular fitness needs to be considered. An athlete may rehabilitate an acute injury only to find that he or she returns to the sport with a significant loss of conditioning. Fortunately, the aquatic environment can help to mitigate some, if not all, of the potential fitness loss.
A study by Michaud, Brennan, Wilder, and Sherman (1995) demonstrated that a progressive, 8 wk deep-water running program can successfully increase V.O2max. Exercise sessions performed three times per week at an intensity of 63 to 82% of maximal HR on land for 16 to 36 min per session were sufficient to produce a training stimulus. For the athlete, specificity of training is an important element to maximizing the application of fitness. Athletes who participate in sports that involve running could benefit from either shallow- or deep-water running, depending on weight-bearing limitations. When they are able to do so, athletes should “run off the shallow end” into the deep water to maintain proper running form (Thein and Brody 1998). They should include a slight forward lean and take the leg through to the horizontal position in a swing, avoiding circular motions (see figure 11.8). The elbows should be at 90° with the hands open, avoiding a dog paddling motion (Chu and Rhodes, 2001). As previously stated, HR, running cadence (with a metronome), and RPE (respiratory and leg musculature) are all useful tools to ensure that the cardiorespiratory system is challenged.
The cross-country skiing motion is an effective way to challenge both the upper and lower extremities. The reciprocal motion also recruits the oblique muscles to contribute to trunk stabilization. Swimming can be incorporated into a cardiovascular program in many ways. Although the front crawl and backstroke utilize a variety of large-muscle groups, many athletes are not accomplished swimmers and may not be able to achieve an adequate cardiovascular workout. Modifications such as flutter kicks or dolphin kicks with flippers or holding a kickboard with the hands can provide a conditioning effect to the unskilled swimmer. The athlete can perform any of these tasks exclusively or in combination to achieve a sustained workout in the range of 60 to 90% of maximal HR reserve or an RPE of 13 or 14 (somewhat hard or harder).
In addition, using interval training or circuit training can add variety to a program and reduce the risk of boredom. Interval training consists of alternating bouts of high-intensity and low-intensity (recovery) periods. Work periods should last for 2 to 8 min, and HR should be in the 80 to 90% range for the high-intensity periods and in the 60 to 70% range for the low-intensity periods. Total workout duration should be 20 to 50 min (Bates and Hanson 1996). A lower-extremity sample program is displayed in table 11.10, and an upper-extremity program is shown in table 11.11.
Table 11.10
| Lower-Extremity Aquatic Exercises for Athletes |
| Exercise | Duration | Intensity |
| Water running | 3-5 min | High |
| Scissor kicks | 2-3 min | Low |
| Cross-country skiing | 3-5 min | High |
| Trunk rotations | 2-3 min | Low |
| High knee running | 3-5 min | High |
| Leg figure-eights | 2-3 min | Low |
| Water running | 3-5 min | High |
| Double knee to chest | 2-3 min | Low |
| Cross-country skiing | 3-5 min | High |
| Butt kicks | 2-3 min | Low |
| Total time | 25-40 min | |
Table 11.11
| Uper-Extremity Aquatic Exercises for Athletes |
| Exercise | Duration | Intensity |
Reciprocal arm swings
| 3-5 min | High |
Sagittal elbow flexion and
extension
| 2-3 min | Low |
| Rowing with a float board | 3-5 min | High |
Trunk rotations holding a ball
| 2-3 min | Low |
Arm jumping jacks
| 3-5 min | High |
Ball press-downs
| 2-3 min | Low |
Reciprocal arm swings
| 3-5 min | High |
Horizontal elbow flexion and extension
| 2-3 min | Low |
Arm figure-eights
| 3-5 min | High |
Arm press-outs (serratus)
| 2-3 min | Low |
| Shoulder internal and external rotation | 3-5 min | High |
| Total time | 25-40 min | |
In circuit training the athlete uses a series of exercises that alternates the use of muscle groups. Again, the workload of each activity in the circuit should be 50 to 70% of functional capacity (Bates and Hanson 1996). By alternating muscle groups, the athlete can mitigate muscle fatigue to achieve the objective of continuous movement with the HR in the target training zone. Each activity may be performed for 2 to 3 min or for 30 to 50 repetitions. Some suggestions of sport-specific tasks are displayed in table 11.12. Increasing the speed of movement increases turbulence, which in turn increases resistance. Increasing the surface area of the moving body part with flippers, floats, boots, mitts, water wings, or paddles will also increase resistance to movement. Flotation devices such as float boards, AquaJoggers, and Aqua-Belts can allow a person to work in a non-weight-bearing situation. Thus, individual muscles and the cardiovascular system can be challenged without the joint compression forces experienced on land.
Table 11.12
| Sport-Specific Aquatic Exercises for Athletes |
| Sport | Aquatic exercise |
Tennis
Baseball
Softball | • Swinging a tennis racket (forehand and backhand) or baseball bat in the water
• Lower-extremity braiding
• Forward, backward, and side-to-side ricochets
• Scissor kicks
• Shoulder IR and ER with paddles |
| Football | • Plowing through the water with a kickboard
• High-knee running
• Forward and backward running
• Ball push-downs |
Soccer
Field Hockey
Lacrosse | • Forward, backward, and side-to-side ricochets
• Lower-extremity braiding
• Upper-body wall push-ups
• Walking lunges
• Leg figure-eights
• Reciprocal rowing with paddle |
Gymnastics
Track and Field Jumpers
Basketball
Volleyball | • Floating squats*
• Tuck jumps
• High-knee skipping
• Straddle jumps
• Box drops
• Ball push-downs
• Upper-body wall push-ups |
| Sprinters | • Floating squats
• Tuck jumps
• High-knee skipping
• Straight-leg kicks
• Split jumps
• Horizontal squats with push-offs from the side
• Box drops
• Reciprocal rowing with paddles |
Skating
Ice hockey | • Plowing through the water with a kickboard
• Lower-extremity striding
• Floating squats
• Tuck jumps
• Lower-extremity braiding
• Diagonal scissor kicks
• Reciprocal rowing with paddles |
| Cycling | • Bicycle motion with a flotation device
• Floating squats
• Walking lunges
• Flutter kicks with a float board
• Box drops
• Deep-water high-knee jogging |
| Wrestling |
• Floating squats
• Walking lunges
• Tuck jumps
• Plowing through the water with a kickboard
• Resisted trunk rotation
• Ball push-downs
• Upper-body wall push-ups |
*Floating squats=perform a leg press motion while standing on a float board.
This is an excerpt from Aquatic Exercise for Rehabilitation and Training.
Aquatic exercise offers safe fitness activity for pregnant women
Non-weight-bearing activities such as swimming have well-known benefits on maternal fitness.
The American College of Obstetrics and Gynecology and the American Society of Obstetrics and Gynecology recommend that healthy women maintain their exercise programs during pregnancy (Artal, Clapp, and Vigil 2000). Non-weight-bearing activities such as swimming and cycling and low-impact aerobics have well-known benefits on maternal fitness. Large increases in core body temperature, however, should be avoided during pregnancy. Proper hydration, appropriate modes of heat dissipation, and diligent monitoring can help mitigate significant increases in body temperature.
A study by McMurray, Katz, Bery, and Cefalo (1988) examined the effects of submerged cycling on 12 women at 15, 25, and 35 wk gestation. First, the researchers had the subjects pedal on land cycles at 50 rpm at increasing workloads (increased by 12 to 25 W every 3 min) to determine each person's 60% maximal HR. Karvonen's formula of 0.6 (220 - age - resting HR) + resting HR was used. The subjects then pedaled in xiphoid-level water for 20 min at their individual equivalent of 60% of their maximal HR as determined on the land cycle. Risch et al. (1978) selected this level of submersion (and vertical position) and reported that the same effect on the heart exists as in horizontal swimming. Subjects showed no significant difference in V.O2 or DBP. When subjects were cycling in the water, HR and SBP were lower than on land for a given workload. Overall, the cardiovascular response to cycling in the water followed the trends identified on land. The researchers stated that pregnant women could safely exercise in the water at a workload that corresponds to 60% of their maximal HR on land. In many clinical and recreational environments, testing workload may not be possible. If this is the case, the general recommendation for an aquatic target HR is to reduce the target HR on land by 15 bpm (when submerged to the xiphoid process). This level has been determined to be a safe zone for the pregnant female (McMurray, Katz, Berry and Cefalo 1988; Risch et al. 1978).
Of course, the status of the fetus is also a concern when a pregnant woman is exercising. Katz, McMurray, Goodwin, and Cefalo (1990) compared land and water cycling at 70% of maximal HR. As a result of discrepancies in using land target HR to monitor aquatic exercise, the researchers elected to standardize pedal frequency. On land, pedal frequency was recorded at 70% of maximal HR and V.O2. Subjects, submerged to the level of the xiphoid, pedaled for 20 min at the target pedal frequency. Maternal HR, fetal HR, SBP, DBP, and rectal temperature were all monitored. Maternal HR, SBP, and rectal temperature were higher during land cycling than during water cycling, whereas fetal HR and DBP were similar for the two conditions. The researchers concluded that 70% of maximal HR and V.O2 were acceptable limits of exercise for pregnant women. They further stated that with a lower HR and SBP, mothers and fetuses tolerated water exercise at 70% of maximal HR and V.O2 better than they did land exercise.
A study by Watson, Katz, Hackney, Ball, and McMurray (1991) looked at the effect of maximal swimming and cycling exercise at 25 and 35 wk gestation. BP, HR, fetal HR (FHR), and umbilical and uterine artery systolic-diastolic ratios were monitored. The swimming program used a pulley system to provide resistance while subjects swam a breaststroke. Subjects swam for 3 min bouts with 1 min rest periods. Weight was progressively added to the pulley at each bout until the subject could no longer propel herself forward. No difference was found in maximal HR, FHR, or umbilical and uterine artery systolic-diastolic ratios between cycling and swimming. But cycling caused a greater increase in maximal V.O2 and hematocrit and a greater decrease in plasma volume compared with swimming. The buoyancy effect and thermal conductivity of the water required less blood flow to the skin to dissipate the internal heat produced, therefore preserving blood flow to the uterus (Watson, Katz, Hackney, Ball, and McMurray 1991). Again, this research has demonstrated that aquatic exercises may be safer for the fetus than land-based exercises of comparable intensity.
This is an excerpt from Aquatic Exercise for Rehabilitation and Training.
Correct form for the breaststroke
Learn the proper technique for the breaststroke
The breaststroke is a prone stroke with symmetric movement of the arms and symmetric movement of the legs.
The glide position is prone and streamlined. The hips and knees are extended, and the ankles are plantarflexed. The arms are flexed overhead and about 6 to 8 in. (15 to 20 cm) below the surface of the water. The hands are close together, and the wrists are pronated so that the palms are down. The head is positioned so that the waterline is near the hairline of the forehead (American Red Cross 1992). The trunk should be in a neutral position, nearly horizontal to the arms and legs.
From the glide position the shoulders internally rotate and the wrists pronate so that the palms turn outward at a 45° angle to the surface of the water (American Red Cross 1992). With the elbow extended, the shoulder is adducted to press the palms laterally until the hands are spread wider than the shoulders. From this position, the elbows flex and press the hands caudally and laterally until they pass near the elbows, with the forearms vertical. At this point, the wrists are supinated and the palms are circumducted medially and cephalad until the palms are below the chin and facing each other, almost touching. Throughout the power phase, the elbows should point laterally and be higher than the hands and lower than the shoulders.
Immediately after the power phase, the shoulders adduct horizontally, squeezing the elbows together so that the palms face each other. Then the arms reach overhead and the wrists pronate so that the palms face down and end in the glide position.
The recovery begins with hip and knee flexion and slight hip abduction. This motion brings the heels toward the buttocks, and the knees are hip-width apart or slightly wider (depending on the swimmer's preference) (Styer-Acevedo and Charness 1985). At the end of the recovery, the ankle dorsiflexes and everts. The ankles are just below the surface of the water at the end of the recovery, and the hip is flexed to roughly 125° (American Red Cross 1992). The trunk remains in roughly the same position as it is in the glide.
From the end of the recovery phase, the whipping motion is initiated by internally rotating the hip so that the feet end up lateral to the knees. Then the plantar surface of the foot and the medial lower leg engage the water, while the knee and hip extend, rotate, and adduct toward the glide position. The knee is almost fully extended when the feet are a few inches (centimeters) apart, and the ankle finishes in plantarflexion (Styer-Acevedo and Charness 1985). The ankle forms a circular motion with this kick, and the legs should be under the surface of the water for the entire power phase. The therapist may choose to modify the whip kick to the frog kick for most clients because the frog kick is easier to teach and places less stress on the knee, hip, and low back.
The recovery begins with knee and hip flexion, and hip external rotation and abduction. This motion brings the knees hip-width apart or wider, while the heels draw down together toward the buttocks. At the end of the recovery, the ankles dorsiflex and evert, ending just below the surface of the water with the hips flexed. The trunk remains in the same position as it is in the glide.
From the end of the recovery, the hip internally rotates toward neutral rotation. The plantar surface of the foot and the medial lower leg then engage the water as the knee extends, the hip adducts, and the ankles plantarflex and invert, drawing the legs together. The legs finish in the glide position.
The swimmer lifts the head to breathe during the arm power phase. As the arms recover, the swimmer lowers the face into the water and should slowly exhale bubbles through the mouth. At the end of the arm recovery phase, the swimmer explosively exhales the last of the breath and starts lifting the head for the next breath.
The arm power phase starts from the glide position. At the end of the arm power phase, the swimmer lifts the head to breathe and starts to recover the legs. After the swimmer has taken a breath, she or he should immediately lower the face into the water and start to recover the arms while the legs are finishing the recovery (American Red Cross 1992). The arms reach full overhead flexion just before the legs finish the kick. The swimmer should glide briefly and start the next stroke before losing momentum.
- More difficult stroke, more difficult breathing pattern
- May be stressful on neck and back injuries that do not tolerate spinal extension (although modification by using mask and snorkel can reduce strain on back, neck, and shoulder with breathing technique)
- May be stressful on shoulder injures that do not tolerate repetitive motions
- Can increase strain on low back and knees for clients with tight hip rotators who have difficulty with the whip kick
- Requires coordination, may be challenging for clients with no previous experience with this stroke
- Need body awareness and trunk stabilization strength, especially with extension forces
- Upper- and lower-extremity strengthening and active stretching
- Trunk stabilization
- Endurance training
- Breathing control
| Typical problems | Corrections or modifications |
| Poor coordination with arms or legs, causing difficulty with breathing technique and poor forward propulsion | Give the cue for the arms to “push down, around, up, and then glide.” Explain that the arms will draw an upside-down heart. |
| Give the cue for the legs to move “up, out, together, and glide.” Give the cue to start the stroke with the arms and finish with the legs: “Pull and breathe, kick and glide.” |
| Too little glide time inhibiting forward propulsion of stroke and causing early fatigue | Stress the importance of gliding to prevent slowing of forward momentum. |
| Poor strength or propulsion with whip kick | Can work on hip rotator stretching followed by motor planning and strengthening with the Bad Ragaz ring method lower-extremity pattern (bilateral symmetric hip flexion-abduction-internal rotation to reverse; see chapter 6). |
This is an excerpt from Aquatic Exercise for Rehabilitation and Training.
