November 2017: Specialty Techniques



Content courtesy of the National Swimming Pool Foundation


Contrary to therapeutic mythology, all care which occurs in the water is not identical. Clinicians make use of as broad a spectrum of treatment options in water as they do on terra firma. On land, therapists offer patients the sum total of their knowledge as health care professionals. This knowledge manifests itself as specific interventions or (if you will) as specialty techniques. 

Since water provides a therapeutic environment much different than land, it is unusual for therapists to merely take land-based treatments and place them in toto in the pool. It is much more typical for therapists to either significantly modify existing land-based treatments or to perform techniques which were specifically created to be used in water. 

Below is a list of the definition of the most well-established specialty techniques currently being performed in the aquatic therapy setting. 

Ai Chi – A form of active aquatic therapy or fitness modeled after the principles of T'ai Chi and yogic breathing techniques. Ai Chi is typically provided in a hands-off manner (the provider stands on the pool deck to allow visual imaging of complex patterns by the client). The client stands in chest-deep water and is verbally and visually instructed by the provider to perform a slow, rhythmic combination of therapeutic movements and deep breathing.

Bad Ragaz Ring Method  – A form of active or passive aquatic therapy modeled after the principles and movement patterns of Knupfer exercises and Proprioceptive Neuromuscular Facilitation (PNF). Bad Ragaz is always performed in a hands-on manner by the provider. The client is verbally, visually and/or tactilely instructed in a series of movement or relaxation patterns while positioned horizontally and supported by rings or floats in the water. The patterns may be performed passively (for flexibility and relaxation), actively, or with assistance or resistance provided by a provider.[3]

Fluid Moves (Aquatic Feldenkrais) – A form of active or passive aquatic therapy modeled after the Feldenkrais Method. Fluid Moves may be provided in either a hands-on or hands-off manner by the provider. During active Fluid Moves, the student in a guided exploratory process, follows a sequence of movements based on the early developmental stages of the infant. The client stands in chest-deep water, typically with his back to the pool wall, and is verbally and visually instructed by the provider to perform a slow, rhythmic combination of therapeutic movements and deep breathing. The passive, hands-on component to Fluid Moves is modeled after the "Functional Integration" component of the Feldenkrais Method.

Halliwick Concept  – A form of adapted aquatics which can be modified into active aquatic therapy. Halliwick is almost always performed in a hands-on manner by the provider and is typically done through the use of games within groups of client-provider pairs. The client is usually held or cradled in the water while the provider systematically and progressively destabilizes him in order to teach balance and postural control. The provider progresses the client through a series of activities which require more sophisticated rotational control in an attempt to teach the client to swim (for adapted aquatics clients) or in an attempt to teach control over movement (for aquatic therapy clients). The client is continuously required to react to, and eventually to predict, the demands of an unstable environment. The Halliwick Concept combines the unique qualities of the water with rotational control patterns.

Salzman Blanket Drills – A form of active aquatic therapy which makes use of towels, blanket or weight-weight scarves or wraps to create resistance and a visual effect in water. Created by physical therapist Andrea Salzman, these activities are designed to mimic functional movements and are named accordingly (Matador, Cursive writing, Spaghetti wrap, Parachute Bounce, Balance ball, etc). These activities are not a closed system; rather, the Blanket Drills are taught as an open system, encouraging new ideas and extrapolation from existing patterns.

Swim Stroke Training and Modification – A form of active aquatic therapy which makes use of swim stroke training and modification with the intent to rehabilitate, not to teach swimming skills or to promote swim stroke efficiency. Swim Stroke Training and Modification may be provided in either a hands-on or hands-off manner by the provider. The client is positioned horizontally and is verbally, visually and/or tactilely instructed in order to modify and execute various swim strokes.

Task-Type Training Approach – A set of principles that guide clinicians as they design treatment programs for reducing clients' disabilities. Task Type Training Approach (TTTA) was first described as a way to teach functional activities to clients who had sustained a stroke. The principles can be extended to include treatment of all patient disorders, particularly those involving neurologic dysfunction. The TTTA is best described as a task-oriented approach because it emphasizes functional skills performed in functional positions. Clients are encouraged to be active participants in their skill development, an important characteristic of task-oriented rehabilitation.

Watsu – A form of passive aquatic therapy modeled after the principles of Zen Shiatsu (massage). Watsu is always performed in a hands-on manner by the provider. The client is usually held or cradled in warm water while the provider stabilizes or moves one segment of the body, resulting in a stretch of another segment due to the drag effect. The client remains completely passive while the provider combines the unique qualities of the water with rhythmic flow patterns.


Adler, D. (2016). Ai Chi Body/Mind/Spirit Adaptations.

Bahmani, D., Farnia, V., & Shakeri, J. (2015). The comparison of the effect of yoga and aquatic exercises on depression and fatigue in patients with multiple sclerosis. Pharmacopsychiatry, 25(6), 52. Retrieved from

Barbosa, G. (2014). Effect of Watsu therapy on psychological aspects and quality of life of patients with temporomandibular disorder: case report. RGO-Revista Gaúcha …, 62(3). Retrieved from

Bayraktar, D., Guclu-Gunduz, A., Yazici, G., Lambeck, J., Batur-Caglayan, H. Z., Irkec, C., … Nazliel, B. (2013). Effects of Ai-Chi on balance, functional mobility, strength and fatigue in patients with multiple sclerosis: A pilot study. Neuro Rehabilitation, 33(3), 431–437.

Calderón García, A. (2015). Effectiveness of the Halliwick Method in the treatment of subacute stroke. fisioGlía: Revista de Divulgación En Fisioterapia. FisioEducación. Retrieved from

Camilotti, B., Leite, N., & Alberti, D. (2015). Effects of Ai Chi and Yamamoto new scalp acupuncture on chronic low back pain. Fisioterapia Em Movimento, 28(4), 723–730. Retrieved from

Case-Smith, J., Weaver, L. L., & Fristad, M. A. (2014). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism : The International Journal of Research and Practice, 19(January), 133–48. 

Cha, H. G., Shin, Y. J., & Kim, M. K., Cha, H.-G., Shin, Y.-J., & Kim, M.-K. (2017). Effects of the Bad Ragaz Ring Method on muscle activation of the lower limbs and balance ability in chronic stroke: A randomised controlled trial. Hong Kong Physiotherapy Journal, 37, 39–45.

Cheung, C., Wyman, J. F., Resnick, B., & Savik, K. (2014). Yoga for managing knee osteoarthritis in older women: a pilot randomized controlled trial. BMC Complementary and Alternative Medicine, 14(1), 160.

Covill, L. G. L., Utley, C., & Hochstein, C. (2016). Comparison of Ai Chi and Impairment-Based Aquatic Therapy for Older Adults With Balance Problems: A Clinical Study. Journal Of Geriatric Physical Therapy, Epub ahead of print.

Cruz, S. P. de la, Lambeck, J., Pérez de la Cruz, S., & Lambeck, J. (2016). A new approach to the improvement of quality of life in fibromyalgia: a pilot study on the effects of an aquatic Ai Chi program. International Journal of Rheumatic Diseases, Epub ahead of print.

Cruz, S. P. la, Luengo, A., & Lambeck, J. (2016). Effects of an Ai Chi fall prevention programme for patients with Parkinson’s disease. Neurología (English Edition), 31(3), 176–182. Retrieved from

Herold, B., Stanley, A., Oltrogge, K., Alberto, T., Shackelford, P., Hunter, E., & Hughes, J. (2016). Post-Traumatic Stress Disorder, Sensory Integration, and Aquatic Therapy: A Scoping Review. Occupational Therapy in Mental Health, 36(4), 392–399.

Keane, L. G. (2017). Comparing AquaStretch with supervised land based stretching for Chronic Lower Back Pain. Journal of Bodywork and Movement Therapies, 21(2), 297–305.

Kochar, R. D. (2011). Effect of AquaStretch on Range of Motion at Knee Joint in Total Knee Arthroplasty Patients. ProQuest Dissertations and Theses, 56. Retrieved from\n

Kokaridas, D, Lambeck, J. (2015). The Halliwick Concept: Toward A Collaborative Aquatic Approach. Inquiries in Sport & Physical Education, 13(2), 65 – 76. Retrieved from

Kurt, E. E. E., Büyükturan, B., Büyükturan, Ö., Erdem, H. R., & Tuncay, F. (2017). Effects of Ai Chi on balance, quality of life, functional mobility, and motor impairment in patients with Parkinson’s disease. Disability and Rehabilitation, Epub ahead of print.

Maia, A., Amarante, J., Serra, N., & Vila-Chã, C. (2017). Can a Halliwick swimming programme develop water competence, static and dynamic balance in disabled participants? Motricidade; Ribeira de Pena, 13(1), 134–135. Retrieved from

Martínez, P., López, J., & Valenzuela, A. (2015). Hydrokinesitherapy program using the Halliwick method on strength endurance and flexibility in a person with poliomyelitis sequelae. Nutricion Hospitalaria, 31(3), 1452–1454.

Perez-de la Cruz, S., Garciía Luengo, A. V., & Lambeck, J. (2016). Effects of an Ai Chi fall prevention programme for patients with Parkinson ’ s disease. Neurologia, 31(3), 176–182. 

Perez-De la Cruz, S., & Lambeck, J. (2015). Effects of a programme of aquatic Ai Chi exercise in patients with fibromyalgia. A pilot study. Revista de Neurologia, 60(2), 59–65. Retrieved from

Resende Silveira Leite, J., Almeida Galdino Alves, D., Alves Silva, D., Fernandes Do Prado, L., Fernandes Do Prado, G., Bizari Coin De Carvalho, L., … Bizari Coin De Carvalho, L. (2013). Watsu therapy in the treatment of fibromyalgia syndrome. Sleep Medicine, 14(2013), e180–e181.

Rico-Martín, S., Santano-Mogena, E., Cobos-Serrano, J. L., Calderón-García, J. F., Hägglund, E., Hagerman, I., … Strömberg, A. (2017). Effects of yoga versus hydrotherapy training on health-related quality of life and exercise capacity in patients with heart failure: A randomized controlled study. European Journal of Cardiovascular Nursing, Epub ahead of print.

Skinner, E. E. H., Dinh, T., Hewitt, M., Piper, R., & Thwaites, C. (2016). An Ai Chi-based aquatic group improves balance and reduces falls in community-dwelling adults: A pilot observational cohort study. Physiotherapy Theory and Practice, 32(8), 581–590.

So, B. C. L. B., Kong, I. I. S. Y., Lee, R. K. L. R., Man, R. W. F. R., Tse, W. H. K., Fong, A. K. W., & Tsang, W. W. N. (2017). The effect of Ai Chi aquatic therapy on individuals with knee osteoarthritis: a pilot study. Journal of Physical Therapy Science, 29(5), 884–890.

Teixeira, R., Perez, L., Lambeck, J., & Neto, F. (2011). The influence of ai chi on balance and fear of falling in older adults: A randomized clinical trial. Physiotherapy (United Kingdom), 97, eS654.

Villegas, I. L., & Israel, V. (2014). Effect of the Ai-Chi Method on Functional Activity, Quality of Life, and Posture in Patients With Parkinson Disease. Topics in Geriatric Rehabilitation, 30(4), 282–289.

Wratten, S. (2017). Ai Chi -- what is it and why use it within a healthcare setting? A summary of the presentation at the November 2016 ATACP study day. Aqualines: The Journal of the Hydrotherapy Association of Chartered Physiotherapists, 29(1), 6–7. Retrieved from

Schitter, A. A. M., Nedeljkovic, M., Baur, H., Fleckenstein, J., & Raio, L. (2015). Effects of passive hydrotherapy WATSU (WaterShiatsu) in the third trimester of pregnancy: results of a controlled pilot study. Evidence-Based Complementary and Alternative Medicine, Epub ahead of print. 

Shams-Elden, M. (2017). Effect of aquatic exercises approach (Halliwick-therapy) on motor skills for children with autism disorders. Ovidius University Annals, Series Physical Education & Sports/Sciences, 17(2). Retrieved from

Stan, A. E. (2016). Applications Of Bad Ragaz Method In Aquatic Programs Of Rehabilitation. Marathon, 8(1), 110–117. Retrieved from 

Statement, P. (2012). Sensory Integration Therapies for Children With Developmental and Behavioral Disorders. Pediatrics, 129(6), 1186–1189. 

Tripp, F., Krakow, K., Krakow, R., Tripp, F., & Krakow, K. (2014). Effects of an aquatic therapy approach (Halliwick-Therapy) on functional mobility in subacute stroke patients: a randomized controlled trial. Clinical Rehabilitation, 28(5), 432–439.

Vaščáková, T., Kudláček, M., & Barrett, U. (2015). Halliwick Concept of Swimming and its Influence on Motoric Competencies of Children with Severe Disabilities. European Journal of Adapted Physical Activity, 8(2), 44–49. Retrieved from

Vute, R. (2017). Halliwick swimming methods in the wellness reflexions as swimming for everytone. Acta Salus Vitae, 5(1), 56–63. Retrieved from