Last month, we emphasized the importance of exercise to combat the natural aging process. Specifically, exercises like Pilates, Tai Chi and Yoga provide coordinated full body workouts with an emphasis on core muscle strengthening, balance and fluidness of movements. But what if you have pain in your knees or back making even simple movements like walking difficult? Thank your lucky stars because here in Hawai‘i, you are surrounded by the perfect modality—water.

Physical therapists have been utilizing the unique properties of water to rehabilitate patients for decades. We call it Aquatic Therapy. By submerging the body partially in water, it creates weightlessness and takes the pressure off our knees, hips and spine. This is especially useful for patients with arthritis, healing fractured bones, or who are overweight. By decreasing the amount of joint stress it is easier and less painful to perform exercises.

Once submerged, the viscosity of water provides resistance so you can build strength without using additional weights. Slow controlled movements like leg lifts and arm circles under water can be very effective for strengthening your legs, arms and back. Even simply walking in chest-height water can improve leg and back strength, balance and cardiovascular fitness.

Another important feature of aquatic therapy is hydrostatic pressure, which is the evenly distributed pressure that is exerted on the body when it is submerged under water. This pressure provides joint positional awareness. As a result, your proprioception, the sense of where your body is in space, is improved. This is important as proprioception naturally declines with age, beginning at around 40, and is critical factor for balance reactions. Hydrostatic pressure also allows for pain free movements by decreasing swelling caused by injury or arthritic disorders.

For rehabilitation purposes, Aquatic Therapy is often done in a heated pool, which helps to increase circulation and allow muscles to relax and stretch safely. However, if your goal is fitness and not rehabilitation from injury, any pool will do.

Many facilities have “water aerobics” for a more structured program. Hawai‘i’s beaches are superb for aquatic fitness too. The calm waters at Magic Island are ideal. Simply walking in waist to chest-high water is an excellent workout and the gentle currents will help improve balance. As always, use good safety precautions at the beach.

Physical therapists like to say, “Motion is lotion,” the more we move, the easier it will be to keep moving!

Teresa Wong is a physical therapist, certified Pilates instructor and manager of the Rehab Hospital Of the Pacific Nu‘uanu Clinic. The clinic provides state-of-the-art rehabilitation programs for individuals recovering from injuries and illnesses. Visit online at; email,