Faced with a choice, Pat Butz decided 21 months ago not to take life sitting down.
was extraordinarily difficult for me to walk," says the 47-year-old Monkton resident, whose multiple sclerosis had progressed to the point that she was almost ready for a wheelchair.
Instead, she opted for therapy and exercise in a heated pool, where she is freed of gravity's drag by the buoyancy of the water and loosened up by its warmth. These days, thanks to her three-times-a-week water workout, she is able to do strength training at the gym as well.
Physical therapy in water cannot make Mrs. Butz's MS go away, of course, and she still needs a cane when she walks on land. The important thing for her is that she's able to walk at all -- that she can move about on her own two feet when she goes sightseeing, that she can get up and dance with her husband.
"We were at a black tie affair a few months ago," she says, "and I realized that if I had never come to therapy, I would not even be there."
Warm water therapy is as old as the Romans, and as new as the spanking bright pools at the modern facilities that house sports medicine and rehab centers, such as PPI in Owings Mills where Ms. Butz goes.
The principle behind it is the same as for a long soak in a warm tub: It gets the kinks out.
Moreover, the social, recreational and therapeutic options are almost unlimited. Those who simply want to maintain cardiovascular fitness while recovering from accident, illness or operation can don flotation vests and jog in deep water. Or they can make their muscles work as they walk at the shallow end.
Advances in medical care that led to longer life for the disabled also led to greater appreciation of the benefits of water. "As soon as the population of handicapped people began to increase in the '50s and '60s, [their] therapists found they could perform more and get better results in a heated pool," says Clint Williams, a therapeutic recreation specialist at the Maryland Rehabilitation Center.
"In the water, people can perform a range of motion exercises they cannot do on land," Mr. Williams continues. "It's almost like being on the moon -- the water enables them to use whatever muscles they do have."
Therapeutic heat -- around 90 degrees -- soothes, relaxes, makes you feel good, notes Dr. Richard Schlesinger, whose medical rehabilitation practice is in the Greenspring Sports Medicine and Rehabilitation Center.
The combination of heat and buoyancy means you don't hurt as much as when you move on dry land, the doctor explains. Your muscles don't clench in reflexive spasms. You begin to walk without the limp you've developed to alleviate your pain.
"Many times, people come here after hip and knee replacements because their doctor wants them to walk back and forth in the water to build up their strength," reports Connie Tressler, recreation administrative assistant at the League for the Handicapped.
There are, however, some medical conditions that can be exacerbated by thermal therapy. Some people with multiple sclerosis cannot tolerate the heat, and those with heart disease or high blood pressure require careful monitoring.
Moreover, the buoyancy can be deceiving: You may not realize how hard you're working against the water's resistance. "The general rule is that if a patient is feeling discomfort for more than two hours after a session in the pool, the work is at too high a level," says Bobbie G. Zabriskie, physical therapist and arthritis rehabilitation coordinator at the Maryland Center for Physical Therapy.
A variety of water workouts can be found around the state, including recreational therapy programs such as the "Arthritis-Aquatics Program" developed in 1983 by national representatives of the Arthritis Foundation and the YMCA, and now available at 17 sites in Maryland.
At PPI, a component of the Maryland Center for Physical Therapy, participants in the arthritis class bend and stretch, sweep outstretched arms through the water, do leg lifts and knee bends and even play a rousing game of beach ball -- all without getting their hair wet.
It's designed partly to be social, to provide an outlet for those who might otherwise be immobilized and isolated by joints that ache too much for recreation on dry land. And although it is not supposed to be a substitute for prescribed individual therapy, it's a means to a similar end: According to the Arthritis Foundation, the gentle water-based exercise "can help decrease pain and/or stiffness and help improve or maintain joint flexibility."
Water therapy can also be tuned to the special needs of a patient, according to Savas Koutsantonis, a partner at the Maryland Center for Physical Therapy. There, a 5-year-old recovering from a knee injury does his kicking activities in the pool; a ballplayer practices throwing, his injured arm supported by the water; and dancers rehabilitate their injured ankles and do stretches using the pool's railings as a barre.
For Mrs. Butz, therapy begins with gentle movement, first of her whole body, and then of her legs, as she lies on her back supported by flotation devices. Physical therapist Mary Salmon also has her work on balance: Mrs. Butz must stand on a float, raising one leg and then the other, using her arms to steady herself as Ms. Salmon makes little waves around her. Seated on a float, she has to mobilize her abdominal muscles to keep her balance as Ms. Salmon tips her from side to side.
"You have to find your center of gravity," Mrs. Butz says. "That's something I can extrapolate to land and use instead of flailing around when I lose my balance."
They've also taught her to walk sideways in the water, says Mrs. Butz, who recently put that lesson to use. "In a crowded situation on land, where I couldn't get through going straight, I turned sideways and thought: 'Hey! I can do that! It's just like walking sideways in the pool.' "
For information about Arthritis Aquatics Programs, call the Arthritis Foundation, Maryland Chapter, at 561-8090.