Hydrotherapy is the ‘forgotten’ exercise

Quote from physio at Royal Hospital (Chelsea Pensioners’ pool)

The warmth of the water can improve flexibility, due to increased blood dilating into the tissues, which allows them to be stretched more comfortably, enabling greater range of motion in a multitude of joints.

Hydrostatic pressure – mild water pressure – helps reduce localised oedema following tissue injury. By supporting the body, the water pressure also helps joint stability and reduces risk of injury from falls.

Buoyancy reduces the majority of body weight on painful, injured or surgically repaired tissues, joints, and bones. This allows the patient to regain increased range of motion without the pain associated with full weight bearing. It also allows rehabilitation to start much sooner after injury or surgery, as in chest deep water body weight is effectively reduced by as much as 75%.

Private: sessions cost £80 a session

However, a pool doesn’t have to be enormous to give tremendous benefits and help with rehabilitation.


I ‘mix-and-match’ NHS care with private appointments with consultants who have left the NHS in frustration.  I happen to believe my health is important, so forego expensive holidays to pay to go privately.  More and more, I am finding private consultants tell me “keep on with hydrotherapy – it’s the best exercise”;  NHS consultants don’t – because they know pools are being closed down.

At Charing Cross Lymphoedema clinic I was interviewed by a bright young doctor, who mentioned Paolo Zamboni’s research into aqua aerobics, describing the benefits of Acqua Aerobics.  He promised to send over the paper, and when it arrived, I realised I had had one of his aqua aerobics classes when I was treated at Casciana Terme, over three years ago.

Zamboni and others produced a paper (extract in the magazine Phlebology (Oct. 18th 2016), on a specifically designed aquatic exercise protocol to reduce chronic lower limb edema, exploring advantages of basic aqua aerobics; this mentions sources including work at University of Ferrara.

Italy of course has an enormous advantage in that warm mineral spring are to be found all over the country, making it easy for every hospital and medical centre to have gallons of warm mineral waters gushing up (only I am not too keen on the sulphur-smelling ones around Tivoli – phew!)

Some hydrotherapy pools are run by Physios who use exercises developed in the thermal pools at Bad Ragaz, Switzerland, and others have been to the fantastic Clinic Bad Sulza (part of University of Jena, Germany) where their Olympic sized pools are state of the art – as is the physiotherapy

What does Lymphoedema Support Network advise?

They sent me a link http://www.lymphnotes.com/article.php/id/24/

which provides invaluable advice: from temperature of water, advice on exercises and wearing compression garments whilst exercising.

Pretty well any exercise in a pool is good – but those on the website seem the same as I was being taught in, in Italy.

Talk to your Physio and see if they can offer help with specific exercises for ‘your’ lymphoedema.  They may well want to read Zamboni’s article to learn more.Work Starts on New Children's Hospital Hydrotherapy Pool

Why does exercise work?

The lymphatic system is made up of a network of vessels that carry a clear fluid called lymph throughout the body. Lymph fluid serves the important purpose of carrying nutrients to the cells that bathe in the fluid. The lymph fluid then delivers cellular waste to the bloodstream, which carries it to the kidneys, colon and lungs for elimination. If your lymphatic system is blocked or clogged, you may experience a number of symptoms, including back pain, constipation, fatigue, depression and weight gain. However certain exercises can help release blockages and promote healthy movement of nutrients and waste throughout the body.

What exercises

Settle yourself standing in the water.   As you inhale, slowly turn your head to the right to a count of five. Pause for one second and then exhale, bringing your head back to centre for a count of five. Repeat on the left side. Do five repetitions on each side.
Stand or sit in a comfortable position. As you inhale, draw both shoulders up toward your ears and then exhale, releasing your shoulders to a neutral position. Repeat five times. Stand.  Flex the ankle and extend the ankle six times, flexing and pointing the toe like a ballerina. Repeat on each side.Stand and hold onto side rail.  
Get up on tip of toes. Stand.  Flex the ankle and extend the ankle six times, flexing and pointing the toe like a ballerina. Repeat on each side. Stand and hold onto side rail.  Get up on tip of toes for count of 30.  Then down.
Once you are warmed up, you can then go on with exercises using  the ‘toys’ that surround most pools, and HAVE FUN!
Hydro sessions at London Hospitals
  • Your doctor may recommended you, or generally you can self-refer
  • Generally there is no limit to number of sessions
  • Soap usually provided, sometimes hair shampoo and conditioner, plus lots of towels
  • Most offer cheaper deals if you buy a package of 6 – 10 sessions


  • Your GP has to refer you, and there is usually a limit to number of session (4 – 6).  Some hospitals offer further sessions if you pay.
  • Bring your own  (soap, towels, shampoo)

Both types generally keep the water at a temp. from 33-35 º (unlike general fitness club pools which are usually at a temp. of 27 – 30 º , which is too cold).


King Edward’s                                   WC1

Parkside                                          Wimbledon

Royal Free                                       NW3

University College Hospital                NW1

Royal Hospital (Chelsea Pensioners) SW3


Guys                                             SE1                        extra sessions @ £20 = 3 in pool with one physio

Charing Cross                                W6                          extra sessions £35 for 5;  you are exercising on your own

Chelsea and Westminster               SW10                        extra sessions available at extra charge

St. Thomas                                   SE1

Have a pool at home
Thanks to a firm called Endless Pools, this is no longer a far-fetched idea.  If you have the space, you can install your own pool in the garden, and cost is from £19,000 for a heated pool with equipment.  
The Brownlee Brothers,  Triathlon medal winners in the Olympics, have installed one in their backgarden;  theirs includes a Treadmill – ideal for weight-bearing exercise.  
More details:  Endlesspools.co.uk


1 Comment

  1. Vivienne Du Bourdieu

    This is absolutely fascinating information. I went to Poland to explore the use of spas and hydrotherapy about 2009. Tremendously useful; especially for those over 60. And it was free in government-run ‘baths’ and therapy centres. These were less elegant than private ones – which I was also shown and tried out – but the one-to-one care at the government ones was terrific. And so many happy older people! I concentrated on Gdansk, on that occasion.

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