Sunday, September 21, 2014

Is Water Therapy Good for Your Knees?

I recently came across the question above in the comment section.

My answer is scattered all over this blog, but I don’t think I’ve dedicated an entire post to the subject.

So here’s my opinion:


In fact, if I were to suggest a “Holy Trinity” of the most excellent knee exercises -- those where you can get in lots of nourishing high repetition movement with little strain on the joint -- it would look like this (in no particular order):

(1) easy walking (initially stay on flats, take breaks every 20 minutes or so, and don’t let your legs slam down -- ever)

(2) easy cycling (a stationary bike though more boring is better as it’s easier to control the force you exert; cycle backwards if your knees are really weak)

(3) easy water movement (careful -- swimming may be a very bad idea if you’re kicking vigorously with your legs; you’ll need exercises designed for people with tender knee joints)

The right kind of water exercises can be a great way to heal bad knees. Water provides gentle resistance and support when you're moving about. Of course just jumping in and doing the overhead crawl from one end of the pool to the other usually won’t be a smart idea.

Where do you find good exercises?

Heal Your Knees is a book that contains many water exercises designed for those with hurt knees. A frequent commenter here likes The Complete Waterpower Workout Book (both books share an author, who evidently has made water therapy a key part of her physical therapy treatments).

My biggest reservation about telling people to try to heal through water therapy:

Most of us simply aren’t close enough to pools, or can’t afford pool memberships, or can’t align our schedules with pool hours, to make this a really practical option. A nice thing about a walking regimen is that walking can be done anywhere, anytime.

The other thing to note: Water therapy may not be the best treatment plan for you, regardless of whether there's a convenient pool nearby. I did try it for a while and had some good results. But then I had a setback and found I wasn’t getting the same benefits as before, so I changed to a walking-centered program.


  1. Hello! I came up with your blog and book when I was searching for a cure for my 9 years old daughter's knee. 3 months ago she had an accident at school and had lots of pain on her knee. For 1 month, they could not diagnose anything and than they found out that a part of her knee cartilage is broken (about 3 cm.). This week, she had a microfracture surgery where they removed the broken piece and made holes on her bone. I read a lot about the subject and most of what I read made me go in a depresssion. On the other hand, your blog gave me the hope. Do you have any recommendations for us? She has physiotherapy, will have water therapy and uses a kinetic machine 3 hours per day. I am really worried for her future and try to the best I can for her to make her future brighter. I would appreciate a lot if you can answer me... kind regards...

    1. Well, I'm not an expert and I certainly don't know the extent of your daughter's injury, but I would tend to be optimistic. I would think your daughter's age is on her side, being so young and still growing. Also, a microfracture isn't a bad kind of surgery, from what I know, if you're going to have knee surgery (I'm not crazy about some other kinds). And it sounds like you're going to be doing smart physiotherapy, with a passive motion machine perhaps and easy water movement.

      I would be quite optimistic, in fact, as long as you take it very slow and don't rush things (I wouldn't do jumping jacks on the new cartilage for a while). There is a lot of writing about how cartilage produced by a microfracture is bad, inferior, rubbery cartilage, but there's evidence that that tissue does start to evolve toward the more robust, normal variety. You just need to give it some time and not rush things. Check back in the future and let us know how she is doing! All the best.

  2. As a child, I had the so called 'growing pains'. What really happens is that when a child grows fast, the muscles are not strong enough to sustain that rapid growth and the cartilage bears the brunt of the walking, jumping and running that every child in the 80's was doing at least 5 hours a day. The GP at the time mentioned an operation, I didn't need any as after months of pains the knees settled on their own accord. In fact, I think I had stumbled upon Richard's 'cure' by chance, we moved and I started walking to school and because I was a bit older I didn't do as much skipping and hop scothing.
    Pains only started again last year, so about 28 years later, which for sure is a good sign!

    Good luck for your daughter. And it's great that she is doing water therapy, I love it

  3. Hi Richard. You mentioned doing a video of the devices you created to do the exercises. One was using a rubber tyre fixed to a nail, the other one some bungee cords fixed to your garage walls. Would you be able to post a diagram explaining these visually?


  4. Sorry, I never made a video. Doug Kelsey was the inspiration for the rubber inner tube contraption that I used for knee bends. Here are a couple of posts where I talked more about these exercises and how I did them:

    You might be able to find out more about the knee-bends-with-waist-belt exercise at Doug Kelsey's website.

  5. Thanks Richard. I'll try to adapt these.
    My osteopath mentioned a trial survey being doing by the top osteo surgeons and sport clinicians to which he will take part (as a guinea pig as he too has issues with cartilage). Apparently, they are coming back on the old idea of 'strengthening the quads' (about time!). Trials will consist in drilling micro fractures to force the cartilage to bleed and thus regenerate on some cases. I forgot what the second was meant to be, some kind of injections (not plasma). He will give me a copy of the lecture next month, I'll post it here

    1. That sounds good. I would be very interested to learn what they find. Thanks!

  6. Actually, microfracture is not a new thing, but there is a new element to it, can't remember what it is, duh!
    There is also this:

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  8. Hi!
    This is "Knee Pain" who is the person Richard mention who found the book "The Complete Water Workout" helpful for my knee. As Richard said, I want to emphasize that "water therapy" is not at all the same thing as "swimming.". Well-meaning people always say "I've heard swimming is good for knees. You should try that." that may be true when someone's knees are in a state that can handle swimming, but my knees were in too bad of shape for swimming. The act of kicking during the crawl stroke was just not a possibility!

    Also, the book I mentioned has a special section for people with really really bad knees -- and even at that i still had to work up slowly over time to be able to do some of the exercises.

    As Richard mentioned, water therapy depends on access to a pool. Not always possible. I got lucky because after some research i Found a public pool near where I live that has a designated "therapy area." it's heated to a higher temperature than the lap pool and also you are not required to do laps. They have a variety of water floatation devices. A lot of the exercises are done in a small area of the pool -- sometimes floating in the deep end, sometimes holding onto the side, sometime standing in the shallow end. And, I don't even have to put my face in the water or dunk my hair in the water.

    I also learned that some YMCA's have water therapy areas.

    Good luck!
    From "Knee Pain."