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Justifiable Aquatic Therapy Strategies for the Total Hip and Knee Replacement Client
Taught By: Bruce Becker, MD; Andrea Salzman, MS, PT

Minneapolis, MN

Oops. You missed it. See our 2014 schedule here
Or bring this EXACT class to your pool.


A 4-hr ATU Bootcamp is offered at no additional cost immediately prior to this class (see next column for schedule). This class is required before taking any ATU course (current water-gurus excepted).


A 18 hr. training module packed into 2 days (4 hr. Boot Camp plus 14 hr. main course). Designed to provide evidence-based support for treating the hip and knee replacement patient in water – and then to practice these techniques in water. Will focus exclusively on the THR and TKR patient. Examines recent research findings which support aquatic therapy for this population. Provides detailed instruction of the following techniques as relates to the hip and knee population: PNF, Aquatic Blanket Drills (ABD), aquatic adaptations of the Berg (for balance), plyometrics, edema control, and more.


  1. Describe 2-3 important factors for therapists to remember about joint replacement surgery patients (lecture)
  2. Describe why aquatic therapy may be the treatment of choice if (a) the patient demonstrates an abnormal gait pattern or the need for an assistive device post-operatively due to pain or weakness, (b) the patient is experiencing post-operative edema limiting ROM  (c) the patient is unable to exercise in a gravity-dominant environment (lecture)
  3. Recite 3-4 aquatic precautions and contraindications specific to the pre- and post- total hip and total knee replacement patient (lecture)
  4. Understand, from the physician's perspective, under what circumstances it would be appropriate to begin aquatic therapy as early as 5-7 days post-operatively (lecture)
  5. List 2-3 distinctions which should be made in working with the anterior vs. posterior approach THR patient in water (lecture)
  6. Document medical necessity for aquatic therapy and locate what payers (including Medicare) have to say about its use for the pre- and post-operative total joint replacement patient (lecture)
  7. Be able to identify and locate supportive research to bolster case (lecture)
  8. Understand what information physicians would look for in a brief Powerpoint presentation on aquatic therapy services for this population. Be able to make a 3-minute "case" for treating this population in water.
  9. Outline a sample baseline protocol (either conservative, moderate or aggressive) for working with a THR or TKR patient in water. Include frequency, duration, intensity, and a progression of interventions (lecture)
  10. Understand if aquatic therapy should -- or should not -- be a part of post-manipulation rehab for a stiff knee syndrome. Make a case for treating these patients in water more often than 2x/week (lecture)
  11. Understand what information physicians would look for in a brief Powerpoint presentation on aquatic therapy services for this population. Be able to make a 3-minute "case" for treating this population in water.
  12. Match 2-3 mock patient scenarios with the specific aquatic techniques that are most appropriate (lab)
  13. Progress a specific aquatic task (such as turning, stepping, squatting) from a lower level of function towards increased independence. Demonstrate skilled use of verbal and tactile cueing to engage patient participation (lab)
  14. Understand the basic principles of the following techniques and apply them to the pre- and post-operative total joint replacement patient:
  • Aquatic adaptations of the Berg
  • Aquatic Blanket Drills (ABDs)
  • Aquatic manual therapy and stretching
  • Functional skills training
  • Progressive resistive exercise
  • Proprioceptive neuromuscular facilitation (PNF)
  • Watsu (lab)
  1. Working with a partner, design and implement a 15-minute aquatic treatment plan (including equipment selection) for 1-2 of the following:
  • Pre-operative treatment for total hip replacement candidate
  • Post-operative treatment for total hip replacement candidate
  • Pre-operative treatment for total knee replacement candidate
  • Post-operative treatment for total knee replacement candidate

View all 2010 classes

Download brochure (PDF)

ATU Schedule

Friday AM (Bootcamp)
8:30-9:00 Registration
9:00-10:30 Lecture
10:30-1:15 Pool lab

Friday PM (Main course)
2:00-2:30 Registration
2:30-4:15 Lecture
4:15-5:00 Supper
5:00-9:00 Pool lab

9:00-12:00 Lecture
12:00-12:45 Lunch
12:45-3:30 Pool lab
3:30-4:00 Energy break
4:00-6:30 Pool lab

Aquatic therapy seminars and trainings

Schedule Changes
Due to unforeseen circumstances or events, ATU schedules, instructors
or venues are subject to change without notice.

Cancellation Policy
The final date for refunds (minus $175 reseating fee) for cancellations by students is 2 wks before class start date. No refunds given for cancellations after this date.



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