The Aquatic Physiotherapy Level 1 course - what I learnt!

We are committed to ongoing professional development of our team to deliver evidence informed physiotherapy care. Our Splash Physiotherapists complete the APA Aquatic Physiotherapy Level 1 course in their first year of working with us. Here's what I learnt!

What is the Aquatic Physiotherapy Level 1 course about?

As health professionals based in evidence and practice, physiotherapists must constantly learn new skills to help provide best care for their patients and clients.

One of our Splash values is our commitment to life long learning.

All Splash Physiotherapists complete the Australian Physiotherapy Associations’ Aquatic Physiotherapy (Level 1) course.

This article will provide a brief overview of what this course teaches, so that you can become aware of the kind of things that go through our heads as we see your child.

The course is broken down into several sections, including:

  • the properties of water and their effects on our bodies

  • rotation of the body in multiple directions (axes) and how to work with these axes

  • risk management of working in the water

  • manual techniques specific for the water

  • the evidence behind aquatic physiotherapy

  • how to use clinical reasoning in this specialised environment.

ID: Splash value "We are committed to life long learning. We are highly skilled and up to date. We are constantly improving. Evidence informed practice, quality improvement'. This Splash Values card is accompanied by Shayna, one of our Splash Physiotherapists, in an aquatic session with a child who is looking up towards the camera. Splash logo in the corner.

Properties of the water

Properties of the water define the environment in which we work. They have implications for how we treat, the effectiveness of our treatments, and the overall safety of working in the water. We consider hydrodynamics, hydrostatics, relative density (how easily we sink or float in the water), buoyancy, metacentre and drag force.


Buoyancy is the upward force we experience in water. It's the opposite to gravity, pulling us down into the ground.

You may have noticed that you feel lighter while in the pool and that this feeling increases as you move deeper.

The deeper you are, the less body weight you experience.

For example, when the water is at the depth of your hips, you experience around 50% of your total body weight.

As Physiotherapists, we can use the concept of buoyancy to help in our treatments.

We may use buoyancy to either assist or resist movement, making them easier or harder.

Many of the children we work with love the freedom they feel in water as they are able to move more easily when assisted by buoyancy.


Metacentre refers to the centre of our bodies, that we rotate around in water.

For example, we can use this to help strengthen and develop coordination of the abdominal muscles, trunk and neck, through trying to keep the body stable while we move our limbs.

Drag force

Drag force relates to the “thickness” of the water and the notion of turbulence. It increases when we move faster, or push a larger surface area against the water.

We can use this for strengthening, building control, and providing feedback for sensory processing.

We can also use turbulence to help train balance, by asking the individual to keep upright while we create turbulent forces around them.

All of these concepts are not used by themselves either!

As Physiotherapists we are constantly thinking of ways in which we can combine them to help create the greatest effect.

ID: Alex and a Splash kid float underwater as the sun shines through the surface on to them

Rotation Around Three Axes

When we swim, walk or reach for an object, we often move in more than one direction at any given time. This is because we are constantly working against multiple separate forces.

Knowing how the body balances and rotates around these forces/axes is important, as it relates to muscular control and how we move in the water effectively.

We can use these forces to help train certain muscles and improve certain skills such as trunk control.

We use these forces when teaching swim safer skills.

Risk Management

It is also important that we are constantly thinking about the risks of working in the pool and how we should manage them.

The latest Australian Physiotherapy Association Aquatic Guidelines (2015) were developed to assist our work in this specialised environment as it carries specific risks.

Examples of areas covered include: infection control, falls risk, pool management, and how different medical conditions respond to submersion in water. Pool rescue is covered through our swim teacher training that Splash Physiotherapists complete through ASCTA.

Splash families have aquatic risk screens done before any sessions and these are regularly updated.

Methods and Manual Techniques

Aquatic Physiotherapy involves many different approaches, and as Physiotherapists we must be able to choose which one is right for our clients at any given time.

There are many things that we need to think about to help tailor our techniques to the individual. This includes “what is the goal of the technique?”, “how can we use the properties of the water to make the technique harder or easier?”, “what can the client do at the time?” and “how can we progress the exercise?”

Overall though, we use Aquatic Physiotherapy for strengthening, improving control and movement, balance, cardiovascular conditioning, improving an individuals’ ability to swim, joint mobilising, stretching and relaxation.

At Splash Physiotherapy, we are always linking our sessions back to participation and functional goals, which could be water based (eg. swim safer skills and behaviours) or land based (eg. mobility, agility, sport and recreation specific goals).

Evidence Based Practice and Clinical Reasoning

Physiotherapists use evidence informed practice, and we at Splash are no exception.

What this means is that we take the best evidence available at the time, our own clinical expertise, and your goals and values to provide the best care possible.

We do this through applying what is known as “clinical reasoning”. This reasoning is adaptive, using all available information, and is always evolving through the incorporation of new information presented.


Aquatic Physiotherapy is an extremely beneficial area of Physiotherapy, and is one that involves many aspects that don’t apply on land.

I hope I have been able to inform you on the kinds of things that we are thinking about during our sessions, and that you have a better understanding of us and what we do!

Alexander Cowcher is a Splash physiotherapist working with young children to young adults in aquatic, land and telehealth physiotherapy. He has a strong focus on developing the skills that help kids to join in with activities in their everyday life at home, school and the community, and loves to see kids getting active riding their bikes and joining in with their sports teams. He has sessions available for aquatic physiotherapy at our Greensborough pool and nearby wheelchair accessible pool, visits and telehealth, and loves our sports and recreation intensives over the school holidays.

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