DRAFT. Property of the Aquatic Rehab & Wellness Center. Do not copy, modify or reproduce without authorized consent.

Transcription

1 TM

2 Basics + Welcome to AquaStretch Basics+ Training. We are dedicated to provide a hands-on learning experience for an in-depth appreciation and comprehensive approach to AquaStretch. A special thank you to George Eversaul who has blessed us with the knowledge, performance and creativity of AquaStretch. This manual is dedicated and designed to supplement and respect the skilled hands-on didactic training method George prefers for appropriate dissemination of this modality. AquaStretch is truly a learned skill which requires practice and follow up. Let the healing begin

3 Theory &Concepts Patient Education This technique is based on the belief that your body knows how to fix itself better than you or I may know how. I will be taking you through a series of different positions in which we are going to stretch. Once we are in the starting position, I will apply a little pressure/stretch to an area of your body and then I will ask you to move, if you feel the need to move. At that time, I want you to feel free to move your body to stretch in all different ways. I am here to assist and provide additional pressure (accentuation) to help dissolve the adhesions that are causing you pain and discomfort. Instructions There is Good pain and Bad pain. Do you know the difference? (If no, explain the difference between) Good pain is ok, Bad pain is not ok. If you experience any Bad pain at all, I want you to tell me to stop immediately. (or say less) Now, please tell me what I told you about pain. NO BAD PAIN!!!

4 Theory &Concepts 4 Basic Step Procedure 1. Play 2. Freeze 3. Pressure 4. Move as you feel the need to move During Play, the patient is encouraged to randomly move part of their body (i.e., leg or arm) and to freeze in the position their body experiences pain or restriction. While the patient maintains their frozen position, the patient verbally (not pointing with their finger), directs the therapist to the anatomical location where the patient feels the pain or restriction. (The therapist observes the patient s motion just prior to the freeze point to determine their vector of movement) Then, the therapist places pressure with their appropriate digit (finger/thumb) in the exact location the patient indicates pain or restriction and is asked to Move, if they feel the need to move. The therapist continues to stretch the patient s body in the same vector of motion observed just prior to freezing. Repeat steps 1 4 above, as required, putting pressure on each new point of restriction or pain. Often, the pain will seem to travel to new locations. This is expected and appropriate. Repeat all positions / grips / holds (listed on the following pages) on both sides of the body. Start with the unaffected or least problematic side of the person s body. This allows the facilitator to learn what is normal for that client. This also allows the client to learn the AquaStretch process without defensive reactions.

5 Theory &Concepts Fascial Adhesion Cycle Fasciae are connective-tissue found throughout the entire body. Fasciae encompass and hold muscles, nerves and blood vessels tightly together. According to the Fascial Adhesion Theory, excessively micro-calcified adhesions may form within the fasciae. These adhesions develop as a normal response to an injury. They may excessively calcify if the injured area is used prematurely. These adhesions may also excessively calcify following intense training workouts or in response to occupational aggravations. (ie. food servers, hairstylists) Fascial adhesions are essentially internal band-aids that form around the injury to protect it while it heals. The formation of fascial adhesions causes a person to compensate and move out of their normal range of motion. The longer the body compensates, the harder the adhesions become. This may also lead to layers of fascial adhesions around the injury, and layers of fascial adhesions throughout the rest of the body due to compensated movement patterns. If left untreated, may contribute to neurological Property and of the vascular Aquatic Rehab entrapments/impairments. & Wellness Center. Do not copy, modify or reproduce without authorized consent.

6 Precautions/Contraindications No Breaks (Fractures) No Tears Joint laxity Post-op considerations Joint Replacements Osteoporosis Anticoagulant medications (possible bruising) Long - term steroid use Edema of unknown cause (medical clearance recommended) Active cancer, current or past radiation (at least over the area) Heavy meds or substance abuse Litigation cases (in wellness/ fitness situations) Non responsive first treatment (i.e., hydrophobic)

7 Fracture Red Flags Infection Cauda Equinae Ankylosing Spondylitis Aortic Aneurysm Cancer

8 BASIC Starting Positions & Grips Wall Hang : WH; Foot/ankle work including Foot Grip (FG), Ankle Grip (AG) & Toe Grip (TG) IT Pump : ITP; Fascial release to the Iliotibial band Hip Rock : H/Rock; Works to release adhesions during anterior/posterior movement of the lumbar spine. Hip Roll : H/Roll; Fascial release for the lumbar, sacrum, and iliac crest regions. One Leg Standing : OLS; Fascial release for the hip, knee, and lower back. Hip Fulcrum: Pressure applied to posterior hip/ql during OLS; works to release adhesions in the SI joint. Two Heavy Feet THF:(with five variations): Lean Back (LB); Cervical adhesion release Arch Forward (AF), Cervical anterior adhesion release with cervical extension Back to Wall (BTW); knee pressure applied to release adhesions in fascia along the spine. Hands/Lean on Wall (Cops); Fascial release for the Sacro-iliac, lower back, and neck. Shoulder Roll; works to release adhesions in the clavicle and scapula. Wrist/Elbow work: releases adhesion for the carpal tunnel and elbow. Head Hang : (HH) Fascial release for the neck and capitus muscles.

9 Wall Hang Foot Grip Thenar Eminence lays between the 4th and 5th tarsal ray Top hand provides pressure into plantar flexion & Inversion Fingers gently wrap around the arch of the foot Bottom hand cups the calcaneus and provides a horizontal adduction force

10 Wall Hang Ankle Grip The thumb and either middle or index fingers is placed anterior to the talofibular articulation The client s calcaneus is placed in the palm of the facilitators hand. The facilitator provides a superior pressure on the calcaneus The facilitators L hand is on top when treating the L lower extremity

11 Wall Hang Toe Grip Proximal Thumb: Roll the side of the thumb to apply medial pressure onto the 1st MTP joint with the pad of the thumb. Distal Hand: Provides traction to the distal MTP.

12 Wall Hang Palpation to the IT Band is applied by the facilitator s proximal hand/thumb while the legs is pumped up and down. IT Pump/Palpation The facilitator starts distal and moves proximal along the posterior edge of the IT Band. The facilitator moves up ~ 1/2 inch with each pump. Pressure is applied during the downward motion as the leg is pumped up and down. No pressure applied with hip flexion Pressure is applied with hip extension Once the adhesion has been located, a V-Spread hold can be utilized to maintain pressure with active thigh rolling.

13 AquaStretch TM Wall Hang Hip Rock DRA FT The proximal hand is cupped and placed on the spine. The facilitator moves up and down the spine accenting hip and spinal extension when the legs are out straight. The cupped hand is moved ~2 inches with each movement. Hip Roll Figure 8 movement The facilitator s thumbs are placed on the ASIS and provide an inferior pressure. Initially, the facilitator assists the client into a lateral sway, followed by a figure 8 to the pelvis.

14 One Leg Standing Foot Grip with Traction Foot Grip with Traction: Same hand grip as seen during wall hang. However, now the client is standing with one weighted leg while the facilitator applies traction to the opposing leg. Stance leg is weighted with 7-14 lbs to keep the leg grounded Hip Fulcrum Accenting may bring the leg out of the water depending on the client s flexibility. When movement dysfunction or pain is detected at the hip, pressure can be applied to the posterior hip (PSIS/QL and/or piriformis) while the facilitator continues to accent the moving leg.

15 Precautions to Cervical Work O-A instability (Rheumatoid Arthritis, Down s syndrome, post high velocity i.e., MVA) Whiplash (do not perform within first 2 weeks of injury) Cervical Fusion Cervical Spine Red Flags Vertebral Artery Compromise Drop Attacks Lip Paresthesia Nystagmus Spinal Cord Compression/compromise Multiple Extremity Symptoms Signs of nerve root compression Pain, numbness and tingling distally Loss of sensation Isolated muscle weakness

16 Two Heavy Feet Lean Back With your thumbs crossed, gently rest your hands on the client s upper traps. Gently let your fingers wrap around to support the neck. The client is asked to spread their weighted feet and to lean back. Once rested in the water, the client is asked to move, if you feel the need to move 7-10 lbs are placed on both of the client s ankles

17 Two Heavy Feet Arch Forward With your thumbs crossed, gently rest your hands on the client s upper traps. Gently let your fingers wrap around to support the neck. The client is asked to spread their weighted feet and arch/fall forward into the water. Feet remain contact on the ground. Alternate hand hold: The head hang hold may also be used in this position depending on the patient and client comfort lbs are placed on both of the clients ankles

18 Two Heavy Feet Hands/Lean on Wall aka: Assume the Position The client is asked to face the wall, spread their feet, then lean onto the wall. The facilitator s thumbs are placed on the PSIS while providing an inferior pressure. Initially, lateral movement, followed by a figure 8 motion is accented by the facilitator. The client has 7-10 l bs on each leg

19 Two Heavy Feet Back Against the Wall With your thumbs crossed, gently rest your hands on the client s upper traps. Gently let your fingers wrap around to support the neck. The facilitator places their back against the wall and asks the client to stand in front of them. The client is asked to squat down, lean back and walk their feet out in front of them and put them together. The facilitator s knee is placed at C7-T1 and provides a gentle inferior pressure lbs are placed on both of the clients ankles

20 Two Heavy Feet Shoulder Roll The client is asked to squat into the water with their opposite hand on the wall to provide stability. The facilitator accents the rolling motion of the shoulder. The client has 7lbs on each leg

21 Head Hang Clear the cervical spine before you begin! *Left handed Grip shown, place the right hand under the chin if you are dominant right. The client s chin is placed into the palm of the facilitator s dominant hand. The thumb and fingers of the non-dominant hand are placed on the A/O joint. The client is asked to squat into the water and lift their heels behind them. The client has 5lb weights placed below the knee

22 Patient After Care Instructions What to Expect Possible muscle soreness Use ice / heat for any residual soreness as needed Use anti-inflammatory medication as needed Follow up Exercise Gentle Stretch and Range of Motion Core Stabilization ADL Modifications Postural Awareness/Corrections Work Ergonomics Drink Plenty of Water Get Rest!

23 Documentation Suggested functional outcome measurement tools: FIQ Fibromyalgia Impact Questionnaire GROC Global Rate of Change Scale SF 36 v2 Health Survey Scoring Demonstration Modified Oswestry Low Back Pain Questionnaire Tampa Scale for Kinesiophobia

24 Documentation Name: DX: Position/Grip Date: *Keep in mind to always note specific muscle groups and target areas PRE A/S MEASUREMENTS Wall Hang: (WH) C: S / N C: S / N C: S / N C: S / N Foot Grip B L > R; Ankle Grip B L > R Toe Grip B L > R ; All toes medial pressure IT Pump/Palpation Hip Rock Hip Sway/Roll B L > R;Proximal/distal/anterior/posterior Paraspinals; L > R QL/Lats/Traps L > R One Leg Standing: (OLS) 7-14 # # # # Foot Grip with Traction Hip Fulcrum B L > R L only Piriformis R only Two Heavy Feet: (2HF) 5-7 # # # # Lean Back Arch Forward Hands on Wall (ATP) Back against the Wall Lat Roll/Row Shoulder Roll Trap Tap B UT R > L A/O or cervical hold; B PSIS; L > R Knee placement; hand hold (cervical or A/O) B R > L B R > L B UT R > L Head Hang (HH) 0-5 # # # # A/O; R > L; specific muscles Floatwork Cervicals Specific area emphasized; suboccipital, scalenes, SCM etc Pressure/Accenting Tolerance min/mod/max ROM/SPL Following Tx Total A/S Time

25 Physical Therapy Principles Summary Outline by George Eversaul, What is AquaStretch (A/S)? Assisted stretching in water, with resistance to trigger a stretch reflex. The purpose of A/S is to restore (not increase) flexibility, and as possible, symmetrical movement. Levels of AquaStretch: The same A/S principles may be used for 3 different purposes. Fitness: (AEA, ACE) No Head Hang, No Back to Wall, May add Cobra See Fitness Summary Wellness: (NCB, ATRI) Whole body procedure, with chronic pain/problems > 3 months. Medical: (APTA PT, PTA) Whole body plus cranial osteopathy, recent trauma/surgery. Pain Instructions: During your A/S session, you may experience good or bad pain. If you feel any bad pain, tell me to stop immediately. What did I just tell you? Then use Socratic questions to confirm patient understood pain instructions, i.e. What type of pain? When should you tell me to stop? Why are the pain instructions important? 1. If bad pain is experienced, patient may have a tension defensive reaction that inhibits stretch reflex. 2. Patient may develop fear of AquaStretch. What are the Starting Positions & Grips of the A/S Wellness service? 1. Wall Hang: Footwork (foot grip, ankle grip, toe grip), IT Pump, Hip Rock & Roll 2. One Leg Standing: Foot grip with traction, and Hip Fulcrum Start on least afflicted i.e. leg. 3. Two Heavy Feet: Lean Back, (Arch Forward aka Cobra optional), Back to Wall, Cops-Assume/Position 4. Shoulder Roll: Wrist, Elbow, Hands/Fingers 5. Head Hang: A/O Grip, Cervical Grips, Head Roll (back/forth, left/right, roll chin follows hand ) Stretch Reflex: Like waking cat. AKA intuitive movement, unwinding in cranial osteopathy. Body knows what to do, but needs additional strength and endurance assistance (accenting). Patient is encouraged to Move, if you need to move. Reduce expectation of being done by therapist. Stages of Stretch Reflex (intuitive movement): Trigger, Accent, Move with Me (See document) What are the 3 ways to trigger the stretch reflex? Gradually put a joint into stretch, gradually increase pressure on a fascial adhesion, or use intentional movement until intuitive movement is experienced. How much pressure do you put on a fascial adhesion or to stretch a joint? Enough to trigger the reflex. What are Playing instructions? Directed: (i.e. Leg) frog kick, reverse frog, bicycle, while rolling hips Random: Please move your (i.e. arm) any direction you want & freeze if you feel any pain or restriction. What is the Playing sequence? Unilateral-least afflicted, A/B compare, Unilateral-worse side, Bilateral Least afflicted first for 4 reasons: What s normal; Reduce compensation problems; A/S safe; Better comparative. After A/B comparision by patient (i.e. left vs right leg/ankle), ask them if they d like a matched pair. :o) A/B test helps patient psychologically understand A/S is working, and to identify when to freeze. If you observe patient spontaneously playing, encourage them to continue randomly testing for fascial adhesions. Patient may report adhesion is moving. Patient is actually unmasking previously hidden adhesions What is Proprioceptive Encroachment? When the facilitator s body or the environment cause the patient s brain to limit playing because of a fear their body may hit something or someone.

26 Physical Therapy Principles cont. What is the Basic A/S Procedure? Loose wrists, with firm grip (finger/thumb pads, not tips) Play: Have patient move some part of their body randomly or by direction until they feel pain or restriction. Freeze: When feeling pain/restriction, patient freezes their body position to maintain tension on fascia. Pressure: Without pointing, patient directs facilitator where to put pressure. Up, down, left, right, front, back Pointing may change the patient s body position, taking tension off the fascial adhesion. Ask patient to re-position a few degrees before freezing point, to position pressure properly. Move: Patient asked to Move, if they feel the need to move, with continuation of vector. What is the Continuation of Vector? When patient plays, observe direction (vector) of movement just before they freeze. After putting pressure on adhesion, the body will usually continue or need to continue in the same vector. Specific frozen spots may need stretching in multiple vectors. (See Move with Me document.) Why does A/S Work? 1. In water, you can stretch into positions not possible, and hold stretches much longer, than on land. 2. In water muscles float, allowing you to identify and stretch fascial restrictions more effectively. 3. A/S accents the body s natural stretch reflex, that itself is freer & more dynamic without gravity. What is the Fascial Adhesion Theory? Theoretically fascia excessively calcifies on a protein collagen matrix, similar to dental plaque or arteriosclerotic plaque. The body is a tissue sandwich (layers of skin, agonist muscle, antagonist muscle, bone) in which the fascia both separates and connects the entire body. Fascial adhesions may restrict flexibility, cause a mal-adaptive range of motion (ROM), and/or irritate nerves causing pain/dysfunction. What 3 factors cause fascial adhesions? Not resolved by exercise/movement, i.e. after injury/surgery. Muscular over-use (occupational/recreational), improper healing (premature use), & genetic propensity. Fascial calcification may be aggravated by diet (i.e. GMO wheat), certain drugs, hormone imbalances, etc. How are massage and A/S different? Massage focuses on the muscles, A/S on the fascia. In the tissue sandwich, massage moves fascial adhesions in circles from vertical pressure, A/S stretches horizontally. A/S generally more effective than massage (and OMT), and lasts 3 to 4 times longer. Great synergy, A/S first. A/S Marketing: Free sessions key. A/S must be experienced to be believed. It is not logically predictable. Print ads/articles don't work, social media minimal. s (etc) for free sessions good, word of mouth best. Free demos for friend, by after or in person during 1 st or 2 nd A/S session, because A/S works immediately. Free 10 min demos for foot/ankle/knee/hip/clb pain. Wall Hang & One Leg only until clear release or A/B even. Free 10 minute demos for seniors, in Yoga & dance classes or aquatic programs for Water Walking & arthritis, etc. Free first sessions for fibromyalgia patients (Speak at support groups), Hair Stylists aka Follicle Surgeons :o) Fibromyalgia Patients (Best to develop A/S skills): Huss >100 pts, 3/4 sessions, then 8-12 week A/S tuneup New PT services: Wellness - 70% of Huss s rehab pts continue with cash pay A/S, Practice 50% wellness Pre-surgical: May reduce rehab time & pain med needs, better sleep. Relieve compensation problems FAQ (Frequently Asked Questions) 1. A/S how often? Weekly, until you don t get better. A/S tuneup when pain 20% of original > 3 days. 2. Can you do A/S on land? Yes, but results may be less effective, more painful, and take more time. 3. Who are contra-indicated? Infection risks, MRI confirmed spinal stenosis but helps secondary. A/S generally ok for MRI confirmed disk disease, suspected muscle/ligament tears (differential dx) 4. HydroFit.com 6 lb + 8 or 10 lb Pair Weighted Cuffs Keifer.com Ankle weights (5 lb) if low volume

27 Continuation of Vector & Client/Patient Assisted Accenting Move with Me Continuation of Vector: To summarize, the Continuation of Vector (C/V) procedure is a significant enhancement in the execution of the 2 nd and 3 rd steps (Freeze & Pressure) of the 4 step Basic A/S Procedure [1. Play 2. Freeze 3. Pressure 4. Move, if you feel the need to move]. C/V requires three facilitator tasks: 1) To determine the vector (direction), observe the movement the client/patient is performing immediately prior to the patient freezing into the position in they feel pain, restriction, stiffness, or tension. 2) After the client/patient freezes, into their pain or restriction and directs you (without pointing, so they don t change their body s frozen position) where to put pressure (via your thumb, fingers, palm, etc), you then ask the c/p to move whatever part of their body they were using to play backwards slightly in their motion just before freezing. This almost always frees the muscle tension needed for freezing and allows the A/S facilitator thumb or finger, etc, to penetrate into the fascial adhesion more deeply and maintain pressure on it more firmly. And 3) Finally, ask your client/patient to continue moving in the same direction and motion (not usually linear) as they were just before they froze, which usually then stimulates intuitive movement. Continuation of Vector seems to work more quickly and effectively in resolving fascial adhesions because your grip and pressure are more firmly on the connective tissue and because you are having your client/patient continue to move their joint and muscles in the same vector as their body needs to encounter resistance or pain from that specific fascial adhesion. C/V works especially well when combined with Client/Patient Assisted Accenting ( Move with Me ). MOVE WITH ME (Client/Patient Assisted Accenting): To summarize, client/patient assisted accenting is asking the c/p to Move with Me after the A/S facilitator has either stimulated and accented intuitive movement (unwinding), or has generated an intentional movement in an attempt to restore a more normal range of motion to joint movement which displayed restriction and/or a mal-adaptive range of motion. Client/Patient assisted accenting has proven so clinically efficient that it is recommended as a standard component of the A/S intuitive movement process, consisting of four steps: 1. Stimulate intuitive movement by gradually increasing stretch resistance on a joint or fascial adhesion, or by gradually increasing pressure on a fascial adhesion. 2. After giving the c/p permission to Move, if you feel the need to move, (so they don t inhibit their desire to stretch), follow their Intuitive movement to determine the body s natural need to dynamically stretch. 3. Accent the client/patient s intuitive movement, based on the thinking that their body knows what to do but doesn t have sufficient strength and/or endurance. 4. Ask the client/patient to Move with Me, to further accent their natural intuitive movement. Please note that in steps 1, 2, & 3, the A/S facilitator must discourage the client/patient from making intentional, voluntary movement. Similarly, Client/Patient Assisted Accenting is also recommended as a standard component for both major A/S intentional movement procedures: patients with heavily calcified fascial adhesions. 1. Diagnostic Intentional Movement, and 2. Intentional Movement of client/

28 Continuation of Vector & Client/Patient Assisted Accenting Move with Me Before using the 4 step Basic A/S Procedure (Play, Freeze, Pressure, & Move/Stretch), and rather than using palpation, it is acceptable to use diagnostic intentional movement to identify fascial adhesions. Such intentional movement is usually originated using the basic A/S starting positions and grips such as Foot & Ankle grip, IT pump, Assume the Position, Head Hang, etc. Utilizing intentional movement suspected to have a mal-adaptive range of motion caused by fascial adhesions is performed after first AquaStretching the least affected joint (the good side). For example, if the complaint is the right hip, you first AquaStretch the left leg to reduce compensation issues and to better understand what the normal range of motion of that leg and hip are for that individual client/patient (c/p). In the process of A/Sing the left leg/hip, some facilitators also use intentional movement to dynamically feel that normal ROM. To use Diagnostic Intentional Movement, the A/S facilitator attempts to move the affected extremity (right leg/hip in this discussion) in its normal ROM to feel for the presence of fascial adhesions causing mal-adapted ROM. When the location of a suspected fascial adhesion is identified, the A/S facilitator usually changes their grip so that pressure (and/or a V-spread) is applied to that fascial adhesion. This is usually performed while the c/p continues their intentional movement. The fascial pressure, V-spread, and/or intentional movement then stimulates their usual intuitive movement reflex, and the facilitator then follows and accents that intuitive movement. After the intuitive movement is established and accented, the facilitator would then ask the c/p to Move with Me, to further amplify the c/p s intuitive movement. Again, the c/p is instructed not to help by voluntary movement until requested to Move with Me. Similarly, intentional movement may be used with A/S client/patients who do not demonstrate the normal intuitive movement reflex. Intentional movement can be helpful when a joint or fascial adhesion is resistant to gradually given normal amounts of increased stretch resistance pressure. After the A/S facilitator determines that the c/p does not have a normal intuitive movement reflex, the facilitator then intentionally stretches with a strong grip in a normal ROM, as best as possible. After the desired motion has been established, the c/p is asked to Move with Me, to take advantage of their natural strength, which also allows the facilitator to use less strength. "Move with Me" is especially important when your client/patient is larger or more muscular than the facilitator and/ or with people suspected to have heavily calcified fascial adhesions, (i.e., c/p s who are noticeably inflexible and in many male "fitness" clients who do not have sufficient flexibility training) Move with Me is also very useful when combined with the A/S Continuation of Vector procedure which generally allows the facilitator to put pressure more firmly on a fascial adhesion by reducing muscle tension over that adhesion with slight retrograde movement from the frozen position where constriction or pain is felt while playing. For example, it has been consistently beneficial while doing A/S Shoulder Roll.

29 Fitness Training George Eversaul, UNLV Wellness Center, There are six major reasons why athletic trainers, personal trainers, yoga instructors and others who provide fitness training should know how AquaStretch may benefit their clients. A/S may: 1. Restore Flexibility lost from prior accidents, surgeries, sports injuries, or over-training. 2. Increase Wellness Motivation by reducing chronic aches & pains, and improving sleep. 3. Decrease Muscle Soreness/Tension due to intense physical training or excessive workouts. 4. Increase Training Efficiency by decreasing recovery time from workout soreness. 5. Help Get Loose before competition because of A/S s profound relaxation benefit. 6. Improve Sports Performance by restoring systemic flexibility and reducing pain. AquaStretch May Restore Flexibility: When athletes or dancers get hurt, they often start using their injured body before it heals properly. If an ankle injury takes 4 weeks to heal, they often exercise, train, compete, or perform after one week. This may result in healing improperly, with connective tissue (fascia, muscles,) excessively calcifying (fascial adhesions), causing a decrease in flexibility and/or pain on movement. A/S often immediately (1 st session) and dramatically (>60%) resolves fascial adhesions, even if they formed after accidents or surgeries years ago. AquaStretch May Increase Wellness Motivation: Clients frequently say AquaStretch reduces chronic aches & pains, and helps improve sleep. Physiologically A/S may help improve systemic vascular and neurological functions that may increase health and energy in many ways. Psychologically AquaStretch often creates a general sense of well being that motivates people to start other wellness activities like diet & exercise they become addicted to health. AquaStretch May Decrease Muscle Soreness: Many people experience muscle soreness after workouts, whether they are experienced athletes doing intense training, or beginners who do too much, too soon. Reducing this soreness may motivate some clients to continue their fitness training or yoga classes, and may allow the client to feel the benefit of their exercise more significantly. Consider using AquaStretch immediately after exercising to reduce soreness, i.e. from grade 3/4 to 1/2 pain. And consider A/S before training, and especially before stretching classes like yoga, to reduce the future intensity of that soreness and to prevent client dropouts. AquaStretch May Increase Training Efficiency: AquaStretch may also significantly decrease the recovery time after intense or excessive exercise. For example, following intense weight training, a client may experience soreness for 48 hours; with A/S, it may reduce to hours. This may allow weight training every other day, rather than every third day, and may be an important quality of life improvement for professional and serious amateur athletes.

30 Notes

31 Notes

32 Closing Thoughts Dear New AquaStretch Facilitator, Thank you for taking the time to participate in our AquaStretch skilled training course! I believe you will be as thrilled with the wide-based applications and outcomes as we are! I want to take a moment to share some tips on how you, as a facilitator, can keep yourself healthy-- as this can be a very physical and taxing modality with heavy workloads. First, expect that your hands will be tired and you may experience cramping as they become conditioned for this modality. Please remember to take care of your wrist flexors and extensors through selfstretching exercises, and AquaStretch to your upper body as needed! As this technique becomes popular at your facility be sure to schedule your clientele appropriate for you. Personally, I choose not to spend more than 6 hours in the pool a day treating clients. I find it helpful and usually wear a 10# belt around my waist while performing this technique. This helps to keep me grounded and able to adjust to quick changes in direction of the client s intuitive movement (Especially in one leg standing) as well as to assist with accenting. When you have large, muscular clients, you may choose to use additional weights to stretch deeper layers of adhesions and may also want to utilize an additional AquaStretch facilitator for 4 hand work. The new patient needs constant reminding to breathe, relax and MOVE!! (It may take a first time patient/ client 1-2 sessions to begin to move intuitively especially if they are heavily calcified). Patient education is crucial for patients to understand what they should be doing, and what they should expect following their session. As always, remember to eat a nourishing breakfast and stay hydrated! Maintain a healthy lifestyle through healthy eating and exercise! As you spend longer days in the pool, leg work outs on land become increasingly important. As you continue with AquaStretch, avoid over-gripping by keeping a firm grip, but loose wrists. Additionally, check yourself once in a while to be sure you are not creating the movement for the patient, but are truly following and accenting their intuitive movement. Be ready to change direction at any moment and surprised at the amazing effects of AquaStretch! As mentioned previously, AquaStretch is a skilled technique that requires follow up training and skill checks. We look forward to seeing you again soon! Blessings as you help to heal others though AquaStretch! Sincerely, Jessica Huss PT, DPT, CCI AquaStretchPT.com

33 Aquatic Rehab &Wellness Center P.O. Box 3681 Lake Havasu City, AZ Information ( A/S ) has been described as a breakthrough in preventive medicine and pain management (F. Royal, M.D.) is a form of assisted stretching performed in warm water (3 2 to 5 6 deep) with 5 to 15 lb weights attached to your body. frequently produces immediate and significant results following the first session. What can I expect from my first ( A/S ) session? It is recommended that you arrive 10 minutes prior to your appointment to get into the pool and perform a gentle warm-up exercise. Before the A/S begins, your facilitator will give you pain instructions (good pain vs. bad pain). You will be asked to repeat them back. The basic principal of this technique is that your body knows what it needs better than you or the facilitator knows. Therefore, you will be encouraged to actively participate by utilizing your intuitive movement by being asked to move, if you feel the need to move. The facilitator will take you through a series of positions and stretches and often apply weights to your body. Your only job is to move, if you feel the need to move. The facilitator is there to accent your natural body movement. How does work? Fasciae are connective-tissue found throughout the entire body. Fasciae encompass and hold muscle, nerves and blood vessels tightly together. According to the Fascial Adhesion Theory, micro-calcified adhesions may form excessively within the fasciae. These adhesions develop as a normal response to an injury. They may excessively calcify if the injured area is used prematurely, following intense training workouts or in response to occupational aggravations. (ie. food servers, hairstylists). Fascial adhesions are essentially internal band-aids that form around the injury to protect it while it heals. The formation of fascial adhesions causes a person to compensate and move out of their normal range of motion. The longer the body compensates, the harder the adhesions become. This may also lead to layers of fascial adhesions around the injury and throughout the rest of the body due to compensated movement patterns. If untreated, they may cause neurological and vascular entrapments and/or impairments. Fascial adhesions may form due to a number of factors, that may act in combination: 1. Improper Healing: It s common to use injured joints prematurely, i.e. sprained ankles. 2. Lack of Sufficient Exercise: Especially flexibility exercise. 3. Occupation and/or Recreational Aggravation: Excessive or repetitive joint use.

34 works to break down and dissolve calcified fascial adhesions. The combination of intuitive movement, accented movement and the properties of warm water make this a perfect environment for joint and soft tissue releases to occur. What is a release, what will I feel? Releases occur when a fascial adhesion has diminished or absolved. This usually occurs after you have placed your body in the position that was creating pain, tension or discomfort, the facilitator has applied pressure to that area, and you have been asked to Move if you feel the need to move. There are a couple of things you may experience as a result of a release. You or the facilitator feel a pop (joint) or a melting (soft tissue) of that adhesion. Your body will stop its intuitive movement. What should I expect after my session? You should expect an amazing sense of relaxation and overall sense of feeling loose. Many have reported dramatic improvements in their ability to sleep, which overall facilitates healing. You may experience muscle soreness the first hours following your session because you have been stretched in ways you may not have stretched for years. It is advised that you drink plenty of water following your sessions as warm water exercising may cause dehydration. What is an Wellness Program? An A/S Wellness program consists of two stages: 1. Restoration 2. Maintenance Restoration: The Restoration stage usually involves 2-4 A/S sessions for 1-2 weeks. However, A/S may be performed daily depending on recovery time from treatment soreness. The purpose of this stage is to restore flexibility in the connective tissue (fascia) that has been lost due to prior injuries, surgeries, improper healing, lack of exercise, excessive training, and/or occupational/recreational stresses. Maintenance: The Maintenance stage consists of intermittent facilitated sessions (i.e., once every month or two). It is also recommended that you perform a combination of individual A/S exercises and/or perform other land-based exercises that encourage flexibility (ie., Yoga). The purpose of this stage is to maintain the flexibility and well-being that was achieved in the Restoration stage. When do I need to have more? There are generally 4 reasons why people need A/S again or regularly following the restoration stage. 1. They have recurring fascial adhesions that are occupationally aggravated, ie., repetitive use. 2. They over-play recreationally or physically train too quickly or excessively. 3. They have genetically predisposed or chronic conditions like scoliosis or fibromyalgia. 4. They do something goofy, i.e., lift boxes/bags improperly, move as if 20 years ago.