Table 2 Description of aquatic therapy protocol

Warm-up (15 min)

1. Running in water: With water at waist level, patients will run along the bottom of the pool, changing trajectory. 2. Can-Can kicks: Submerged to chest depth, patients will kick the water with alterating legs. 3. Hydro-Jumps: With feet on the pool’s floor, patients will jump, bending their knees at the highest point in their jump. 4. Pedaling: With a pool noodle under the neck, patients will move their legs in the motion of pedaling a bicycle while moving along the pool. 5. Rocking Horse: With one foot before the other, patients will alternate jumps with the front and back leg. 6. Relay Race: 2 groups. The winner will be the group that returns the baton to the first participant in the shortest time.

1. 3 min uninterrupted activity. 2. 3/30 s/15 s. 3. 3/30 s/15 s. 4. 3 min uninterrupted activity. 5. 3/30 s/15 s. 6. 2/1 min/20 s.

Proprioceptive exercises (25 min)

1. Playing Catch: In a group, patients will be sitting on a pool noddle and will have to maintain balance while throwing and catching the ball.

1. 3 min uninterrupted activity.

2. Balance over pool noodles: Patients will be sitting on a pool noodle with hips and knees bent 90° and will have to keep balance in 3 different positions: a. With arms submerged and 90° abduction; b. one arm out of water and the other under water; c. from the initial position, they will have to do a trunk extension with shoulder extension, hip extension, knees pointing to the pool’s floor and neck extension.

2. 2 (for each position)/1 min/20 s.

3. Turbulence standing: Standing, with water at the level of the chest and arms along the body; patients will have to do quick and short flexion/extension movements with the ULs generating significant turbulence. A good activation of local musculature will be essential for avoiding imbalance.

3. 4/15 s/15 s.

4. Exercises with kickboard: a. Patients will be sitting on a kickboard, with water at the height of neck. They will have to keep afloat with only the aid of pedaling and without moving along the pool. b. With one foot on the kickboard and the other on the pool’s floor, patients will have to lower the kickboard and place it 10 cm above the pool’s floor. They will have to maintain this position and move the kickboard forward, backward and sideways without allowing it to go to the water’s surface. The exercise will be done with both LLs, first placing the kickboard vertically and then horizontally.

4. a. 2/1 min/20 s.; b. 2/40 s/15 s.

5. Double pool noodle: Patients will be standing with a pool noodle in each hand. They will have to submerge them in the water while raising knees to chest.

5. 3/50 s/20 s.

6. The boat: 2 groups. Patients will have to submerge a large mat while maintaining a standing position with different supports: Double, single-leg and tandem.

6. 3 min uninterrupted activity.

Stretching (8 min)

Gastrocnemius, quadriceps, ischiotibial, adductors, quadratus lumborum, deltoid, triceps brachii, superior trapezius.

2 (right and left side)/30 seg/5 seg.

Relaxation (12 min)

An Ai-Chi sequence with music. 6 movements of the 19 that comprise the Ai-Chi done in the following order: “Folding”, “Soothing”, “Gathering”, “Freeing”, “Shifting” and “Accepting”.

12 min uninterrupted activity.