As Watsu® and other forms of aquatic bodywork gain in popularity, it's helpful to review the history of these practices and how they have been integrated into the aquatic therapy field. This guest post features a valuable article by Mary Essert; it ends by asking practitioners an important question ... read on and add your thoughts below.
This article, with updated information provided by Sara Firman, is reprinted with permission from the Aquatic Therapy & Rehab Institute, Inc. and the author Mary Essert. The article is one of numerous peer-reviewed articles in the Aquatic Therapy Journal Anthology II available at www.atri.org.
Thermal Aquatic Bodywork: Watsu® and Jahara®
by Mary Essert, BA, ATRIC
Everywhere you go in the aquatic therapy field, you hear about Watsu®. This article contains some background, some "do's and don'ts" and anecdotal benefit information on this popular technique.
Watsu® means Water Shiatsu. It is a form of warm water body work pioneered by Harold Dull in the eighties after he studied with a Shiatsu master in Japan and brought that art home to Harbin Hot Springs, a retreat/spa located in Middletown, CA. Dull integrated energy work, stretches and pressure point techniques with massage and added the fluidity of movement in warm water to birth a new approach: Watsu®.
"Dull describes the technique as Zen shiatsu principles applied to people floating in the water. Watsu® was created as a wellness technique; it was not originally intended for patients with neurologic disorders. Rehabilitation therapists have applied the approach to patients with a variety of physical disorders, however, and anecdotal reports indicate clinical success.
Based on Eastern medicine theory, Watsu® stretches to body's meridians (pathways of energy). Through stretching, these pathways are thought to be brought closer to the body's surface, where energy can be released. These effects are enhanced by rotational movements that release blocked energy from joint articulations. As a completely passive recipient, the patient experiences profound relaxation from the water's support and the continual, rhythmic movement that flows gracefully from one position to the next.
The stretches comprise specifically described transitions and sequences of movement. In general, the therapist stabilizes or moves one segment of the body while movement through the water, resulting in a drag effect, stretches another segment. Once the transitions and sequences are learned, therapists are encouraged to vary them according to the needs and limitations of the patient." Aquatic Rehabilitation .
What it is
Simply explained, Watsu® uses 92-96 degree water and a variety of stretches and gentle movements to relax the body and mind and allow them to release pain and stress. The receiver floats on his back with ears underwater and eyes closed while being gently guided through a series of smooth movements by a practitioner. Movements vary from flexion to extension with traction and rotation. Trust of the practitioner and surrender to the water are vital.
Benefits include increased range of motion, deeper breathing, emotional release, improved posture and body awareness, bolstered self-esteem and aid with sleep and fatigue. Research shows us that moist warmth causes relaxation. The warmth of the water aids superficial circulation while its buoyancy relieves the workload of painful joints. The client is free to be in a peaceful environment without distraction.
Watsu® is not only capable of reducing or eliminating pain, it can also decrease muscle guarding and tension. My personal experience in working with a severely involved 7-year-old with cerebral palsy has underlined this quality for me. Her decrease of spasticity took 45 minutes when we started to work together 18 months ago. Now she relaxes in 5 minutes. Watsu® practitioners see the benefits, but in our search for scientific explanations we're stymied.
In [an] article in PT-OT-Speech Today, Andrea Saltzman, M.S. P.T. states, "After five years of PT practice, (and almost four years of a purely aquatic practice), I find it is the rare session that Watsu® is solely a matter of fluid mechanics. I find it stirs the patient's soul. I do not seek this out. In fact, I guard myself from it. And yet, there it is. The human psyche, immersed in warm water. How does this phenomenon occur?"
The following are comments from individuals who have received a Watsu® or Jahara®:
"After my session, I felt uplifted and less burdened..."
"A wonderful opportunity for letting go, both physically and emotionally... a time to surrender."
"I have never felt so relaxed and stress free."
"When I came, my pain index was a 9.5, now I am pain free..."
"I cannot tell you how, but I know the experience was life changing. It was joyful, relaxing, nurturing and a wonderful gift to myself."
Indications and Contraindications
Those who benefit include persons with acute/sub/chronic pain, neuromuscular disorders, head injury, soft tissue dysfunction, chronic headaches, chronic fatigue, fibromyalgia and joint disease.
Intimacy issues are a consideration. Watsu® is an intimate form of therapy and professionalism is paramount in the maintenance of a therapeutic quality. Intake or orientation forms often mention this and need to be read and signed by clients. If at any time there seems to be inappropriate behaviors, the session should end.
Contraindications to aquatic therapy in very warm water include: fever, uncontrolled epilepsy, severe cardiac conditions, very high or low BP [blood pressure], open wounds, limited vital capacity (less than 1500 ml), severe urinary tract problems, respiratory tract or blood infection, tracheotomy, bowel incontinence, menstruation without internal protection, sensitivity to pool chemicals, behavior problems, at risk pregnancy, excessive vertigo, excessive fear of water.
For further information regarding precautions, please refer to "Adapting Watsu® for People with Special Needs", by Peggy Schoedinger, PT, pages [119-133, 2008 edition], in Watsu® Freeing the Body in Water.
So effective has Watsu® been that others have developed modified techniques and claimed them as their own. Elaine Marie, who [taught] at Harbin Hot Springs at the School of Shiatsu & Massage, has developed a series of movements which characterize her work [now called Aquatic Massage, an approved elective towards Watsu® certification].
Mario Jahara, a therapist from Brazil, created a system of warm water bodywork which utilizes the "third arm" [Third Arm™ (TA)] which is a flotation device, and is especially appropriate for use with individuals who have disabilities. This technique offers precise support to the body and a sense of freedom to both practitioner and client. A passive technique, it consists of a series of gentle, flowing stretches and circling movements. During a session, one is held within the water by the practitioner and floated effortlessly.
The use of the [Third Arm™] extends the technical possibilities. Most importantly, with this system, no body type is too difficult to hold or to maneuver in the water. Proper alignment of the musculoskeletal structure is maintained, expansion of the spine is facilitated, while support of the back assures safe, comfortable treatment. Persons already familiar with Watsu® find this a compliment to their skill, however, there is no prerequisite to the study of Jahara Technique [now named Jahara®].
Several underwater techniques have grown from Watsu® and are called Wassertanzen®, Aquadance, and Jahara's unique (without nose plug) underwater work. Other therapists have developed their own style as well. In addition to these therapies, other ramifications are possible with the introduction of sound therapy and use of appropriate music.
Whichever techniques a practitioner makes her own, the effect of giving a session and becoming a part of a profound experience with the individual who receives, is a true gift. When one assumes a listening presence and commitment to give that individual what is needed, the present moment is all that matters. Because the receiver can sense tension, the practitioner learns to "be in the moment and to follow stillness". This premise is key to a successful session. People have equated the experience to holding a sleeping baby. Others have described the experience as a dance with the same music in two bodies.
Pool and Equipment
Accessibility issues follow ADA guidelines for therapy pools. The Watsu® pool should be from 3½ to 4½ feet deep. Temperatures of 92 to 98 degrees Fahrenheit are ideal but exceptions may be made. Aquatic Therapy Innovations therapists give "wetsuit Watsu®" in 10-15 minute segments in an 84 degree Fahrenheit pool with success.
Equipment is generally not used in Watsu®, however, [flotation cuffs] are sometimes ... placed at upper arm and thigh for use with receivers who are dense or large for a given practitioner. In the Jahara® Technique, the Third Arm™ is utilized which is a 30-inch half-noodle. Some receivers like to use ear plugs to keep water out of their ears. Finally, some givers use aqua shoes to add to their stability.
Submerge your patient in a thermoneutral therapy pool, and you eliminate the temperature gradient between skin and air. Have him close his eyes and he often loses the ability to determine where his body ends. Immerse his ears, and sound is eliminated. Lift his feet from the bottom of the pool, cradle him in a flexed position and he feels like an infant. Let his body rise and fall in the water with his breath. You have begun Watsu®, a graceful and artistic technique. But are you capable of handling what you now hold in your arms? A "Broken" body, yes- and quite possibly, a vulnerable one.
For our busy clients who permit themselves this magic experience, life in the fast lane soon becomes life in the present moment.
For more information: Worldwide Aquatic Bodywork Association
Mary B. Essert, B.A.,ATRIC, has been involved in the aquatic industry since 1949. Among her many credentials, she is an assistant teacher for Watsu® and a Jahara practitioner. Last summer, Mary presented workshops on Watsu® for chronic pain management and the aquatic management of fibromyalgia at the Jornadas Naionales y Internacionales de Hidroterapia y Actividad Acuatica Adaptada at El Picacho Consejeria de Education, Junta de Andalucia in Sanlucar de Barrameda, Cadiz – Andalucia Spain on July 19, 2011. These were part of a week-long gathering centered on adapted aquatics for children and adults with special needs.
Mary serves as a trainer for the Arthritis Foundation, Red Cross WSI, AAHPERD Adapted Aquatics, and holds many instructor certifications from organizations including AEA , USWFA, Medical Health & Fitness Cancer Wel-Fit, and the MS Society. She received the Aquatic Exercise Association Lifetime Achievement Award, the Aquatic Therapy and Rehab Institute (ATRI) Aquatic Therapy Professional of the Year Award for 2002. She was recognized in Who’s Who in Aquatic Leadership in the US for the past 5 years. She was honored to receive the Arkansas State Senior Fitness Leadership Award in 2009.