Utilizing Watsu with Clients with Special Needs


By Peggy Schoedinger, PT


Note:  Watsu training alone does not qualify any person to diagnose or specifically treat any medical or psychological condition.  The following information is only intended to provide guidelines for the use of Watsu by those who have appropriate training.  



Safety is Number 1 !!!


1.   Keep yourself and your client safe at all times.  Appreciate your own

strengths and limitations in terms of your physical self and also your

knowledge base and educational training.  Watsu training alone does not qualify practitioners to work with all physical and emotional special needs.  To work with clients with some physical and emotional needs may require more specialized medical and/or psychological education and training.   


Ask for assistance and medical advice as needed.  If you need physical assistance with a client, be sure to arrange for extra help.  Review a listing of

precautions for Aquatic Bodywork.  If you have ANY questions about a specific diagnosis or impairment, be sure to seek medical advice before proceeding.  Do not proceed with a session if you have any uncertainty or concerns.


2.  Be sure to keep your first aid and CPR training up-to-date.


3.  Have emergency plans and practice them.  Plan for cuts, slips and falls,

     heart attacks, seizures, low blood sugar, etc.  Document your plan.  If an

     incident occurs, document exactly what was done for the client.


4.  Have a way access emergency assistance while you are in the pool.  A cell

     phone at the side of the pool is one possibility.  Be sure that emergency

     personnel will always have access to your pool from the street.


5.  Have emergency equipment available including rescue equipment, first aid  

     kit, ice/cold packs, glucose, latex gloves, mask for CPR, clock

     with a second hand for measuring heart rate.  Consider purchasing a

     blood pressure monitor.  If you have any clients with any difficulties with

     walking, a gait (walking) belt is also very helpful to use outside of the pool

     and during pool entry/exit.


6.  Have a plan for getting each individual safely into and out of the pool.




Start of Session


1.   Before the first session, ask the client to fill out a brief questionnaire

      which covers pertinent medical information and emergency contact information. Follow up with more detailed questions about any problem areas or impairments that the client states on the questionnaire.


2.  Seek further medical advice before the session if you have ANY

     questions.  Reschedule session if necessary. 


3.  Encourage client to be comfortable at all times.  “Move or wiggle your

     head, or move my arm so that your head and neck always feel supported

     ‘just right,’ like your pillow when you go to sleep at night.”


4.  Encourage feedback from the client if a movement feels especially good or

     not quite right.  Encourage the client to let you know immediately if he/she

     feels any dizziness, motion sickness or pain at any time.


5.  Tell your client that if he/she wants to stop the session at any time for

 any reason, just say, “Stop.”


6.  Begin session in the appropriate position for that individual’s condition.

     Also, begin by standing next to the client’s less impaired (less painful,

     less stiff, etc.) side.



Working With A Client Who Has A Painful Orthopedic Or Rheumatic Condition


1.  Be certain you have the necessary medical and/or psychological training to

     work with each client without exacerbating his/her condition.  Seek medical

     advice if necessary, before proceeding with the session.


2.  Be a detective!  Ask your client questions.  People can tell us a great deal

     about their own bodies if we ask the right questions and listen carefully.      

     a.  “Where is your discomfort?”

     b.  “What movements or positions increase your symptoms?  What

              movements or positions decrease your symptoms?”  The answers to

              these questions will guide you in the type of movements you use

              during the session.  For example, if your client says sitting increases

              his/her symptoms, then movements which cause spinal weight bearing

              and/or flexion may increase symptoms.         

              Other Examples:

              Standing (spinal extension, weight bearing)

              Walking (weight bearing, spinal rotation, lumbar extension, cervical


              Tying shoes (spinal and hip flexion, flexion with rotation)

              Arching backwards (lumbar extension)

              Stomach sleeping (lumbar extension, cervical rotation)

              Sleeping/resting on his/her back with a pillow under the knees (lumbar


     c.  “Is there anything else you can think of which changes your symptoms

              in any way?”

     d.  “Is there anything else you would like to share with me about

              yourself?”  This is an open-ended question that permits the client to share information about anything else he/she feels is relevant.  This may include information about daily life stress or past physical or emotional traumas.  Listen quietly and without judgment.


3.  Plan the beginning of your session based on the information you have

     gained from the client.  Begin with the movements that you know are

     pain-free, and/or movements that you know will decrease the client’s

     symptoms.  During the early portion of the session, focus the movements

     and bodywork on non-painful areas of the body.  As the client’s body

     relaxes, you can then begin to gently address painful areas.


4.  As the session develops, you can GENTLY invite other movements.  If you

     sense any reluctance or resistance in the body to acceptance of the

     invitation, return to safer movements.


5.  As the session develops, you can gently begin to follow the client’s



6.  Move slowly!  It is always better to do too little than do too much.


7.  It is OK to check-in with the client from time to time, especially early in

     the session to assess whether what you are doing is increasing or

     decreasing the client’s symptoms.


8.  Appropriate use of flotation devices (foam leg wraps, noodles, soft

     collars/head floats) can be very helpful.


9.  Pay special attention to the alignment of the client’s body at all times

     during the session.  It is crucial to maintain optimal alignment.



Working with A Client with Neurological Challenges


These clients may have a wide variety of different problems including stroke, traumatic brain injury, cerebral palsy, spinal cord injury, Parkinson’s Disease, etc.  They also may have medical reasons why immersion in water would not be safe.  Be sure to screen carefully for any such condition.  If there is ANY question concerning the safety of Watsu for a client, do not proceed until you have discussed the matter with the client’s physician. 


Be certain you have the necessary medical and/or psychological training to work with these clients without exacerbating their condition.  Seek medical advice if necessary, before proceeding with sessions.


However, Watsu can be enormously beneficial for clients with these conditions.  It is especially helpful for decreasing spasticity/stiffness.  For clients with spasticity/stiffness, the following guidelines may be helpful:


1.   Plan ahead for how you are going to get the client safely into and out of

      the pool.  Will the client need assistance dressing, walking, etc.?


2.   Keep the client warm before and after the session.  Be sure to have towels ready to wrap around the client immediately when he/she exits the pool.  If the client becomes chilled, spasticity will increase.


3.   Start with the client leaning against the wall or sitting down if his/her balance is impaired.


4.   Start by standing next to the client’s less impaired side.


5.   Emphasize flexion of the spine.  Flexion is especially important if the

      client is very spastic or rigid and if the legs tend to be stiff and extended.

      a.  Start under the client’s knees rather than starting with an arm supporting

           under the pelvis. 

      b.  Keep the hips and knees flexed. 

      c.  Avoid allowing the hips and knees to fully extend. 

      d.  Maintaining flexion helps to decrease extensor spasticity/stiffness. 

      e.  If a joint needs to be stretched into extension, avoid stretching

           multiple joints into extension at the same time.  Example:

            Stretch the hip into extension while maintaining some lumbar and knee flexion. 


7.   Emphasize rotation of the spine.  Rotation of the spine helps decrease



8.   Focus first on spinal movements and then progress to the extremities.

      Start with the shoulder and scapula and then progress to the elbow, wrist and finally the fingers.  Progress in the same way with the legs (hip, then knee, ankle, toes.)



Vestibular Sensitivity (tendency to develop motion sickness)


1.  Move slowly.


2.  Change positions extremely slowly (standing to position 1 in supine, supine

     to Open Saddle, etc.)  


3.  Use more linear movements for the body.


4.  Avoid rotational movements that cause the head to turn/roll from side

     to side.


5.  Avoid turning and spiraling movements.


6.  Before the session, ask the client to give you feedback as needed during the



7.  Ginger tea before the session may help.  Wrist bands with small

     acupressure knobs may help.



End of Session


1.   All clients drink water and walk/move around in the pool before exiting

      the pool.  Make sure the client is fully alert before exiting the pool.


2.   Guard clients closely when exiting the pool and while walking on the deck.

      Prevent falls.   


3.   Be sure to have towel(s) within easy reach so that clients can wrap

      up immediately upon exiting the pool.  A heat lamp, installed in

      a safe location, can be used to keep clients warm while they change.


4.   Record a brief summary of the session including any types of movements

      which increased or decreased the client’s symptoms.  Also include

comments from the client and/or caregivers pre and post session.

Precautions with Watsu ... Watsu with Special Needs