Category Archives: Treatment

Osteoarthritis? Exercise in Water!

Relieve pain with Aquatic Exercise

The prevalence of knee and hip osteoarthritis (OA) has increased in recent years as the average age of our population advances.  Increased patient cost reduces clinical time treating symptoms.  Yet, increasing incidence of OA challenges therapists to use the most effective ways to treat the pain and functional deterioration, which often accompany OA.

There has-been much research into bodyweight supported treadmill walking as an treatment.  A reasonable and similar alternative is aquatic therapy. The buoyant nature of water is similar to bodyweight supported treadmill therapy in that it reduces the amount of force transmitted through the joints of the lower body. When a person is standing in water, which is neck deep, 90% of their body weight is eliminated and at waist deep, 50% is eliminated.

Aquatic therapy encompasses any therapeutic activities, which occur in a pool. Often times these activities will include walking, balance exercises, stepping, etc. Using exercises such as these it is possible to target the hip and knee muscles which are often weak and in need of strengthening.

It is also possible to break functional activities into smaller parts and practice these with proper form in a non-painful environment thereby increasing the patient’s ability to perform the selected activity on dry land. By targeting these exercises to a patient’s specific needs and deficits in an environment of decreased weight bearing, we can make an impact on a patient’s functional ability.

Closed Kinetic Chain Exercises

Most functional movements in the lower extremity take place when the foot is on the ground. The hip, knee and ankle joints, together, comprise the lower extremity kinetic chain. Muscle contractions in closed kinetic chain motion are different from open kinetic chain motion. Joint motion is caused by many controlled muscle contractions. Closed kinetic chain rehabilitation is more closely related to function than open kinetic chain exercise.

Closed kinetic chain exercises are safer for the healing anterior cruciate ligament (ACL) graft. Research has shown that ACL strain is reduced during closed kinetic chain exercise.  Through recruitment of all hip, knee and ankle muscles in synergy, specific training and strengthening are functional and effective.

Research has also shown that closed kinetic chain exercise is more effective in patellofemoral dysfunction, improving reflex stabilization and proprioception, reducing pain and promoting a return to normal daily activities and sports. For athletes, closed kinetic chain exercise improves strength and jumping ability more than open kinetic chain exercise.

While open kinetic chain exercise certainly has its benefits and its own place in rehabilitation and strength training of the lower extremities, it is important to incorporate (and quite possibly emphasize) closed kinetic chain exercises for the greatest functional gains.

Spinal Stabilization Exercise

spinal stabilization exerciseSpinal stabilization is an important aspect of recovery from spinal pain, whether the problem is newly acquired or chronic. Exercise and proper body mechanics are well matched in this approach. Injuries and poor posture cause pain resulting in weakness that will not resolve completely without personal effort on the part of the person seeking assistance.  The symptomatic spinal segment may be held in a comfortable mid-range position by muscle force rather than a back brace.  Joint or disc pain will cause muscle spasm to protect itself, triggering additional pain.  By practicing “muscular fusion” during movement and static postures,  the pain is most often controlled and the muscles supporting the painful segment begin to overcome inhibition.  During movement, stability may also be maintained.  Proper muscle development and volitional control can be difficult to teach.  Spinal stabilization is a well-structured and meaningful application of tasks that result in balanced strength and reaction skills sufficient to control spinal pain.

The muscles responsible for the support of spinal segments are compromised by direct injury, and indirect factors including postural faults, gait deviations, hypermobile ligaments, muscle weakness, substitution or imbalances, and post-surgical or post-partum conditions.  Identifying and addressing problems in leg length discrepancies, foot position and support, knee and hip function, and whether they are symptomatic or simply inefficient are critical clinical decisions.  The most significant factor in clinical success with back pain is the consistency with which the back pain sufferer can be motivated, inspired, prodded, schmoozed, compelled, tricked, or simply asked to perform specific tasks (exercises and proper body mechanical movement) every single day.  Success is likely within 3 weeks if compliance is achieved.  Additional exercise training in aquatic,
unloaded and remedial situations bring the spinal pain sufferer back to the level of activities desired.

Osteopathic and chiropractic physicians and physical therapists attempt to restore normal joint mobility and position.  The only substantive support following these procedures is the normal muscle function of the region.  As in other joint issues, the ability to discontinue passive treatment of the spine is ultimately linked to the restoration of normal muscle strength, balance and reaction time.

How The Back Works

By Guy Slowik MD FRCS –

The spine, which connects the skull to the pelvis, is also called the vertebral column. It consists of 24 segments of block-shaped bone called vertebrae and an additional 9 fused vertebrae that make up the lowest part of the spine, the sacrum and tailbone. Each vertebrae of the vertebral column has protruding bony areas for the attachment of muscles that are important for the spine to move. The spinal column protects the spinal cord and its emerging nerves that run down most of the length of the spine.

The vertebrae have two major functions:
· To bear the weight of the body
· To house the spinal cord or spinal nerve roots (cauda equina) within the spinal column

The spine is arranged in three natural curves:
· The neck region or cervical spine, made up of 7 vertebrae – where the vertebrae curve forward.
· The trunk region or thoracic spine, made up of 12 vertebrae – where the vertebral column curves backward, and to which the ribs attach
· The low back region or lumbar spine, made up of 5 vertebrae – which curves forward in the same direction as the cervical spine.

When these curves are in their normal alignment, the body is in a balanced position. This distributes weight evenly throughout the vertebrae so one is in a less vulnerable position for strain and injury.

There are two major parts to each vertebra:
· Vertebral body – The vertebral body is the front portion of the vertebrae. It is shaped like a cylinder and is greater in height than the back portion.
· Vertebral arch – The vertebral arch is the back portion of the vertebrae. It is an irregularly shaped structure.

At the center of each vertebra is a hole, protected by the surrounding strong bone. Placed together, the central opening of each vertebra makes up the spinal canal through which the spinal cord, cauda equina, or spinal nerve roots pass. The spinal cord is the mass of nerve that connect the brain to the rest of the body.

Each vertebra has important bony projections called processes that provide sites for the attachment of ligaments and muscles that are important for the stability and movement of the spine.
· The projections on either side of each vertebra are called transverse processes, and the ones at the back are called the spinous processes. The transverse processes are long and slender; the spinous processes are broad and thick.
· The back portion of the vertebrae, behind the transverse processes, consists of an area of bone called the laminae.
· On the back part of the vertebrae are two upper and two lower processes that form the joints connecting the back part of each vertebra. These are the facet joints. They are important for movement between each vertebra and for movements of the entire vertebral column as a unit.

The Discs Of The Back
Between each vertebra are spongy pads, like soft cushions, called discs – or more correctly, intervertebral discs. Each disc has a soft jelly-like center called the nucleus pulposus, which is surrounded by a fibrous outer envelope called the annulus fibrosis. Eighty percent of the disc is water, which is why it is so elastic. Together, a disc with the attached part of the vertebra above and below is considered an intervertebral joint. These joints allow the movement of the back.

Healthy discs are elastic and springy. They make up 20% to 25% of the total length of the vertebral column. Initially, the disc contains about 85% to 90% water, but this amount decreases to 65% with age, resulting in disc degeneration.

The Spinal Cord And The Lower Back
The nerves that come off the spinal cord are called nerve roots. These nerve roots pass through small openings on either side of the connecting vertebrae. Various nerve roots combine to form spinal nerves.  There are five pairs of lumbar (lower back) spinal nerves. The nerve roots that arise from the end of the spinal cord and continue down the spinal canal through the lower part of the spine looks like a “horse’s tail” and are collectively named the cauda equina.

The Ligaments Of The Back

There are a series of ligaments that are important to the stability of the vertebral column. Important to the lumbar spine (lower back) are seven types of ligaments:
· Anterior longitudinal ligaments and posterior longitudinal ligaments are associated with each joint between the vertebrae. The anterior longitudinal ligament runs along the front and outer surfaces of the vertebral bodies. The posterior longitudinal ligaments run within the vertebral canal along the back surface of the vertebral bodies.
· The ligamentum flavum is located on the back surface of the canal where the spinal cord or caude equina runs.
· The interspinous ligament runs from the base of one spinous process (the projections at the back of each vertebra) to another.
· Intertransverse ligaments and supraspinous ligaments run along the tips of the spinous processes.
· Joint-related structures called capsular ligaments also play an important role in stabilization and movement.

The Muscles Of The Lower Back
The muscles and tendons of the spine have been described as being a supporting system for the spine, much like a tent supported by guide ropes.
· A group of back muscles called the erector spinae are an example of these muscles, which form on each side of the spine and consist of three columns. These muscles move the lower back, help straighten the back, provide resistance when a person is bending forward at the waist, and help a person return to the erect position.
· The multifidus is another important muscle of the lumbar region. This muscle is thick and prominent in the lumbar spine and becomes smaller at its attachments high up the spine. It is an effective lever arm that allows the lumbar spine to bend backward.
· The interspinales muscles, located on either side of the interspinous ligament, also are active in the backward bending of the lumbar spine.
· The intertransversarii muscles attach to the transverse processes. These muscles are not only active in backward bending, but also in bending from side to side.
· The intersegmental muscles are a series of muscles near the bottom of the spine that connect one intervertebral segment to another.
The abdominal muscles, located at the front and side of the abdomen, are very important in supporting and protecting the abdominal internal organs. They also play an important role in protecting movement of the vertebral column in backward bending, forward bending, and side bending.

Reference: http://ehealthmd.com/content/understanding-how-back-works –  Edited by Guy Slowik MD FRCS

Exercise Heals

 

Active exercise has become better understood over the past ten years as a valuable tool in soft tissue pain and injuries. Improved circulation of blood and other body fluids and controlled reactivation of the joints and muscles are achieved with exercise.

Eccentric Exercise
Widely publicized in the early and mid 1970’s for its value in body building and fitness training, eccentric exercise has proven to be an effective component of the rehabilitation in tendinitis and epicondylitis conditions like tennis elbow.

Unloading Techniques
When exercise is applied while the effects of gravity are minimized, several conditions see benefits that otherwise might have been aggravated by exercise. The spine, shoulder and knee joints are commonly approached at Accelerate PT with exercise setups, which eliminate the use of secondary muscles that substitute for the weakened primary movers of the effected joints. A gradual progression in the loading of the joints facilitates progress in functional tasks including weight-bearing activities.

Aquatic Exercises
Another transitional form of exercise is submersion in water for both loading the muscles with resistance and/or to unload gravity from the body. Stimulation of proprioceptors and assisting the body to withstand longer duration exercise training are possible using public and private swimming pools and hot tubs.

Stretching Exercises
In addition to restoring range of motion for joint and muscle conditions, nerve tissue benefits from stretching techniques for the extremities and the trunk. Specific techniques carried out daily are important in the management of postoperative joint conditions and postural maladies including thoracic outlet and carpal tunnel syndromes.

What Is A Stress Fracture?

Each day, the body makes new bone to replace the bone that is broken down by the stress of everyday living. Usually, this process is balanced, with the body replacing the equal amount of bone lost. However, this balance may become upset. The body, due to several factors, may not produce sufficient bone. As a result, micro cracks, called stress fractures, can occur in the bone.

Factors that may affect the building process are too little sleep, a diet with inadequate calcium, a rapid increase in activity. Sometimes stress fractures may result from minor trauma, like accidentally kicking one leg when running.

How Will I Know If I Have A Stress Fracture?

Stress fractures produce pain in a limited area directly over the point of the bone where the fracture has occurred. The pain is made worse by activity and is improved with rest.

On physical examination, there is pain when pressure is applied to the injured area. Hopping or jumping on a leg with a stress fracture will cause increased pain. Frequently, but not always, there is swelling around the injured area.

X-rays are not usually helpful in diagnosing an early stress fracture because the bones will look normal and the micro cracks are not visible. After several weeks of rest to allow the bone to repair itself, a healing reaction callus can be seen on an X-ray.

The diagnosis of an early stress fracture can usually be confirmed by a bone scan. In this procedure, a substance normally used by the bone for repair is injected into the patient’s bloodstream. After 2 or 3 hours, the patient is placed under a scanner to detect the amount of the substance distributed throughout the bones. All of the bones will absorb some of the substance, but if a bone is repairing a stress fracture, it will absorb more of it at the fracture site, and will appear darker than the other bones. An MRI may also be used to confirm the diagnosis.

How Is A Stress Fracture Treated?

A cast is usually not required for a stress fracture. Unlike a fracture caused by a blow to the body which injures the skin, muscle, and bone, a stress fracture involves only the bone. Therefore the skin and muscles provide protection for the injured bone.

If pain occurs while walking, crutches or a cane should be used to keep weight off the injured extremity. Returning to activity will be a gradual process. Swimming or biking, both non-weightbearing activities can be done to maintain cardiovascular and muscle conditioning in the early period after the stress fracture.

Gradually, impact activities like walking can be added. When the patient can walk rapidly without pain, running can be started. Jumping should only be done when running does not cause any pain. A gradual increase of stress to the bone is the key. Each increase in activity should be done slowly and for short amounts of time. After a while, the activity can be done at a higher intensity and a longer duration. Eventually, the level of activity can be increased.

If, when advancing to the next level of intensity, pain occurs, the patient should return to the lower level for several day before trying again. The physician will guide the patient through these steps and can monitor the degree of fracture healing with X-rays.

It should be noted that while the normal amount of calcium required for bone repair is 1500 milligrams in postmenopausal women and 1000 milligrams for all other adults, increasing calcium intake above this level will not help the stress fracture heal more rapidly.

Treatment of Stress Fracture of the Lower Extremity

Activity Progression

  • Nonweightbearing, non-impact activities like swimming or biking.
  • Weightbearing, non-impacting activities like a stair machine or a cross country machine.
  • Weightbearing, impacting activities like walking.

Intensity Progression

  • Low intensity, short duration.
  • Low intensity, increased duration.
  • Higher intensity, short duration.
  • Higher intensity, increased duration.
  • Advance to next activity level.

– American Orthopaedic Society for Sports Medicine

What is Physical Therapy … really?

All of the following describe generally accepted, well established and widely used physical therapy modalities and procedures provided at Accelerate Physical Therapy. These procedures are used as primary or adjunctive techniques in soft tissue treatment for the progressive development of strength, mobility and to improve functional outcomes.

Physical Therapy Procedures

The level of complexity can characterize the following physical therapy procedures and the expertise required to perform the task. These procedures involve training exercises or modalities requiring more specific skill than those characterized as modalities, but may be provided by assistants under the direct supervision of a licensed physical therapist.

Soft Tissue Mobilization is the skilled manual application of techniques designed to normalize movement patterns through the reduction of soft tissue pain and restrictions for the following reasons:
Muscle spasm around a joint
Trigger points
Adhesions
Neural compression

Joint Mobilization is the passive movement performed in such a manner (particularly in relation to the speed oft he movement) that it is, at all times, within the ability of the patient to prevent the movement if they so choose. Skilled manual joint tissue stretching is used to improve, and as possible, normalize joint movement of the spine and extremities and is performed for the following reasons:
To improve joint play/mobility
Improve intrascapular arthrokinematics
Reduce pain associated with tissue impingement or friction
Functional Activities involve the instruction, active-assisted training and/or adaptation of activities or equipment and has the following results:
Improves a person’s capacity for homemaking, including meal preparation
Improves a person’s capacity form communication, utilizing equipment
Facilitates return to work at previous level of function in lifting, driving, climbing, pushing, pulling, etc.
Job site modification to decrease postural dysfunction/pain

Therapeutic Exercise with or without mechanical assist or resistance has the following indications:
Improve cardiovascular fitness
Reduces edema
Improves muscle strength and coordination
Improves connective tissue strength and integrity
Promotes circulation to enhance soft tissue healing/metabolism
Increases bone density
Increases endurance, reduces fatigue

Massage – Manual or mechanical manipulation of soft tissue to achieve:
Reduced swelling
Reduced muscle spasms
Improved outlying circulation
Increased muscle tone prior to exercise
Reduced adhesions
Increased muscle length

Neuromuscular Re-education is the skilled application of exercise with manual, mechanical or electrical facilitation and through its use enhances motor response, strength and recruitment rate with independent control.

Neurodevelopmental Activities/Reflex and Sensory Integration/Proprioceptive Neuromuscular Facilitation (PNF) involves the skilled use of activities and exercises that promote neuromuscular responses through carefully timed proprioceptive stimuli to normal neurologically developed sequences. It also improves neuromotor response and reduces risk of impromptu muscle failure. It improves tolerance and enhances strength, normalizes movement patterns and improves cell waste and bacteria removal, and increases the muscular sense and perception of movement, stabilization and reaction time. These techniques achieve sensitization, or if required, desensitization of joint movement.

Gait Training – Crutch walking or walker instruction to a person with lower extremity injury or surgery:
Promotes normal gait pattern with assistive device
Promotes safety in proper use of assistive device
Instructs in progressive use of more independent devices (platform walker, walker, crutches, an cane)
Instructs in gait on uneven surfaces and steps (with and without railings) to reduce risk of fall or loss of balance
Instruction in the use of equipment to limit weight bearing for the protection of a healing injury or surgery

Straight Plane Exercises with or without mechanical assistance or resistance has the following effects:
Improves strength and coordination
Reduces atrophy
Improves reaction, recruitment and endurance
Supervises safe progression of resistance
Teaches techniques which promote accelerated muscle development
Increases size and strength in musculotendinous tissue and tensile strength

Activities of Daily Living involves the instruction, active-assisted training and/or adaptation of activities for personal care or equipment for mobility and self-care. This includes:
A person’s capacity in mobility and self-care to move from floor or sitting levels to standing, fluently and without pain.
Aids in sleeping without pain, grooming and self care including hygiene.

P.T. Physical Agents (Modalities)

The primary use of thermal modalities is for pain, swelling and to improve the rate of healing soft tissue injuries. Extended use is supported by consistently measured changes. Certain diagnoses and post surgical conditions may require periods of treatment beyond the normal ranges of 3-6 weeks.

Additional procedures are occasionally necessary to help control swelling, pain or inflammation during the rehabilitation process. They may be used intermittently as a therapist believes appropriate, or regularly if there is specific measured improvement during the treatment.

If our patient is not responding within 3-4 weeks, alternative treatment, further diagnostic studies, or further consultations with their physician or another physical therapist should be considered.

Ultrasound is the use of sonic generators to deliver acoustic energy for thermal and/or non-thermal soft tissue treatment. There may be a concurrent delivery of electrical energy. Ultrasound can be used to obtain the following results:
Softening scar tissue and reduce pain associated with scar tissue and adhesions
To soften collagen fiber
Accelerate soft tissue healing process
Increase flexibility of muscles and tendons
Reduce muscle spasms and reduce pain associated with muscle spasms

Hot Packs
Reduce pain or raise the pain threshold before exercise, postural training and gait training
Reduce muscle spasm to promote increased movement
Increases circulation to aid healing

Cold Packs
Lowers body tissue temperature for reduction of inflammation
Lessens pain resulting from injury or exercise by increasing the pain threshold
Reduces swelling and hemorrhage. Used in combination with compression and elevation
Lessens pain and inflammation from tendinitis and bursitis
Diminishes muscle spasm to promote stretching and decreases exercise induced muscle soreness
Increases circulation to aid healing

Electrical Stimulation
Applies electrical current (AC or DC) over skin to muscles, joints or other soft tissue for the following reasons:
Relaxes muscle spasms (including TENS)
Reduces pain (including TENS)

Iontophoresis – The transfer of medication (including but not limited to steroidal anti-inflammatories and pain relievers) through the use of electric stimulation. This procedures has the following results:
Pain reduction
Inflammation reduction
Reduction in swelling
Aids circulatory problems in the extremities
Decreases muscle spasms
Breaks down calcium deposits and softens scars

Phonophoresis – The application of ultrasound using a medicated lubricant that introduces molecules into the tissue similar to those used in iontophoresis.

Contrast Baths – Involves alternating immersion of the extremities; promotes circulation and has the following results:
Reduces swelling in the subacute stage of healing
Improves outlying circulation
Decreases joint pain and stiffness

Paraffin Baths
A form of heat application that uses paraffin wax/mineral oil mixture applied safely at 126 degrees Fahrenheit.
Symptomatic resolution of pain
Elevates pain threshold
Prepares for exercise, mobilization of the distal extremities and gait training

Ball Stretching for Back and Radiating Leg Pain

Click on the links and watch the  exercise videos, which provides the same decompressive effects provided by expensive mechanical traction devices in physical therapy, and recently, chiropractic’ offices.  Position yourself on a ball that is appropriate for your body type and size.  Stretch over the top of the ball far enough to feel your lumbar spine stretch.  This will gradually relieve the compressed tissue in your lower spine.  Repeat it daily for progressive improvement.  Hopefully it can offer you consistent relief.  These balls can be seen in advertisements somewhere  every week for $15-25.

For Those Whose Back or Leg Hurts:

Ball Stretching

Ball Stretching – Rocking Technique

Bridging

Bridging with Ball Squeezes

Where can you find warm water exercise?

The benefits of warm water therapy include increased joint and muscle flexibility, increased muscle strength, relaxation, increased balance and coordination, increased endurance and increased circulation. Individuals of all ages and activity levels have reported excellent results while taking an active role in their recovery. We have successfully treated high school, college, and weekend athletes, workers’ compensation clients, and seniors with a variety of painful conditions. The pool offers a unique medium to relieve pain while providing a serious resistive exercise challenge.

Acute and chronic conditions benefit from the weightless buoyancy, the graded resistance, and the hydrostatic pressure provided by the water. A weak and debilitated individual can use the water effectively for each stage of their recovery and the able, athletic individual with back pain, or a knee injury can withstand different levels of training in the same aquatic environment..

Pool therapy is not swimming – it is standing, walking, reaching, lifting, kicking, floating, running, jumping, treading, etc. It includes a variety of creative challenges, which are endless. The therapists at Accelerate Physical Therapy are ready for any challenge – using pool therapy provides us with one more creative tool to help our patients achieve their physical goals.

The buoyancy decreases the load on the joint structure, which eliminates pain, assists range of motion, and improves circulation. Thirty to ninety percent of body weight can be eliminated allowing early aerobic and resistive training for the athlete. Relieving weight through the spine offers significant pain relief for disc and radicular pathologies while allowing for functional gait, transfers, and resistive strength conditioning.

Arthritic conditions benefit from the reduced compressive forces while allowing for smooth synovial motion and muscle strengthening. Water provides an environment that reduces body weight by 90% when standing in shoulder depth water, thus decreasing musculoskeletal stress or impact on the body. What better way to encourage normal motion in a joint than by eliminating gravity?

Graded resistance is accomplished by varying speed of motion and surface area of the extremity. Upper extremity, lower extremity and trunk exercise performed at a slow speed is assisted while fast motion creates a resistive challenge. Use of water dumbbells, fins, and paddles increase muscle recruitment for higher level strengthening. Furthermore, motion in the water is highly functional as trunk and proximal stabilization musculature are recruited throughout movement in the pool. This challenge incorporates movement of the injured area of the body with the whole person-reinforcing normal motion and coordination. Throwing, pushing, pulling, lifting and reaching can be incorporated into the independent exercise program for return to sports or functional activity. When able, one may initiate high level activities early in the pool with faster return to activity. Further, the use of underwater exercise allows the muscles to be exercised in all directions. This is due to the fact that water resistance is 12 times greater than air resistance.

Confidence increases as the individuals we serve improve their level of control in the water. Soon the activity becomes easier and less challenging out of the water as strength gains continue.

Accelerate Physical Therapy offers one-on -one aquatic therapy treatment. Cost may be discounted by your insurance plan. Programs are tailored to the individual needs of the patient and the treatment diagnosis. Accelerate Physical Therapy. PC are Medicare B (outpatient) providers. If you are covered under Medicare B, we are paid 80% of Medicare’s fee schedule after your deductible is met. There is a limit of ~$,1900 benefits under Medicare B for all physical therapy provided to you everywhere in each calendar year. Medicare benefits are renewed every January. We are participating providers in nearly all insurance plans. We have only abstained from participation with group health insurance carriers who offer less than reasonable and customary reimbursement.

We teach aquatic exercise at the Wheat Ridge Recreational Center, 4005 Kipling St, Wheat Ridge, CO 80033, where the therapeutic pool is 88 degrees.

A cost effective community resource is the warm water therapy pool located at Margaret Walters Center features 92 degree water, pool depth of 0 to 4’6″, a walkway with rail, a hydraulic lift and easily accessible dressing rooms with lockers. Individuals and organizations may purchase swimming services from the DDRC Recreation Division. Please call (303) 431-0734. DDRC’s Walters Center offers Open Swim hours Tuesday through Friday mornings (8:30 – 9:30 AM), and afternoon Open Swim on Tuesday and Thursday (3:00 to 4:00 PM), and also Wednesdays (4:00 to 5:00 PM).

DDRC Recreation
Walters Center
12665 W. 52nd Ave.
Arvada, CO 80002
(303) 431-0734

Here is a list of some other sites to contact about warm water exercise opportunities:

Apex Center
13150 W 72nd Ave
Arvada, CO 80005
(303) 424-2739

Easter Seals Steve Vestal Center
5755 West Alameda Avenue
Lakewood, CO 80226
(303) 233-1666

Wheat Ridge Recreation Center
Therapeutic Pool (adjacent to the Hot Tubs)
4005 Kipling St
Wheat Ridge, CO 80033-4125
(303) 231-1300

YMCA of Arvada
6350 Eldridge St
Arvada, CO 80004
(303) 422-4977

We will update the list as we discover other options for you.