Question and Answer Session: How This Physical Therapist Successfully Uses Hydrotherapy

Carolina Spine & Neurosurgery Center (CSNC) has a thriving hydrotherapy practice. It is one of the largest private neurosurgical and spine care centers in Western North Carolina. CSNC operates as an independent part of the Mission Hospital System and is a major reason the hospital was named one of the top 101 hospitals for spine care by Becker’s Hospital review.

The therapists at CSNC understand the beneficial properties of water and use hydrotherapy as a successful tool for patient recovery, well-being, and rehabilitation. Here’s how they achieve success.

The hydrotherapy room includes a warm-water (94-degree) therapy pool with independent performance zones at depths of 4 feet, 5 feet; and 6 feet. The pool generates a water current with 99 speeds and can accommodate patients at all stages of recovery to safely improve mobility, balance and confidence.


with Roger Meade, DPT, director of physical therapy at the Carolina Spine & Neurosurgery Center.

What are the common diagnoses where you utilize hydrotherapy?

We work with the following:

A: Orthopedic: all joint replacements (once incisions heal); strain/sprains all joints, trauma fractures to limbs requiring multiple joint limitations in rehab (once incisions heal); all sports injuries especially with sooner initiation of Rehab post injury; arthritic issues to improve movement and conditioning.

B: Neuro/Orthopedic: all spinal surgeries, basic head trauma with difficulty in coordinated movement patterns, CVA varied levels depending on cognitive and bladder/bowel issues, Parkinson’s (to work patient outside comfort zone), MS if we can keep pool cool; or central neurological systemic issues depending on physician’s projection of recovery. Most spinal paralysis except high quadriplegic.

Balance issues not related to inner ear issues or Menier’s Disease; but more related to CVA, physical de-conditioning, dementia, and proprioceptive loss lower extremities.

C: Pediatrics for birth defects, injuries during delivery, or early trauma. Extremely effective with children 1-8 years old.

What does a typical week look like for pool hours and scheduling?

Our pool is open 7AM to 7PM, 5 days per week. Patients are scheduled for 45 minute slots and up to four may be scheduled in same slot depending on difficulty. We schedule “high water current” patients together.

Who do you have on staff for hydrotherapy?

We have 5 therapists and 5 PTAs on staff. All PTAs work in the hydrotherapy pool. I am the only therapist at the present time that works in the pool. Patients are evaluated and treatment plans proposed to the physician. If approved, the PTA will follow the plan as outlined with the therapist checking at least every 4-6 visits for changes needed.

How do you schedule therapists?

Each PTA will work one half day in the pool – AM or PM. This is rotated by schedule through the 5 PTAs. I see complicated patients and would be the only one working with patient in the pool.

PTAs are required to be in the pool with patients. We have a waterproof computer at side of pool for writing notes, charges, and reviewing patient’s history and physician notes.

How many patients do you schedule in one session?

We see up to 4 patients per 45 minutes depending on the difficulty of the patient, however we leave this up to the therapist to decide the number to schedule.

How do you bill for hydrotherapy?

We charge in 15 minute increments, and we have a number of different systems to maximize billing. But all insurance is different and it’s important to understand parameters specific to each state, plan and region.

Do you use your pool in other ways?

We hold classes in pool that are offered at specifically blocked times. These group classes are very successful and generate extra revenue. They include Aqua Yoga and Tai Chi.