FORT EUSTIS, Va. –
ike ducks to water, Soldiers from the Fort Eustis Warrior Transition Unit have taken to the water as an alternative to traditional physical therapy in search of relief and rehabilitation from the wounds of war.
The Aquatic Warrior Exercise Program was developed by Dr. Mary Wykle, an aquatics and fitness expert contracted by the U.S. Army Surgeon General's office to develop and implement an aquatic rehabilitation program for Wounded Warrior Transition Units.
The Army asked Wykle to develop the program in response to the vast number of Soldiers returning from Overseas Contingency Operations with musculoskeletal injuries.
"So many Soldiers are coming back with lower back injuries, but there's also a lot of knee, ankle and shoulder injuries. Regardless of whatever other injuries a Soldier has, most of the problem is due to the strain on the back - most often from carrying the heavy [rucksack]. The back can only take so much stress," Wykle said.
The program is currently a pilot offered at only three Army installations: Fort Belvoir and Fort Eustis in Virginia and Fort Lewis, Wash. Fort Eustis and Fort Lewis, Wash., were chosen because each has multiple indoor pools and their WTUs have 250 to 500 Soldiers assigned to them. Fort Belvoir was chosen because of the size of its WTU -- about 250 Soldiers, its close proximity to Army Headquarters in Washington, D.C., and because the new hospital currently under construction will feature an indoor pool. Construction is due completion later this year.
The number of Soldiers is important for the study because installations with large WTUs such as Fort Hood, Texas, or Fort Bragg, N.C., with more than 500 Soldiers are too large to manage data for the study.
After meeting with the ASG's office, Wykle developed the AWEP. The program goal is to help Soldiers with pain management and to rebuild and strengthen wounded Soldiers' bodies so they can return to regular unit physical training.
"We're not only looking at pain management; we're looking to help Soldiers to be able to do more and find a way for them to become more active. The idea is to develop an aquatic exercise program for the Soldiers and get it standardized throughout the Army," Wykle said in a recent interview.
The aquatic exercise program Wykle has developed is two-fold. The first part is the Aquatic Rehabilitation Program for Soldiers undergoing rehabilitation for musculoskeletal injuries under the care of a doctor or physical therapist. The second part is the Aquatic Warriors Exercise Program for Soldiers who have completed rehabilitation programs but still experience pain and limitations that prevent them from participating in regular unit physical training.
For years, doctors have prescribed aquatic therapy for patients with arthritis and other joint maladies because it can relieve joint pain and stiffness and increase range of motion and flexibility. AWEP incorporates aquatic therapy and lumbar stabilization exercises to strengthen the core muscles to help alleviate or prevent lower back pain.
Because the program is a pilot at only three installations, Wykle can personally train cadre members as AWEP instructors. The Fort Eustis WTU has six certified AWEP instructors with three actively leading physical training every weekday morning at the Aquatic Center. None of the instructors has previous water safety, physical therapy or medical occupation backgrounds.
"I'll admit, when I was first told that I was picked for the program, I imagined little old ladies in the water, and I was very resistant. After I went through the two days of training, muscles I didn't even know I had were sore, and I had a whole different outlook about it," said Sgt. 1st Class Robert Sallade, an activated National Guard Soldier who is one of the first cadre members at the Eustis WTU certified by Wykle.
Training for certification is a two-day course, covering topics such as water safety, dynamics of the water and the body's response to water exercises. In two days of training, instructors spent about 12 hours in the pool learning and performing the exercises.
Warriors with musculoskeletal and other injuries or no injuries and varied levels of athleticism can benefit from the program.
"The program is primarily centered around back injuries, but we've got knee injuries, hip and ankle injuries, the gamut of injuries. We can customize the exercises so that we're working around or at the injury, strengthening the injured area," Sallade said.
Water provides 10 times more resistance than air and increases the drag, making it an ideal alternative or adjunct to traditional therapy such as performing land exercises likewalking, running and jumping jacks that intensify the workout but with strain on weight-bearing joints such as hips, knees and ankles.
"There's all different effects that water has on a body. For instance, if you're up to your neck in water, you're only dealing with 10 percent of your body weight. Then there's the static pressure of the water on your body. It improves circulation but decreases your air, your lung capacity," Sallade said.
Another facet of the program is that no swimming experience is needed to participate, so anyone cleared by medical personnel to participate can do so.
"The program has nothing to do with swimming because you're never swimming and any time you go into the deeper water you have an Aquabelt [floatation belt] on, you have a floatation device and your head never goes underwater," said Sallade. "At first, a lot of people were resistant to get in the water. There was a lot of 'I can't swim,' or 'I don't like the water.' Once we got them in, they absolutely loved it because they feel the benefits," he added.
Along with conventional land exercises, pool accessories such as foam tubes or "noodles," Aquabells and floatation belts are used to assist and further challenge the warriors.
"Even though we use the equipment, just being in the water and keeping a straight posture, standing toe-to-heel, and maintaining balance works your core strength," Sallade said.
Trainers usually conduct training from above the water on the pool deck, allowing instructors to look down into the water to ensure Soldiers are doing the exercises and doing them correctly, however joining them in the water is beneficial to both trainers and trainees.
"There's what's called the 'bucket effect' where your legs float up rather than stay straight beneath you or behind your body. We walk on deck where we can see into the water and provide advice to the Soldiers in the water," Sallade said.
Staff Sgt. Tiara Warrick, another certified AWEP instructor at the WTU, not only conducts the training on deck, she often joins the Soldiers in the water, leading the exercises from the same level.
"I sometimes get in the water with them; it helps them and gives me a chance to exercise as well," she said.
"For me, personally, two days out of the week I'll go into the pool and work out. General aches and pains are less and my endurance seems to be a little higher, my breathing seems to be a little better," Sallade said.
Sgt. Raymond Leplant, an Apache helicopter mechanic and another of the WTU's AWEP-certified trainers, concurs.
"The best part about this program that I've noticed is that regardless of your level of fitness, you can and will get something out of it," he said.
Sgt. Jason Johnson, recovering from a back injury, regularly attends AWEP sessions and says that the program has proven beneficial for him.
"Whenever I can be, I'm here because I definitely feel it. It's the same workout as a regular [land] workout and it helps, but you have to do it steadily," Johnson said. "It works but only if you're not cheating yourself, as long as you do it right," he said.
Wykel visited the Eustis WTU in March for recertification and to proctor a training session, giving tips and advice to the instructors and participants.
"Doctor Wykel has come down and I'm in constant contact with her through e-mail or on the phone to stay on top of changes and advances in the program," Sallade said.
The Eustis program kicked off Jan. 4, and since then the number of participants has varied from five to 20 Soldiers participating at any given time. Because the program is on a volunteer basis, the number varies not only because of scheduling conflicts, but also because of misconceptions about the program, Leplant said.
"The biggest problem that this program carries with it -- and I heard it a lot when we first started -- is the stigma of 'Oh, like synchronized swimming.' I also heard a lot of, 'This isn't going to do anything for me' but once we get them in the water and get them going, once they see that it is an actual, formal program in which you're actually doing something, they're all for it," Leplant said.
The program also provides an outlet for former competitive and devoted athletes such as weightlifters, runners, martial artists and cyclists.
"Because of whatever injuries they had, they really can't do anything now except maybe ride an exercise bike. Putting them in the water has given that back. They have more freedom; they're not feeling the weight of their own bodies, and it [the water] increases their mobility," added Leplant.
"An absolutely huge benefit for Soldiers is when they see they can be more active, still do just as much as before," said Wykle.
Some participants have said that regaining abilities lost to injuries is one of the draws for participating. The exercises are challenging, however the trainers try to keep the time in the water fun as well.
"We make it fun, we try to play tag on Thursdays and the WTs have said that is the hardest workout they've done yet because you can't stop moving. Once your momentum is going, it's hard to stop the motion and it's a major workout," Sallade said.
To participate, a WT must first graduate from the prescribed aquatic physical therapy course and then register for the AWEP.
Like their regular-duty counterparts, Soldiers in the AWEP are tested periodically on their physical fitness with a 100-step or "Cadence" test.
"We take the resting pulse first, put the WTs in the water and start them running, and we time them. When they hit one hundred, we stop the time and take their pulse again. That data then gets entered into an online database and the WTs enter their information. They also use this to track their pain levels," Sallade said.
The online database is the Aquatic Rehabilitation and Aquatic Warrior Survey, a 26-question survey used to measure participants' progress and to provide suggestions for improvement as needed. The data collected will help Wykle to define the benefits the program provides for reintegrating Soldiers back to their units or civilian life. Wykle hopes these results will move the AWEP from a pilot initiative to an Army-wide program.
Wykle said that another facet of the program is that it also addresses the five dimensions of the Army Comprehensive Soldier Fitness Program: emotional, physical, social, spiritual and family fitness.
"I see a definite way that it can relate to all five parts of the program. If they [Soldiers] do transition out of the Army, they have a new activity they can take with them and share with their families, increasing that bond. That's the family fitness aspect of the program. If they stay in on a permanent profile this can become a part of their regular PT program and that can address other dimensions," said Wykle.
Besides helping Soldiers rebuild, the program also provides emotional benefits -- another dimension of the CSF program.
"Whenever you get into the water, just the feel of the water on the skin can be a calming effect for Soldiers and this also ties in with the overarching goals of the CSF, the emotional part," said Wykel.
Answering survey questions and keeping track of statistics may be one way to measure the program's success, but the experience of Sgt. Daniel Lopez, a Warrior in Transition previously assigned to the Fort Eustis Warrior Transition Unit, can be held up as a living example.
Lopez lost his right leg to injuries sustained in an accident in 2006 while home on leave after serving in Iraq. Joining the Eustis WTU in 2008 for rehabilitation, Lopez completed his prescribed aquatic physical therapy and graduated to the AWEP. After months of training and preparation, Lopez earned certification as a lifeguard and logged more than 10 miles of lap swimming.
"Sergeant Lopez was not only able to pass his certification as a lifeguard, I was able to award him his lifeguard instructor certification in May," said Wykle.
Lopez competed in four events at the Warrior Games in Colorado Springs, Colo., May 10 through 14. Hosted by the U.S. Olympic Committee, the competition featured 200 ill, wounded or injured servicemembers from all branches of the military. Lopez won a silver medal in the sitting volleyball event.
To learn more about the Aquatic Warrior Exercise Program, visit
www.aquaticwarrior.com.