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The Not-So-Perfect Pool

Byline: Andrea Salzman, MS, PT

Overcoming noise, crowding and water quality problems at the community pool Too crowded? Too loud? Too dirty? Too bad. After all, it's the only pool you've got. Therapists who outsource their aquatic therapy to a community pool know exactly what I mean. Swimming pools were made for swimming. Recreational pools, for recreation. Such community pools neither look -- nor function -- like therapy pools. But therapy pools they must become.

In a prior article "The Not so Perfect Pool" (Advance for PTs/PTAs; 2009: 20(4):19), I addressed how to work with community pools which are too cold or too deep for therapy. But these are not the only challenges out there. In addition to temperature and depth issues, many community pools are crowded, loud, dirty, and not available for exclusive use (although, if the pool is cold, deep, loud, and dirty, and you still want to use it, you may have other issues to worry about).

Good news. You don't have to suffer without remedy. Straight from the therapy trenches, I've gathered ideas for fixing what ails these not-so-perfect pools.

The Problem: The pool is crowded and loud.

Therapists who try to work with patients in a community setting sometimes feel hamstrung by their surroundings. The therapist may be trying to establish a nurturing, soothing atmosphere for pain relief. And at that beautiful moment when the patient finally "let's go" of her pain, a plastic beach ball whacks her in the back of the head. Community pools which are designed primarily as recreational pools are often loud and somewhat chaotic. They often have water sprays, slides and other features which make the water turbulent and the atmosphere more festive than therapeutic. This may not mix with your patient population.

The Solution

Cover patient ears, schedule during down-times, and lease exclusive use of a portion of the pool. Some adults and especially some children need a quiet atmosphere to remain calm or to help them process information. Amy Dzingle-Niemoth, PTA, Owner Wholistic Therapy Services (Hastings, Nebraska) suggests trying ear-plugs or a headband. When working with patients with severe auditory defensiveness, Dzingle suggests using both -- a neoprene headband placed over top of ear plugs. To keep children on task - and less distracted by ambient noise -- consider using a picture schedule. "We have utilized laminated pictures to help a child make a choice of activity and a picture schedule for the child to know what is coming next," reports Kari Valentine, OTR/L, owner of Wholistic Therapy Services. She also suggests bringing another child of a similar age (perhaps an older sibling) to therapy sessions to keep the focus away from others using the pool.

Treating adults? Treating patients at the same time as group classes doesn't work well.

Examine the pool schedule closely: there are repeating patterns to classes. See if you can schedule your therapy time during off-hours. Providing therapy sessions during busy pool times may be more than just a bother - it may create problems with Medicare. Medicare no longer states that an independent practice therapist must lease the entire pool when treating patients. However, Medicare still requires that that therapist contract exclusive use of some portion of the pool (for instance, 3 lanes) in order to convert the pool into a treatment "office" for the therapist. If the private practice therapist does not have exclusivity over a portion of the pool, Medicare considers this a reason not to pay for therapy. Interestingly, this is not an issue for hospital-based therapists or other non-independent providers. [Puzzled? For more details on this Medicare policy, here is the link to an Advance for PTs/PTAs editorial I penned on the matter:].

The problem: The pool is dirty

This is a biggie and horror stories abound. Therapists who rent space at someone else's pool are often at the mercy of the standards of that someone. When the pool is a well-established facility, such as a YMCA pool, it's rarely an issue. But some hotel and community pools can be a problem.

A colleague tells the story (always with a grimace) of her experience at the local motel pool. She had been performing therapy there for several months and had seen the water quality diminish quite dramatically. Finally, on the day she could not longer see the main drain, she approached the front desk to ask to speak with the designated pool operator to try and figure out what was the problem. Imagine the belly-clinching moment when (together) the front desk clerk and she figured out it was "Jeff" who had quit a month ago. There wasn't a drop of chlorine in that building, much less that pool.

The Solution

Get trained in pool chemistry, insist on water quality, or find another pool. Face it. You are in the water quality business. You are offering your patients health... via water. And if that water is gruesome, how can you do your job? You owe it to yourself to understand the basics of water chemistry. If your skin is itching and your patients are breaking out in hives, it would behoove you to know if the pool you are soaking in has a certified pool operator on-site and in charge. It does not work well for pools to contract-out this service. There are too many adjustments that need to be made multiple times a day to maintain water clarity.

Do you even know what an optimum pH or chlorine level should run? No? You should. You don't have to become a full-blown certified pool operator yourself (although that only takes two days and classes are available in every major city). Nowadays, you can take an abbreviated therapist-friendly, Internet version called Pool Operator Primer from the

National Swimming Pool Foundation ( It's just enough information to help you help yourself. Using a pool outside your own facility can be a challenge. Frankly, it's just not the same as having your own warm therapy pool. Still, it is possible to make a sub-optimum community pool function as a therapy pool.

Just remember your first charge as a health care provider should be to "do no harm". Here's a quick rule of thumb. If you are running into persistent water problems, ask someone who should know "who is the pool operator working today?" If the answer is a deer-in-the-headlights stare, run, don't walk, to the nearest pool exit.

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Interested in similar topics? Read about chemical contaminants in swimming pools: Tiffany L.L. Teo, Heather M. Coleman, Stuart J. Khan, "Chemical contaminants in swimming pools: Occurrence, implications and control." Environment International, Volume 76 (2015), 16-31.

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