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Thoughts on Aquatic Rehabilitation


Written by
Anne Cole

Photography by
Megan Paulsen

Known for his advancements in the field of aquatic rehabilitation, work in non-operative rehabilitation and the creation of the not-for-profit organization Community Based Rehabilitation International, Andrew Cole is not only a fascinating doctor; he happens to be my dad. We sat down for a conversation about his career.


Reflections magazine: When did you realize you wanted to work in non-operative medicine rather than perform surgery?

Andrew Cole: I think sometime during my third year of medical school, during my clinical training. Because of my own spine injuries that were successfully rehabilitated non-surgically, I felt I wanted to offer people better options to help them avoid surgery if possible. Of course, if the patient needed a surgeon immediately or if they did not respond to nonsurgical care satisfactorily, I guided them to a surgeon who best met their needs. 


RM: What exactly is aquatic rehabilitation?

AC: Aquatic rehabilitation is the practice of using water to help facilitate recovery from various types of injuries, illnesses and long-term medical problems. This type of rehabilitation can help back pain, shoulder pain, knee pain, elbow pain, joint replacements, spinal cord injuries, stroke, amputations, multiple sclerosis, muscular dystrophy and more. Water has properties that facilitate a more rapid progress from musculoskeletal injuries as well as many other types of medical problems. The buoyancy alone helps reduce pain, and the water acts as resistance to movement so you can work harder or slower against it. It also helps improve range of motion. Interestingly, aquatic rehabilitation can also help other problems like certain types of heart and lung problems, because it facilitates exercise in a safe environment based on the physiology of how the water affects blood flow and blood pressure and swelling in the limbs.


RM: What does a typical aquatic rehabilitation program look like?

AC: Like any prescription, the most important thing is to customize for each person’s own medical problem and rehabilitation needs. You have to specify the type of exercise. Specify how often it’s supposed to be used and the dose, or how intense the episode of exercise should be. Depending on the problem you’re trying to help rehabilitate, the prescription for aquatic rehab is almost infinitely variable. 


RM: What would you say is the biggest accomplishment in your career to date?

AC: I think that’s a multi-part answer. First, having the opportunity to treat so many people and have them share their most personal concerns with me. Helping people improve and guiding their care are by far the most gratifying clinical things I’ve done. Administratively, creating a team with the goal of developing programs for non-surgical care of musculoskeletal injuries and pain has been extraordinarily gratifying for me. I think the third thing is the opportunity to mentor and teach. Mentoring one-on-one with younger physicians, helping them learn clinically and academically how to advance care for their patients in both small and large health-care systems. I really enjoy helping people achieve their maximum potential. I’ve always felt that having someone succeed is the greatest reflection of me. 


RM: You have written a number of books about aquatic rehabilitation. What was your inspiration?

AC: My interest in aquatic rehabilitation stemmed from when I hurt my own back. I went to see John Downey, MD, former chairman of the Department of Rehabilitation at Columbia University Medical Center in New York. He told me one of the best things I could do for my low back pain was swim. I started to realize his advice was extremely helpful, but there were certain movements that seemed to cause more pain. I then realized it wasn’t as simple as “go swim.” I wanted to understand a lot more about the mechanics of swimming and water exercise in order to make sure patients were getting the appropriate types of exercise for their particular diagnoses. Dr. Downey, who is one of the original leaders in our field of physical medicine and rehabilitation, was one of my greatest mentors; he encouraged me to explore the science supporting the use of the aquatic environment for rehabilitation. 


RM: What challenges do you face in this turbulent time for medicine?

AC: A big part of my role as a physician executive is to help develop better and more efficient ways to provide higher-quality care at lower cost. We call this the value relationship. To do that requires a lot of forward thinking and teamwork among many different providers. And at the end of the day, you usually get better clinical results at a lower cost. Using evidence-based medicine, or what science tells us, can help guide us to make better decisions about how to use the limited amount of health-care dollars that are available. At the end of the day, the most important thing is the patient comes first, and we never want to do anything that will sacrifice the quality of care we provide. Dr. Rayburn Lewis was also an extraordinarily talented mentor for me as I shifted my career from purely seeing patients to executive leadership. I have been very lucky to have some wonderful people mentor me during my career.


RM: How do you balance a thriving career and being a father?

AC: I’ve tried very hard over the years to do a better job of making family time and not letting work intrude upon it. However, when I was trained, one of the parts of the training was that the medicine and the patient always come first. The balance is something that’s different for everybody but is extremely important to be aware of and work on. When I didn’t have the quantity of time, I tried to provide the quality. However, there’s also a balance between quantity and quality, and you can’t shortchange either one in trying to find the right work-life balance. 


RM: Outside of your career, what do you enjoy doing in your free time?

AC: Spending family time with my daughter! I like sailing, freshwater fishing, cooking, gardening, reading and exercise. I do Pilates and yoga. But I think the best of all is spending time with my daughter. 


RM: Did you ever consider another career path?

AC: When I was in college, I wasn’t sure if I wanted to go into the U.S. Foreign Service, because I was particularly interested in international health, or go into medicine. My father said to me, knowing my personality, I would do better being a doctor, and then if I wanted to do international health, I could do that later. It turns out he was right. I have gotten involved with international health. During my last year of medical school I volunteered for five months in the third-world part of the Caribbean country St. Vincent and the Grenadines. The team I joined had a grant from Rusk Institute to identify people with different types of disabilities, impairments and handicaps. Using the World Health Organization model of Community-Based Rehabilitation, we developed treatment plans for them. Ultimately, about 30 years ago I helped start a nonprofit health organization called Community-Based Rehabilitation International to continue this work.


RM: Working in such a high-intensity career can be both physically and mentally demanding; how do you remain relaxed and grounded?

AC: It’s been challenging. Most doctors are not relaxed, but try to find ways to do so. I find that sailing, fishing and regular exercise are very helpful. I help myself stay grounded by working with those less fortunate than me through volunteer work and the types of patients that I see. The practice of medicine itself is very humbling.  

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