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Hydrotherapy can be a great tool for some people for some things. As you say it has different roles.

Where it starts to get into some less convincing territory is when it begins to purely fill a fitness void as opposed to a rehab one. You mentioned certain types that might end up in this :)

Maybe a patient went in for conservative treatment instead of surgery and the HT is not solving what they want, but it's making them a bit fitter and upping their exercise tolerance (which they can't even monitor themselves in a lot of cases.), and actually helping towards what they think surgery should do. So they think the HT is doing nothing. It actually is doing something, but not what they went in for.

So they get the surgery, the HT having failed in their mind, only to be put back in HT again post-surgery as a kind of rehab. The surgery didn't actually work. The HT works a bit again for their general fitness which they can't feel, but that can be seen. 2 years later, rinse, repeat.

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