By Wade Sheldon, Tulalip News
Physical therapy has long been proven to help individuals regain strength, mobility, and independence, particularly after an injury or surgery. However, recent studies indicate that aquatic physical therapy can enhance these benefits even further. The buoyancy of water reduces stress on joints, making movement easier and less painful, while the resistance naturally strengthens muscles and improves balance. Research published in the JAMA Network Open found that patients who participated in aquatic therapy experienced longer-lasting relief from chronic pain and improved mobility compared to those who received traditional land-based therapy. Water’s hydrostatic pressure also improves circulation and stability, allowing participants to move freely and safely while rebuilding confidence in their bodies.
That same philosophy of movement through healing water is now being offered to Tulalip community members through the new Aquatic Physical Therapy program led by physical therapist Agnes Borjal of the Tulalip Health Clinic. The program, held at the Stanwood YMCA, represents a thoughtful blend of science, accessibility, and cultural connection.
Agnes explained that the decision to host the program in Stanwood was made after carefully evaluating several nearby facilities. “My background with aquatic physical therapy is that I had been working at the Everett YMCA with Providence Physical Therapy, and I created the aquatic program there,” she said. “The amenities were essentially the reason why we chose Stanwood. We originally tried to get the Everett locale, but they had so many programs, and I didn’t want our elders or patients to feel rushed to participate in their aquatic program. Then we looked at the Marysville Y, but it didn’t have the riverwalk or stairs into the pool space. The Stanwood YMCA mirrored what I had created before at Everett, and I knew patients would feel more comfortable with that kind of timing.”
Her passion for water therapy runs deeper than convenience or logistics. It is rooted in understanding how water connects to the Tulalip community’s identity. “Learning about the history of the Tulalip Tribes, I’m essentially an outsider. I’m Indigenous to my culture, which is the Philippines, but learning about the Coast Salish tribes and how water was so fundamental in their life, I felt like pool therapy would be so meaningful as a medium,” she said. “Water is healing. We talk about movement being medicine, but in my 20 years as a therapist, I’ve learned that the medium of water brings its own properties into that healing space. I love that historic background for the tribe.”
When Agnes joined the Tulalip Health Clinic, she saw an opportunity to expand the integrative health program to include aquatic therapy. “Coming onto the team, I loved the direction the clinic was taking,” she said. “They had this holistic vision of Native health, healing, Reiki, massage therapy, acupuncture, and physical therapy, and I wanted to bring in another aspect for our skilled PT services. I asked, ‘Have you considered aquatic physical therapy?’ because of chronic pain. At my previous clinic, we successfully transitioned many of our chronic pain patients into aquatic programs, not just for the physical benefits, but also for the social ones. Group sessions foster connections and promote wellness beyond just recovery. Since Tulalip already had partnerships with the YMCA, it made sense to create this bridge for patients to feel safe and supported in that space.”
Each aquatic therapy session begins on land at the Tulalip Health Clinic, where a physician’s referral helps determine treatment needs. “You’ll see me on land first because our goal is always to perform better on land,” Agnes said. “The first visit is a session in the clinic, and then we move into the water. We do warm-ups, balance and endurance exercises, and cool-downs, just like on land. However, underwater, we can also perform manual therapy, which is really enjoyable. Patients can experience weightless posture, and their joint and muscle tensions release in a totally different way.”
The program is designed for individuals facing chronic pain, arthritis, mobility challenges, or those recovering from surgery. “It’s great for people with multiple joint pain, chronic pain issues, or balance problems, and for anyone who has a high fall risk or struggles to exercise on land,” Agnes said. “Because a physician prescribes the therapy, it’s covered through insurance for Tulalip Health Clinic patients.”
Currently, the Aquatic Physical Therapy program is exclusively available to Tulalip tribal members who receive care through the Tulalip Health Clinic. Because it’s a medically prescribed service rather than a public exercise class, participants are referred directly by their healthcare providers.
Since the sessions take place at the Stanwood YMCA, about a 25-minute drive from Tulalip, transportation can be a consideration for some patients. Currently, there is no formal shuttle or group transportation in place, although the idea has been discussed among clinic staff and community programs.
“Right now, our physical therapy patients are getting to the Stanwood YMCA on their own,” Agnes explained. “There have been early discussions about possible transportation support through the senior program or community health, but since the program is still new, patients are currently responsible for arranging their own rides.”
Since its recent launch, the feedback has been overwhelmingly positive. “They’ve loved it,” Agnes said with a smile. “Usually, sessions start one-on-one, then move into duet or group sessions. I think the biggest thing is that people are learning how their bodies respond to active recovery. I’ve seen so much improvement, especially among patients preparing for surgery. Some are waiting on knee replacements and tell me how much better they feel just being able to move their whole body again.”
The partnership with the Stanwood YMCA has also been strong. “They’ve been so welcoming and kind,” Agnes said. “The staff and regular members are supportive, and I’ve had patients say how comfortable they feel there. Some people even ask if they can join our sessions, but I remind them it’s exclusive for Tulalip Health Connect patients, which is kind of neat because it shows how visible and valued the program is becoming.”
When asked how she measures success, Agnes didn’t hesitate. “It’ll come from our patients, their outcomes, how they feel treated, and how their recovery carries forward,” she said. “Our goal is to help them become independent with a mindful movement program for themselves. The true testament is when they can go back to their normal routines, gardening, fishing, preparing their boats, without worrying about pain holding them back.”
For anyone hesitant to try aquatic therapy, her message is simple. “This is an environment meant to help your body feel lighter and freer,” she said. “Let the water support you. Let it help you find movement again.”
Agnes hopes this new program will become a lasting part of Tulalip’s larger health and wellness journey. “I think this is one of those things that can help inspire,” she said. “Learning about the Coast Salish tribes and their water connection, I see how resilient the Tulalip people are, always doing their best for their community. This program is a reflection of that. We just want to do our best by the people, following the Tribe’s vision, mission, and values.”