Table of Contents > Alternative Modalities > Hydrotherapy Print

Hydrotherapy

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Also listed as: Balneotherapy, Water therapy
Related terms
Background
Theory
Evidencetable
Tradition
Safety
Attribution
Bibliography

Related Terms
  • Aquatic physical therapy, bath, cold therapy, colonic hydrotherapy, colonic irrigation, constitutional hydrotherapy, Dead Sea bath, douche, external hydrotherapy, fomentation, foot bath, hot therapy, hot tub, hot tub therapy, immersion bath, internal hydrotherapy, jet spray, local hydrotherapy, motion-based treatment, mud bath, poultice, purifying bath, salt bath, sauna, shower, sitz bath, spa treatment, soaked towel, temperature-based treatment, Turkish bath, warm salt water immersion, warm sulfur water immersion, warm tap water immersion, water bath, water birth, water mineral bath, Watsu®, whirlpool.
  • Note: This review does not include discussions of therapies that may include the use of water as a part of the technique, such as colonic irrigation/enemas, nasal irrigation, physical therapy in pools, steam inhalation/humidifiers, drinking of mineral water/"enriched" water, coffee infusions, aquatic yoga, aquatic massage (including Watsu®), or aromatherapy/baths with added essential oils.

Background
  • Water has been used medicinally for thousands of years, with traditions rooted in ancient China, Japan, India, Rome, Greece, the Americas, and the Middle East. There are references to the therapeutic use of mineral water in the Old Testament. During the Middle Ages, bathing fell out of favor due to health concerns, but by the 17th century, "taking the waters" at hot springs and spas became popular across Europe (and later in the United States).
  • Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. There are other therapies that may include the use of water as a part of a technique, but are not included in this review, such as colonic irrigation/enemas, nasal irrigation, physical therapy in pools, steam inhalation/humidifiers, drinking of mineral water/"enriched" water, coffee infusions, aquatic yoga, aquatic massage (including Watsu®), or aromatherapy/baths with added essential oils.
  • Modern hydrotherapy originated in 19th century Europe with the development of spas for "water cure" ailments, ranging from anxiety to pneumonia to back pain. Father Sebastian Kneipp, a 19th century Bavarian monk, spurred a movement to recognize the benefits of hydrotherapy. His methods were later adopted by Benedict Lust who immigrated to the United States from Germany in 1896, and founded an American school of naturopathic medicine. Lust claimed to have cured himself of tuberculosis with Kneipp's methods, and hydrotherapy was included as a component of naturopathic medicine. In modern times, a wide variety of water-related therapies are used, some of which are described below.
  • Sitz bath: A Sitz bath is administered in a tub that allows the hips to be immersed in water. Sitz baths have been used in the management of back pain, sore muscles/muscle spasm, body aches, sprains, hemorrhoids, pruritis (itching), inflammation, rashes, anxiety, for wound care/hygiene, and to promote relaxation. For various ailments, different temperatures may be used, and minerals or medications may be added to the water.
  • Arm bath: For a cold arm bath, the arm is placed in a basin of cold water with the water level reaching just above the elbow. A rising temperature arm bath uses the same principle as a rising temperature footbath.
  • Foot bath: Cold foot baths involve placing the feet in a bath filled calf-deep with cold water. "Walking in water" involves stepping on a non-slip mat placed under water. For warm/rising temperature foot baths, the feet are immersed in water at body temperature. Hot water is gradually added until the temperature reaches approximately 103-104 degrees Fahrenheit. Therapy may last for 10-15 minutes. Caution is warranted not to cause burns.
  • Rising temperature hip bath: These baths are administered in tubs initially filled with shallow tepid water. Hot water is gradually added until levels reach the navel. A common temperature is 103-104 degrees Fahrenheit. The bather may then be wrapped in warm dressings.
  • Cold rubbings: This technique may use linens or towels soaked in cold water then wrung out and vigorously rubbed on the upper and lower trunk or the entire body.
  • Douches: "Douches" may be carried out with a watering can or hose. Treatments can be applied to any area of the body, with the intention to relieve tension or pain, or to affect blood flow.
  • Steam bath/sauna: Heat may be used to cause sweating, and these techniques are variably included in the definition of hydrotherapy. People should not spend more than 15-20 minutes in a steam bath or sauna, and individuals with medical conditions such as heart or lung disease should avoid prolonged heat exposure (as directed by a qualified healthcare provider).
  • Wraps: Hot or cold wet wraps may be used around various parts of the body. This technique is sometimes used with the intention to reduce fever or foster relaxation. Hot fomentation involves the application of warm liquid or moist heat with towels to the surface of the body.
  • Spa/hot tub/whirlpool/motion-based hydrotherapy: These therapies are sometimes used in people with wounds, chronic musculoskeletal pain, or inflammation. People should be aware of the risk of introducing infections into wounds, and the importance of keeping wounds clean.
  • Purifying/mineral bath: Prior to immersion, solutes or other components may be added to water, such as sea salt, lemon juice, turmeric, Epsom salts, baking soda, chlorine bleach, or essential oils.
  • Dead Sea balneotherapy: There are numerous published articles regarding the use of therapeutic uses of water immersion in the Dead Sea (and other salt water bodies), particularly for chronic skin conditions. Because this therapy also involves prolonged exposure to sunlight, it is not clear to what extent possible benefits are due to the water, to minerals/high salt content in the water, to sun exposure, or to a combination of factors.
  • Water birth: Potential benefits of giving birth in water have been explored. Research is not definitive in this area.
  • Aquatic physical therapy/Watsu®: Physical therapy in pools is a well-established technique that takes advantage of buoyancy and resistance to movement in water. Watsu® is a form of bodywork conducted in pools.

Theory
  • There are numerous proposed mechanisms of action of hydrotherapy, depending on the specific technique used. Hydrotherapy practitioners and texts propose that immersion treatments and wraps may serve to detoxify the blood.
  • Alternating cold with hot temperatures is suggested to alter blood circulation, enhance the immune system, and improve digestion. Applying warmth to skin surfaces does cause vasodilation (expansion of blood vessels), which brings blood to the body's surface. Cold temperature has the contrary effect. Warmth also causes muscle relaxation. Some hydrotherapy techniques make use of these physiologic changes, although correlation to long-term health benefits is not clear.
  • Electrical stimulation is sometimes used, and is proposed to stimulate muscles, digestion, and circulation (although caution is warranted due to risks associated with using electricity while in water).
  • Physical therapy in water makes use of buoyancy (ability to float) to reduce work against gravity, as well as the resistance of motion through water.
  • It is difficult to design high-quality studies in this area due to the challenge of creating "placebo" hydrotherapy.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Several small controlled trials report that regular use of hot whirlpool baths with massaging jets improves the duration and severity of back pain when added to standard therapy, compared to standard therapy alone (Constant, 1995; Constant, 1998; Guillemin, 1994; McIlveen, 1998). It is not clear if there is a reduced need for pain control drugs, or if benefits are long-standing. Because these studies are small with flaws in design and reporting, better quality research is necessary before a strong conclusion can be drawn.

B


There is preliminary evidence supporting the use of sitz baths people with anorectal conditions, particularly for symptom relief. Sitz baths are offered to patients in many hospitals. However, controlled studies are needed to determine the effectiveness and optimal use of sitz baths.

C


There is preliminary evidence that some hydrotherapy techniques may reduce bacteria on the surface of the skin. It is not known if there are benefits (or potentially harmful effects) of reducing skin bacteria. There may be benefits in people with skin wounds or ulcers who are at risk of infection. There is no evidence that infection of the skin itself (cellulitis) is improved.

C


Hydrotherapy has been used historically for the treatment of symptoms related to rheumatoid arthritis and osteoarthritis. Multiple studies have been published, largely based on therapy given at Dead Sea spa sites in Israel. Although most studies report benefits in pain, range of motion, or muscle strength, due to design flaws, there is not enough reliable evidence upon which to base recommendations.

C


There is preliminary evidence that hydrotherapy in an acidic hot spring bath may reduce the severity of symptoms in atopic dermatitis. Evidence from controlled trials is necessary before a clear conclusion can be drawn.

C


Hydrotherapy is widely used in hospitals and rehabilitation centers in the management of burns. Various techniques are used, with variations in methods, lengths of time, frequency, and training levels of personnel administering treatments. There is limited research at this time, and no clear conclusions can be drawn.

C


There is preliminary evidence that daily breathing exercises in a warm pool may improve lung function measurements in patients with COPD. It is not clear if this technique is superior to breathing exercises alone. Evidence from controlled trials is necessary before a clear conclusion can be drawn.

C


Hydrotherapy is used in Europe for chronic venous insufficiency (CVI), a syndrome that may include leg swelling, varicose veins, leg pain, itching, and skin ulcers. A small number of trials have applied cold water stimulation alone or in combination with warm water, and reported improvements in cramps and itching when compared to no therapy. Better quality research is needed before a clear conclusion can be drawn.

C


There is preliminary evidence that daily showers with warm water followed by cold water, or cold water alone, may reduce the duration and frequency of common cold symptoms. Additional research is needed in this area before a clear conclusion can be drawn.

C


There is insufficient research in this area to make a recommendation.

C


Studies report that hydrotherapy may improve blood flow to the legs, and increase the pain-free walking distance of people with claudication due to peripheral vascular disease. Additional research is needed in this area before a clear conclusion can be drawn.

C


There is preliminary research of the effects of giving birth in water on labor pain, duration of labor, perineal damage to the mother, and birth complications. Further studies of effectiveness and safety are necessary before a conclusion can be drawn.

C


There is insufficient research in this area to make a recommendation. PID is a potentially serious medical condition that should be evaluated by a qualified, licensed healthcare provider.

C


Hydrotherapy has been used in patients with pressure ulcers, and preliminary research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in this area before a firm conclusion can be drawn. There is a risk of infection from contaminated water if sanitary conditions are not maintained.

C


There is insufficient research in this area to make a recommendation.

C


There is insufficient research in this area to make a recommendation.

C


Preliminary research reports improved symptoms and blood flow in patients with varicose veins undergoing hydrotherapy with intermittent cold and hot water hydrotherapy. Additional research is needed in this area before a clear conclusion can be drawn.

C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Acute tubular necrosis, allergies, angina pectoris, animal bites, anxiety, ascites, asthma, attention deficit hyperactivity disorder, back muscle strengthening, bacterial infections, balance disorders, blood clot prevention, blood detoxification, blood flow enhancement, body tone improvement, bowel function improvement, bronchitis, cancer, candidiasis, chronic pain, colitis, constipation, contusions, cough, Crohn's disease, cystitis, dental surgery adjunct, depression, digestion disorders, eczema, energy level enhancement, fibromyalgia, gallbladder disorders, gastric acid reduction, fatigue, fever reduction, food poisoning, fractures, glomerulonephritis, headache, heart disease, high blood pressure, high cholesterol, hormonal disorders, Huntington's disease, immune system stimulation, inflammation, influenza, insect bites, intestinal motility disorders, kidney infection (pyelonephritis), kidney stones, laryngitis, liver disorders, low blood pressure, lung diseases, lymphatic disorders, menstrual cramps, mucositis, mucus production enhancement, multiple sclerosis (MS), muscle atrophy, musculoskeletal injuries, neurologic disorders, otitis media (ear infection), paralysis, parasitic infections, peptic ulcer disease, peripheral edema (leg swelling from fluid accumulation), peritonitis (abdominal wall irritation), polio, pleurisy (inflammation of the pleural lining around the lung), post-operative recovery, pregnancy preparation, premenstrual syndrome (PMS), prostatitis, psychiatric disorders, rash, relaxation, sciatica, scleroderma, sepsis, sinus pain, sleep enhancement, soft tissue injuries, sore muscles, sore throat, sprains, stiff muscles, tinnitus, tired eyes, toothache, trigeminal neuralgia, tuberculosis, urinary tract infection, vaginitis, viral infections, vocal cord disorders, well-being.

Safety

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

  • The safety of various hydrotherapy techniques is not well studied.
  • Sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy should be avoided, particularly in patients with heart disease, lung disease, or during pregnancy. Warm temperature therapies can cause dehydration or low blood sodium levels, and adequate hydration and electrolyte intake should be maintained. Cold temperatures may worsen symptoms in patients with Raynaud's disease, chilblains, acrocyanosis, or erythrocyanosis.
  • The temperature of water should always be carefully monitored, particularly when treating patients with impaired temperature sensitivity, such as neuropathy. High temperatures or hydrotherapy involving electrical currents should be avoided in patients with implanted medical devices such as pacemakers, defibrillators, or hepatic (liver) infusion pumps.
  • Skin irritation (dermatitis) may be caused by contact with contaminants or additives in water (such as essential oils or chlorine). Skin infections may occur if water is not sanitary, particularly in patients with open wounds. There are several reported cases of dermatitis and bacterial skin infections (such as with Pseudomonas aeruginosa or Staphylococcus aureus) associated with hot tub or whirlpool use.
  • Vigorous use of water jets should be avoided in patients with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy.
  • Although water births are used popularly, safety has not been well studied. The fetal effects of prolonged labor in high or low temperature waters are not known.
  • Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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