Hydrotherapy

Hydrotherapy techniques applied to a patient are a form of stress to the cells that influences their metabolic function, regulates their environment, and provides an opportunity for the body’s natural healing processes to take place.

From: Textbook of Natural Medicine (Fifth Edition), 2020

Chapters and Articles

Volume 1

Jamie Doughty BSc, ND, Venessa Wahler ND, in Textbook of Natural Medicine (Fifth Edition), 2020

A Brief History of Naturopathic Medicine Introduction

Hydrotherapy is a form of physical medicine using the therapeutic application of water in a variety of ways, both internally and externally, on the body. Topical applications of cold or hot water packs, compresses, baths, pools, steams, sweats, showers, enemas, and colonics are all forms of hydrotherapy. Profound, multisystem physiological effects result from the thermodynamic property of water and its effects on an organism’s circulation and capability to remove waste and eliminate. Hydrotherapy techniques applied to a patient are a form of stress to the cells that influences their metabolic function, regulates their environment, and provides an opportunity for the body’s natural healing processes to take place.

Hydrotherapy has been used by human civilizations for thousands of years and has grown to have literature demonstrating scientific evidence-based applications and uses worldwide today.

Naturopathic physicians are trained in harnessing the curative power of nature through hydrotherapy techniques to treat a myriad of chronic diseases by supporting the innate ability of the human body to heal. Naturopathic medicine follows the principle of “first do no harm,” which analyzes the risks versus benefits of any therapeutic intervention. Hydrotherapy is a simple nature cure—a gentle, effective, and curative modality for modern culture. In the words of Dr. Simon Baruch (1840–1921): “No remedy in the entire materia medica demands as clear judgment and as much knowledge of the patient’s condition as does the application of water.”

In North America there are seven different accredited naturopathic educational institutions that all teach and practice the therapeutic application of water through many lecture hours and much clinical experience.1 The working hypothesis of naturopathic hydrotherapy is that the state of being free from illness and injury is proportional to the normal flow of healthy blood, lymph, and qi.

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Hydrotherapy

David A. Soto-Quijano, Martin Grabois, in Pain Management (Second Edition), 2011

Conclusion

Hydrotherapy has been used in the management of pain since ancient times, and more recently its use has increased again. Reduction of pain and increase in function are accomplished by using the physiologic and biodynamic properties of water. This chapter presents a basic understanding of different techniques of hydrotherapy. In addition, the physical properties of water are reviewed, including buoyancy, hydrostatic pressure, viscosity, refraction, and specific heat.

The use of water has many physiologic effects. These effects are seen in the cardiopulmonary, circulatory, autonomic, and renal systems. Most appropriate to patients with pain are the physiologic and therapeutic effects seen in patients with musculoskeletal pain. The primary therapeutic effects of hydrotherapy are the promotion of muscle relaxation with decreased muscle spasm and the increased ease of joint motion. Additionally, decreased pain sensitivity, reduced gravitational forces, increased circulation, increased muscular strength, and improved balance can be helpful in the rehabilitation of patients with chronic pain.

Water-based exercises can be used for the treatment and rehabilitation of almost any musculoskeletal problem. For patients with pain who cannot exercise on land, water provides a positive medium in which to move and relax. The ease of movement allows the patient to achieve much more benefit than on land and provides the patient with confidence to aid rehabilitation because he or she has less fear of falling or of hurting the injured or painful sites. The different water-based exercise programs are prescribed, depending on the severity, body characteristics, overall health status, and needs of the patient. Aquatic exercise programs have been proposed for the treatment of knee and hip osteoarthritis, rehabilitation after joint replacement, low back pain, fibromyalgia, stroke, lymphedema, rotator cuff repair surgery, and rheumatoid arthritis. As with other therapeutic treatment techniques, more clinical studies are needed to validate efficacy.

Whirlpool and Hubbard tank baths are used for adjunctive treatment of degenerative arthritis and acute musculoskeletal injuries, as well as for cleansing and débridement of burns or skin ulcerations. Patients with musculoskeletal pain and spasm can benefit from the massage created by water turbulence, the therapeutic effect of water temperature, and the decreased stress on bones and joints that the aquatic environment provides. This technique also is useful for resolution of edema and swelling. Antibacterial solutions such as sodium hypochlorite or povidone-iodine may be added to the water when concerns about infection exist. Contrast baths produce neurologic desensitization by alternating heat and cold cyclic vasodilation and vasoconstriction. Contrast baths have been used for subacute or chronic traumatic and inflammatory conditions, impaired venous circulation, indolent ulcers, neuropathic pain, rheumatoid arthritis, chronic pain syndromes, and complex regional pain syndrome.

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Inflammatory arthritis

Anne O’Brien MPhil Grad Dip Phys MCSP, Catherine Backman PhD OT(C) FCAOT, in Rheumatology, 2010

Hydrotherapy

Hydrotherapy uses the properties of water, buoyancy, turbulence and drag during exercise to achieve an end functional goal. Hydrotherapy remains popular, despite efficacy having been challenged in some studies (Verhagen et al 1997, 2004). However, benefit has been demonstrated (Hall et al 1996) with patients reporting continued pain relief and reduced morning stiffness by diminishing muscle spasm. Some consider this an expensive resource (Epps et al 2005) not available to all. Consequently, therapists should be clear about their rationale for prescribing hydrotherapy as opposed to land-based exercise. However, it may be cost-effective if sufficient numbers utilise the resource throughout the day.

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Physical Medicine and Rehabilitation

Y.-F. Lin, ... C.-K. Cheng, in Comprehensive Biomedical Physics, 2014

10.20.2.4 Hydrotherapy

Hydrotherapy is the use of water to revitalize, maintain, and restore health. Hydrotherapy treatments include saunas, steam baths, foot baths, sitz baths, and the application of cold and hot water compresses. Father Sebastian Kneipp, a nineteenth century Bavarian monk, is said to be the father of hydrotherapy. Kneipp believed that disease could be cured by using water to eliminate waste from the body. Hydrotherapy is popular in Europe and Asia, where people ‘take the waters’ at hot springs and mineral springs. In North America, it is often recommended as self-care by naturopathic doctors.

There is a physiological basis to hydrotherapy. Cold is stimulating, and it causes superficial blood vessels to constrict, shunting the blood to internal organs. Hot water is relaxing, causes blood vessels to dilate, and removes wastes from body tissues. Alternating hot can cold water also improves elimination, decreases inflammation, and stimulates circulation.

Hydrotherapy involves the use of water for pain relief and treating illness.

Hydrotherapy, water therapy, is an important tool in physical therapy. It is used as a cleansing agent as well as a medium for delivery of heat and cold to the body, which has long been the basis for its application.

Hydrotherapy involves a range of methods and techniques, many of which use water as a medium to facilitate thermoregulatory reactions for therapeutic benefit. While the physiological mechanisms were initially poorly understood, the therapeutic benefits have long been recognized, even if the reason for the therapeutic benefit was in dispute. With improved knowledge of physiological mechanisms, practitioners wrote specifically of the use of hot and cold applications to produce ‘profound reflex effects,’ including vasodilation and vasoconstriction (Goldby and Scott, 1993; Higgins and Kaminski, 1998; Michalsen et al., 2003). These cause changes in blood flow and associated metabolic functions, via physiological mechanisms, including those of thermoregulation are these days fairly well understood and which underpin the contemporary use of hydrotherapy. By constricting or dilating arterioles in specific areas of the body, such as skeletal muscles, the skin, and the abdominal region, it is possible not only to regulate the blood pressure but also to alter the distribution of blood in various parts of the body (Driver et al., 2006; Giaquinto et al., 2007; Gordon and Lubitz, 2009; Shevchuk, 2008).

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Naturopathic hydrotherapy in the treatment of fibromyalgia

Eric Blake, in Fibromyalgia Syndrome, 2010

Sedative effects of hydrotherapy

Hydrotherapy can also be used to bring about a sedative effect. A sedative effect was classically referred to as a nerve sedative in the hydrotherapeutic literature. The principal hydrotherapy sedatives as classified by Abbott (1915) are as follows:

cold sitz bath

hot foot bath with cold to the head

alternate hot and cold foot bath

neutral or warm bath: 94–98°F (34.4–36.7°C)

neutral wet sheet pack

sponge baths (cool, tepid or warm)

warm or hot shower, spray, douche or affusion.

Pure sedative techniques are indicated in nervous disorders, mania, insomnia and spasticity.

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Peripheral Vascular Disease

Danna Park MD, FAAP, Melinda Ring MD, in Integrative Medicine (Second Edition), 2007

Hydrotherapy

Hydrotherapy, or balneotherapy, is an ancient therapy used for the treatment of disease and injury by many cultures, including those of ancient Rome, China, and Japan. It is now most often employed by naturopaths and in European therapeutic spas. Naturopaths believe that, beyond the vasodilatory effects, hydrotherapy functions by affecting the quality of the blood through detoxification. The technique often recommended involves alternating immersion in hot and cold containers of water. In some cases minerals are added to the baths.98 Limited evidence, primarily from German studies in the 1950s, suggests that hydrotherapy may be a helpful adjuvant therapy.

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Unique Circumstances and Adjunct Therapies

Sandy Fritz MS, NCTMB, ... Glenn M. Hymel EdD, LMT, in Clinical Massage in the Healthcare Setting, 2008

HYDROTHERAPY

Hydrotherapy is a distinct form of therapy that combines well with massage. Water is a near-perfect natural body balancer and is necessary for life. It accounts for the largest percentage of our body weight.

The effects of water are primarily reflexive and focus on the autonomic nervous system. The addition of heat energy or the dissipation of heat energy from tissues can be classified as a mechanical effect. In general, cold stimulates sympathetic responses, and warmth activates parasympathetic responses. Short- and long-term applications of hot or cold differ in effect. For the most part, short cold applications stimulate and cause vasoconstriction, with a secondary effect of increased circulation as blood is channeled to the area to warm it. Long cold applications depress and decrease circulation. Short applications of heat cause vasodilation of vessels and depress and deplete tone, whereas long heat applications result in a combined depressant and stimulant reaction.

Different water pressures can exert a powerful mechanical effect on the nerves and blood supply of the skin. Techniques include a friction rub with a sponge or wet mitt and directing pressurized streams of hot and cold water at various parts of the body (Box 12-1).

Diffusion is a principle of hydrotherapy by which water moves across a permeable or semipermeable membrane from a low mineral salt concentration to a high concentration to equalize the solution's consistency. If the salt content of the water used for hydrotherapy is lower than that of the body fluids, water moves from the outside of the body to the inside through the semipermeable superficial tissue of the skin and superficial fascia. If the salt content of the water external to the skin is higher (e.g., as in mineral salt baths), water from the body moves into the external soak water. This reduces surface edema.

In the medical and physical therapy settings, the physician assistant, medical technician, or physical therapist applies hydrotherapy. The massage therapist must make sure that massage techniques do not interfere with the outcomes of these treatments. Primarily, do not massage an area that has been iced. Let the body restore circulation to the area to warm it. Hot and cold contrast hydrotherapy is effective at supporting fluid movement. Epsom salts and salves can help manage surface edema.

Cold is most effective for just about everything, and the application of ice is a component of acute care for many injuries (i.e., protection, rest, ice, compression, and elevation [PRICE]). When in doubt, put ice on it. Real ice is safer than chemical ice packs. Immersing an area in ice water is extremely effective, especially for sprains, strains, and similar injuries. Heat is more effective for palliative care and as a surface muscle relaxer.

If neither illness nor injury is a factor, a general rule can be: ice joints and heat muscles. Warm applications (e.g., rice or seed bags that can be heated in the microwave) are pleasant during a massage, especially on the feet. You can easily make such a bag by filling tube socks (I like hunting socks) with rice and tying them off. I put one sock inside another and tie each one so that the outer sock can be removed and laundered. Warm the rice bag in the microwave for 1 to 3 minutes.

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Physical Agent Modalities

Chueh-Hung Wu, in Braddom's Rehabilitation Care: A Clinical Handbook, 2018

Hydrotherapy

Hydrotherapy treats the patient through the medium of water. Water can provide warmth and coldness, moisten the soft tissues, and support the tissues. In addition to the thermal benefits of reducing pain, edema, and muscle spasm, a quick jet stream or stroking motion during whirlpool therapy has a local massage effect, which might cause further muscle relaxation and increase local circulation. When using a whirlpool, the patient can move the treated part easily in the whirlpool, which produces the additional benefit of exercise. A warm whirlpool is an excellent treatment for rheumatoid arthritis and osteoarthritis as it increases systemic blood flow and mobilization of the affected body part without exerting too much pressure on the joints.

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Medical liberty and vaccination

Ian R. Tizard, in A History of Vaccines and their Opponents, 2023

Hydropathy

Hydrotherapy makes use of the properties of water such as temperature, dissolved salts, or pressure, to stimulate blood circulation and so treat certain medical conditions. It can be applied in many forms from cold showers to hot baths. It has a long history beginning in ancient Egypt, Rome, and Greece. Victor Preissnitz (1799–851), the founder of modern hydrotherapy, believed that smallpox should be encouraged since “it relieves the system of humors that ought to be carried out of it and is a healthy process.” (This reflected the humoral concept that smallpox developed within the body and the clinical disease resulted when the smallpox “toxins” tried to escape from the body through the skin.) Preissnitz was a very successful physician, and his ideas were widely adopted, especially in the United States. One American doctor who promoted hydrotherapy was Christian C. Schiefferdecker. He was a major opponent of vaccination in the 1850s and published a book entitled Dr. CGG Nittinger's Evils of Vaccination in 1856. Schiefferdecker claimed that vaccination was “nonsense before reason” and “the greatest crime that has been committed in this last century” (Kaufman 1967).

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Principles of rehabilitation and considerations for sport, performance and fitness

Jane Simmonds, in Hypermobility, Fibromyalgia and Chronic Pain, 2010

Aquatic and hydrotherapy

Hydrotherapy and exercising in water is an effective and popular exercise medium for individuals with JHS. The combination of buoyancy, support and warmth makes it a very conducive arena for exercise. As well as being a medium for achieving physical goals, hydrotherapy has added psychological and social benefits (Skinner & Thomson 1993, Petajan 1996). The reduction in sympathetic activity that occurs as a result of buoyancy may alter tone, diminish pain and spasm and achieve relaxation. Sensory stimulus provided by turbulence can increase body awareness (Mano et al 1985, Hurley & Turner 1991, Fuller 1998). The three-dimensional resistive environment, combined with the viscosity of the water, aids kinaesthetic sense and improves the synchronization of motor unit contractions through the whole range of joint movement (Fuller 1998).

Bad Ragaz techniques as described by Davis & Harrison (1988), rhythmic stabilizations, isometrics, slow walking and carefully controlled active exercises using open and closed chain movements are particularly helpful for developing core stability in the early and middle stages of rehabilitation. Exercises can be progressed using turbulence, webbed gloves and weights to increase resistance. Core stability, proprioception and balance can be further developed and progressed by reducing and/or modifying the base of support, for example, moving from arm exercises with a wide base of support to a narrow base (Fig. 13.3).

Once effective trunk and proximal stability have been achieved, deep water walking and running with the aid of a buoyancy vest can be used to improve co-ordination and cardiovascular fitness. This form of aerobic exercise training is particularly popular with injured athletes, those needing to lose weight, individuals with chronic low back pain and JHS sufferers, because they are often able to exercise for longer without exacerbation of symptoms. Water immersion has the added advantage of improving the circulation of blood to working muscles, which enhances oxygen supply and aids the removal of carbon dioxide and lactic acid (Fuller 1998). It is also a potent diuretic, natriuretic and kalluretic which may explain some of the perceived benefits (Grahame et al 1978).

Deep water running should not be undertaken in over-heated hydrotherapy pools because of the risk of hyperthermia and may be commenced with as little as 5 minutes. Speed and distance can then be gradually increased as tolerated, applying the principles of overload training as used for cardiovascular training.

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