Related Terms

• Aqua lymphatic therapy, aquatic physical therapy, balneopelotherapy, balneoradonokinesitherapy, balneotherapy, bath, climatotherapy, cold therapy, cold water cure, colonic hydrotherapy, colonic irrigation, constitutional hydrotherapy, crenotherapy, Dead Sea bath, douche, dry-air radon bath, external hydrotherapy, fomentation, footbath, home spa, hot springs, hot therapy, hot tub, hot tub therapy, ice water immersion, immersion bath, internal hydrotherapy, Jacuzzi®, jet spray, local hydrotherapy, motion-based treatment, mud bath, pack, poultice, purifying bath, radon and iodine-bromine baths, radon bath, salt bath, saltwater baths, sauna, sauna bathing, shower, siliceous baths, sitz bath, soaked towel, spa treatment, specialized bathing systems, Stanger bath therapy, sulfide mud, temperature-based treatment, therapeutic bath in mineral water, thermal spring water, thermal therapy, Turkish bath, warm saltwater immersion, warm sulfur water immersion, warm tap water immersion, water bath, water birth, water immersion, water mineral bath, Watsu®, whirlpool, whirlpool bath.

• Note: This review does not include in-depth 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 or "enriched" water, coffee infusions, aquatic yoga, aquatic massage (including Watsu®), or aromatherapy or 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, such as colonic irrigation, enemas, nasal irrigation, physical therapy in pools, steam inhalation, humidifiers, drinking of mineral water or "enriched" water, coffee infusions, aquatic yoga, aquatic massage (including Watsu®), or aromatherapy or baths with added essential oils, however, they are not discussed in-depth in this review.

• 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 so hydrotherapy was included as a component of naturopathic medicine. In the present day, a wide variety of water-related therapies are used, some of which are described below.

• 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 Chinese form of bodywork conducted in pools.

• Coffee infusions: The use of coffee infusions was developed by Dr. Max Gerson. It is thought to stimulate intestinal contractions and is used in cases of indigestible food and nausea.

• Cold 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.

• Cold footbath: Cold footbaths involve placing the feet in a bath filled calf-deep with cold water. "Walking in water" involves stepping on a nonslip mat placed under water.

• 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.

• Cold water therapy (60 degrees Fahrenheit): Cold water therapy is used to stimulate blood flow in the skin and underlying muscles.

• Colonic hydrotherapy: Colonic hydrotherapy uses water as a vehicle to eliminate toxins and wastes in the colon, which are either immobilized in pockets or glued to its sides. Colonic hydrotherapy frees the intestinal tract of organic wastes. During colonic irrigation, a therapist inserts a plastic tube into the person's rectum and pumps water or herbal solutions until the colon is full (called an enema). Once the colon is full, the therapist massages the abdomen area and then draws the fluid out. The procedure is repeated for up to an hour. Body-temperature water is used. Some experts in the field claim this treatment is unnecessary and possibly harmful.

• Constitutional hydrotherapy: Constitutional hydrotherapy is hydrotherapy used on the whole person, usually by being wrapped in sheets and blankets of varying temperatures. Constitutional hydrotherapy is thought to reestablish normal brain function.

• 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 and high salt content in the water, to sun exposure, or to a combination of factors.

• Douches: Douches may be carried out with a watering can or hose. Treatments may be applied to any area of the body, with the intention to relieve tension or pain, or to affect blood flow.

• Hot fomentation: Hot fomentation involves application of warm liquid or moist heat to the surface of the body. Practitioners believe that this enhances the body's ability to fight cancer cells, viruses, and bacteria. This therapy is often used to relieve fever, because it raises the body temperature to 101-103 degrees Fahrenheit, which is suggested to reestablish the natural fever cycle, allowing the body to heal itself.

• Hot water therapy: Hot water therapy (around 100 degrees Fahrenheit) is used to relax muscles and cause sweating. It is commonly used for arthritis, rheumatism, poor circulation, and sore muscles.

• Internal hydrotherapy: Internal hydrotherapy consists of colonic irrigations and enemas. It also includes steam baths or inhalation of steam to relieve respiratory congestion, and drinking mineral water to restore electrolyte balance or cleanse the system.

• Local hydrotherapy: Local hydrotherapy is hydrotherapy used on one part of the body.

• Packs: Cold or warm packs are applied to treat certain muscular, joint, or psychiatric conditions.

• Poultices: Poultices are used for health maintenance and treatment of disease.

• Purifying baths: Purifying baths include bathing in solutions of chlorine bleach, sea salt, lemon juice, turmeric, Epsom salts, baking soda, or other substances in order to purify the body of radiation, toxins, or heavy metal deposits.

• Rising-temperature arm bath: In the rising-temperature arm bath, arms are immersed in a bath with water at body temperature. Hot water is gradually added until the temperature reaches 103-104 degrees Fahrenheit. The whole process lasts for 10-15 minutes and may be done daily. Caution is warranted so as not to cause burns.

• Rising-temperature footbath, warm footbath: In these baths, feet are immersed in water at body temperature. Hot water is gradually added until the temperature reaches 103-104 degrees Fahrenheit. The process lasts for 10-15 minutes and may be done daily. Caution is warranted so as 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. Caution is warranted so as not to cause burns. The bather may then be wrapped in warm dressings.

• Shower: Hot, cold, or alternating-temperature sprays are commonly used.

• 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 spasms, body aches, sprains, hemorrhoids, pruritus (itching), inflammation, rashes, and anxiety; for wound care and hygiene; and for relaxation. For various ailments, different temperatures may be used, and minerals or medications may be added to the water.

• Spa/hot tub/whirlpool/motion-based hydrotherapy: These therapies are sometimes used in people with wounds, chronic musculoskeletal pain, or inflammation. Awareness of the risk of introducing infections into wounds and keeping wounds clean is important.

• Steam bath/sauna: Heat may be used to cause sweating, and this technique is 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).

• Stanger bath therapy: Stanger bath therapy consists of application of a current through metal electrodes placed in a special water tub. It is most often used in the relief of pain.

• Water birth: The potential benefits of giving birth in water have been explored. Water births may be as safe as vaginal births if they are conducted by experienced professionals with low-risk women.

• 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.

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 physiological changes, although the correlation to long-term health benefits is not clear.

• Electrical stimulation is sometimes used and is suggested to stimulate muscles, digestion, and circulation (although caution is warranted due to the risks associated with using electricity while in water).

• Physical therapy in water makes use of buoyancy (the ability to float) to reduce working against gravity, as well as making use of 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.

Scientific Evidence

Tradition/Theory

The below uses are based on tradition or scientific theories. 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 health care professional.

• Acute tubular necrosis, alcohol withdrawal, allergies, angina pectoris, animal bites, antibacterial, anxiety, ascites, attention deficit disorder, back muscle strengthening, bacterial infections, balance disorders, bladder infections, blood clot prevention, blood flow enhancement, body tone improvement, bowel function improvement, bronchitis, cancer, candidiasis, chronic pain, complex regional pain syndrome, constipation, contusions, cough, cramps, Crohn's disease, cystitis, degenerative and inflamed joints, dental surgery adjunct, depression, detoxification (blood), detoxification from alcohol or toxins, digestive disorders, distended abdomen, drug withdrawal, eczema (anal), edema, energy level enhancement, fatigue, flu, food poisoning, fractures, gallbladder disorders, gastric acid reduction, gastrointestinal motility, glomerulonephritis, headache, hepatomegaly, high cholesterol, hormone related problems, Huntington's disease, immune stimulation, improved blood circulation, inflammatory bowel disease, influenza, irritable bowel syndrome, kidney infections, kidney stones, laryngitis, low blood pressure, lung disease, lymphatic disorders, lymphedema, menstrual cramps, mental disorders, migraine, mucositis, multiple sclerosis, muscle atrophy, musculoskeletal injuries, nasopharyngeal catarrh, neurologic disorders, paralysis, parasitic infections, peptic ulcer disease, peripheral artery disease, peritonitis, pleurisy, pneumonia, postoperative recovery, post-polio pain, pregnancy preparation, pregnancy problems, premenstrual syndrome, problems with blood sugar metabolism, prostate enlargement, prostatitis, psychiatric disorders, rectal complaints, rehabilitation, relaxation, respiratory disorders (vocal cord disorders), respiratory tract infection (Legionnaires' disease), sciatica, scleroderma, seizure disorders, septicemia (acute), sinus pain, Sjögren's syndrome, soft tissue injuries, sore throat, spine problems, sports injuries, sprains, stiffness, stress, sweating (excessive), swelling, syphilis, thrombophlebitis, tinnitus, tired eyes, toothache, trigeminal neuralgia, tuberculosis, ulcerative colitis, urinary tract infections, viral infections.

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 has not been well studied.

• Use cautiously in young children, the elderly, or people with weakened immune systems or implanted medical devices, such as pacemakers, defibrillators, or liver infusion pumps.

• Use aquatic physical therapy cautiously in people with inner ear problems, spine disorders, multiple sclerosis (in warm water), orthopedic injuries, unstable joints, or any other conditions that make breathing difficult.

• Use Watsu® cautiously in people with head injuries and in people who dislike intimate contact.

• Use forms of hydrotherapy that expose the patient to cold temperatures cautiously in people with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, irritable bladder, urinary tract infections, diabetes, or vascular occlusion (blood vessel blockage).

• Vigorous use of water jets should be used cautiously in people with fractures, known blood clots, bleeding disorders, or severe osteoporosis.

• Use cautiously in people taking sedatives, diuretics, drugs that affect the immune system, or drugs that affect blood sugar.

• Use cautiously in people with high or low blood pressure or in those taking drugs that affect blood pressure.

• Use cautiously in people with hemorrhoids, polycythemia rubra vera (a bone marrow disease), colitis (inflamed colon), open burns or sores, urinary tract infections, irritable bladder, sciatica (pain or weakness in the leg), enlargement of the thyroid, raised intraocular (eye) pressure, or during menstruation.

• The temperature of water should always be carefully monitored, particularly when treating people with impaired temperature sensitivity, such as that caused by neuropathy.

• People using psychotropic drugs or alcohol should avoid use of saunas and hot tubs.

• Hot tub use should be avoided in people with seizures and during early pregnancy.

• Sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy should be avoided, particularly in people with heart disease, lung disease, varicose veins, lymphostasis, edema, infections, or during pregnancy. Warm-temperature therapies can cause dehydration or low blood sodium levels, and adequate hydration and electrolyte intake should be maintained.

• People with a known allergy or hypersensitivity to water should avoid use of hydrotherapy.

• Dermatitis (skin irritation) 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 people 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.

• 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. People with known illnesses should consult their physicians before starting hydrotherapy.

Author Information

• 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).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. Acikel C, Ulkur E, Guler MM. Prolonged intermittent hydrotherapy and early tangential excision in the treatment of an extensive strong alkali burn. Burns 2001;27(3):293-296. View Abstract

2. Aderhold KJ, Perry L. Jet hydrotherapy for labor and postpartum pain relief. MCN Am J Matern Child Nurs 1991;16(2):97-99. View Abstract

3. Ammer K, Melnizky P. [Medicinal baths for treatment of generalized fibromyalgia]. Forsch Komplementarmed 1999;6(2):80-85. View Abstract

4. Beamon S, Falkenbach A, Jobst K. Hydrotherapy for asthma. Cochrane Database Syst Rev 2001;(2):CD001741. View Abstract

5. Brock FE. [Additive effects of vein-typical hydrotherapy according to Kneipp and topic treatment with arnica-containing gel in patients with chronic venous insufficiency-synergism of naturopathic therapies]. Erfahrungsheilkunde 2001;6:357-363.

6. Constant F, Guillemin F, Collin JF, et al. Use of spa therapy to improve the quality of life of chronic low back pain patients. Med Care 1998;36(9):1309-1314. View Abstract

7. Danesino V. [Balneotherapy with arsenical-ferruginous water in chronic cervico- vaginitis. A case-control study]. Minerva Ginecol 2001;53(1):63-69. View Abstract

8. Ekmekcioglu C, Strauss-Blasche G, Feyertag J, et al. The effect of balneotherapy on ambulatory blood pressure. Altern Ther Health Med 2000;6(6):46-53. View Abstract

9. Elkayam O, Ophir J, Brener S, et al. Immediate and delayed effects of treatment at the Dead Sea in patients with psoriatic arthritis. Rheumatol Int 2000;19(3):77-82. View Abstract

10. Ernst E, Pittler MH. [How effective is spa treatment? A systematic review of randomized studies]. Dtsch Med Wochenschr 1998;123(10):273-277. View Abstract

11. Franke A, Reiner L, Pratzel HG, et al. Long-term efficacy of radon spa therapy in rheumatoid arthritis--a randomized, sham-controlled study and follow-up. Rheumatology (Oxford) 2000;39(8):894-902. View Abstract

12. Kurabayashi H, Machida I, Kubota K. Improvement in ejection fraction by hydrotherapy as rehabilitation in patients with chronic pulmonary emphysema. Physiother Res Int 1998;3(4):284-291. View Abstract

13. Mcllveen B, Robertson VJ. A randomised controlled study of the outcome of hydrotherapy for subjects with low back or back and leg pain. Physiotherapy 1998;84(1):17-26.

14. Moore JE, Heaney N, Millar BC, et al. Incidence of Pseudomonas aeruginosa in recreational and hydrotherapy pools. Commun Dis Public Health 2002;5(1):23-6.

15. Robertson PA, Huang LJ, Croughan-Minihane MS, et al. Is there an association between water baths during labor and the development of chorioamnionitis or endometritis? Am J Obstet Gynecol 1998;178(6):1215-1221. View Abstract