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Hydrotherapy

Hydrotherapy

Definition

Hydrotherapy, or water therapy, is the use of water (hot, cold, steam, or ice) to relieve discomfort and promote physical well-being.

Origins

The therapeutic use of water has a long history. Ruins of an ancient bath were unearthed in Pakistan and date as far back as 4500 b.c. Bathhouses were an essential part of ancient Roman culture. The use of steam, baths, and aromatic massage to promote well being is documented since the first century. Roman physicians Galen and Celsus wrote of treating patients with warm and cold baths in order to prevent disease.

By the seventeenth and eighteenth centuries, bath-houses were extremely popular with the public throughout Europe. Public bathhouses made their first American appearance in the mid 1700s.

In the early nineteenth century, Sebastien Kneipp, a Bavarian priest and proponent of water healing, began treating his parishioners with cold water applications after he himself was cured of tuberculosis through the same methods. Kneipp wrote extensively on the subject, and opened a series of hydrotherapy clinics known as the Kneipp clinics, which are still in operation today. Around the same time in Austria, Vincenz Priessnitz was treating patients with baths, packs, and showers of cold spring water. Priessnitz also opened a spa that treated over 1,500 patients in its first year of operation, and became a model for physicians and other specialists to learn the techniques of hydrotherapy.

Benefits

Hydrotherapy can soothe sore or inflamed muscles and joints, rehabilitate injured limbs, lower fevers, soothe headaches, promote relaxation , treat burns and frostbite, ease labor pains, and clear up skin problems. The temperature of water used affects the therapeutic properties of the treatment. Hot water is chosen for its relaxing properties. It is also thought to stimulate the immune system. Tepid water can also be used for stress reduction, and may be particularly relaxing in hot weather. Cold water is selected to reduce inflammation. Alternating hot and cold water can stimulate the circulatory system and improve the immune system. Adding herbs and essential oils to water can enhance its therapeutic value. Steam is frequently used as a carrier for essential oils that are inhaled to treat respiratory problems.

Since the late 1990s, hydrotherapy has been used in critical care units to treat a variety of serious conditions, including such disorders of the nervous system as Guil-lain-Barré syndrome.

VINZENZ PRIESSNITZ 17991851


Hydrotherapy inventor Vinzenz Priessnitz was the son of a Silesian farmer from a remote Austrian territory in the Jeseniky Mountains. From the age of 12, Priessnitz dutifully provided for his blind father, his elderly mother, and his sister. His formal education was sporadic at best. However, Priessnitz possessed a level head and a high degree of intelligence along with a keen and active mind. As he matured he became extremely aware of his surroundings in nature.

At age 16, Priessnitz fell from a horse and was seriously hoofed by the animal. He received the morbid prognosis that he might be crippled at best, or might die at worst. He set to treating his own chest wound with cold packs, in emulation of a doe that he had once observed bathing a wound in a cool mountain stream. The hydrotherapy regimen proved highly effective and drew considerable attention to his small hometown of Gräfenberg. In 1822 he rebuilt the family home, renovating its wooden frame into a solid brick spa structure. The spa, known as the castle, housed as many as 1,500 guests each year by 1839. Among the guests were medical professionals who were intent upon exposing the therapy as a sham.

Detractors notwithstanding, word of the simple and effective treatment spread to Vienna, where Priessnitz traveled on occasion to provide counsel at the emperor's court. Priessnitz, for his remarkable discovery, received the Austrian Gold Civil Merit Medal First Class, the highest civilian honor of the Austrian government.

Priessnitz died on November 28, 1851. He was survived by a wife, Zofie Priessnitz, and a young son, Vinzenz Pavel. Joseph Schindler took over the operation of the spa at Gräfenberg following the death of its founder.

Gloria Cooksey

Description

Water can be used therapeutically in a number of ways. Common forms of hydrotherapy include:

  • Whirlpools, Jacuzzis, and hot tubs. These soaking tubs use jet streams to massage the body. They are frequently used by physical therapists to help injured patients regain muscle strength and to soothe joint and muscle pain . Some midwives and obstetricians also approve of the use of hot tubs to soothe the pain of labor.
  • Pools and Hubbard tanks. Physical therapists and rehabilitation specialists may prescribe underwater pool exercises as a low-impact method of rebuilding muscle strength in injured patients. The buoyancy experienced during pool immersion also helps ease pain in such conditions as arthritis. The Arthritis Foundation has put together a set of Aquatic Program exercises that have been shown to improve isometric strength and range of motion in osteoarthritis patients.
  • Baths. Tepid baths are prescribed to reduce a fever . Baths are also one of the oldest forms of relaxation therapy. Aromatherapists often recommend adding essential oils of lavender (Lavandula angustifolia ) to a warm to hot bath to promote relaxation and stress reduction. Adding Epsom salts (magnesium sulfate) or Dead Sea salts to a bath can also promote relaxation and soothe rheumatism and arthritis.
  • Showers. Showers are often prescribed to stimulate the circulation. Water jets from a shower head are also used to massage sore muscles. In addition, showering hydrotherapy has been shown to be preferable to immersion hydrotherapy for treating burn patients.
  • Moist compresses. Cold, moist compresses can reduce swelling and inflammation of an injury. They can also be used to cool a fever and treat a headache . Hot or warm compresses are useful for soothing muscle aches and treating abscesses.
  • Steam treatments and saunas. Steam rooms and saunas are recommended to open the skin pores and cleanse the body of toxins. Steam inhalation is prescribed to treat respiratory infections . Adding botanicals to the steam bath can increase its therapeutic value.
  • Internal hydrotherapy. Colonic irrigation is an enema that is designed to cleanse the entire bowel. Proponents of the therapy say it can cure a number of digestive problems. Douching, another form of internal hydrotherapy, directs a stream of water into the vagina for cleansing purposes. The water may or may not contain medications or other substances. Douches can be self-administered with kits available at most drug stores.

Preparations

Because of the expense of the equipment and the expertise required to administer effective treatment, hydrotherapy with pools, whirlpools, Hubbard tanks, and saunas is best taken in a professional healthcare facility, and/or under the supervision of a healthcare professional. However, baths, steam inhalation treatments, and compresses can be easily administered at home.

Bath preparations

Warm to hot bath water should be used for relaxation purposes, and a tepid bath is recommended for reducing fevers. Herbs can greatly enhance the therapeutic value of the bath for a variety of illnesses and minor discomforts.

Herbs for the bath can be added to the bath in two waysas essential oils or whole herbs and flowers. Whole herbs and flowers can be placed in a muslin or cheesecloth bag that is tied at the top to make an herbal bath bag. The herbal bath bag is then soaked in the warm tub, and can remain there throughout the bath. When using essential oils, add five to 10 drops of oil to a full tub. Oils can be combined to enhance their therapeutic value. Marjoram (Origanum marjorana ) is good for relieving sore muscles; juniper (Juniperus communis ) is recommended as a detoxifying agent for the treatment of arthritis; lavender, ylang ylang (Conanga odorata ), and chamomile (Chamaemelum nobilis ) are recommended for stress relief; cypress (Cupressus sempervirens ), yarrow (Achillea millefolium ), geranium (Pelargonium graveolens ), clary sage (Salvia sclaria ), and myrtle (Myrtus communis ) can promote healing of hemorrhoids ; and spike lavender and juniper (Juniperus communis ) are recommended for rheumatism.

To prepare salts for the bath, add one or two handfuls of Epsom salts or Dead Sea salts to boiling water until they are dissolved, and then add them to the tub.

A sitz bath, or hip bath, can also be taken at home to treat hemorrhoids and promote healing of an episiotomy. There is an special apparatus available for taking a seated sitz bath, but it can also be taken in a regular tub partially filled with warm water.

Steam inhalation

Steam inhalation treatments can be easily administered with a bowl of steaming water and a large towel. For colds and other conditions with nasal congestion, aromatherapists recommend adding five drops of an essential oil that has decongestant properties, such as peppermint (Mentha piperita ) and eucalyptus blue gum (Eucalyptus globulus ). Oils that act as expectorants, such as myrtle (Myrtus communis ) or rosemary (Rosmarinus officinalis ), can also be used. After the oil is added, the individual should lean over the bowl of water and place the towel over the head to trap the steam. After approximately three minutes of inhaling the steam with eyes closed, the towel can be removed.

Other herbs and essential oils that can be beneficial in steam inhalation include:

  • Tea tree oil (Melaleuca alternifolia ) for bronchitis and sinus infections.
  • Sandalwood (Santalum album ), virginian cedarwood (Juniperus virginiana ), and frankincense (Boswellia carteri ) for sore throat.
  • Lavender (Lavandula angustifolia ) and thyme (Thymus vulgaris ) for cough.

Compresses

A cold compress is prepared by soaking a cloth or cotton pad in cold water and then applying it to the area of injury or distress. When the cloth reaches room temperature, it should be resoaked and reapplied. Applying gentle pressure to the compress with the hand may be useful. Cold compresses are generally used to reduce swelling, minimize bruising, and to treat headaches and sprains.

Warm or hot compresses are used to treat abscesses and muscle aches. A warm compress is prepared in the same manner as a cold compress, except steaming water is used to wet the cloth instead of cold water. Warm compresses should be refreshed and reapplied after they cool to room temperature.

Essential oils may be added to moist compresses to increase the therapeutic value of the treatment. Peppermint, a cooling oil, is especially effective when added to cold compresses. To add oils to compresses, place five drops of the oil into the bowl of water the compress is to be soaked in. Never apply essential oils directly to a cloth, as they may irritate the skin in undiluted form.

Precautions

Individuals with paralysis, frostbite, or other conditions that impair the nerve endings and cause reduced sensation should take hydrotherapy treatments only under the guidance of a trained hydrotherapist, physical therapist, or other appropriate healthcare professional. Because these individuals cannot accurately sense temperature changes in the water, they run the risk of being seriously burned without proper supervision. Diabetics and people with hypertension should also consult their healthcare professional before using hot tubs or other heat hydrotherapies.

Hot tubs, Jacuzzis, and pools can become breeding grounds for bacteria and other infectious organisms if they are not cleaned regularly, maintained properly, kept at the appropriate temperatures, and treated with the proper chemicals. Individuals should check with their healthcare provider to ensure that the hydrotherapy equipment they are using is sanitary. Those who are using hot tubs and other hydrotherapy equipment in their homes should follow the directions for use and maintenance provided by the original equipment manufacturer.

Certain essential oils should not be used by pregnant or nursing women or by people with specific illnesses or physical conditions. Individuals suffering from any chronic or acute health condition should inform their healthcare provider before starting treatment with any essential oil.

Such essential oils as cinnamon leaf, juniper, lemon, eucalyptus blue gum, peppermint, and thyme can be extremely irritating to the skin if applied in full concentration. Oils used in hydrotherapy should always be diluted in water before they are applied to the skin. Individuals should never apply essential oils directly to the skin unless directed to do so by a trained healthcare professional and/or aromatherapist.

Colonic irrigation should be performed only by a healthcare professional. Pregnant women should never douche, as the practice can introduce bacteria into the vagina and uterus. They should also avoid using hot tubs without the consent of their healthcare provider.

The vagina is self-cleansing, and douches have been known to upset the balance of vaginal pH and flora, promoting vaginitis and other infections. Some studies have linked excessive vaginal douching to increased incidence of pelvic inflammatory disease (PID).

Side effects

Most forms of hydrotherapy are well tolerated. There is a risk of allergic reaction (also known as contact dermatitis ) for some patients using essential oils and herbs in their bath water. These individuals may want to test for allergic sensitization to herbs by performing a skin patch test (i.e., rubbing a small amount of diluted herb on the inside of their elbow and observing the spot for redness and irritation). People who experience an allergic reaction to an essential oil should discontinue its use and contact their healthcare professional for further guidance.

The most serious possible side effect of hydrotherapy is overheating, which may occur when an individual spends too much time in a hot tub or Jacuzzi. However, when properly supervised, this is a minimal risk.

Research & general acceptance

Hydrotherapy treatments are used by both allopathic and complementary medicine to treat a wide variety of discomforts and disorders. Not as well accepted are invasive hydrotherapy techniques, such as colonic irrigation, enemas, and douching. These internal cleansing techniques can actually harm an individual by upsetting the natural balance of the digestive tract and the vagina. Most conventional medical professionals agree that vaginal douches are not necessary to promote hygiene in most women, and can actually do more harm than good.

Training & certification

Hydrotherapy is practiced by a number of physical therapists, medical doctors (especially those specializing in rehabilitation), nurses, and naturopathic physicians. Medical doctors, physical therapists, and nurses are licensed throughout the United States. Naturopaths are licensed in a number of states. Aromatherapists, who frequently recommend water-based treatments with herbs and essential oils, are not licensed, although there are certification programs available for practitioners.

Resources

BOOKS

Chaitow, Leon. Hydrotherapy: Water Therapy for Health and Beauty. Boston: Element Books, 1999.

Lawless, Julia. The Complete Illustrated Guide to Aromatherapy. Boston: Element Books, 1997.

Pelletier, Dr. Kenneth R. The Best Alternative Medicine, Part I: Naturopathic Medicine. New York: Simon and Schuster, 2002.

PERIODICALS

Baird, Carol L. "First-Line Treatment for Osteoarthritis: Part 2: Nonpharmacologic Interventions and Evaluation." Orthopaedic Nursing 20 (November-December 2001): 1320.

Barker, K. L., H. Dawes, P. Hansford, and D. Shamley. "Perceived and Measured Levels of Exertion of Patients with Chronic Back Pain Exercising in a Hydrotherapy Pool." Archives of Physical Medicine and Rehabilitation 84 (September 2003): 13191323.

Cider, A., M. Schaufelberger, K. S. Sunnerhagen, and B. Andersson. "HydrotherapyA New Approach to Improve Function in the Older Patient with Chronic Heart Failure." European Journal of Heart Failure 5 (August 2003): 527535.

Johnson, Kate. "Hydrotherapy Greatly Eases Delivery Stress, Pain." OB GYN News 34 (November 1999): 27.

Keegan, L. "Therapies to Reduce Stress and Anxiety." Critical Care Nursing Clinics of North America 15 (September 2003): 321327.

Mayhall, C. G. "The Epidemiology of Burn Wound Infections: Then and Now." Clinical Infectious Diseases 37 (August 15, 2003): 543550.

Molter, N. C. "Creating a Healing Environment for Critical Care." Critical Care Nursing Clinics of North America 15 (September 2003): 295304.

Taylor, S. "The Ventilated Patient Undergoing Hydrotherapy: A Case Study." Australian Critical Care 16 (August 2003): 111115.

ORGANIZATIONS

American Association of Naturopathic Physicians. 8201 Greensboro Drive, Suite 300, McLean, Virginia 22102. (206) 298-0126. <http://naturopathic.org>.

Canadian Naturopathic Association/Association canadienne de naturopathie. 1255 Sheppard Avenue East at Leslie, North York, ON M2K 1E2. (800) 551-4381 or (416) 496-8633. <http://www.naturopathicassoc.ca>.

Paula Ford-Martin

Rebecca J. Frey, PhD

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Hydrotherapy

Hydrotherapy

Definition

Hydrotherapy, or water therapy, is the use of water (hot, cold, steam, or ice) to relieve discomfort and promote physical well-being.

Purpose

Hydrotherapy can soothe sore or inflamed muscles and joints, rehabilitate injured limbs, lower fevers, soothe headaches, promote relaxation, treat burns and frostbite, ease labor pains, and clear up skin problems. The temperature of water used affects the therapeutic properties of the treatment. Hot water is chosen for its relaxing properties. It is also thought to stimulate the immune system. Tepid water can also be used for stress reduction, and may be particularly relaxing in hot weather. Cold water is selected to reduce inflammation. Alternating hot and cold water can stimulate the circulatory system and improve the immune system. Adding herbs and essential oils to water can enhance its therapeutic value. Steam is frequently used as a carrier for essential oils that are inhaled to treat respiratory problems.

VINZENZ P RIESSNITZ(17991851)

Hydrotherapy inventor Vinzenz Priessnitz was the son of a Silesian farmer from a remote Austrian territory in the Jeseniky Mountains. From the age of 12, Priessnitz dutifully provided for his blind father, his elderly mother, and his sister. His formal education was sporadic at best. However, Priessnitz possessed a level head and a high degree of intelligence along with a keen and active mind. As he matured he became extremely aware of his surroundings in nature.

At age 16, Priessnitz fell from a horse and was seriously hoofed by the animal. He received the morbid prognosis that he might be crippled at best, or might die at worst. He set to treating his own chest wound with cold packs, in emulation of a doe that he had once observed bathing a wound in a cool mountain stream. The hydrotherapy regimen proved highly effective and drew considerable attention to his small hometown of Gräfenberg. In 1822 he rebuilt the family home, renovating its wooden frame into a solid brick spa structure. The spa, known as the castle, housed as many as 1,500 guests each year by 1939. Among the guests were medical professionals who were intent upon exposing the therapy as a sham.

Detractors notwithstanding, word of the simple and effective treatment spread to Vienna, where Priessnitz traveled on occasion to provide counsel at the emperor's court. Priessnitz, for his remarkable discovery, received the Austrian Gold Civil Merit Medal First Class, the highest civilian honor of the Austrian government.

Priessnitz died on November 28, 1851. He was survived by a wife, Zofie Priessnitz, and a young son, Vinzenz Pavel. Joseph Schindler took over the operation of the spa at Gräfenberg following the death of its founder.

Since the late 1990s, hydrotherapy has been used in critical care units to treat a variety of serious conditions, including such disorders of the nervous system as Guillain-Barré syndrome.

Description

Origins

The therapeutic use of water has a long history. Ruins of an ancient bath were unearthed in Pakistan and date as far back as 4500 b.c. Bathhouses were an essential part of ancient Roman culture. The use of steam, baths, and aromatic massage to promote well being is documented since the first century. Roman physicians Galen and Celsus wrote of treating patients with warm and cold baths in order to prevent disease.

By the seventeenth and eighteenth centuries, bathhouses were extremely popular with the public throughout Europe. Public bathhouses made their first American appearance in the mid 1700s.

In the early nineteenth century, Sebastien Kneipp, a Bavarian priest and proponent of water healing, began treating his parishioners with cold water applications after he himself was cured of tuberculosis through the same methods. Kneipp wrote extensively on the subject, and opened a series of hydrotherapy clinics known as the Kneipp clinics, which are still in operation today. Around the same time in Austria, Vincenz Priessnitz was treating patients with baths, packs, and showers of cold spring water. Priessnitz also opened a spa that treated over 1,500 patients in its first year of operation, and became a model for physicians and other specialists to learn the techniques of hydrotherapy.

Water can be used therapeutically in a number of ways. Common forms of hydrotherapy include:

  • Whirlpools, jacuzzis, and hot tubs. These soaking tubs use jet streams to massage the body. They are frequently used by physical therapists to help injured patients regain muscle strength and to soothe joint and muscle pain. Some midwives and obstetricians also approve of the use of hot tubs to soothe the pain of labor.
  • Pools and Hubbard tanks. Physical therapists and rehabilitation specialists may prescribe underwater pool exercises as a low-impact method of rebuilding muscle strength in injured patients. The buoyancy experienced during pool immersion also helps ease pain in conditions such as arthritis.
  • Baths. Tepid baths are prescribed to reduce a fever. Baths are also one of the oldest forms of relaxation therapy. Aromatherapists often recommend adding essential oils of lavender (Lavandula angustifolia ) to a warm to hot bath to promote relaxation and stress reduction. Adding Epsom salts (magnesium sulfate) or Dead Sea salts to a bath can also promote relaxation and soothe rheumatism and arthritis.
  • Showers. Showers are often prescribed to stimulate the circulation. Water jets from a shower head are also used to massage sore muscles. In addition, showering hydrotherapy has been shown to be preferable to immersion hydrotherapy for treating burn patients.
  • Moist compresses. Cold, moist compresses can reduce swelling and inflammation of an injury. They can also be used to cool a fever and treat a headache. Hot or warm compresses are useful for soothing muscle aches and treating abscesses.
  • Steam treatments and saunas. Steam rooms and saunas are recommended to open the skin pores and cleanse the body of toxins. Steam inhalation is prescribed to treat respiratory infections. Adding botanicals to the steam bath can increase its therapeutic value.
  • Internal hydrotherapy. Colonic irrigation is an enema that is designed to cleanse the entire bowel. Proponents of the therapy say it can cure a number of digestive problems. Douching, another form of internal hydrotherapy, directs a stream of water into the vagina for cleansing purposes. The water may or may not contain medications or other substances. Douches can be self-administered with kits available at most drug stores.

Preparations

Because of the expense of the equipment and the expertise required to administer effective treatment, hydrotherapy with pools, whirlpools, Hubbard tanks, and saunas is best taken in a professional healthcare facility, and/or under the supervision of a healthcare professional. However, baths, steam inhalation treatments, and compresses can be easily administered at home.

Bath preparations

Warm to hot bath water should be used for relaxation purposes, and a tepid bath is recommended for reducing fevers. Herbs can greatly enhance the therapeutic value of the bath for a variety of illnesses and minor discomforts.

Herbs for the bath can be added to the bath in two waysas essential oils or whole herbs and flowers. Whole herbs and flowers can be placed in a muslin or cheesecloth bag that is tied at the top to make an herbal bath bag. The herbal bath bag is then soaked in the warm tub, and can remain there throughout the bath. When using essential oils, add five to 10 drops of oil to a full tub. Oils can be combined to enhance their therapeutic value. Marjoram (Origanum marjorana )is good for relieving sore muscles; juniper (Juniperus communis ) is recommended as a detoxifying agent for the treatment of arthritis; lavender, ylang ylang (Conanga odorata ), and chamomile (Chamaemelum nobilis ) are recommended for stress relief; cypress (Cupressus sempervirens ), yarrow (Achillea millefolium ), geranium (Pelargonium graveolens ), clary sage (Savlia sclaria ), and myrtle (Myrtus communis ) can promote healing of hemorrhoids ; and spike lavender and juniper (Juniperus communis ) are recommended for rheumatism.

To prepare salts for the bath, add one or two handfuls of epsom salts or Dead Sea salts to boiling water until they are dissolved, and then add them to the tub.

A sitz bath, or hip bath, can also be taken at home to treat hemorrhoids and promote healing of an episiotomy. There is special apparatus available for taking a seated sitz bath, but it can also be taken in a regular tub partially filled with warm water.

Steam inhalation

Steam inhalation treatments can be easily administered with a bowl of steaming water and a large towel. For colds and other conditions with nasal congestion, aromatherapists recommend adding five drops of an essential oil that has decongestant properties, such as peppermint (Mentha piperita ) and eucalyptus blue gum (Eucalyptus globulus ). Oils that act as expectorants, such as myrtle (Myrtus communis ) or rosemary (Rosmarinus officinalis ), can also be used. After the oil is added, the individual should lean over the bowl of water and place the towel over head to trap the steam. After approximately three minutes of inhaling the steam, with eyes closed, the towel can be removed.

Other herbs and essential oils that can be beneficial in steam inhalation include:

  • tea tree oil (Melaleuca alternaifolia ) for bronchitis and sinus infections
  • sandalwood (Santalum album ), virginian cedarwood (Juniperus virginiana ), and frankincense (Boswellia carteri ) for sore throat
  • lavender (Lavandula angustifolia ) and thyme (Thymus vulgaris ) for cough

Compresses

A cold compress is prepared by soaking a cloth or cotton pad in cold water and then applying it to the area of injury or distress. When the cloth reaches room temperature, it should be resoaked and reapplied. Applying gentle pressure to the compress with the hand may be useful. Cold compresses are generally used to reduce swelling, minimize bruising, and to treat headaches and sprains.

Warm or hot compresses are used to treat abscesses and muscle aches. A warm compress is prepared in the same manner as a cold compress, except steaming water is used to wet the cloth instead of cold water. Warm compresses should be refreshed and reapplied after they cool to room temperature.

Essential oils may be added to moist compresses to increase the therapeutic value of the treatment. Peppermint, a cooling oil, is especially effective when added to cold compresses. To add oils to compresses, place five drops of the oil into the bowl of water the compress is to be soaked in. Never apply essential oils directly to a cloth, as they may irritate the skin in undiluted form.

Precautions

Individuals with paralysis, frostbite, or other conditions that impair the nerve endings and cause reduced sensation should only take hydrotherapy treatments under the guidance of a trained hydrotherapist, physical therapist, or other appropriate healthcare professional. Because these individuals cannot accurately sense temperature changes in the water, they run the risk of being seriously burned without proper supervision. Diabetics and people with hypertension should also consult their healthcare professional before using hot tubs or other heat hydrotherapies.

Hot tubs, jacuzzis, and pools can become breeding grounds for bacteria and other infectious organisms if they are not cleaned regularly, maintained properly, kept at the appropriate temperatures, and treated with the proper chemicals. Individuals should check with their healthcare provider to ensure that the hydrotherapy equipment they are using is sanitary. Those who are using hot tubs and other hydrotherapy equipment in their homes should follow the directions for use and maintenance provided by the original equipment manufacturer.

Certain essential oils should not be used by pregnant or nursing women or by people with specific illnesses or physical conditions. Individuals suffering from any chronic or acute health condition should inform their healthcare provider before starting treatment with any essential oil.

Essential oils such as cinnamon leaf, juniper, lemon, eucalyptus blue gum, peppermint, and thyme can be extremely irritating to the skin if applied in full concentration. Oils used in hydrotherapy should always be diluted in water before they are applied to the skin. Individuals should never apply essential oils directly to the skin unless directed to do so by a trained healthcare professional and/or aromatherapist.

Colonic irrigation should only be performed by a healthcare professional. Pregnant women should never douche, as the practice can introduce bacteria into the vagina and uterus. They should also avoid using hot tubs without the consent of their healthcare provider.

The vagina is self-cleansing, and douches have been known to upset the balance of vaginal pH and flora, promoting vaginitis and other infections. Some studies have linked excessive vaginal douching to increased incidence of pelvic inflammatory disease (PID).

Side effects

Most forms of hydrotherapy are well tolerated. There is a risk of allergic reaction (also known as contact dermatitis ) for some patients using essential oils and herbs in their bath water. These individuals may want to test for allergic sensitization to herbs by performing a skin patch test (i.e., rubbing a small amount of diluted herb on the inside of their elbow and observing the spot for redness and irritation). People who experience an allergic reaction to an essential oil should discontinue its use and contact their healthcare professional for further guidance.

The most serious possible side effect of hydrotherapy is overheating, which may occur when an individual spends too much time in a hot tub or jacuzzi. However, when properly supervised, this is a minimal risk.

Research and general acceptance

Hydrotherapy treatments are used by both allopathic and complementary medicine to treat a wide variety of discomforts and disorders. Not as well accepted are invasive hydrotherapy techniques, such as colonic irrigation, enemas, and douching. These internal cleansing techniques can actually harm an individual by upsetting the natural balance of the digestive tract and the vagina. Most conventional medical professionals agree that vaginal douches are not necessary to promote hygiene in most women, and can actually do more harm than good.

KEY TERMS

Contact dermatitis Skin irritation as a result of contact with a foreign substance.

Episiotomy An incision made in the perineum during labor to assist in delivery and to avoid abnormal tearing of the perineum.

Essential oil A volatile oil extracted from the leaves, fruit, flowers, roots, or other components of a plant and used in aromatherapy, perfumes, and foods and beverages.

Hubbard tank A large water tank or tub used for underwater exercises.

Resources

BOOKS

Chaitow, Leon. Hydrotherapy: Water Therapy for Health and Beauty. Boston, MA: Element Books, 1999.

Pelletier, Dr. Kenneth R. The Best Alternative Medicine, Part I: Naturopathic Medicine. New York: Simon and Schuster, 2002.

PERIODICALS

Baird, Carol L. "First-Line Treatment for Osteoarthritis: Part 2: Nonpharmacologic Interventions and Evaluation." Orthopaedic Nursing 20 (November-December 2001): 13-20.

Barker, K. L., H. Dawes, P. Hansford, and D. Shamley. "Perceived and Measured Levels of Exertion of Patients with Chronic Back Pain Exercising in a Hydrotherapy Pool." Archives of Physical Medicine and Rehabilitation 84 (September 2003): 1319-1323.

Cider, A., M. Schaufelberger, K. S. Sunnerhagen, and B. Andersson. "HydrotherapyA New Approach to Improve Function in the Older Patient with Chronic Heart Failure." European Journal of Heart Failure 5 (August 2003): 527-535.

Johnson, Kate. "Hydrotherapy Greatly Eases Delivery Stress, Pain." OB GYN News 34 (November 1999): 27.

Keegan, L. "Therapies to Reduce Stress and Anxiety." Critical Care Nursing Clinics of North America 15 (September 2003): 321-327.

Mayhall, C. G. "The Epidemiology of Burn Wound Infections: Then and Now." Clinical Infectious Diseases 37 (August 15, 2003): 543-550.

Molter, N. C. "Creating a Healing Environment for Critical Care." Critical Care Nursing Clinics of North America 15 (September 2003): 295-304.

Taylor, S. "The Ventilated Patient Undergoing Hydrotherapy: A Case Study." Australian Critical Care 16 (August 2003): 111-115.

ORGANIZATIONS

The American Association of Naturopathic Physicians. 8201 Greensboro Drive, Suite 300, McLean, Virginia 22102. (206) 298-0126. http://naturopathic.org.

Canadian Naturopathic Association/Association canadienne de naturopathie. 1255 Sheppard Avenue East at Leslie, North York, ON M2K 1E2. (800) 551-4381 or (416) 496-8633. http://www.naturopathicassoc.ca.

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hydrotherapy

hydrotherapy, use of water in the treatment of illness or injury. Although the medicinal and hygienic value of water was recognized by the early Greeks, hydrotherapy attained its widest use in the 18th and 19th cent. through the practice of the British physician Sir John Floyer and an Austrian peasant, Vincenz Priessnitz. Priessnitz is credited with a number of inventions still in use including the sponge bath, the douche, and the wet sheet pack, and he is acknowledged as an important contributor to the rise of the health spa movement in Europe. Scientific hydrotherapy is based on the conduction of heat to or from the body by means of a water medium. Heated water is used for its sedative effect, and hot water vapor is used in controlled situations to relieve pain. Patients who have suffered extensive burns are often immersed in water for long periods. Maintained at skin temperature, i.e., approximately 93°F (34°C), the water prevents loss of body heat. Fevers are reduced by cold sponge baths taken on rubber sheets. Whirlpool baths are used to relieve painful muscle and joint conditions, and underwater exercise has proved a useful physical therapy in cases of paralysis and stiffness of the extremities.

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hydrotherapy

hy·dro·ther·a·py / ˌhīdrəˈ[unvoicedth]erəpē/ • n. another term for hydropathy. ∎  the use of exercises in a pool as part of treatment for conditions such as arthritis or partial paralysis. DERIVATIVES: hy·dro·ther·a·pist / -pist/ n.

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hydrotherapy

hydrotherapy (hy-droh-th'e-ră-pi) n. the use of water in the treatment of disorders, now restricted in orthodox medicine to exercises in remedial swimming pools for the rehabilitation of arthritic or partially paralysed patients.

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hydrotherapy

hydrotherapy Use of water within the body or on its surface to treat disease. It is often used in conjunction with physiotherapy.

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Hydrotherapy

Hydrotherapy

Definition

Hydrotherapy, or water therapy, is the use of water (hot, cold, steam, or ice) to relieve discomfort and promote physical well-being.

Purpose

Hydrotherapy is intended to relieve pain, increase mobility, and promote a feeling of well-being. Various methods are used to apply heat or cold to different body parts. Water is a non-toxic substance that is also used for cleansing and irrigating selected body cavities.

Hydrotherapy is an ancient technique. Historical and archeological evidence has shown that it has been used for several thousand years in both the east and west. Naturally occurring hot or mineral springs have long been used for therapeutic purposes. Herbs and scented oils have been added to heated water for almost as long a period of time.

Hydrotherapy treatments are used by both allopathic and complementary medicine to treat a wide variety of discomforts and disorders. Not as well accepted are invasive hydrotherapy techniques, such as colonic irrigation, enemas, and douching. These internal cleansing techniques can actually harm an individual by upsetting the natural balance of the digestive tract and the vagina. Most conventional medical professionals agree that vaginal douches are not necessary to promote hygiene in most women, and can actually do more harm than good.

Precautions

Water should not be hot enough to cause burns. Ice should not be left in contact with the skin for prolonged periods of time. Time in a sauna should be limited to avoid hypotension. Persons receiving whirlpool or Jacuzzi treatment should be monitored to avoid accidental drowning or loss of consciousness. Water in whirlpool baths or Jacuzzis should be changed after each use or regularly sanitized and tested. Long hair should be covered when a person is immersed in a whirlpool or Jacuzzi bath. Jewelry should be removed before any hydrotherapy treatment.

Individuals with paralysis, frostbite, or other conditions that impair the nerve endings and cause reduced sensation should only take hydrotherapy treatments under the guidance of a trained hydrotherapist, physical therapist, or other appropriate healthcare professional. Because these individuals cannot accurately sense temperature changes, they run the risk of being seriously burned. Diabetics and people with hypertension should also consult their healthcare professional before using hot tubs or other heat hydrotherapies.

Hot tubs, Jacuzzis, and pools can become breeding grounds for bacteria and other infectious organisms if they are not cleaned regularly, maintained properly, kept at the appropriate temperatures, and treated with the proper chemicals. Individuals should check with their healthcare provider to ensure that the hydrotherapy equipment they are using is sanitary. Those who are using hot tubs and other hydrotherapy equipment in their homes should follow the directions for use and maintenance provided by the equipment manufacturer.

Certain essential oils should not be used by pregnant or nursing women or by people with specific illnesses or physical conditions. Individuals suffering from any chronic or acute health condition should inform their healthcare provider before starting treatment with any essential oil.

Essential oils such as cinnamon leaf, juniper, lemon, eucalyptus blue gum, peppermint, and thyme can be extremely irritating to the skin if applied in full concentration. Oils used in hydrotherapy should always be diluted in water before they are applied to the skin. Individuals should never apply essential oils directly to the skin unless directed to do so by a trained healthcare professional or aromatherapist.

Colonic irrigation should only be performed by a healthcare professional. Pregnant women should never douche, as the practice can introduce bacteria into the vagina and uterus. They should also avoid using hot tubs without the consent of their healthcare provider.

The benefit of vaginal douching for all women is questionable. The vagina is self-cleansing, and douches have been known to upset the balance of vaginal pH and flora, promoting vaginitis and other infections. Some studies have linked excessive vaginal douching to increased incidence of pelvic inflammatory disease (PID).

Description

Water can be used therapeutically in a number of ways. Common forms of hydrotherapy include:

  • Whirlpools, Jacuzzis, and hot tubs. These soaking tubs use jet streams to massage the body. They are frequently used by physical therapists to help injured persons regain muscle strength and to soothe joint and muscle pain. Some midwives and obstetricians also approve of the use of hot tubs to soothe the pain of labor.
  • Pools and Hubbard tanks. Physical therapists and rehabilitation specialists may prescribe underwater pool exercises as a low-impact method of rebuilding muscle strength in injured people. The buoyancy experienced during pool immersion also helps ease pain in conditions such as arthritis.
  • Baths. Tepid baths are prescribed to reduce a fever. Baths are also one of the oldest forms of relaxation therapy. Adding Epsom salts (magnesium sulfate) or Dead Sea salts to a bath can promote relaxation and soothe rheumatism and arthritis.
  • Showers. Showers are often prescribed to stimulate the circulation. Water jets from a shower head are also used to massage sore muscles.
  • Moist compresses. Cold, moist compresses can reduce swelling and inflammation of an injury. They can also be used to cool a fever and treat a headache. Hot or warm compresses are useful for soothing muscle aches and treating abscesses.
  • Steam treatments and saunas. Steam rooms and saunas are recommended to open the skin pores and cleanse the body of toxins. Steam inhalation is prescribed to treat respiratory infections.
  • Internal hydrotherapy. Colonic irrigation is an enema that is designed to cleanse the entire bowel. Douching, another form of internal hydrotherapy, directs a stream of water into the vagina for cleansing purposes. The water may or may not contain medications or other substances. Douches can be self-administered with kits available at most drug stores.

Preparation

Because of the expense of the equipment and the expertise required to administer effective treatment, hydrotherapy with pools, whirlpools, Hubbard tanks, and saunas is best taken in a professional healthcare facility under the supervision of a healthcare professional. However, baths, steam inhalation treatments, and compresses can be easily administered at home.

Bath preparations

Warm-to-hot bath water should be used for relaxation purposes, and a tepid bath is recommended for reducing fevers. To prepare salts for the bath, add one or two handfuls of Epsom salts or Dead Sea salts to boiling water until they are dissolved, and then add them to the tub.

A sitz bath, or hip bath, can be taken at home to treat hemorrhoids and promote healing of an episiotomy. A special apparatus is available for taking a seated sitz bath, but one can also have a sitz bath in a regular tub partially filled with warm water.

Steam inhalation

Steam inhalation treatments can be easily administered by holding one's head over a bowl of steaming water and using a large towel as a tent.

Compresses

A cold compress is prepared by soaking a cloth or cotton pad in cold water and then applying it to the area of injury or distress. When the cloth reaches room temperature, it should be resoaked and reapplied. Gentle pressure can be applied with the hand to the compress. Cold compresses are generally used to reduce swelling, minimize bruising, and to treat headaches and sprains.

Warm or hot compresses are used to treat abscesses and muscle aches. A warm compress is prepared in the same manner as a cold compress, except steaming water is used to wet the cloth instead of cold water. Warm compresses should be refreshed and reapplied after they cool to room temperature.

Aftercare

Typically, no special care is required after receiving hydrotherapy.

Complications

Most forms of hydrotherapy are well-tolerated and complications are unusual. Water that is too hot may cause burns. Contact with cold temperatures may cause transient hypothermia to the treated portion of the body. The effects of hydrotherapy typically wear off with time, so additional treatments are required if the problem persists. Repeated use of colonic hydrotherapy, however, may impair function of the large intestine, leading to dependence on the hydrotherapy to maintain normal bowel function.

There is a risk of allergic reaction (also known as contact dermatitis) for some people using essential oils and herbs in their bath water. These individuals may want to test for allergic sensitization to herbs by performing a skin patch test (i.e., rubbing a small amount of diluted herb on the inside of their elbow and observing the spot for redness and irritation). People who experience an allergic reaction to an essential oil should discontinue its use and contact their healthcare professional for further guidance.

The most serious possible side effect of hydrotherapy is overheating, which may occur when an individual spends too much time in a hot tub or Jacuzzi. However, this is a minimal risk when the patient is properly supervised.

Results

Relief from pain or discomfort is the usual result of hydrotherapy. Increased mobility, especially in joints, also frequently occurs. Many persons receiving hydrotherapy report having higher levels of energy.

Hydrotherapy can soothe sore or inflamed muscles and joints, rehabilitate injured limbs, lower fevers, soothe headaches, promote relaxation, treat burns and frostbite, ease labor pains, and clear up skin problems. The temperature of water used affects the therapeutic properties of the treatment. Hot water is chosen for its relaxing properties. It is also thought to stimulate the immune system. Tepid water can also be used for stress reduction and may be particularly relaxing in hot weather. Cold water is used to reduce inflammation. Alternating hot and cold water can stimulate the circulatory system and improve the immune system.

Health care team roles

A variety of doctors, such as orthopedic surgeons, sports medicine doctors, and rheumatologists may make an initial referral for some forms of hydrotherapy. Individuals also sometimes initiate visits themselves. A hydrotherapist provides the requested services.

Hydrotherapy is practiced by a number of physical therapists, medical doctors (especially those specializing in rehabilitation), nurses, and naturopathic physicians. Naturopaths are licensed in a number of states. Aromatherapists, who frequently recommend water-based treatments with herbs and essential oils, are not licensed, although there are certification pro-grams available for practitioners.

KEY TERMS

Contact dermatitis Skin irritation as a result of contact with a foreign substance.

Episiotomy— An incision made in the perineum during labor to assist in delivery and to avoid tearing of the perineum.

Essential oil— A volatile oil extracted from the leaves, fruit, flowers, roots, or other components of a plant and used in aromatherapy, perfumes, foods and beverages.

Hubbard tank— A large water tank or tub used for underwater exercises.

Resources

BOOKS

Bates, Andrea, Norm Hanson, and Margaret Biblis. Aquatic Exercise Therapy. Philadelphia: Saunders, 1996.

Becker, Bruce E. and Andrew J. Cole. Comprehensive Aquatic Therapy. Woburn, MA: Butterworth-Heinemann Medical, 1997.

Buchman, Dian D. The Complete Book of Water Healing. New York, Contemporary Books, 2001.

Campion, Margaret R. Hydrotherapy: Principles and Practice. Woburn, MA: Butterworth-Heinemann Medical, 1997.

Chaitow, Leon. Hydrotherapy: Water Therapy for Health and Beauty. New York: Harper-Collins, 1999.

Kiss, Agnes. New Techniques in Aqua Therapy. Orlando, FL: Rivercross Publishers, 1999.

Ruoti, Richard G., David M. Morris, and Andrew J. Cole. Aquatic Rehabilitation. Philadelphia: Lippincott Williams & Wilkins, 1997.

Troeller, Linda. Healing Waters. New York: Aperture, 1998.

PERIODICALS

Acikel, C., Ulkur, E., Guler, M. M. "Prolonged intermittent hydrotherapy and early tangential excision in the treatment of an extensive strong alkali burn." Burns 27, no. 3 (2001): 293-296.

Benfield, R. D., Herman, J., Katz, V. L., Wilson, S.P., Davis, J. M. "Hydrotherapy in labor." Research in Nursing and Health 24, no. 1 (2001): 57-67.

Braslow, J. T. "History and evidence-based medicine: lessons from the history of somatic treatments from the 1900s to the 1950s." Mental Health Service Research 1, no. 4 (1999):231-240.

Lipow, V. "Water-proofing. Measuring aquatic therapy effectiveness." Rehabilitation Management 11, no. 4 (1998): 34-39.

Moss, G. A. "Medicine 2000 years ago: the case of Qumran and other biblical sites." Journal of the Royal Society of Health 120, no. 4 (2000): 255-261.

Purssell, E. "Physical treatment of fever." Archives of Diseases of Children 82, no. 3 (2000): 238-239.

Reilly, K. A., Bird, H. A. "Prophylactic hydrotherapy." Rheumatology (Oxford) 40, no. 1 (2001): 4-6.

ORGANIZATIONS

American Academy of Physical Medicine and Rehabilitation. One IBM Plaza, Suite 2500, Chicago, IL 60611-3604. (312) 464-9700. Fax (312) 464-0227. 〈http://www.aapmr.org/consumers/public/amputations〉. [email protected]

American Association of Naturopathic Physicians. 8201 Greensboro Drive, Suite 300, McLean, Virginia 22102. (703) 610-9037. Fax (703) 610-9005. 〈http://naturopathic.org〉. [email protected]

American College of Sports Medicine. 401 W. Michigan St., Indianapolis, IN 46202-3233. (317) 637-9200. Fax (317) 634-7817. 〈http://www.acsm.org〉. [email protected]

OTHER

Healthy.Net. 〈http://www.healthy.net/asp/templates/article.asp?PageType=Article&ID=724〉.

Holistic Online. 〈http://www.holisticonline.com/hydrotherapy.htm〉.

Merck Manual. 〈http://www.merck.com/pubs/mmanual/section21/chapter291/291d.htm〉 and 〈http://www.merck.com/pubs/mmanual/section10/chapter122/122a.htm〉.

PageWise. 〈http://vava.essortment.com/whatishydroth_rsse.htm〉.

World Medicus. 〈http://www.worldmedicus.com/servlet/Controller/$700a004e1adb0000.sj〉.

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Hydrotherapy

Hydrotherapy

Definition

Hydrotherapy is the external use of water to improve health, relieve pain , or treat a disease or condition.

Purpose

Hydrotherapy is used for a wide variety of purposes. In general, it is used to treat diseases or

conditions, to relieve pain, and to improve or maintain general health and well being. Hydrotherapy has a very long history. For hundreds of years people have believed in the curative powers of water, and for many years “taking the waters” at natural hot springs was thought to be a curative for a variety of ailments.

Today many people still believe in the healing power of water. Some types of hydrotherapy, such as exercising in a body of water, have been shown to have very positive effects. Others have not been shown to be effective at all. Hydrotherapy is believed to help a wide variety of diseases and conditions including depression , acne, and stomach problems. It is often used to treat or help relieve the pain of arthritis, joint problems, and muscle aches. Hydrotherapy is even sometimes recommended for polyps, ear infections, and the common cold .

Precautions

Hydrotherapy in most of its forms is safe for most people. Individuals should check with their doctor to make sure that the form of hydrotherapy they are considering is safe for them. Hydrotherapy should not be used for individuals who are not able to feel the temperature of the water as it can lead to burns. Hydrotherapy can be a very effective addition to many treatment plans. However, it is extremely important never to use an alternative therapy like hydrotherapy for a disease or condition instead of getting traditional medical care. Many diseases and conditions can become much more serious if they are not treated promptly using scientifically proven medical treatments.

Description

There are many different form of hydrotherapy. The most common forms of hydrotherapy are exercise hydrotherapy, whirlpool hydrotherapy, and sauna hydrotherapy. Exercise hydrotherapy involves doing aerobics, yoga , or other forms of exercise in a body of water such as a swimming pool. Often, the water in the swimming pool is heated to slightly above body temperature to help soothe joints and muscles during the exercise.

Whirlpool hydrotherapy involves the use of a whirlpool bath or hot tub to relive stress , sooth joints, and relieve muscle pain. A whirlpool bath is a tub of water that is usually keep fairly warm that has a variety of different jets that create a massaging, whirlpool-like effect. Sauna hydrotherapy uses heated steam in an enclosed space to cause sweating.

There are many other less common forms of hydrotherapy. Some involve the individual sitting in, or putting the affected body part, in a tub of water that has a variety of dissolved minerals in it. Others involve alternating cold and hot water. Some involve soaking a compress in warm or cool water and applying it to the area being treated. Other forms of therapy place the patient under cold, damp, sheets which are then covered with dry sheets and blankets.

Preparation

Hydrotherapy does not require any special patient preparation.

Aftercare

Hydrotherapy does not require any special aftercare.

Complications

The complications likely to result from hydrotherapy depend on the type and duration of the hydrotherapy. Some complications that may occur from hydrotherapy include headache, nausea, burns, and infection. The most concerning complication of some hydrotherapy treatments that involve heat is dehydration . This is of special concern among seniors who are often more likely to experience dehydration. Dehydration can occur due to sweating induced by warm or hot temperatures of the water or steam over a long duration.

Results

The results of hydrotherapy can vary greatly depending on the type of hydrotherapy used, the skill and experience of the practitioner performing or overseeing the hydrotherapy, and the disease or condition being treated. Hydrotherapy that consists of stretching, yoga, or exercise in a swimming pool or other body of water can be a very effective method of increasing fitness and cardiovascular health, increasing range of motion and flexibility, and promoting weight loss and increased energy levels.

Hydrotherapy involving emersion in warm water, such as in a hot tub, or warm bath, can help relax tense muscles and provide relief from some types of pain. Although some types of hydrotherapy can be very effective, not all types of hydrotherapy are effective for all disease, conditions, and problems. Many scientists are doing research to try and determine which forms of hydrotherapy really work. It has been shown in peer-reviewed scientific study that exercise hydrotherapy can be an effective for individuals with arthritis, although not necessarily more effective than regular exercise. As of 2008 many kinds of hydrotherapy had not been shown to be effective in carefully controlled scientific studies. Before beginning hydrotherapy, especially one claiming to treat a specific disease or condition, the patient should ask the practitioner about the proven effectiveness of the therapy.

QUESTIONS TO ASK YOUR DOCTOR

  • Is the type of hydrotherapy I am considering safe for me?
  • Are there any warning signs I should look out for during hydrotherapy?
  • Do you have any suggestions about what types of hydrotherapy are most likely to be effective at improving my disease or condition?

Caregiver concerns

Many different members of the health care team may be involved in providing treatment with hydrotherapy. A physical therapist may use hydrotherapy in one or more forms as a part of standard treatment for rehabilitation. A naturopath or a practitioner of alternative medicine may prescribe hydrotherapy treatments or provide them in the office. Many community centers offer exercise and yoga classes that take place in the water to help build muscle and relieve pressure on the joints. These classes may be taught by many different individuals including yoga and fitness instructors or certified personal trainers. Many spas even offer hydrotherapy treatments. As with any medical treatment, the patient's primary care physician should play an integral role. The primary care physician can recommend forms of hydrotherapy that are most likely to be effective for the particular patient's problems. The doctor can also tell the patient which hydrotherapy treatments are not appropriate because they may be dangerous for the patient or interfere with traditional treatments that are being received. Patients should be sure to discuss the option of hydrotherapy with their doctors before beginning any treatment.

Resources

BOOKS

Fleckenstein, Alexa, and Roanne Weisman. Health2O: Tap Into the Healing Power of Water to Fight. New York: McGraw-Hill, 2007.

Roeder, Giselle. Healing with Water: Kneipp Hydrotherapy at Home. Summertown, TN: Books Alive, 2008.

Vasey, Christopher. The Water Prescription: For Health, Vitality, and Rejuvenation. Rochester, VT: Healing Arts Press, 2006.

PERIODICALS

Grant, Ruth Ann. “Water Therapy May Aid Daily Functioning for Osteoarthritis.” McKnight's Long-Term Care News (December 2007): 6.

Silva, Luciana, et al. “Hydrotherapy Versus Conventional Land-Based Exercise for the Management of Patients with Osteoarthritis of the Knee: A Randomized Clinical Trial.” Physical Therapy 88.1 (January 2008): 12 22.

Vaile, Joanna, et al. “Effect of Hydrotherapy on the Signs and Symptoms of Delayed Onset Muscle Soreness.” European Journal of Applied Physiology 103.1 (May 2008): 121–123.

ORGANIZATIONS

American Alternative Medical Association, 2200 Market Street, Suite 329, Galveston, TX, 77550-1530, (409) 621-2600, (888) 764-2237, (775) 703-5334, www.joinaama.com.

Helen Davidson

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