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?.