Hydrotherapy the use of water to treat disease and maintain health has been practiced in one form or another by most cultures throughout history, from the ancient Babylonians, Greeks, and Israelites to the Indians, Chinese, and Native Americans. Today, various water-based treatments are used primarily to treat wounds, burns, and injuries; to aid physical rehabilitation; and to relieve tension. The water can be hot or cold; liquid, frozen, or steam; and applied externally or internally.

There are three types of external hydrotherapy: hot, cold, and contrast. Hot water therapies such as saunas, sweat baths, and application of heat work by dilating the blood vessels and increasing circulation in the area being treated. Increasing the supply of blood to muscles can relieve pain as well as soothing and relaxing the body. These therapies may also stimulate immune system functioning, encouraging white blood cells to leave the blood vessels and migrate into the surrounding tissues, where they scavenge for toxins and help eliminate them from the body. The copious sweat stimulated by these heat treatments is also believed to help release toxins from the body. Cold water therapies such as application of ice and cold packs cause vasoconstriction, which decreases circulation to the body part being treated, thereby reducing swelling and inflammation. Cold water may also tone muscle weakness by stimulating muscle contractions. Alternating between hot and cold application in the same treatment, known as contrast therapy, may stimulate endocrine function, reduce inflammation, decrease congestion, and improve organ function.

Reported uses

Whirlpool baths (heated baths with jets that force water to circulate) are used to assist in the rehabilitation of injured muscles and joints. The water temperature can be either hot or cold, depending on the desired effect; the jets of water act as a massage on soothing muscles. These baths are also used to treat burn patients and to aid healing of skin sores and infected wounds. Patients suffering from paraplegia and polio receive whirlpool baths to increase circulation in atrophied muscles.

A neutral bath is the immersion of the body up to the neck in water that is near body temperature. This soothing bath calms the nervous system and is used to treat emotional disturbances and insomnia. In a sitz bath, the pelvic area is immersed in a tub of warm water; this treatment is used to increase circulation, reduce inflammation, and relieve perianal pain, swelling, or discomfort.

Ice, usually applied locally, is another common therapy used to relieve sprains, strains, and inflammation. Contrast hydrotherapy can be used for trauma relief.

How the treatment is performed

The equipment needed depends on the type of therapy. It may include tub, steam, sauna (a sealed, steam-filled room), pool, hose, hot or cold pack, or Jacuzzi or whirlpool bath. Depending on the type of therapy used, the patient enters the water (hot, cold, or warm) or the sauna and remains in it for the prescribed amount of time. The desired temperature is maintained to prolong the therapy’s benefits. If hot or cold packs are used, they’re applied to the target body area for the specified length of time and changed as needed to maintain the desired temperature.


Any therapy involving heat can produce harmful effects, such as burns, if applied improperly. In addition, very hot treatments can cause elderly people and children to become exhausted or faint. Cold may aggravate painful spasms or acute lung congestion. Some traditional hydrotherapy practitioners consider ice therapies inappropriate and don’t use them.

Clinical considerations

  • Hot baths, saunas, and immersion baths are not recommended for pregnant women, children, elderly people, or patients with diabetes, multiple sclerosis, hypertension, or hypotension.
  • Warn patients using hydrotherapy to stop the treatment if they feel lightheaded, dizzy, or faint (possible symptoms of decreased blood pressure).
  • Cold applications are contraindicated for patients with conditions that would be exacerbated by vasoconstriction, such as Raynaud’s disease or sickle cell anemia.
  • Use caution. when administering a hot bath or steam bath to prevent burns, light-headedness, and falls.
  • Patients shouldn’t remain in a sauna for more than 20 minutes and should wipe their faces frequently with a cool cloth to avoid becoming overheated.
  • Many hydrotherapy treatments, such as whirlpool and steam baths, can be performed at home, but more intensive forms are best performed in a clinical setting, where response to the therapy can be monitored by experienced therapists.

Research summary

The concepts behind the use of hydrotherapy and the claims made regarding its effects haven’t yet been validated scientifically.

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