Aquatic physical therapy, bath, cold therapy, colonic hydrotherapy, colonic irrigation, constitutional hydrotherapy,

Dead Sea bath, douche, external hydrotherapy, fomentation, foot bath, hot therapy, hot tub, hot tub therapy,
immersion bath, internal hydrotherapy, jet spray, local hydrotherapy, motion-based treatment, mud bath, poultice,
purifying bath, salt bath, sauna, shower, sitz bath, spa treatment, soaked towel, temperature-based treatment,
Turkish bath, warm salt water immersion, warm sulfur water immersion, warm tap water immersion, water bath, water
birth, water mineral bath, Watsu, whirlpool.
Note: This review does not include 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/"enriched" water, coffee infusions, aquatic yoga, aquatic massage (including Watsu), or
aromatherapy/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, but are not included in this review, such as colonic irrigation/enemas, nasal
irrigation, physical therapy in pools, steam inhalation/humidifiers, drinking of mineral water/"enriched" water, coffee
infusions, aquatic yoga, aquatic massage (including Watsu), or aromatherapy/baths with added essential oils.
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 tuberculosiswith Kneipp's methods, and hydrotherapy was included as a
component of naturopathic medicine. In modern times, a wide variety of water-related therapies are used, some of
which are described below.
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 spasm, body aches, sprains, hemorrhoids, pruritis
(itching), inflammation, rashes, anxiety, for wound care/hygiene, and to promote relaxation. For various ailments,
different temperatures may be used, and minerals or medications may be added to the water.
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. A rising temperature arm bath uses the same principle as a rising temperature footbath.
Foot bath: Cold foot baths involve placing the feet in a bath filled calf-deep with cold water. "Walking in water"
involves stepping on a non-slip mat placed under water. For warm/rising temperature foot baths, the feet are
immersed in water at body temperature. Hot water is gradually added until the temperature reaches approximately
103-104 degrees Fahrenheit. Therapy may last for 10-15 minutes. Caution is warranted 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. The bather
may then be wrapped in warm dressings.
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.
Douches: "Douches" may be carried out with a watering can or hose. Treatments can be applied to any area of the
body, with the intention to relieve tension or pain, or to affect blood flow.
Steam bath/sauna: Heat may be used to cause sweating, and these techniques are 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).
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.
Spa/hot tub/whirlpool/motion-based hydrotherapy: These therapies are sometimes used in people with wounds,
chronic musculoskeletal pain, or inflammation. People should be aware of the risk of introducing infections into
wounds, and the importance of keeping wounds clean.
Purifying/mineral bath: Prior to immersion, solutes or other components may be added to water, such as sea salt,
lemon juice, turmeric, Epsom salts, baking soda, chlorine bleach, or essential oils.
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/high salt content in the water, to sun exposure, or to a combination of factors.
Water birth: Potential benefits of giving birth in water have been explored. Research is not definitive in this area.
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 form of bodywork conducted in pools.
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, but are not included in this review, such as colonic irrigation/enemas, nasal
irrigation, physical therapy in pools, steam inhalation/humidifiers, drinking of mineral water/"enriched" water, coffee
infusions, aquatic yoga, aquatic massage (including Watsu), or aromatherapy/baths with added essential oils.
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 hydrotherapy was included as a
component of naturopathic medicine. In modern times, a wide variety of water-related therapies are used, some of
which are described below.
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 spasm, body aches, sprains, hemorrhoids, pruritis
(itching), inflammation, rashes, anxiety, for wound care/hygiene, and to promote relaxation. For various ailments,
different temperatures may be used, and minerals or medications may be added to the water.
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. A rising temperature arm bath uses the same principle as a rising temperature footbath.
Foot bath: Cold foot baths involve placing the feet in a bath filled calf-deep with cold water. "Walking in water"
involves stepping on a non-slip mat placed under water. For warm/rising temperature foot baths, the feet are
immersed in water at body temperature. Hot water is gradually added until the temperature reaches approximately
103-104 degrees Fahrenheit. Therapy may last for 10-15 minutes. Caution is warranted 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. The bather
may then be wrapped in warm dressings.
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.
Douches: "Douches" may be carried out with a watering can or hose. Treatments can be applied to any area of the
body, with the intention to relieve tension or pain, or to affect blood flow.
Steam bath/sauna: Heat may be used to cause sweating, and these techniques are 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).
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.
Spa/hot tub/whirlpool/motion-based hydrotherapy: These therapies are sometimes used in people with wounds,
chronic musculoskeletal pain, or inflammation. People should be aware of the risk of introducing infections into
wounds, and the importance of keeping wounds clean.
Purifying/mineral bath: Prior to immersion, solutes or other components may be added to water, such as sea salt,
lemon juice, turmeric, Epsom salts, baking soda, chlorine bleach, or essential oils.
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/high salt content in the water, to sun exposure, or to a combination of factors.
Water birth: Potential benefits of giving birth in water have been explored. Research is not definitive in this area.
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 form of bodywork conducted in pools.
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 causesmuscle relaxation.
Some hydrotherapy techniques make use of these physiologic changes, although correlation to long-term health
benefits is not clear.
Electrical stimulation is sometimes used, and is proposed to stimulate muscles, digestion, and circulation (although
caution is warranted due to risks associated with using electricity while in water).
Physical therapy in water makes use of buoyancy (ability to float) to reduce work against gravity, as well as 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.
Evidence
DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been
proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Low back pain: Several small controlled trials report that regular use of hot whirlpool baths with massaging jets
improves the duration and severity of back pain when added to standard therapy, compared to standard therapy
alone (Constant, 1995; Constant, 1998; Guillemin, 1994; McIlveen, 1998). It is not clear if there is a reduced need
for pain control drugs, or if benefits are long-standing. Because these studies are small with flaws in design and
reporting, better quality research is necessary before a strong conclusion can be drawn.
Grade: B
Anorectal lesions (hemorrhoids, anal fissures): There is preliminary evidence supporting the use of sitz baths
people with anorectal conditions, particularly for symptom relief. Sitz baths are offered to patients in many hospitals.
However, controlled studies are needed to determine the effectiveness and optimal use of sitz baths.
Grade: C
Skin bacteria: There is preliminary evidence that some hydrotherapy techniques may reduce bacteria on the surface
of the skin. It is not known if there are benefits (or potentially harmful effects) of reducing skin bacteria. There may be
benefits in people with skin wounds or ulcers who are at risk of infection. There is no evidence that infection of the
skin itself (cellulitis) is improved.
Grade: C
Arthritis: Hydrotherapy has been used historically for the treatment of symptoms related to rheumatoid
arthritis and osteoarthritis. Multiple studies have been published, largely based on therapy given at Dead Sea spa
sites in Israel. Although most studies report benefits in pain, range of motion, or muscle strength, due to design flaws,
there is not enough reliable evidence upon which to base recommendations.
Grade: C
Atopic dermatitis: There is preliminary evidence that hydrotherapy in an acidic hot spring bath may reduce the
severity of symptoms in atopic dermatitis. Evidence from controlled trials is necessary before a clear conclusion can
be drawn.
Grade: C
Burns: Hydrotherapy is widely used in hospitals and rehabilitation centers in the management of burns. Various
techniques are used, with variations in methods, lengths of time, frequency, and training levels of personnel
administering treatments. There is limited research at this time, and no clear conclusions can be drawn.
Grade: C
Chronic obstructive pulmonary disease (COPD): There is preliminary evidence that daily breathing exercises in a
warm pool may improve lung function measurements in patients with COPD. It is not clear if this technique is superior
to breathing exercises alone. Evidence from controlled trials is necessary before a clear conclusion can be drawn.
Grade: C
Chronic venous insufficiency (CVI): Hydrotherapy is used in Europe for chronic venous insufficiency (CVI), a
syndrome that may include leg swelling, varicose veins, leg pain, itching, and skin ulcers. A small number of trials
have applied cold water stimulation alone or in combination with warm water, and reported improvements in cramps
and itching when compared to no therapy. Better quality research is needed before a clear conclusion can be drawn.
Grade: C
Common cold: There is preliminary evidence that daily showers with warm water followed by cold water, or cold
water alone, may reduce the duration and frequency of common cold symptoms. Additional research is needed in
this area before a clear conclusion can be drawn.
Grade: C
Diabetes mellitus: There is insufficient research in this area to make a recommendation.
Grade: C
Claudication (painful legs from clogged arteries): Studies report that hydrotherapy may improve blood flow to the
legs, and increase the pain-free walking distance of people with claudication due to peripheral vascular disease.
Additional research is needed in this area before a clear conclusion can be drawn.
Grade: C
Labor/birth: There is preliminary research of the effects of giving birth in water on labor pain, duration of labor,
perineal damage to the mother, and birth complications. Further studies of effectiveness and safety are necessary
before a conclusion can be drawn.
Grade: C
Pelvic inflammatory disease (PID): There is insufficient research in this area to make a recommendation. PID is a
potentially serious medical condition that should be evaluated by a qualified, licensed healthcare provider.
Grade: C
Pressure ulcers/wound care: Hydrotherapy has been used in patients withpressure ulcers, and preliminary
research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in
this area before a firm conclusion can be drawn. There is a risk of infection from contaminated water if sanitary
conditions are not maintained.
Grade: C
Psoriasis: There is insufficient research in this area to make a recommendation.
Grade: C
Spinal muscular atrophy: There is insufficient research in this area to make a recommendation.
Grade: C
Varicose veins: Preliminary research reports improved symptoms and blood flow in patients with varicose veins
undergoing hydrotherapy with intermittent cold and hot water hydrotherapy. Additional research is needed in this area
before a clear conclusion can be drawn.
Grade: C