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Posted 05/07/2009

What Is It?
Hydrotherapy is the use of water to maintain health or promote healing. Ice, steam, and hot, tepid, and cold water are all used in a number of different ways–some widely accepted, others controversial. For example, external treatments, such as the application of ice to a sprained ankle or soaking in a hot tub to soothe sore muscles, have become common remedies and some are universally prescribed by both conventional and alternative practitioners, particularly naturopaths. However, internal therapies such as colonic irrigation are considered suspect and even dangerous by most mainstream doctors.

Water has been part of the therapeutic arsenal since the beginning of civilization. The ancient Greek physician Hippocrates promoted the healthful effects of taking a bath. Regular trips to the bathhouse were part of the Roman regimen for good health and hygiene. The most rapid growth of hydrotherapy, however, occurred in Germany during the nineteenth century, when Vincenz Priessnitz (1799-1851) and Father Sebastian Kneipp (1821-1897) established independent hydrotherapy centers there.

Although many in the scientific community questioned the effects of hydrotherapy, its popularity spread. By the late-nineteenth century, hydrotherapy centers had begun to spring up in the United States in places like Saratoga Springs, New York, Hot Springs, Arkansas, and Warm Springs, Georgia. Seeking cures for everything from arthritis to warts, wealthy visitors came regularly to these early spas to “take the waters.”

Hydrotherapy gained some scientific credence in 1900, when J. H. Kellogg, a medical doctor and the brother of the founder of the cereal empire, published his book Rational Hydrotherapy. Documenting Kellogg’s numerous research experiments on the therapeutic effects of water, the book quickly became the definitive work on the subject. It is still used today by many naturopaths, who learn hydrotherapy as part of their training.

How Does It Work?
The basic properties of water allow this nontoxic and readily available substance to be used in many aspects of patient care. Not only does water keep people hydrated, its universal solvent properties make it essential for cleaning wounds and preventing infection. Water is also useful in its other physical states: Steam can open clogged sinuses; ice packs can relieve swelling.

Hydrotherapy also takes advantage of water’s unique ability to store and transmit both cold and heat. Cold-based hydrotherapies, such as ice packs and cold compresses, have what is known as a “depressant” effect: Cold decreases normal activity, constricting blood vessels, numbing nerves, and slowing respiration. On the other hand, heat-based hydrotherapies, such as whirlpools and hot compresses, have the opposite effect. As the body attempts to throw off the excess heat and keep body temperature from rising, dilation of blood vessels occurs, providing increased circulation to the area being treated.

Contrast hydrotherapies, which typically involve compresses or immersion, alternate heat with cold and are mainly used to dramatically stimulate local circulation. For example, a 30-minute contrast bath to the lower extremities (four minutes hot, one minute cold, repeated for a total of 30 minutes) can produce a 95% increase in local blood flow.

What You Can Expect
Today hydrotherapy is a part of the physical therapy department of virtually every hospital and medical center. Various techniques using water are considered standard strategies for rehabilitation and relief of pain. Exercises in hydrotherapy pools, whirlpool baths, and swimming pools are among the basic offerings that continue to be a part of the long heritage of hydrotherapeutic techniques.

Some treatments are done only by a complementary-care specialist, such as a naturopathic doctor; others require the supervision of a trained therapist. After examining you and taking your history, the doctor will explain how you can perform the appropriate therapy for your condition yourself or will send you to an appropriate facility.

Treatments such as icing, hot and cold compresses, friction rubs, and sitz baths are easily learned and can be done at home as part of a self-care program (see Health Benefits, below).

Many forms of hydrotherapy are also available at health spas and resorts. Be sure to check the credentials of the spa before going.

Health Benefits
Used mainly to treat wounds and burns, to provide pain relief, to facilitate physical rehabilitation, and to promote relaxation, water-based therapies are currently used throughout conventional, complementary, and alternative medicine.

The physiological effects depend on the type of hydrotherapy used. The following are commonly recommended techniques:

Icing. Ideal for strains, sprains, and bruises, icing can easily be done at home if the injury isn’t too severe. If you sprain your ankle while jogging, for example, the best thing you can do is go right home and ice it to minimize the swelling and internal bleeding. Be sure to wrap the ice–whether it’s ice cubes in a plastic bag or a gel pack–in a towel. Putting ice directly on your skin can cause nerve damage. Keep the ice in place for 20 minutes. Depending on the severity of the injury, repeat the ice application every two hours for 24 hours. After this time, taking a hot shower or bath, or applying a hot compress, can increase circulation to the injured area and speed the healing process.

Compresses. To make a compress, a cloth is soaked in hot or cold water and then wrung out so the desired amount of moisture remains. Single or double compresses may be used. A single compress simply involves placing one layer of the wet cloth over the affected area. A double compress involves putting a dry material such as wool or flannel over the wet compress. When using hot water, the double compress serves to retain the heat. When using cold water, the body gradually warms the compress and the transition from cold to warm adds to the therapeutic value. A cold compress can be used to prevent or relieve congestion, reduce blood flow to an area, and inhibit inflammation. A hot compress can have an analgesic effect, thereby decreasing pain. Hot compresses can also be used to lessen the discomfort from menstrual cramps and irritable bowel syndrome, and to increase blood flow to a particular part of the body. A hot or cold compress (depending on individual preference) can relieve a headache.

Baths. You can use baths to either immerse the entire body or simply the affected body part. Hot full-immersion baths can help with arthritic discomfort and conditions where muscles are in painful spasm, such as fibromyalgia. For a neutral (or tepid) bath the temperature should be neither too hot nor too cold. These are mainly used for relaxation purposes and to treat stress-related ailments such as insomnia, anxiety, and nervous exhaustion. Cool baths can relieve irritation and itching caused by hives or other skin disorders.

Sitz baths. Taking sitz baths involves partially immersing the pelvic region. A hot sitz bath can help reduce pain from hemorrhoids, menstrual cramps, and sciatica. A neutral sitz bath is best for bladder infections or severe itching in the anal region. A cold sitz bath constricts blood vessels and may be helpful for excess vaginal bleeding and mild constipation. A contrast sitz bath–from hot to cold–increases circulation in the pelvis and may be useful for chronic prostatitis and pelvic infections. You can buy a special sitz-bath seat to fit over your toilet seat or you can simply sit in your bathtub.

Cold friction rubs. A friction rub involves massaging a particular area of the body with a rough washcloth, terry towel, or loofah, that has first been place in ice water. Friction rubs have a tonifying effect on the body, increasing circulation and tightening muscles.

How To Choose a Practitioner
The type of practitioner you consult depends on the nature of your ailment. If you have a sports injury, for example, you would most likely visit your primary-care physician, a chiropractor, or a physical therapist. If you have a more serious condition, such as irritable bowel syndrome, you would most likely see your regular doctor or a gastroenterologist.

If you are interested in complementary forms of hydrotherapy, you might wish to talk to a licensed naturopathic doctor. To find one who practices hydrotherapy, contact a professional association.

Take precautions with both hot and cold water treatments. Do not use a microwave to heat a compress because the material will get too hot too quickly. Soak the compress in hot water from the tap and test its temperature before applying it to your body. When using ice, do not put the ice or ice pack directly on your skin. Wrap it in a towel and then apply.

Hydrotherapy that uses extreme temperatures is not recommended for pregnant women or for people who have a heart condition, circulation disorder, high blood pressure, or diabetes.

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