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Hydrotherapy is the use of water, ice, steam, and hot and cold temperatures to maintain and restore health. Treatments include full body immersion, steam baths, saunas, sitz baths, colonic irrigation and the application of hot, and/or cold compresses. Hydrotherapy is effective for treating a wide range of conditions and can easily be used in the home as part of a self-care programme.


Although the use of water to treat illnesses is a time-honoured medical technique, it has recently declined in popularity among mainstream physicians. The application of hot and cold water or water-soaked compresses to manage the pain and swelling of soft tissue injuries and burn is still standard practice, and has been proven effective in a variety of well-controlled clinical trials. Likewise, physical therapy performed in water is still a common treatment for the disabled. However, other forms of hydrotherapy are no longer routinely used in hospitals, and most medical schools no longer teach the techniques. The hydrotherapy formerly used in psychiatric clinics is now considered obsolete. In the world of natural healing, however, hydrotherapy continues to claim devoted proponents. Techniques such as constitutional hydrotherapy and hot fomentation, both of which seek to rid the body of toxins, are advocated for a wide range of diseases. Watsu, a sort of aquatic version of Chinese deep-tissue massage, is said to help pain, stiff joints, spasticity and tension. Although none of these techniques has been validated through clinical trials, practitioners point to a growing file of case studies as proof of their successs.

Among hydrotherapy's more conventional uses are treatment of soft-tissue injuries, musculoskeletal injuries, back pain, arthritis, premenstrual syndrome, menstrual cramps, diabetes and other diseases that impair circulation, balance disorders, and muscle weakness.

In the alternative medicine realm, claims for procedures such as constitutional hydrotherapy and hot fomentation tend to be much more extravagant. They include treatment of ear infections, high fever, multiple sclerosis, cancer, fractures, migraine, digestive problems, prostatitis, kidney and bladder infections, depression, attention deficit disorder and anxiety.

Procedure of Treatment

Constitutional Hydrotherapy: Typically given in the practitioner's office, this form of therapy combines systematic application of hot and cold wet towels with administration of mild electrical stimulation to various muscle groups. Before starting the therapy, the practitioner may conduct a physical examination to diagnose your condition. The sophistication of the exam will depend on the type of practitioner. The recommended number of sessions will be based on the therapist's assessment of your condition.

Here is how a typical session progresses: First, as you lie face-up on an examination table, the therapist will cover your torso with two hot, wet towels, wrung out so that they are moist but not dripping, and folded in half. The temperature of the towels will be about 120 degree Fahrenheit. Once the towels are in place, the therapist will pull a wool blanket up to your shoulders, leaving it loose so that air can circulate around the body. The towels are left in place for 5 minutes. Next, the therapist will pull the blanket down and place a new set of hot towels over the original ones, which will have cooled. He will then flip the towels so that new ones are next to your body, and remove the old ones. Next, he will place folded cold towels, described by one practitioner as at 'gasping temperature', over the hot towels and flip the towels again. The cold towels remain in place on the chest for 10 minutes. Again, you will be covered by a blanket. During application of the cold wet towels, the therapist will place 'sine wave' (electrical) pads on either side of your spine just below the shoulders. The pads will deliver a mild electrical current to the muscles. This current feels like a buzzing or tickling sensation. It is not painful, but it should be firm. The sine wave machine will run for 10 minutes. You will be able to control the strength of the current. (when used to encourage healing after a fracture-once the bones have been set-the sine wave pads are positioned directly over the injured bone.) after 10 minutes, the therapist will remove the cold towels and reposition the pads, with one placed on the centre of the lumbar spine or lower back area and the other located just under your rib cage in the solar plexus region. The sine wave machine will then run for another 10 minutes, without the benefit of new towels. The entire process is then repeated as you lie face-down. At the end of the treatment, the therapist will rub your back down with a dry towel-sort of a 'wake-up' call for the skin and body.

Treatment Time: Each session takes about 45 minutes to one hour.
Treatment Frequency: Depending on the condition, as many as 15 sessions may be recommended; children may require fewer treatments. For an acute condition like the flu, for example, a practitioner may suggest constitutional hydrotherapy every day for three or four consecutive days. For a chronic condition, therapy is often recommended two or three times a week. According to practitioners of constitutional hydrotherapy, the treatments are most successful when administered close together.

Hot Fomentation: These treatments are like constitutional hydrotherapy minus the electrical stimulator. They are administered in the practitioner's office, where patients with serious, chronic conditions can be monitored if need be. As you lie on your back, the therapist will place hot towels over your torso. He will then put hot towels over your torso. He will then put hot packs atop the towels, place others under your back, and cover you with a wool blanket. Herbs may be added to the hot water in the towels. This technique can also be used on specific regions of the body to relieve specific symptoms, such as menstrual cramps or PMS. Other variations include placing your feet in hot water while the hot towels are being applied to your chest, or putting a cold compress on your forehead while you are wrapped in the blankets. A rub down over the chest with a cold towel sometimes follows the hot towel application.

Treatment Time: Each session lasts about one hour.
Treatment Frequency: Sessions may be repeated once a week or more frequently, depending on the illness under treatment.

Other Hot/Cold Treatments: Some naturopathic practitioners recommend a procedure called a 'wet T-shirt treatment' for use at home. To relieve symptoms of a cough, for example, the patient is told to stand in a hot shower long enough for a steam to build up. He then dries off, wrings out a T-shirt that has been soaking in ice water, puts it on, covers it with a wool or flannel shirt or sweater, and goes to bed under several layers of blankets. A comparable treatment for children or infants who cannot stand in a shower involves cold, moist socks covered by dry, warm socks. Many primary care physicians recommend a variation of this procedure for colds, coughs and congestion, especially in young children and infants. Parents are instructed to sit with the child in the bathroom while the running shower creates steam. After about 15 minutes in the steam, the parent then holds the child's face in front of the opened freezer compartment of the refrigerator, while encouraging the child to inhale the cold air. If the weather is cold enough, a brief trip outside, holding the child in a blanket, may achieve the same effect. This process should be repeated several times.

Aquatic Physical Therapy: This form of water-supported exercise is recognised by many insurance providers. Still known as hydrotherapy in Europe, it is recommended for patients whose medical condition causes pain during physical therapy outside of water, or whose rehabilitation will be aided by a water environment. Procedures range from immersion in a whirlpool bath to movement therapy in a swimming pool.

WATSU: This unique form of therapy has been described as water ballet, though it is wholly passive on the patient's part. The therapist holds, floats, tosses, or stretches patients through the water in a specific sequence of movements. The effect is somewhat like aquatic yoga combined with manoeuvres from shiatsu, or Chinese massage.


Constitutional Hydrotherapy: The practise of constitutional hydrotherapy originated with Otis G. Carroll in 1908. To earlier forms of water treatment, Carroll added electrical stimulation, shortening the application times for the hot and cold packs. He believed that this regimen could change the constitution of the cells in the body. Today, its advocates claim that the treatments detoxify the system and bring it back into balance. They believe that alternate applications of heat and cold can increase the body's white cell count, and hence boost its ability to fight infection and disease. They claim that, since the nerves in the skin are connected to the central nervous system, the hot/cold treatments can also help reestablish normal neurological functions. They add that the therapy can be expected to improve circulation and metabolism in the digestive organs and increase the amount of oxygen in the blood stream. The mild electrical current administered during the treatments is believed to promote the production of digestive enzymes by stimulating the smooth muscle in the lining of the stomach and the ducts of the pancreas, gallbladder and liver. Despite all these purported benefits, many patients feel worse, rather than better, after a course of these treatments. Advocates of constitutional hydrotherapy (and hot fomentation) explain this reaction as a 'healing crises' said to occur when the body becomes strong enough to throw off harmful toxins. For example, if constitutional hydrotherapy is used to cure a sinus infection, the body is said to eliminate its toxins through the mucous in the sinuses, thus causing what appears to be a relapse. Patients also tend to experience a mild, flu-like feeling for a couple of days as the body restores itself. On the plus side, its advocates promise that once the body has experienced a healing crisis it won't succumb to the same illness as severely in the future. Critics of these treatments suggest that almost any activity, from taking a cold shower to getting too much sleep, can boost the body's infection-fighting T cells. They add that although many of the treatment's actions may sound plausible, there's no evidence that they actually occur.

Hot Fomentation: Some practitioners believe that hot fomentation aids the body in destroying cancer cells, viruses and bacteria, all of which have a narrow tolerance to high temperatures. (The goal when treating cancer, for instance, is to raise the body temperature to 102 to 105 degrees for 30 to 45 minutes.) Other practitioners recommend these heat treatments to relieve fever. The theory here is that fever-reducing medications disrupt the body's normal regulatory mechanisms, ultimately destroying its ability to bring the fever to an end. By raising body temperature to between 101 and 103 degrees, hot fomentation is said to re-establish the natural fever cycle, allowing the body to break the fever itself.

Aquatic Physical Therapy: The uplifting effect of immersion in water can relieve the pain of a compression injury in a joint or the spine. Hydrotherapy can also improve circulation and ` swelling or fluid build-up in the legs. And exercising in water can help patients achieve a more efficient heart rate.

WATSU: Watsu, created by Harold Dull, at the School of Shiatsu and Massage in Harbin Springs, California, has sparked controversy among physical therapists. Although some consider its methods helpful for some patients, others find its intimate, though non-sexual, nature uncomfortable. It is typically recommended to relieve stiffness and tension.

Who Should Avoid This Therapy?

Hot/cold treatments, including constitutional hydrotherapy and hot fomentation, are ill advised for anyone suffering from loss of sensation in a part of the body to be exposed to the treatments. You should also avoid this type of therapy if you have asthma, kidney disease, a weak heart, a bleeding disorder or an organ transplant. Likewise, frail people such as the elderly may not tolerate the treatments well. Constitutional hydrotherapy, in particular, is inadvisable for people with metal implants or pacemakers, due to the electrical stimulation used during treatment. Aquatic physical therapy and techniques such as Watsu are best avoided if you have inner ear problems, a disorder of the spine, multiple sclerosis (in warm water), an acute orthopaedic injury or unstable joint, or a condition that makes breathing in water difficult. Avoid Watsu, in particular, if you have a head injury or a dislike of intimate contact.


The 'healing crisis' often encountered in constitutional hydrotherapy and hot fomentation is an unpleasant, but short-lived, side-effect. Procedures that leave one tightly wrapped in towels and blankets sometimes trigger feeling of claustrophobia in those prone to the problem. The heat used in many of the treatments can also prove overwhelming to some patients. For the majority, however, these treatments are usually harmless.