Hydrotherapy

safety

The safety of various hydrotherapy techniques is not well studied.
Sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy should be avoided, particularly in patients with heart disease, lung disease, or during pregnancy. Warm temperature therapies can cause dehydration or low blood sodium levels, and adequate hydration and electrolyte intake should be maintained. Cold temperatures may worsen symptoms in patients with Raynaud's disease, chilblains, acrocyanosis, or erythrocyanosis.
The temperature of water should always be carefully monitored, particularly when treating patients with impaired temperature sensitivity, such as neuropathy. High temperatures or hydrotherapy involving electrical currents should be avoided in patients with implanted medical devices such as pacemakers, defibrillators, or hepatic (liver) infusion pumps.
Skin irritation (dermatitis) may be caused by contact with contaminants or additives in water (such as essential oils or chlorine). Skin infections may occur if water is not sanitary, particularly in patients with open wounds. There are several reported cases of dermatitis and bacterial skin infections (such as with Pseudomonas aeruginosa or Staphylococcus aureus) associated with hot tub or whirlpool use.
Vigorous use of water jets should be avoided in patients with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy.
Although water births are used popularly, safety has not been well studied. The fetal effects of prolonged labor in high or low temperature waters are not known.
Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.

evidence table

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 (Grade: B)
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.
Anorectal lesions (hemorrhoids, anal fissures) (Grade: C)
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.
Skin bacteria (Grade: C)
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.
Arthritis (Grade: C)
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.
Atopic dermatitis (Grade: C)
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.
Burns (Grade: C)
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.
Chronic obstructive pulmonary disease (COPD) (Grade: C)
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.
Chronic venous insufficiency (CVI) (Grade: C)
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.
Common cold (Grade: C)
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.
Diabetes mellitus (Grade: C)
There is insufficient research in this area to make a recommendation.
Claudication (painful legs from clogged arteries) (Grade: C)
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.
Labor/birth (Grade: C)
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.
Pelvic inflammatory disease (PID) (Grade: C)
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.
Pressure ulcers/wound care (Grade: C)
Hydrotherapy has been used in patients with pressure 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.
Psoriasis (Grade: C)
There is insufficient research in this area to make a recommendation.
Spinal muscular atrophy (Grade: C)
There is insufficient research in this area to make a recommendation.
Varicose veins (Grade: C)
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.