Hydrotherapy Evidence

safety

The safety of various hydrotherapy techniques has not been well studied.
Use cautiously in young children, the elderly, or people with weakened immune systems or implanted medical devices, such as pacemakers, defibrillators, or liver infusion pumps.
Use aquatic physical therapy cautiously in people with inner ear problems, spine disorders, multiple sclerosis (in warm water), orthopedic injuries, unstable joints, or any other conditions that make breathing difficult.
Use Watsu® cautiously in people with head injuries and in people who dislike intimate contact.
Use forms of hydrotherapy that expose the patient to cold temperatures cautiously in people with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, irritable bladder, urinary tract infections, diabetes, or vascular occlusion (blood vessel blockage).
Vigorous use of water jets should be used cautiously in people with fractures, known blood clots, bleeding disorders, or severe osteoporosis.
Use cautiously in people taking sedatives, diuretics, drugs that affect the immune system, or drugs that affect blood sugar.
Use cautiously in people with high or low blood pressure or in those taking drugs that affect blood pressure.
Use cautiously in people with hemorrhoids, polycythemia rubra vera (a bone marrow disease), colitis (inflamed colon), open burns or sores, urinary tract infections, irritable bladder, sciatica (pain or weakness in the leg), enlargement of the thyroid, raised intraocular (eye) pressure, or during menstruation.
The temperature of water should always be carefully monitored, particularly when treating people with impaired temperature sensitivity, such as that caused by neuropathy.
People using psychotropic drugs or alcohol should avoid use of saunas and hot tubs.
Hot tub use should be avoided in people with seizures and during early pregnancy.
Sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy should be avoided, particularly in people with heart disease, lung disease, varicose veins, lymphostasis, edema, infections, or during pregnancy. Warm-temperature therapies can cause dehydration or low blood sodium levels, and adequate hydration and electrolyte intake should be maintained.
People with a known allergy or hypersensitivity to water should avoid use of hydrotherapy.
Dermatitis (skin irritation) 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 people 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.
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. People with known illnesses should consult their physicians 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.
 
Arthritis (Grade: B)
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, additional studies are needed in this important area.
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. 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 in people with anorectal conditions, particularly for symptom relief. Sitz baths are offered to people in many hospitals. However, controlled studies are needed to determine the effectiveness and optimal use of sitz baths.
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 people 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.
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.
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 preliminary evidence suggesting that hydrotherapy may positively affect blood chemistry in diabetes mellitus. However, there is insufficient evidence on which to base conclusions for its use or to determine realistic expectations of benefit.
Ear infection (Grade: C)
There is limited evidence in this area. One study has shown that treatment with thermal baths cures secretory otitis media (ear infection) and reduces number of infections of the primary airways. Further research is warranted before a conclusion can be made.
Endurance (Grade: C)
There is preliminary evidence suggesting that hydrotherapy may improve endurance performance. A single study found an improvement in endurance performance after a sauna bath. Further research is required before any definite conclusion can be drawn.
Fever (hyperthermia) (Grade: C)
There is preliminary evidence supporting the use of hydrotherapy in hyperthermia (elevated body temperature). A single study concluded that cool water reduces heat strain and increases work performance in hot environments. Further studies are required before a definite conclusion can be drawn.
Fibromyalgia (Grade: C)
Research results are mixed. Further well-designed trials are needed before a conclusion can be made.
Heart failure (Grade: C)
Research results are mixed in this area. One human study suggested that repeated sauna treatment may reduce the risk of arrhythmias, while another suggested that this therapy may improve heart failure-related symptoms and heart rate response to exercise. Further well-designed research is needed before firm conclusions can be drawn.
High blood pressure (Grade: C)
There is preliminary evidence supporting the use of hydrotherapy for high blood pressure. A study has found hydrotherapy useful in people with high or medium blood pressure. Further research is warranted in this area.
Insomnia (Grade: C)
Preliminary research on hydrotherapy for insomnia shows inconclusive results. A single study has shown that sitting in baths of warm water had positive effects on sleep parameters. Further research in this area is warranted.
Jellyfish stings (Grade: C)
Preliminary evidence supports the use of hot water for bluebottle stings over ice packs. However, further research is necessary before conclusions can be made.
Labor/birth (Grade: C)
There is preliminary research on 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.
Muscle soreness (Grade: C)
Preliminary research suggests that using ice water may not be effective in reducing symptoms of delayed-onset muscle soreness (DOMS). Further research is warranted in this area.
Neck pain (Grade: C)
There is limited evidence supporting the use of hydrotherapy in chronic neck pain. A study concluded that pulsed electromagnetic field therapy was superior to spa therapy in the treatment of chronic neck pain, although both were more cost effective than routine care. Further research is warranted in this area.
Pelvic inflammatory disease (Grade: C)
There is insufficient research in this area to make a conclusion. Pelvic inflammatory disease is a potentially serious medical condition that should be evaluated by a qualified, licensed healthcare provider.
Post-menopausal bone loss (Grade: C)
There is preliminary evidence suggesting that aquatic exercises, like other forms of weight-bearing exercises, may help increase bone mass.
Pressure ulcers/wound care (Grade: C)
Hydrotherapy has been used in people 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 preliminary evidence from two case series studies suggesting that hydrotherapy may be beneficial in psoriasis. However, there is insufficient research in this area to make a firm conclusion.
Rett's syndrome (Grade: C)
Limited evidence suggests that hydrotherapy may improve Rett's syndrome. Larger trials are required before any firm conclusion is drawn.
Skin conditions (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.
Spinal muscular atrophy (Grade: C)
Some evidence suggests that hydrotherapy, when added to routine physiotherapy, may be of benefit in spinal muscular atrophy. However, there is insufficient research in this area to make a conclusion. More studies are needed.
Traumatic brain injury (Grade: C)
There is insufficient evidence supporting the use of aquatic exercises in people with brain injury to enhance health-promoting behavior. More research is warranted in this area.
Vaginitis (Grade: C)
There is insufficient evidence to support the use of balneotherapy in chronic vaginitis. A single study has found balneotherapy to be effective in chronic vaginitis in groups of childbearing age. Further research is required before any definite conclusion can be drawn.
Varicose veins (Grade: C)
Preliminary research reports improved symptoms and blood flow in people 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.