Hydrotherapy, Balneotherapy

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Hydrotherapy, Balneotherapy

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

Background

Hydrotherapy (also called balneotherapy) involves the use of water in any form or at any temperature (steam, liquid, ice) for the purpose of healing. Water has been used medicinally for thousands of years by many cultures, including ancient China, Japan, India, Rome, Greece, the Americas and the Middle East. Modern hydrotherapy can be traced to the development of "water cure" spas in 19th century Europe.

Today, a wide variety of water-related therapies are used:

• Immersion in a bath or body of water (for example, the ocean or a pool)

• Placement of wet towels (hot or cold) over the skin

• Douches with watering cans or hoses

• Water birth

• Arm and foot baths

• Rising-temperature hip baths

• Sitz baths (soaking in hot or cold water below the hips)

• Steam baths or saunas

• Rubbings with cold, wet towels

• Spa-, hot tub-, whirlpool- or motion-based hydrotherapy

• Purifying mineral baths with additives such as sea salt or essential oils

• Dead Sea water treatments

• Some therapies include the use of water as only one aspect of the technique:

• Nasal irrigation

• Colonic irrigation or enema

• Physical therapy in pools (Physical therapy or exercise in water makes use of the ability to float and resistance of water against motion.)

• Drinking of mineral water or "enriched" water

• Steam inhalation or humidifiers

• Coffee infusions

• Aromatherapy or baths with added essential oils

• Water yoga

• Water massage (including Watsu, a form of bodywork conducted in pools)

Theory

Various theories have been proposed to explain how hydrotherapy works, depending on the specific technique used. Some hydrotherapy practitioners and textbooks suggest that water treatments and wraps may detoxify the blood, stimulate blood circulation, enhance the immune system and improve digestion. Scientific research is limited in these areas.

Some theories are based on the observation that applying warmth to the skin causes vasodilation (expansion of blood vessels), which brings blood to the body's surface. Warmth can also cause muscle relaxation. Cold temperatures have the opposite effect.

Evidence

Scientists have studied hydrotherapy for the following uses:

Unproven Uses

Hydrotherapy has been suggested for many uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using hydrotherapy for any use.

Potential Dangers

The safety of some hydrotherapy techniques is not well studied.

Sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas or other types of hydrotherapy should be avoided, particularly by patients with heart disease or lung disease or by pregnant women. Warm temperatures can lead to dehydration or low blood sodium levels, and hydration and electrolyte intake should be maintained. Cold temperatures may worsen symptoms in people with circulatory disorders, such as acrocyanosis, chilblains, erythrocyanosis or Raynaud's disease.

Water temperature should be carefully monitored, particularly for patients with temperature-sensitivity disorders, such as neuropathy. People with implanted medical devices such as pacemakers, defibrillators or liver infusion pumps should avoid high temperatures or therapies that involve electrical currents.

Contact with contaminants or additives in water (such as essential oils or chlorine) can irritate the skin. 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 after hot tub or whirlpool use.

People with fractures, blood clots, bleeding disorders, severe osteoporosis or open wounds and pregnant women should avoid vigorous therapy with water jets in. Although water births are popular, safety is not well studied. The effects of prolonged labor in hot or cold water are not known.

Hydrotherapy should not delay the time it takes to see a health care provider for diagnosis or treatment with more proven techniques or therapies. And hydrotherapy should not be used as the sole approach to illness. Consult with your primary health care provider before starting hydrotherapy.

Summary

There are many hydrotherapy techniques used for a wide variety of health conditions. Early evidence suggests that regular use of hot whirlpool baths with massaging jets improves the duration and severity of low back pain. Additional research is necessary to make a strong recommendation. There is no conclusive evidence for any other condition.

Prolonged treatments, particularly in extreme temperatures, should be avoided. Skin irritation or bacterial infections may result from additives or contaminants in the water. People with fractures, blood clots, bleeding disorders, severe osteoporosis or open wounds and pregnant women should avoid vigorous therapy with water jets. Although water births are popular, safety has not been well studied. Hydrotherapy should not be used as the sole approach to any illness. Consult with your primary health care provider before starting hydrotherapy.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

Resources

1. An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics

2. A division of the U.S. Department of Health & Human Services dedicated to research

Selected Scientific Studies: Hydrotherapy, Balneotherapy

Natural Standard reviewed more than 500 articles to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

1. Beamon S, Falkenbach A, Jobst K. Hydrotherapy for asthma. Cochrane Database Syst Rev 2001;(2):CD001741.

2. Constant F, Collin JF, Guillemin F, et al. Effectiveness of spa therapy in chronic low back pain: a randomized clinical trial. J Rheumatol 1995;22(7):1315-1320.

3. Constant F, Guillemin F, Collin JF, et al. Use of spa therapy to improve the quality of life of chronic low back pain patients. Med Care 1998;36(9):1309-1314.

4. Eckert K, Turnbull D, MacLennan A. Immersion in water in the first stage of labor: a randomized controlled trial. Birth 2001;28(2):84-93.

5. Embil JM, McLeod JA, Al Barrak AM, et al. An outbreak of methicillin resistant Staphylococcus aureus on a burn unit: potential role of contaminated hydrotherapy equipment. Burns 2001;27(7):681-688.

6. Hall J, Skevington SM, Maddison PJ, et al. A randomized and controlled trial of hydrotherapy in rheumatoid arthritis. Arthritis Care Res 1996;9(3):206-215.

7. McIlveen B, Robertson VJ. A randomised controlled study of the outcome of hydrotherapy for subjects with low back or back and leg pain. J Manip Physiol Ther 1998;21(6):439-440.

8. Mcllveen B, Robertson VJ. A randomised controlled study of the outcome of hydrotherapy for subjects with low back or back and leg pain. Physiotherapy 1998;84(1):17-26.

9. Meldrum R. Survey of Staphylococcus aureus contamination in a hospital's spa and hydrotherapy pools. Commun Dis Public Health 2001;4(3):205-208.

10. Nikodem VC. Immersion in water in pregnancy, labour and birth. Cochrane Database Syst Rev 2000;(2):CD000111.

11. Penny PT. Contact dermatitis due to BCDMH in a hydrotherapy pool. Occup Med 1999;49(4):265-267.

12. Verhagen AP, de Vet HC, de Bie RA, et al. Balneotherapy for rheumatoid arthritis and osteoarthritis. Cochrane Database Syst Rev 2000;(2):CD000518.

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Last updated:	August 21, 2006