Long-time readers of this blog know that I’m a huge advocate for nature therapy. In fact, the biggest problem I have with nature therapy? Not enough people know about it… including hydrotherapy.
I’ve made it my mission to change that by writing informative deep dives on the various diverse kinds of nature therapy out there: topics like gardening for dementia, therapeutic horticulture (and horticultural therapy!), pet therapy, adventure therapy, blue care, ecotherapy, care farms, forest bathing, and more. There’s so much to explore in the wide world of nature therapy, and I’m excited to share it all with my readers.
Today, we’ll be tackling the question: what is hydrotherapy? As you might have guessed, it’s a kind of nature therapy, but what does it look like? How does it work in our brains and bodies? And who is it for? Read on for the answers to all these questions and more.
Part of the “blue care” family
Hydrotherapy, aka blue therapy, water therapy, or aquatic therapy, is a subset of blue care, a sub-category in the nature therapy family. Blue care is the simple but powerful idea that water is medicine.
More specifically, blue care posits that spending time “near, in, on, and under healthy wild, domestic, urban, and virtual waters,” as the Blue Mind Rx mission statement puts it, can be hugely beneficial to our mental and physical health. Just like my efforts to share information about nature therapy as a “green Rx,” blue care is a “blue Rx,” a fantastic natural prescription that should be in every doctor and patient’s natural first aid kit.
As I share in more detail in my blog on blue care (which is definitely worth a read if the concept is new to you), time spent in and near water has been found to reduce chronic stress and anxiety, conditions which can exacerbate and even cause a variety of physical conditions including ulcers, colitis and heart disease. Time spent in and near water can help patients manage problems like depression, trauma, addiction, grief and PTSD. And that time does wonders for fostering essential human qualities like happiness, play, creativity, awe and empathy.
What is hydrotherapy?
So now we know hydrotherapy is part of blue care—but what is it, exactly? Essentially, it’s the use of water as therapy. Hydrotherapy (plan water) is sometimes called balneotherapy (for medical mineral waters) or spa therapy; the use of climatic factors for therapy is called climatotherapy. Types of hydrotherapy include saunas, steam baths, foot baths, contrast therapy, hot and cold showers, watsu, sitz baths, compresses, wraps, hot fomentation, and more.
We can easily see what kinds of blue care hydrotherapy isn’t: it’s not any of the more active or adventure-therapy based options like board sports, scubaing, boating, fishing, water skiing, wind surfing, and more. Instead hydrotherapy uses water in a more specifically targeted way—one that you don’t need to travel to the ocean or lake to experience! So if a day in the spa sounds like your idea of a day at the beach, hydrotherapy might be the right fit for you.
Running hot and cold
Part of what makes hydrotherapy unique in the blue care family is its specific focus, which includes not just water but the temperature of water. The idea is that hot and cold water each have specific benefits, and using them either separately or in combination will produce different results in the body.
With cold water, the chilly temperature causes superficial (or surface-level) blood vessels to constrict, which moves blood flow away from the surface and towards the vital organs (e.g., the heart, the kidneys, the liver). In contrast, hot water causes superficial (or surface-level) blood vessels to dilate, which activates sweat glands and helps remove waste from the body through the pores. And when used in combination, in an alternating fashion, hot and cold water are thought to help decrease inflammation while stimulating circulation and lymphatic damage.
Like almost every type of nature therapy, hydrotherapy has been used intuitively as a therapeutic tool long before we had the science to back it up. We’ve all read about the ancient Greeks and Romans and their baths, and Swiss monks have used thermal waters to help heal sick or disabled patients since at least the 13th century, as did folks in Japan at their natural hot springs. These ancient remedies were thought to promote relaxation and improved circulation, decrease pain, increase flexibility, and have positive effects on wide-ranging problems such as chronic pain, skin problems, menstrual disorders and constipation.
What does the science say?
These days we have way more data to back up our findings—and while the field is still growing, the research so far definitely seems to bolster the claim that hydrotherapy is an extremely useful tool for health and wellbeing.
A 2017 randomized controlled trial took a look at older women with knee osteoarthritis and found that the group undergoing hydrotherapy “had better performance for knee flexor and extensor strength, knee flexor power, and knee extensor endurance,” concluding that “older women with knee osteoarthritis are likely to have benefits” from the therapy.
A 2018 study looked at acupuncture combined with hydrotherapy in diabetes patients with mild lower-extremity arterial disease, finding that the two therapies in combination exerted “a measurable benefit in disease-specific physical functions and health-related quality of life… the combined therapy regulates the inflammatory process and oxidative stress and contributes to immune protection.”
A 2014 systematic review and meta-analysis looked at the effectiveness of hydrotherapy in the management of fibromyalgia syndrome, finding a “moderate-to-strong evidence for a small reduction in pain” while also suggesting more studies with larger sample sizes are needed with focus on long-term results.
A 2018 study looked at the benefits of hydrotherapy for patients with spinal cord injuries and found it improved “underwater gait-kinematics, cardiorespiratory and thermoregulatory responses” for those with spinal cord injuries, as well as reducing spasticity.
A 2010 study looked at the impact of hydrotherapy on anxiety, pain, neuroendocrine responses, and contraction dynamics during labor and found that “hydrotherapy was associated with decreases in anxiety, vasopressin and oxytocin levels at 15 and 45 min,” ultimately concluding that “hydrotherapy during labor affects neuroendocrine responses that modify psychophysiological processes.”
A controlled trial in 2014 looked at hydrotherapy as a recovery strategy after exercise, wherein 34 participants visited a gym and were assigned to either a hydrotherapy group (experimental) or rest in a bed (control) after completing a spinning session. The analysis saw impacts on diastolic blood pressure, heart rate, and self-perceived fatigue in the hydrotherapy group, concluding that “our results support that hydrotherapy is an adequate strategy to facilitate cardiovascular recovers and perceived fatigue, but not strength, after spinning exercise.”
And a randomized crossover-controlled pilot trial published just this year took a look at whether hydrotherapy impacted behaviors related to mental health and well-being for children with Autism Spectrum Disorder (ASD). The study found that kids improved in a number of key areas, concluding that “hydrotherapy may enhance behaviours impacting mental health and well-being of children with ASD and could be considered a beneficial therapy option.”
The jury’s in: For medical issues as diverse as osteoarthritis, diabetes, fibromyalgia, autism, spinal cord injuries, exercise recovery, and painful labor, hydrotherapy is proving itself to be the kind of therapeutic intervention that really holds water!
What’s going on at a cellular level?
So the results are clear—hydrotherapy is hugely helpful for a wide variety of medical concerns. But what’s actually happening to our bodies when we engage in hydrotherapy? A fascinating integrative review conducted by Korean researchers in 2019 sheds some light on the details.
Researchers found that the physiological changes induced by warm water immersion were “vasodilation, increased blood flow, reduction of arterial stiffness, vascular endothelial function, oxygenation, and decreased sleep-related stress.” They found that immersion in warm water actually created physiological changes “similar to the cardiovascular effects of physical activity… Exercise has a variety of effects, particularly the improvement of cardiovascular function, increased cardiac output, decreased atherosclerotic plaque formation, decreased vascular resistance, increased organ perfusion, improved insulin-sensitivity, increased oxygen carrying capacity, and improved plasma lipid profile.” It’s no wonder that folks flock to the sauna after (or instead of) exercise!
And on the cold water front, they found that a dip in cold water “reduced the nerve conduction velocity, which raised the pain threshold to promote pain control. Moreover, it also increased the blood pressure and heart rate variability, the latter of which is an indicator of sympathetic activity.” Sounds like a good reason to take a dip to me!
What different kinds of hydrotherapy are there?
There are so many ways to get your hydrotherapy fix, but here are just a few of the most popular ones.
Watsu massage. Watsu is a type of aquatic massage characterized by one-on-one sessions with a therapist. The “patient” floats comfortably in a warm water pool while the therapist uses various gentle massage techniques on them—as you might guess, it’s wonderful for relaxation!
Sitz bath. Two tubs of water, one warm and cool, sit near one another; the “patient” sits in one tub with their feet in the other and alternates. This one is especially helpful for hemorrhoids, as well as PMS and other menstruation problems.
Steam bath or Turkish bath. Patients relax in a steam room filled with hot, humid air, which is said to help the body release impurities.
Sauna. In contrast to a steam bath, the sauna is filled with dry, hot air, which helps promote sweating—it’s a passive heat therapy. A prospective cohort study of 1688 middle-aged men and women followed up for 15 years found that sauna bathing is associated with reduced cardiovascular mortality, as well as reduced stress, inflammation and pain—the more minutes per week of sauna use, the less mortality from heart disease, with no threshold effect!
Compresses. The athletes among us know this one well: towels soaked in warm and/or cool water are placed on specific parts of the body—especially knees, ankles, wrists and shoulders—before or after exercise. . Cool compresses reduce swelling and inflammation, while warm ones ease sore tissues and promote blood flow.
Contrast hydrotherapy. As the name suggests, this technique involves alternating between hot and cold water on the body. Starting with comfortably hot water and moving to cooling water, usually in a shower, patients repeat this process 3 times, increasing heat and decreasing the cold temperatures slightly each time, and end the cycle with cold water. It’s used to manage musculoskeletal injuries and chronic pain, as well as plantar fasciitis, shin splints, carpal tunnel syndrome, tennis elbow, and Achilles tendinitis.
Pool exercises. Unlike water aerobics, this tends to be much more slow and controlled, often done with the help of a physiotherapist. It allows patients to exercise without fighting gravity and with gentle resistance, which is excellent for those with musculoskeletal conditions, in need of rehabilition, or just extra body weight.
Balneotherapy. This is what the ancient Greeks did: sitting in mineral waters or hot springs. It’s excellent for relaxation as well as for easing painful conditions like arthritis, chronic low back pain, fibromyalgia and certain skin conditions.
Thalassotherapy. From the Greek word thalassa, meaning “sea,” thalassotherapy is all about using the power of the sea to heal. This includes all those folks who rushed to the Dead Sea to heal for so many years, as well as showers with warm seawater, the application of sea mud or algae, seaweed wraps, and even the inhalation of sea fog!
The prodigious research that’s been published in the last decade or so makes it clear: those ancient Greeks and Romans sitting in their hot springs had the right idea! Hydrotherapy is a great fit for a wildly varied set of medical problems, from the mental to the physical, and there’s so many kinds to explore. So why not take a dive and give hydrotherapy a try?