In Hot Water

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For millennia, humans have sought the healing power of immersion. But is hydrotherapy a wash?

Giancarlo La Giorgia

To date, the evidence on hydrotherapy — the use of water, internally or externally, for a  therapeutic outcome — is mostly inconclusive. Still, claims of remedies for everything from acne, arthritis and alcoholism to psoriasis and syphilis have long been attributed to the waters at locales around the world. In Europe, the philosopher Friedrich Nietzsche and the composer Johannes Brahms took the waters at Baden-Baden in Germany, while England’s Queen Anne did the same at Bath.

During the late 19th and early 20th centuries, perhaps the heyday of cure-seeking travel, people would venture from all over the world to the spas such as Vichy, France, where the naturally effervescent water has been touted as a digestive aid since ancient Roman times — or to the Dead Sea, where the super-salty water is said to heal various skin and rheumatic diseases. Today, bottled Vichy mineral water is sold at supermarkets, while Dead Sea salt and mud are added to therapeutic baths and scrubs.

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“Hydrotherapy, in one form or another, is used by people all the time in their daily routines,” says Chandra Kastern, executive director of the Canadian College of Massage and Hydrotherapy’s Calgary campus. “It could be as simple as a hot bath or an ice pack for an injury and as complex as receiving a body scrub and seaweed wrap at a spa,” she says.

Kastern points out that hydrotherapy administered in a spa environment is generally applied for aesthetic purposes, with fringe therapeutic benefits. In her opinion, however, mineral-salt baths can be actively beneficial since soaking in hot spring or salt water allows the body to absorb essential minerals through the skin. “This can help the body detoxify, assist with fluid retention, combat muscle pain and fatigue, improve circulation — and therefore immunity and metabolism — as well as aid in the repair of tissue and act as a natural antibiotic,” she says.

The curative properties of mineral water baths may be articles of faith among the spa set, but the medical community remains largely unconvinced. “Unfortunately, the evidence shows that you can’t cure rheumatoid arthritis by soaking in water, whether in the sea, an expensive spa or your own bathtub,” says rheumatologist Dr. Duncan Gordon, a professor of medicine at the University of Toronto and editor of the Journal of Rheumatology. He concedes that rheumatologists were originally called balneotherapists, from the Latin word for bath, because “cures” used to consist of immersion in water. But despite the historical association, he maintains that hydrotherapy “is not an area of deep study, but of deep claims.”

That said, some studies have demonstrated that an ice bath after strenuous physical activity or acute injury reduces inflammation and muscle soreness, while soaking in a hot tub can help diminish chronic muscle and joint pain. Likewise, contrast hydrotherapy (alternately heating and cooling part or all of the body) is no different from using hot and cold compresses: cold water reduces inflammation and sends blood away from the extremities to the internal organs, while hot water relaxes muscles and joints and increases circulation and sweating. “Anyone who’s ever been in a hot tub knows it feels good, and that cold water is invigorating, but hydrotherapy as a treatment for pain is like acupuncture, where the relief is only temporary,” Gordon says.

Fellow University of Toronto professor Dr. Charles Godfrey, who teaches in the division of physical medicine and rehabilitation, supports the use of hydrotherapy in a strictly rehabilitative context: performing a prescribed set of exercises in a swimming pool or tub. “Exercising in warm water helps reduce spasticity in people with neuromuscular disorders, and the buoyancy that water provides makes exercise easier on the joints,” he says.

According to Janet Holly, a physiotherapist at the Ottawa Rehabilitation Hospital, rehabilitative hydrotherapy can involve stretching exercises or strengthening exercises and hands-on mobilizations of the injured extremities. “If a patient has sustained a knee injury and has only 70% flexibility in the joint, submersion in warm water allows the tissues to stretch better, while also putting less weight on the joint. The result is that most of the remaining flexibility can be brought back,“ she says.

Doctors may prescribe hydrotherapy, but a prescription is not necessary. Some patients,  however, are advised to approach hydrotherapy with caution, says Godfrey. For cardiovascular disease patients, this treatment isn’t absolutely forbidden, as long as the condition is stable. Nevertheless, it’s a good idea to keep heart medication nearby as a precaution, particularly nitroglycerin, angiotensin-converting enzyme (ACE) inhibitors, or any other vasodilator (medication that reduces blood pressure). But any therapy involving prolonged exposure to high-temperature water should be avoided by these patients, since it runs the risk of increasing blood pressure to dangerous levels.

The water in some hot tubs routinely reaches 40ºC (104ºF) or even higher — enough to cause heat stroke, which is why 10 to 15 minutes is the most you should spend in these bubbling baths. Pregnant women should not bathe in water higher than 100ºF since high temperatures can harm the fetus. Additionally, there’s a risk of organ damage in small children and damage to the brains of stroke and head injury patients. When in doubt, it’s best to refer to a physician.

At Holly’s hospital, a typical hydrotherapy routine lasts 30 to 45 minutes: a five-minute warm-up, 10 minutes of mobilizing (stretching), 10 to 15 minutes of strengthening, 10 to 15 minutes of aerobic activity and, if time allows, a five- to 10-minute cool-down. Usually, there are five to eight people per pool, with a therapist in the water alongside the patients, and an assistant on deck to help in case of problems. Once patients are strong enough and sufficiently experienced in their rehabilitation routines, they can perform them on their own in the community setting. Holly recommends doing these exercises in a full-size swimming pool, preferably heated, either at home or during the free swim period at a public pool. “Whirlpools or bathtubs are only useful for wrist or ankle rehab. For full-body exercises, you need shoulder-depth water to have enough room to manoeuvre,” she says.

Furthermore, Godfrey cautions people with skin disorders, weak immune systems and those who have or are susceptible to bladder and bowel infections to avoid hydrotherapy. Also, he says, whether you use a public or private pool, salt-water or UV light purification is preferable to chlorinated water, since chlorine is toxic and may cause skin and eye irritation, as well as respiratory problems after frequent exposure.