Hydrotherapy General Rules of Hydrotherapy Take a full case history to rule out contraindications.

Check for cardiac problems or other circulatory issues. Determine the overall state of health (mental, physical, emotional). People with diabetes should not be treated. Take the client's temperature before beginning treatment to determine temperature of treatment. Ask them what is their normal temperature. If they are above normal, use less heat. You may also want to take their pulse and respiratory rate to use as a guideline during the treatment. Always thoroughly explain the treatment before beginning. Include the procedure, length of session, and any other details. Be sure they understand everything and are 100% comfortable will all aspects of treatment. Stay with the client at all times or have an emergency signal such as a bell (be sure it can be heard above anything else). You can also use a baby monitor in the room. Provide a clean room with adequate temperature control to insure the client does not become chilled or too hot (depending on the treatment) Moderation is the key to a positive treatment. Hydrotherapy can be exhausting and dehydrating to the body. Too much can cause adverse reactions. Keep fresh drinking water available at all times and encourage them to drink regularly. Watch for adverse reactions and stop immediately. General Contraindications/Cautions Please consult the referring physician whenever uncertain about any condition or response. Cancer - Caution is advised when treating clients with cancer. It is best to work with the consent of a physician. Some physicians may not be aware of the effects of hydrotherapy. Hemorrhage- Caution is advised when treating a client who has

a tendency to hemorrhage. Applications of heat and cold which cause vasodilation increase the possibility of hemorrhage. Decreased Sensation- Any condition in which the client has a decrease in sensitivity of the skin Hydrotherapy is contraindicated as they may not be able to feel if the skin is too cold or hot. Weakness -Hydrotherapy may be contraindicated in a client that is weak as a treatment may make the weakness worse. Skin lesions- Applications are contraindicated in the case of broken skin or other skin irritation that may be exacerbated by hot or cold. Skin lesions such as pustules, papules, blisters that are infected may rupture due to increased vasodilation and are contraindicated. Pregnancy - Full body hot applications to a pregnant woman are contraindicated as they may be associated with an increased incidence of birth defects. This contraindicated the use of hot tubs and other steady- temperature hot full body baths as well as local applications of heat to the abdomen. Tuberculosis - Full body hot baths may spread tuberculosis and is contraindicated. Anemia- Full body application of heat increases cellular demands for oxygen that cannot be supplied if the client is anemic. Diabetes Mellitus - Advanced diabetes, especially Type I (juvenile onset) can decrease the client's ability to sense tissue damage especially in the lower extremities. The vascular damage caused by this disease also decreases blood flow to tissues. Heat is contraindicated in these areas. Consult the physician. Heart disease - Heat and cold applications that increase the heart rate and force of contraction are contraindicated in heart disease as it may overwork an already weakened heart. Hypertension - Heat and cold applications that increase the heart rate are contraindicated due to the stress on the heart. Peripheral vascular disease - Athlerosclerosis and arteriosclerosis clients may have weakened or blocked

arteries. Heat applications increase tissue metabolism and demand for oxygen making heat applications contraindicated. Temperature - Body temperature should not go above 104 degrees. Temperatures above this may cause tissue damage. Monitor with oral thermometer. Pulse - Heart rate should not exceed 140 beats per minute as it may over stress the heart. Monitor with lateral anterior wrist. Post treatment rest period - The body should be allowed to rest for at least a half hour after a full body hot application to allow the body to return to normal. Skin sensitivity - Cold applications are contraindicated for clients who have suffered from frostbite previously or who have hypersensitivity to cold due to Raynaud's disease or other conditions such as low blood pressure. Hypothyroidism - Cold applications are contraindicated in clients with hypothyroidism which further causes a reduction in basal metabolic rate Kidney problems - Cold is also contraindicated in kidney malfunction or disease. Inflammation - Heat applications are contraindicated in acute conditions of inflammation such as bursitis, arthritis, tendinitis, sprains and strains. Averse reaction Headaches - may occur as a result of dehydration or reaction to water temperature. Apply cold compresses to the head or back of neck and drink more water. Shivering - may occur if cold treatment is applied for too long or are not followed by appropriate warming. Vertigo - (dizziness) may occur as a result of dehydration or reaction to changes in blood pressure. Have client lay down again and get up slowly. Insomnia - may occur after an invigorating treatment. Heart palpations - may accompany dizziness or occur alone as a result of increased temperature of the body. Skin sensitivity - may be ticklish

Hyperventilation - may occur if client becomes anxious about treatment or any thing else. Fainting - may occur as a result of changes in blood pressure from treatment. Nausea - May occur as a result of detoxification or reaction to treatment. Sensitivity to water- skin irritation due to prolonged application of water. General Hydrotherapy Applications Local Heat : Applying heat to specific areas of the body such as joints, chest, throat, shoulders, spine: use moist hot compress, hot water bottle, hot pack, heating pad, Thermophore. Local cold: Apply cold to specific area of the body; use cold compress, ice bag, ice pack, ice hat, frozen bandage. Cold compress that heats the body: A cold wet cloth that is in contact with the skin and then covered with a water resistant covering will create a physiological response that warms the body from within. This is called a cold double compress. It can be applied to any area of the body or the entire body. Tonic friction: Water sponging or washing combined with some form of friction on the skin produces a tonic effect on the body Sponging: Use alcohol, water or which hazel applied to a sponge to wash the body. Baths: Body is immersed in cold, hot or tepid water. Any part of the body may be bathed; arm bath, eye bath, finger bath, hand bath, foot bath. Showers: Many kinds of water streams can be directed against the body. Steam: Water particles dispersed through the air that affects the skin, lungs and air passages. Cold steam moistens dry rooms in winter and can help prevent colds and sinus headaches. Hot steam increases body temperature and perspiration to release toxins. Sauna: Dry heat which increases body temperature and increases perspiration; May put strain on nasal and lung

passages. Shampoo: Soap and water used on one or all parts of the body

Temperatures for Hydrotherapy Treatments

Sensation on forearm when immersed in this water temperatur e Pain Pain and numbness Sensation of coldness Cool slightly cooling No sensation Comfortably warm Skin redness with prolonged immersion Tolerable for a short time Pain and possible tissue damage Pain and tissue damage

Degrees Fahrenheit

Description of Sensation

Degrees Celsius

32 32-54 55-70 71-80 81-92 body temp 93-100 101-104 105-110 111-120

Ice Very cold Cold Cool Tepid Neutral Warm Hot Very Hot Painfully Hot

0 1-13 14-21 22-27 28-32 body temp 33-38 39-40 41-43 44-49

125+

Damaging

49+

Hydrotherapy Effects of Cold and Hot Water

Cold Water

Hot Water

Primary Effect -peripheral vascular constriction -Pallor of skin, chilliness, shivering, chattering -Increases respiratory rate -Increases muscular tone -Increases blood pressure and heart rate -Increases Body Temperature -Increases Pulse rate (by 10 for every 1 degree increase in body temp) -Increases respiration rate -Increases oxygen consumption and metabolic rate -Peripheral vasodilatation -Increases Circulation -Decreases blood pressure -pH becomes

Secondary Effect Occurs if you warm up: -Peripheral vascular dilation, causing redness of skin -Decrease in respiratory rate -Decrease in blood pressure and heart rate -Muscle relaxation Generally the same as secondary effects of cold; Gradual reduction of these effects as body returns to normal.

more alkaline -Increases in excretion from kidneys General Therapeutic Effects of Cold: Reduces muscle spasm by breaking the pain-spasm-pain cycle. Reduces spasticity when muscle temperature is reduced. Used to move muscles so that they can be reprogrammed to increase motor skills as in subacromial bursitis. Relieves pain through its direct effect on nerve fibers and receptors Reduces Inflammation in the early phase Reduces swelling an edema in the acute phase Secondary effect of cold is heat ad body restores normal temperature Types of cooling: Convective: blowing air over skin Evaporative: removal of heat by using ethyl chloride sprays Conductive: contact with cooled substances such as ice packs or compresses Application Times: Application times must be adjusted to reach the area to be treated. Ligaments need more time because of the depth and type of collagen fibers. Times must be adjusted according to the size of the injured area,

the nervous system sensitivity and the amount of adipose tissue present. Start with a minimum of about 5 minutes and check to see how cold the area is. It also depends on what source of cold you use- straight ice in ziplock or gel packs. Contraindications: Previous frostbite or other hypersensitivity to cold such as Raynaud's disease or Lupus Poor kidney function Hypothyroidism - causes further reduction in basal metabolic rate Advanced Cardiovascular disease because of increase in systolic blood pressure Slows wound healing by slowing cell metabolism General Therapeutic effects of Heat: Increases the extensibility (ability to stretch) of collagen fibers Decreases chronic joint stiffness relieves pain relieves muscle spasm Increases blood flow Can assist in removal of edema and waste products from areas of injury Transmissions of Heat: Conduction: contact with warmed substances such as hot packs, paraffin Radiation: luminous and infrared lamps Conversion: Heat produced as energy from high frequency currents such as ultrasound; penetrates to deeper layers of body

Indications/Applications: Joint contractures to stretch tendons and increase flexibility; Heat and stretch fibers Rheumatoid Arthritis- heat increases the viscosity of the synovial fluid in the joint. Heat and follow with ROM exercises Chronic muscle spasm Contraindications: Any acute inflammation such as bursitis, arthritis, tendonitis, sprains or strains The baths can be a part of your session if you have the equipment at the office to do so or send the directions home with your client for continued relief. Full Bath: Warm baths ( 90-95 F) are calming and soothing to the nerves, help relieve bladder and urinary problems, mild colds. Hot Baths (100-113 F) - shocks the system; causes increased circulation especially when followed by bundling in blankets causes profuse sweating to detoxify the body wastes. Caution: Hot baths can dehydrate the body and can be exhausting. It can also lower blood pressure and result in fainting. Cold baths (55-65 F)- shocks the system initially and then slows the heart down Half Bath: between the full bath and the sitz bath; sit in water up to the navel with the legs and feet under water but the upper body out of the water. Warm half baths : 95 F for 10 minutes can be used for low blood pressure and menopausal problems. Can be accompanied by vigorous brushing of the skin and end with a cool shower. Cold half bath- 5- 15 seconds can be used to treat headaches, insomnia, nervous problems, overactive thyroid, flatulence and constipation. Sitz bath - A partial bath covering only the pelvic region: water reaches your navel. Prop your feet up on a the edge or keep your knees up and splash water onto abdomen (keep feet and knees out of water). Cover top half of body accordingly for warmth. Beneficial for the genito-urinary tract, lower abdominal area and rectum. Effects and Indications: 1. Hot Sitz bath -

Temperature: 105 F to 115 F for 2-10 minutes. Analgesic and stimulant to pelvic circulation. Used for dysmennorrhea, other menstrual problems, hemorrhoids. 2. Cold Sitz bath Temperature : 55 F to 75 F for 2-10 minutes. Increases the tone of smooth muscle of the uterus, lower bowel and rectum reducing tendency to bleed in these areas. Used in subinvoultion of the uterus, metrorrhagia (profuse bleeding from the uterus at any other time other than menstruation) atonic constipation and as a general tonic. 3. Contrast Sitz bath- Alternating hot and cold water. Hot phase 105 F to 115 F for 3 minutes; Cold phase 55 F to 85 F for 30 seconds. Increases pelvic circulation and tone of smooth muscle of the pelvic region. Used in chronic pelvic inflammatory disease, chronic prostatitis, atonic constipation and fistula following rectal surgery. Procedure: Prepare the bath at the desired temperature. Assist the patient into the bath and drape to avoid exposure. Increase and maintain temperature of water for length of time desired. Conclude hot sitz bath by cooling the bath to neutral for 3 minutes. Herbs can be added for treatment. Medicated Baths: 1. Saline Bath - Add 3-5 pounds of magnesium sulfate (salt or Epsom salt) to a full tub of water (30 gallons). Temperature - 95-97 F. 10-20 minutes. Used to relax. Cooler water and shorter time is more of a tonic. 2. Soda bath - Add 1 pound of baking soda to full tub of water (30 gallons). Temperature - 95-97 F 10-20 minutes. Alkaline. Acts as a mild antiseptic, opens pores, relieves itching and skin irritation. Good for skin conditions such as eczema, hives or insect bites. 3. Starch Bath - Add 1 pound of dry corn starch to full tub of water (30 gallons). Temperature - 95-97 F. Acts as a cooling agent relieving skin irritations, itchiness from such conditions as poison ivy, poison oak, eczema and prickly heat. 4. Epsom salt Bath Add 1 cup to 1 pound of Epsom salt to full tub of water (30 gallons). Temperature- as hot as can be tolerated for 10-20 minutes. Increases perspiration, relieves muscular fatigue, aches and pains. Used to relieve pain of arthritis, sciatica. Also used to deter cold, flu, or other infection. Contraindicated for patients in weakened conditions such as heart trouble, arteriosclerosis, diabetes. 5. Detox Bath - 1-2 cups each of Epsom salt, sea

salt, baking soda. Temperature - as hot as can be tolerated for 20-30 minutes. Used to detoxify body after deep tissue work. Used to neutralize energy picked up from doing bodywork. Practitioners will benefit from a bath every night after work! 6. Sulfur Bath - Add 1-2 ounces of potassium sulfate to a full tub of water (30 gallons). (or go to sulfur hot springs) Temperature - 95102 F 10-20 minutes. Can be relaxing or refreshing; increases perspiration, relieves breathing problems in asthma or bronchitis. 7. Oatmeal Bath - 1-2 cups finely ground oatmeal to a full tub of water (30 gallons). Temperature - 95-97 F 15- 30 minutes. Used to relieve skin irritations, relieves sunburn, chafing and windburn. 8. Apple cider vinegar Bath - Use organic, raw, unfiltered and unpasteurized with "mother" in bottle from health food store. Most regular store bought vinegar is made from wood and flavored with apples. 1-4 cups added to full bath (30 gallons). Effective in detoxifying the body and treating vaginal yeast infections. Hot Foot Bath- A local immersion bath covering the feet and ankles at temperatures ranging from 100- 110 F Uses: to decongest internal organs, relieve headaches, relieve chest congestion, relieve pelvic congestion, recommended for bladder, kidney, throat and ear inflammations; for general warming of body, to produce sweating, to help stop or treat a cold; relaxation, treat tired, sore feet. Helpful for chronically cold feet Equipment: foot tub or large container to cover feet and ankles with water, thermometer. Procedure : Have enough water to cover feet and ankles. Add water as needed to keep temperature between 100 F - 110 F . Watch temperature and modify for desired treatment. Watch for reactions such as perspiration. Pour cold water over feet to end treatment. Cool client if needed. Contraindications: Insulin dependent diabetic, frost bite, Arteriosclerosis of lower legs, loss of feeling in feet or legs. Cold Foot Bath - Used for tired feet, constipation, insomnia, headache, nosebleed and colds. Immerse feet in cold water until the cold becomes too uncomfortable of the feet feel warm. Contrast Foot Bath -alternate 1-2 minutes in hot bath, 30 seconds in cold lasting for 15 minutes ending in cold; promotes circulation in the legs, prevents varicose veins, helpful for

insomnia, headache, high blood pressure, and chronically cold feet. Poultices Poultices are used to apply remedies to a skin area using moist heat. Poultices can be kept warm by replacing it entirely or using a hot water bottle on top of pack. Do not allow poultice to become cold. Do not reuse poultices. Do not use a poultice on an open wound or burn. Preparation : Bruise or crush the medicinal parts of the plant to a pulpy mass and heat. If using dried herbs moisten the materials by mixing with a hot, soft, adhesive substance such as moist flour, corn meal, or flaxseed meal. Cleanse skin first with chamomile or mugwort tea or hydrogen peroxide. Apply directly on the skin or wrap the paste or pulp in a wet, hot cloth and wrap the cloth around to retain moisture and heat. If using an irritant herb such as mustard, keep the paste between two pieces of cloth to prevent direct contact with the skin. Use muslin or thin cotton towel to wrap herbs in and cover with towel or plastic to retain heat. Remove before poultice gets cold. A second one can be applied. After removing poultice wash the area with water or herb tea such as chamomile or mugwort. Bran Poultice: Make a paste with hot water and bran, apply as hot as can be tolerated. Used for inflammations, strains, sprains, bruises. Bread and Milk Poultice: mix together to make a paste. Used for bringing boils and abscesses to a head. Cabbage Poultice : Use raw or cooked cabbage. Can use whole leaves layered over area and covered with a hot towel. Has a warming, detoxifying and stimulating effect. Used for ulcers, varicose veins, shingles, eczema, gout, rheumatism, infection. Apply to lower abdomen to promote pelvic circulation and dissolve small fibroids and cysts in pelvic cavity. Used over the liver it will assist in breaking up congestion and detoxify (use only

10 minutes first time and work up to more as it can cause a strong detoxification reaction). Carrot Poultice: Boil carrots until soft or use raw and mash to a pulp. Mix with small amount of vegetable oil. Used for cysts, tumors, boils, cold sores, impetigo Clay Poultice: Use clay that has been cleaned of impurities. Mix with water or apple cider vinegar to make a paste. Allow to dry before removing with warm water. Use on inflammatory skin diseases, bruises, sprains, acne, drawing toxins from the skin. Mustard Poultice: Use powdered mustard and mix with water to make a paste. May need to add flour to hold paste together. Do not apply directly on skin. Wrap in muslin or cheesecloth or cotton towel between skin and paste. Cover with plastic wrap. Remove immediately if stinging or burning occurs. Use with caution. Do not use on sensitive or broken skin. Good for arthritic joints and any condition requiring increased circulation. Used to help relieve congestion, aid asthma, relieve coughs and assists in getting rid of colds and flu when used on the chest. Onion Poultice - Sautee chopped onion in oil add 1-2 tablespoons of flour and wrap in cheese cloth. Apply to area. Excellent for drawing out impurities. High sulfur content makes it good for inflamed areas. Potato Poultice : Grate raw potato, mix with boiling water. Used to reduce inflammation as in arthritis. Has soothing and cooling effect. Can be applied to boils or carbuncles.

HydrotherapyGlossary of Terms
Hydrotherapy- the use of water in any of its forms (solid, liquid, vapor) for the treatment of disease or the maintenance of health; mostly influencing nervous system, circulatory system and the skin. Ablution- Washing of the body by hand, usually using a towel or

mitt Affusion- Pouring on of water Analgesic- Decreases pain Anesthetic- Reduces local pain, diminished or loss of sensation Antipyretic- Reduction in fever Antispasmodic- Reducing muscle spasms Astringent- Agent which causes local vasoconstiction and closing of pores Balneology- The science of baths and bathing Colonics- A washing out of the colon 10-20 times over 45-60 minutes Conduction - Heat is transferred by direct contact of one heated object to another. Consensual reaction- A reflex reaction occurring on the opposite side of the body from the point of stimulation Contrast Bath- The immersion of a body part alternately in hot and cold water in one treatment Convection - transference of heat by moving currents of heated liquids of gasses as in a sauna to increase body temperature Conversion - Heat is generated by passing energy through the tissue or substances in heating of body tissues by ultrasound Cryotherapy- Therapeutic use of cold; ice massage Derivative effect- Transfer of fluid from one part of the body to another; warming the feet to draw congestion from the head: Pulling the blood or lymph out of one area of the body by increasing the amount of blood in another. DiaphoreticIncreases sweating Diuretic- Increases urine production Douche- a stream of water directed at the body or into a body cavity Ecchymosis- Discoloration of the skin due to hemmorrhage Edema- Collection or pooling of fluids in the interstitial tissues Effusion- Collection or pooling of fluids in the joint capsule Eliminative- Dissolves foreign elements in the blood, colon, and interstitial spaces of the body Emetic- Ejecting poisons from the body by drinking warm water or salt water Erythema- Description of color of the skin indicating a red appearance Fomentation- Local applications of moist heat to the body surface, usually made of wool and cotton to retain heat and moisture Heating Compress- An application of a cold compress that when applied and covered causes an initial cooling followed by a warming and increase in circulation. Heliotherapy- Using direct sunlight or other light source for therapeutic purposes; electric, ultraviolet, infrared. Hunting reaction- sudden reddening and warming of cooled skin areas; body's mechanism to avoid tissue damage Hydrocollator- Steam heat packs filled with silicate gel that keeps them hot and moist; Extremely hot -

water is heated to 150-160 F Hydrostatic effect - The shifting of fluid from one part of the body to another Hyperemia- Increase in quantity of blood flowing through the body or part of the body characterized by heat, redness: Vasodilatation HypothermiaExtreme reduction in body temperature Hypoxia- Diminished oxygen supply usually due to poor circulation IschemiaDiminished or lack of circulation in an area Krause CorpusclesCold receptors (sensory organ) in dermal layer of integumentary system Paraffin Bath- Using melted paraffin (wax) to dip body part in to build a paraffin glove to retain heat. Operating temperature 126 degrees to 130 degrees. Used to treat arthritis, bruises, bursitis, gout, spasms Pelotherapy- Therapeutic use of mud, peat moss, or clay applied to the body or part of the body Poultice- External application of warm moist substance to relieve pain, reduce and soothe inflammation, draw impurities from the body, encourages muscle relaxation Purgative- Causing vommitting or bowel evacuation Revulsive effect- Increasing the rate of blood flow by alternate use of heat and cold R.I.C.E Standard care for acute stage of healing: Rest, Ice, Compression, Elevation Retrostasis- The drawing of blood to internal organs Russian Bath- A body steam given with the patient reclining and head outside the steam room or cabinet. Saline Bath- Salt baths Salt Glow Massage- Vigorous rubbing of sea salt over entire body Sauna- Dry Heat which increases body temperature and increases perspiration. May put strain on nasal passages, throat and lungs. Sedative- Causes central nervous system to decrease the responses of nerve stimuli for relaxation ShampooUsing soap and water together on one or all parts of the body Showers- The use of water streams directed at the body to stimulate. Examples are dousing, jet, fan, alternate hot and cold. Sitz Bath- A partial bath covering the pelvic region Spanish Mantle Pack- The client is showered, tubbed or sponged and then wrapped in a dry sheet and blankets while still wet. Sponging- Using a sponge to apply water, alcohol, or witch hazel to the body, usually for a cooling affect. Steam -Water particles dispersed through the air; good for the skin and lungs. Hot seam increases body temperature and perspiration and releases toxins. Cold steam as from a humidifier, moistens dry rooms in winter and can help prevent colds and sinus headaches. Stimulant-

increases nerve stimulation Swedish Shampoo- Shampoo given on a marble slab using soap and skin brushing, usually washing and rinsing one part at a time and drying briskly. Thalassotherapy- Bathing in or drinking of salt water Thermophore- moist heat pack; heating unit wrapped in flannel which absorbs moisture from the atmosphere. Tonic- Increases vigor; return of cellular activity to normal state Turkish BathHot air bath (dry sauna) Whirlpool bath- A partial immersion bath in which water is agitated and mixed with air to be directed at the affected area; Used to soften muscles for massage, stimulate circulation, relieves pain.