Hydrotherapy Applications

General Hydrotherapy Applications, Temperatures, Effects of Hot and Cold

  1. 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.
  2. Local cold: Apply cold to specific area of the body; use cold compress, ice bag, ice pack, ice hat, frozen bandage.
  3. 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.
  4. Tonic friction: Water sponging or washing combined with some form of friction on the skin produces a tonic effect on the body
  5. Sponging: Use alcohol, water or which hazel applied to a sponge to wash the body.
  6. 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.
  7. Showers: Many kinds of water streams can be directed against the body.
  8. 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.
  9. Sauna: Dry heat which increases body temperature and increases perspiration;  May put strain on nasal and lung passages.
  10. Shampoo:  Soap and water used on one or all parts of the body

Temperatures for Hydrotherapy Treatments

Degrees Fahrenheit Description of Sensation Sensation on forearm when immersed in
this water temperature
Degrees Celsius
Ice Pain
Very cold Pain and numbness
Cold Sensation of coldness
Cool Cool
Tepid slightly cooling
body temp
Neutral No sensation body temp
Warm Comfortably warm
Hot Skin redness with prolonged immersion
Very Hot Tolerable for a short time
111 +
Painfully Hot Pain and possible tissue damage
Damaging Pain and tissue damage


Hydrotherapy Effects of Cold and Hot Water

Primary Effect Secondary Effect
Cold Water -peripheral vascular constriction
-Pallor of skin, chilliness, shivering,
-Increases respiratory rate
-Increases muscular tone
-Increases blood pressure and heart rate
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
Hot Water -Increases Body Temperature
-Increases Pulse rate (by 10 for every
1 degree increase in body temp)
-Increases respiration rate
-Increases oxygen consumption and metabolic
-Peripheral vasodilatation
-Increases Circulation
-Decreases blood pressure
-pH becomes more alkaline
-Increases in excretion from kidneys
Generally the same as secondary effects
of cold;  Gradual reduction of these effects as body returns to normal.


Hydrotherapy MassageGeneral 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 zip-lock or gel packs.


Impaired or compromised circulation – diabetes, peripheral artery disease

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

Open wounds, rashes

Hypertension – may temporarily increase blood pressure

Very young or very old – may have impaired regulatory systems and limited communication

Cold allergy or sensitivity

Adverse Effects of Cold:  burns when temperature is below 59 degrees F.

General Therapeutic effects of Heat:

  • Increases the extensibility (ability to stretch) of collagen fibers
  • Decreases chronic joint stiffness
  • Increases range of motion
  • 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


  • 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


  • Any acute inflammation such as bursitis, arthritis, tendonitis, sprains or strains
  • diabetes
  • Deep vein thrombosis
  • impaired circulation or reduced sensation
  • congestive heart failure
  • acute injury, inflammation and edema
  • Pregnancy – no immersion baths or hot packs to the abdomen
  • Very young and very old may be unable to communicate
  • Open wounds, rashes or previous burns

Adverse Effects of Heat

Burns – keep temeratures below 113 degrees, use insulation between the heated object and the skin, use heat packs that cool down.

Fainting –  usually due to lack of blood and oxygen to the brain from peripheral vasodialation, change in body positions that cause a change in blood pressure.