HydroBlog March 23, 2020

Combating COVID-19: Practical Suggestions

Hydrotherapy Guidelines

This section focuses on information about details of hydrotherapy treatments including contraindications and precautions as well as potential adverse reactions with their treatment measures. Hydroreference.com will seek to provide this information according to established standards, scientific principles and research discoveries.  The following categories on this page include;

Hydrotherapy Contraindications and Precautions

Hydrotherapy General Guidelines 

Hydrotherapy and Medication Precautions

The Nitty Gritty: Legalities of Doing Hydrotherapy

In the future we will also include on this page;

Hydrotherapy Adverse Reactions Management 

Pre-Hydrotherapy Assessment Forms


The Nitty Gritty: Legalities of Doing Hydrotherapy

Doing hydrotherapy is somewhat similar to starting an exercise program- it's good for you, but it may also cause adverse reactions or be dangerous for some people who have pre-existing or hidden medical conditions, if not done carefully. So, for this reason it's extremely important to observe guidelines and precautions. Doing this will also ensure that the hydrotherapy technique will be more likely to have a beneficial effect. Besides consulting with your primary care physician, read all the contraindications and precautions listed for any technique which may apply to your condition, especially for those who may have medical conditions. Seek to know the category of the medications you take and to find out if there is information available about whether they may be effected by heat or cold.



Hydrotherapy Contraindications and Precautions

This following table is provided for the purpose of providing guidelines for the safe administration of hydrotherapy, but consultation with a qualified healthcare provider is still recommended for any medical condition prior to performing hydrotherapy. This table is still in the process of development.  In the future it will be more complete and also be provided in downloadable format.

See also our Hydrotherapy and Medications page for important considerations for those taking certain types of medications.

Emergency Conditions Hydrotherapy is NOT suitable for acute conditions requiring emergency medical care such as; myocardial infarction (heart attack), cerebrovascular accident (stroke), pulmonary embolus, etc.
Diabetes Do not use heat to the feet. Increased metabolic processes in the tissues caused by heat in combination with poor circulation in feet of diabetics could predispose them to burns or tissue damage. Additionally, persons with diabetes may have neuropathy and not be able to sense temperature well, leading to burns. Shorten times for any whole body heat treatment, such as steam baths. Carefully observe for potential adverse reactions such as hypoglycemia, or any discomfort. Keep a source of sugar immediately on hand. If the client is using insulin, medical supervision is advisable. Whole body heat treatment may cause blood sugar decrease, so diabetic individual should take a snack in evening before bed time after doing whole body heat treatments, especially if on insulin.
High Blood Pressure Shorten times and avoid prolonged whole body heat, especially for blood pressure above 160/90. Shorter times of heat can decrease blood pressure, but prolonged heat increases it. Certain medications may necessitate caution with the use of heat, such as beta blockers which can effect the ability of the heart to respond with increased rate to the body’s increased oxygen demands caused by heat.
Heart Problems, Congestive Heart Failure Seek medical advice before doing whole body heat techniques, such as steam bath or hot tub bath, and if approved the time and temperature should be shortened, no more than 15 minutes. Heat can increase the cardiac work load and precipitate a crisis situation. Gentle, local hydrotherapy techniques are generally safer than whole body techniques. Don’t use extremely cold water to finish the technique. Cold water to the legs could cause retrostasis with large amounts of blood returning to the congested heart.



 Hydrotherapy General Guidelines

The following general guidelines are given as an example of the typical steps in a hydrotherapy technique, especially if it involves a whole body heat technique (such as a steam bath).  These steps may differ depending on the technique that’s being done. Following these steps will help the person experiencing the hydrotherapy to have a safer and better outcome;

Note that several of the following items are similar to some of the principles outlined by Florence Nightingale in her book "Notes on Nursing."

PREP: Hydrotherapy will have the best overall results if you first prepare the body by these three things during the day several hours before you do hydrotherapy; 

  • 1) Hydrate: drink plenty of water, perhaps with a squeeze of lemon in it, or drink clear herb teas (try to avoid caffeinated drinks due to the dehydrating effects.).  Drinking water before and after hydrotherapy helps to hydrate the body, boost the circulation and prevent dizziness from heat.
  • 2) Internally cleanse: by having a bowel movement some time in the day (avoid hydrotherapy if constipated)
  • 3) Provide nutrients: have a good source of vitamins and nutrients available in the blood (such as from eating fresh fruits, a green salad or drinking some fresh vegetable or fruit juices)

HELPER: It is recommended to have someone assisting or at least occasionally checking on the person who is experiencing hydrotherapy, especially if they have any weakness or conditions that may predispose them to adverse reactions (such as age, generalized weakness, chronic health conditions, etc.).  This is safer and brings a more effective outcome.  While assisting them, also remember to protect their dignity and privacy.

PULSE CHECK:  It is best to check a pulse at least once before a whole body heat treatment to get a base line so that you will have something to compare too later on.  Check the pulse about half way through the treatment again, or upon noticing any discomfort or signs or heat intolerance, such as excessive sweating, redness of the face, or overall discomfort.  Stop the hydrotherapy if the pulse is above 100 and implement emergency precautions, listed below.  Putting an ice bag over the heart, along with using cool, wet cloths to the forehead and face, can sometimes help to prevent the pulse from going up too fast during a hydrotherapy session such as a steam bath  (see here for how to check a pulse). You should check the blood pressure too, if the person taking the hydrotherapy has a history of high or low blood pressure.  Of course, if for some reason it seems they might have a fever, be sure to check their temperature, and if they have a fever it may not be the best time for a full body heat experience (will include more about this under contraindications and precautions in the future). 

AIR: It’s best for there to be a source of fresh air in the room, but to keep it free of cold drafts of air.

GLOVES: Observe “universal precautions” if you are assisting someone to do a hydrotherapy and may come into contact with their body fluids or bath water.  For example, wearing gloves- especially if the client has a wound or open sore, or wearing a mask if they have a cold.

WATER: Always have water available to drink during any whole body heat experience.  The person taking the hydrotherapy should drink some before it starts. Also it should be and offered a time or two during the session.  Drinking hot water or herbal tea during the treatment can assist with causing a stronger sweating response, but also may increase the risk of dizziness in those who are prone to it. Do not give a more water than what is allowed for some one who is on a fluid restriction, such as due to heart or kidney problems (in that case, it might not be suitable for them to take a whole body heating treatment, except with the advice of the primary care physician).

OBSERVE: Watch the person closely for sweating, comfort level and signs of adverse reactions such as dizziness, headache, rapid heart rate, etc.  Typically, the expected or desired result of a whole body heat technique is that the person will begin to sweat and may have slightly pink skin.

COOL CLOTH: When the person taking the hydrotherapy starts sweating and starts to feel hot, dip a wash cloth into a basin with ice water and wring it out, then apply it to the forehead. Renew it in the cold water and reapply every 3-5 minutes as needed.  If the person is sweating a lot and feeling hot, also wrap cool towels around the neck as well and keep wiping the face with a cool cloth.  This is an extremely important step to help enable people to tolerate hydrotherapy comfortably and safely.  Applying cool cloths to the face and forehead cause blood vessels of the brain to reactively contract, preventing blood congestion in the brain which could result in a headache or depressive feelings after the hydrotherapy.

STOP! If the person is prone to dizziness or fainting, or not used to doing heat treatments, reduce the time and temperature. Stop the hydrotherapy session if the person taking the hydrotherapy is having signs of discomfort, (especially such as chest pain, shortness of breath, rapid pulse, or dizziness) and immediately begin the following EMERGENCY INTERVENTIONS....

  • ASSIST TO LIE DOWN; Assist them to a comfortable position, lying down (elevate feet a few inches if they have symptoms of light headedness, dizziness, rapid heart rate).  It is better to have them lie on the floor than to risk having them faint and fall down while trying to walk to the next room!
  • COOL; Help them to cool down by using cool cloths on the face, forehead and neck, and perhaps also arms.  Especially if the reason the person is feeling uncomfortable is related to the heat of the hydrotherapy technique then this will help reduce dizziness by causing peripheral blood vessels to constrict.  It is also standard to finish any heat technique with cooling.
  • WATER; Sometimes people may feel uncomfortable during hydrotherapy because they may be dehydrated, so offer them water if it is readily available.
  • PROTOCOL; Assist or allow the person to follow any emergency instructions specific to their conditions and the symptoms they are having, such as taking nitroglycerine for chest pain (please note contraindications and precautions regarding heart disease and hydrotherapy).
  • CALL 911; If the person doesn’t start to feel better shortly after lying down, prepare call 911, especially if they are having serious symptoms such as chest pain, shortness or breath and/or have any conditions that would place them at risk for serious health conditions (including advanced age, obesity, etc.).

COLD RINSE: In the case that there was no need to prematurely end the hydrotherapy session, typically finish any hot treatment by rinsing for 15-30 seconds in cool or cold tap water, to close the pores, shrink surface blood vessels and stop sweating which could lead to chills, dizziness or other adverse reactions.  Gauge the temperature according to how the person feels they can tolerate it.  Avoid using very cold water if the person is sick, weak, intolerant of cold or doesn’t feel that they can tolerate very cold water.  But it's also advisable to seek to work toward building up a tolerance for the cold rinse, as it has very therapeutic effects and can boost immune responses.  For most people the cold is usually only uncomfortable for the first few seconds, after which it becomes more comfortable and even feels invigorating or refreshing.

STAND SLOWLY: Have the person wrap in a towel and stand up slowly to prevent dizziness or fainting, then find a place to sit down to complete the final steps.

DRY WELL: Dry the feet well and assist them to put socks on.  If they are continuting to perspire a lot, dip the wash cloth back into cool water or ice water and wring it out, then allow them to briefly rub the hot areas of their body to stop the sweating (such as chest, stomach, underarms, etc.), re-dipping the wash cloth in the cold water as needed. Their hair should also be dried well with a towel and/or blow drier if it’s wet. Assist the person to put on dry clothing and shoes or slippers, to avoid exposure to cold drafts when leaving and to avoid walking on the cold floor, which could reduce the effectiveness of the hydrotherapy technique.

REST PERIOD: After completing any hydrotherapy session, the person who experienced it should rest for at least 10 minutes, then dress warmly before going outside in cool weather, in order to prevent chilling. For the best results, they should ideally rest or sleep immediately for at least 30 to 60 minutes after finishing the hydrotherapy, in order to allow the immune system and circulation to react and stabilize, as well as to stop sweating. 

Temperature Extremes Caution: If someone is not as vigorous or healthy, or if they are either young or advanced in age, they may not be able to easily tolerate temperature extremes. Never assume that what is good for one person is good for another. Common sense and paying attention to tolerance are also importance. Never force yourself or someone else to accept hot or cold temperatures if they don’t feel comfortable with it, as this could result in burns, dizziness/fainting, headaches, chilling, etc.




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Because Hydrotherapy Interest Group is committed to continual improvement in seeking to provide accurate information on www.hydroreference.com, we invite anyone who is aware of pertinent information, current research about hydrotherapy or conditions effected by hydrotherapy to please contact HIG.


This website is in development,

we appreciate your patience!
Please check back for further updates.

It should be noted that hydrotherapy treatments can result in serious injury or complications under some circumstances. Prior medical advice should always be sought and extreme caution taken when performing any kind of hydrotherapy treatments for individuals with chronic diseases or decreased skin sensitivity. Hydroreference.com does not recommend the use of hydrotherapy for any condition without prior consultation with a physician or qualified healthcare provider.