Hydrotherapy; Indications, Effects and Uses

Hydroptherapy is a treatment method which utilizes water temperature to influence our body’s soft tissue.  Hydrotherapy can be broken down into three categories: ice, heat, and contrast.  The choice of which option to use depends on the issue or injury we are working with.

Ice Hydrotherapy:

Also known as Cryotherapy, ice hydrotherapy is without a doubt the home care I give most frequently, especially for postpartum patients.  In their article on the use of cryotherapy for ankle sprains, Hocutt et. al (1982) show that cryotherapy is more effective than heat therapy at reducing pain and improving healing outcomes for individuals who are in the acute phase of an ankle sprain (2).  In their study, Algafly and George (2007) were able to specifically show that ice reduces pain by slowing the speed at which pain signals are transmitted along nerves (1).  The result of this is an increase in a patient’s pain threshold, leading to an increased pain tolerance.  In simpler terms, the amount of pain we can cope with goes up when the nerves relaying the pain signals to our brain and spinal cord slow down, making it seem as though we are actually feeling less pain.  Cryotherapy helps reduce swelling and inflammation by causing vasoconstriction.  When blood vessels shrink, blood, fluid and inflammatory products are shunted away from the area being cooled.


Ice Pack Applied to Elbow Tendonitis


Cryotherapy Uses:

Ice as a method of hydrotherapy is most appropriate for any acute injury (1-14 days old), inflammation, swelling, sprain/strain or spasm.  To perform cryotherapy on yourself, first wash your hands and clean and cover any open wounds to help prevent an infection.  Wrap the ice pack in a clean, light weight pillow case and gently apply to the area of injury.  I find it helpful to lightly wrap a tensor bandage around the outside of the ice pack to hold it on the area.  After 10-15 minutes, remove the ice pack, and let the skin re-warm to body temperature over 45-60 minutes.  Repeat as often as you desire.  Be sure to avoid applying ice directly to the skin for prolonged periods of time to minimize the risk of damaging the tissue.


Ice pack wrapped with tensor bandage

Cryotherapy is not indicated for use on areas where there is a loss of sensation (e.g., diabetics with neuropathy), in people who are immobile (infants for instance), or people who are para/quadriplegic.  Individuals with a spinal cord injury are at risk for a syndrome called autonomic dysreflexia that can be life threatening.  Autonomic dysreflexia occurs when the involuntary branch of our nervous system receives a signal but is unable to respond appropriately to that stimulus.

Heat Hydrotherapy:

Also known as thermotherapy, heat is a form of hydrotherapy indicated for scar tissue and chronic injuries such as tendonitis and arthritis.  It can also help relieve muscle tension or stiffness.  The primary intention of using thermotherapy is to increase metabolic activity and circulation to an area and to warm up soft tissues so that they will be more flexible and stretch with ease (4).  It does this by causing vasodilation.  When blood vessels expand, blood, fluid and immune products are drawn towards the area being heated.

Thermotherapy Uses:

To safely use thermotherapy, first ensure that the temperature is warm, but not too hot.  You don’t want to risk burning the tissue.  Apply the heat pack to the affected area for 15-30 minutes, then remove it and allow the tissue to cool for 60 minutes and return to normal body temperature.  Repeat as often as necessary.  Thermotherapy is often most effective when followed by a prolonged stretch.


Heat pack applied to arm

As with ice, heat is not indicated for use in areas that have lost sensation, on people who are immobile, or para/quadirplegic.  Heat should also never be applied to a fresh injury, an open wound, or an inflamed or infected area.

Contrast Hydrotherapy:

Contrasting with ice and heat helps to improve circulation in areas that may be sluggish.  It is also very effective in reducing spasm and minor edema.  The primary intention of using contrast hydrotherapy is to use the processes of vasodilation and vasoconstriction to work like a pump; promoting fresh blood to move towards the area, and stagnant fluid to move away.  In their study, Petrofsky et. al (2007) showed that contrasting significantly increased skin blood flow compared to warm water only (3).

Contrast Uses:

You can utilize contrast hydrotherapy in two different ways; either as a water bath, or applied packs.  In the water bath method, you will require two vessels (double sink or large buckets).  Fill one vessel with warm water, and the other with ice water.  Dip the area of the body (hands/arms, legs/feet) into the warm vessel for 3 minutes.  Remove quickly and transfer the parts to the cold vessel for 1 minute.  Repeat this pattern two more times for a total of three dips in each temperature.  The key to remember is 3 cycles of both temperatures at a ratio of 3:1.

As before, avoid contrasting over open wounds, in areas that have lost sensation, on people who are immobile, or para/quadriplegic.  In addition, those with a systemic condition such as chronic kidney or heart disease should not use contrasting as it may cause changes in blood pressure that their bodies cannot cope with.

If you have questions about whether hydrotherapy would help you, feel free to contact me.  Or if you would like to heal your areas of pain or dysfunction, click here to book an appointment with me.


  1. Algafly, A., and George, K. P. “The Effect of Cryotherapy on Nerve Conduction Velocity, Pain Threshold, and Pain Tolerance. British Journal of Sports Medicine. 2007.
  2. Hocutt, J., Jaffe, R., Rylander, C. R. & Beebe, J. K. “Cryotherapy in ankle sprains,” American Journal of Sports Medicine. 1982.
  3. Petrofsky, J., Lohman, E. 3., Lee, S., de la Cuesta, Z., Labial, L., Iouciulescu, R., & … Al Malty, A. (2007). Effects of contrast baths on skin blood flow on the dorsal and plantar foot in people with type 2 diabetes and age-matched controls. Physiotherapy Theory And Practice23(4), 189-197.
  4. Tepperman, P. S., & Devlin, M. (1983). Therapeutic heat and cold. A practitioner’s guide. Postgraduate Medicine73(1), 69-76.