Modern naturopathic hydrotherapy
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2nd Feb, 2021Article

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Hydrotherapy is a naturopathic modality that involves the therapeutic use of water to restore, maintain, and regulate health. It is also known as water therapy, medical therapy, and hydrothermal therapy. 

The modality covers a broad range of therapeutic techniques which utilise water's physical properties (temperature and pressure) to stimulate or influence various body systems. Mineral or herbal treatments are sometimes administered with hydrotherapy treatments (1,2). The use of natural mineral waters, gases and peloids (mud) is a form of hydrotherapy known as balneotherapy (3).

Water is used internally or externally, in any form (water, ice, steam), although hydrotherapy is predominantly administered via external practices, either to the entire body or specific areas. Applications vary widely, depending on treatment goals, and are individualised to the patient's condition. Examples include steam baths, semi-submersions (like sitz baths), saunas, and hot and cold compresses, wraps and lavations, among others (Table 1) (4,5).

The significant effects of naturopathic hydrotherapy are due to its ability to stimulate the body's innate healing mechanisms, mainly through manipulating circulation. Water's thermal and mechanical properties can be utilised to improve circulation, facilitate the delivery of oxygen-rich and nutrient-rich blood to various organs and tissues, and remove metabolic waste and toxins (4,5). 

Thermal effects are elicited via heat (typically 35-40°), body temperature (32-34°C) or cold therapy (8-10°C) (6). Heat therapy is associated with vasodilatory and circulatory effects, which promote muscle relaxation and analgesia. Cold therapy is associated with vasoconstriction and pain-reducing effects (6). The application of hot and cold therapy stimulates the body's homeostatic mechanisms and has physiological effects on lymphatic, immune and neuroendocrine systems (4,5).

Hydrotherapy is used widely throughout Europe and North America, as an adjunct treatment for a broad range of conditions including arthritis, fibromyalgia, congestive heart failure, chronic obstructive pulmonary disease, stress and anxiety, sports recovery, and for the rehabilitation of patients with an acute injury (2,6,7).


Table 1. Common naturopathic hydrotherapy treatments (4,5,8,9,10,11,12)




Rinses and douches



Rinses (affusion)

Gentle application of water to skin for a thermal effect, e.g. arm rinse, knee, and thigh rinses.

Local and systemic effects - tonifying the body.

Blitz guss

A type of douche involving the application of water in a high-pressure stream to attain both mechanical and thermal effects.

Congestive conditions, low vitality.

Contrast showers

Full body hot rinse followed by a cold rinse.

Traditionally used to enhance vitality and promote detoxification. Support the immune system, circulation, autonomic nervous system, endocrine function, and digestion.




Warming compresses (heat- or inflammation-reducing wraps)

Application of a cool or cold cloth, removed from the skin when the cloth reaches skin temperature.

Local inflammation, sore throat, bronchitis, influenza or swollen lymph glands

Hot compresses (heat-delivering wraps)

Application of a hot damp cloth to deliver heat to the body.

Chronic joint pain, colic, renal colic, dysmenorrhea, chronic lung and airway diseases, nervous tension, insomnia, muscle spasm or pain (non-inflammatory).

Heat- and sweat-producing wraps

Application of three-layered wraps (one wet; two dry), can be a full body wrap (applied in four phases).

Systemic effects (tonification), detoxification, weight loss, acute illness (e.g. cold, influenza), convalescence.


Application of a wet cloth (hot or cold) to a specific area to alter blood flow.

Cold compress – acute inflammation and injury.

Alternating hot and cold – local subacute inflammation and congestion.


Application of a thin film of water to the skin using a sponge or cloth.

Relaxation, sleep promotion, improve circulation, metabolism, and immune function.

Constitutional hydrotherapy

Application of alternating hot and warming (double cold) compresses to the trunk

Enhance the functioning of the immune, circulatory, digestive, nervous and, respiratory systems and detox organs.

(e.g. inflammation, arthritis, respiratory trac infections, depression, female reproductive problems, immune deficiency (e.g. HIV)).




Foot and arm baths

Submersion in hot, cold, or neutral temperature water

Hot foot bath - congestive headache, chest congestion, pelvic congestion, delayed onset of menstruation, chill, or fatigue, flu and colds, insomnia

Cold foot bath – pain and swelling in feet

Contrasting/alternating hot and cold arm of foot baths – injury (24 – 48 hours after), chronic arthritis or swelling

Sitz baths

An immersion bath with the person seated in a tub with water covering the hips, buttocks, and lower abdomen.

Can be hot, neutral, or contrasting/alternating water temperatures.

Traditionally used to decrease congestion and increase circulation to pelvic and lower abdominal organs.

Female reproductive issues e.g. pelvic inflammatory disease, endometriosis.

Constipation, haemorrhoids, lower back problems.

Contrast full bath (full body immersion)

Full immersion in alternating hot and cold water.

Systemic or central congestive conditions (e.g. fibromyalgia, dysmenorrhoea, depression, constipation, oedema).

Neutral bath

Immersion in water at 32 - 35 °C

Insomnia, anxiety, depression, nervous tension, exhaustion, chronic pain.




Immersion in mineral-rich waters or natural mineral hot springs.


Rheumatoid and osteoarthritis, low-grade inflammation and stress-related pathologies, fibromyalgia, low back pain, immune dysfunction, metabolic conditions.

Hyperthermia treatments




A form of hydrotherapy in which dry, warm air induces sweating

Immune dysfunction, detoxification, moderate hypertension, rheumatic disease, congestive heart failure.

Hyperthermia baths

Full immersion in water with a temperature range of 38–42°C for 20–60 minutes.

Detoxification and immune stimulation; muscle tension and spasm.

Steam baths

Room filled with warm, humid air.

Detoxification and immune support; colds, influenza, rheumatoid arthritis, insomnia, hypotension.

Enemas and colonic hydrotherapy

Similar treatments which decrease inflammation of colon and rectum by eliminating faecal matter and toxins. Enemas can be performed at home and do not reach the colon; colonic irrigation requires specialised equipment and reaches the colon. Different additives are often used in enemas for specific conditions.

Constipation, detoxification.


Traditional Understanding

Hydrotherapy is an age-old practice with reports dating back to Hippocrates' time, around 500 BC.  It has been used widely in ancient cultures, including Greece, India, Egypt, Japan, and China.  Hydrotherapy, alone or in combination with other prescriptions, was used traditionally for various conditions such as rheumatism, fevers, joint pain, mood disorders, and headaches (13).

Hydrotherapy was rediscovered and popularised in Europe during the 18th and 19th centuries. Modern naturopathic hydrotherapy has its direct historical roots in Germany, where it was formulated and practised in the German Forest sanatoriums by Nature Cure pioneers. Father Sebastian Kneipp, a 19th-century Bavarian monk, is widely regarded as the father of modern hydrotherapy. Kneipp's use of alternating hot and cold water, called contrast hydrotherapy, is still used today (14).

Hydrotherapy spread to the United States from Europe in the mid-19th century, and today naturopathic hydrotherapy is common, if not central, to current naturopathic practice throughout North America and Europe. Naturopathic hydrotherapy is a clinical treatment tailored to address specific needs of the patient. It may be combined with other treatments, including herbal medicine, homeopathy, and nutrition, to enhance therapeutic outcomes (5).

Naturopathic hydrotherapy was first practised in Australia in the 1840s and was a core of naturopathic practice in Australia for over a century. However, since 2002 it has not been part of naturopathic education in Australia and hydrotherapy has not been retained as a modality in Australian naturopathic practice (4,5). 


Latest Research


Cardiovascular disease

A growing body of clinical evidence supports hydrotherapy as an adjunctive non-pharmacological treatment for cardiovascular disease (15). These benefits primarily result from the effects of water on venous return and cardiac output (mechanical effects) and vasodilation and toning of vascular endothelium (thermal effects) (16).

Contrast hydrotherapy and thermal sauna therapy have been shown to improve peripheral blood flow with long-term improvements in vascular function (17,18,19,20). Hydrotherapy and sauna therapy has been shown to reduce other risk factors of ischaemic heart disease, including total and low-density lipoprotein (LDL)-cholesterol concentrations (21) and triglycerides (22).

Clinical and observational studies have demonstrated positive effects of hydrotherapy (including sauna) in the treatment of hypertension (23,24), congestive heart failure (25,26,27,28,29) and vascular endothelial dysfunction in atherosclerosis (18).

In congestive heart failure, thermal bathing or sauna improves cardiac function (25,26), exercise tolerance in association with improvement in endothelial function (28) and overall quality of life (27).

Hydrotherapy may also have benefits for conditions associated with a poor cardiovascular function (e.g. dementia). Results of two extensive observational studies found risk reductions not only for sudden cardiac death (63%) but also for dementia (66%) and Alzheimer’s disease (65%), as a result of regular sauna (4-7 times per week) (30,31).


Exercise recovery

Cold water hydrotherapy is a popular intervention for exercise recovery. Cold may facilitate recovery from exercise by reducing intramuscular temperature and metabolism (32). It also reduces hypoxic stress, ROS generation and subsequent damage (33,34), induces vasoconstriction to limit oedema formation (32,35), and reduces the inflammatory response and associated damage and soreness (36).

Several studies demonstrate that cold water immersion (CWI) (<15°C) is associated with lower fatigue, improved physical recovery, and delayed muscle onset soreness (DOMS) compared with passive interventions involving rest or no intervention (37,38). 

Contrast water therapy (CWT) is seen as an alternative to CWI for reducing symptoms of muscle damage and associated DOMS, although its mechanisms of action remain unclear (39,40). Body exposure to alternating high and low temperatures is believed to accelerate blood circulation, facilitating metabolite elimination (41).

A recent meta-analysis found benefits for CWT and CWI for recovery in team sports 24-48 hours after exercise. However, results of studies remain ambiguous, and long-term benefits (beyond 48 hours) need to be investigated (42).


Musculoskeletal disorders

Hydrotherapy has been studied extensively in chronic pain and rheumatic and musculoskeletal conditions (7).

A systematic review of hydrotherapy for rheumatoid arthritis (RA) suggests positive effects on relieving pain, joint tenderness, and mood symptoms (43). Hydrotherapy as an adjunct to conventional medications in RA patients produced significant changes in oxidative stress biomarkers and activities of antioxidant enzymes suggesting that hydrotherapy can slow disease progression by ameliorating redox status (44).  

In adults with fibromyalgia, pool-based therapy has some additional benefit as compared with either land-based or no physical therapy, with patients undergoing pool-based exercise program having significantly lower pain scores compared to controls (45). Spa therapy and balneotherapy have also been found to improve pain, fatigue, and anxiety, and improve general well-being in fibromyalgia patients (46,47,48,49).

Clinical studies in osteoarthritis (OA) patients demonstrate the benefit of different hydrotherapy treatments: 

  • A 2016 Cochrane Review of pool-based therapies for OA, concluded that aquatic exercise may have small, short-term, and clinically relevant effects on patient-reported pain, disability, and quality of life (QoL) in people with knee and hip OA (50). 
  • Contrast hydrotherapy has been found to reduce pain and improve QoL in knee osteoarthritis (51
  • Mineral water baths and hot showers and mineral bath were superior to no treatment for pain, function, stiffness, and quality of life at 3, 6, and 9 months in knee OA patients (52). 
  • Hot affusion bath with Epsom salt, three times a week for three weeks significantly reduced pain and stiffness in patients with knee OA, and improved range of motion (53). 
  • Several clinical studies have demonstrated the effectiveness of alternating hot and cold compresses with reducing pain and improving function in knee OA patients (54,55).


Immune system support

Although the mechanisms are not entirely understood, both hot and cold hydrotherapy treatments affect innate and adaptive immunity (11,56). Acute cold exposure following pre-heating (18 °C) increased circulation of leucocytes, granulocytes, natural killer cells, and interleukin-6 (IL-6) as mediated by increased noradrenaline (57)

Hot spring (41°C) hydrotherapy significantly increased the total number of leukocytes and lymphocytes in older subjects (>35 years). These increases were related to blood hormonal levels, mainly adrenocortical hormones (58).

Whole-body hyperthermic water bath (immersions) reduced relative total T-lymphocyte counts, increased relative CD8+ lymphocyte and NK cell counts, and activity (59).

In several low-grade inflammation-related pathologies, balneotherapy and mud therapy have anti-inflammatory and chondroprotective effects by reducing serum concentrations of pro-inflammatory cytokines including TNF-α (60,61,62,63), IL-1β (61), and regulatory cytokine IL-6 (64,65), and increased anti-inflammatory growth factor IGF-1 (60,66).


Respiratory disorders

Hydrotherapy can be used to enhance long-term respiratory function by improving vital capacity (VC), thoracic expansion and breathing control (67).

In patients with chronic obstructive pulmonary disease (COPD) the hydrostatic pressure exerted during immersion facilitates expiration and reduces the residual volume, decreasing air trapping (68,69).

Susceptibility to respiratory infections plays a role in exacerbations of COPD. Repeated cold-water stimulations (affusions) reduced the frequency of respiratory infections via immunomodulation relating to Th-1 cells, and improved peak expiratory flow and overall quality of life in COPD patients (70).


Neuroendocrine system support

Various stress factors, including hyperthermia, are known to activate the hypothalamic-pituitary-adrenal (HPA) axis. Hyperthermia-induced activation of the HPA-axis and sympathetic nervous system (SNS) has been reported mostly in healthy subjects undergoing hydrotherapy or sauna baths (71,72) leading to increases in adrenocorticotropic hormone (ACTH) (73), cortisol (73,74), growth hormone (GH) (74,75), prolactin (76,77), β-endorphins (73,77,78), and noradrenaline (NA) (75,76,77,79). 

These neuroendocrine effects are beneficial for inflammatory pain conditions and mood disorders (80,81). In fibromyalgia patients, mud therapy increased levels of ACTH, cortisol and β -endorphin serum levels. The release of these hormones was associated with pain reduction and improved disability, depression, and quality of life (81). Similar effects were observed in OA patients, where an increase in circulating cortisol concentrations was associated with a decrease in the elevated systemic levels of inflammatory cytokines (80).

Cold hydrotherapy is also known to produce similar effects on the HPA axis. Cold stress-induced analgesia is mediated by increased production of opioid peptide beta-endorphin, an endogenous painkiller (82,83).


Mood disorders

Recent studies have demonstrated the psychological effects of hydrotherapy, such as mental relaxation, and improving mental fatigue, quality of life, and depression/stress (84,85,86). Hydrotherapy can exert anxiolytic and antidepressant effects via effects on stress hormones (e.g. cortisol and noradrenaline) (87), β-endorphins and neurotransmitters, including serotonin (88).

Hydrotherapy reduces anxiety symptoms in diagnosed anxiety disorders (89), during labour (90) and in individuals with co-morbidities including chronic myofascial pain syndrome (91); fibromyalgia (92) and chronic heart failure (93).

In an 8-week clinical study involving 237 patients with a generalised anxiety disorder (GAD), balneotherapy significantly improved anxiety scores compared with antidepressant medication (Paroxetine). Remission and sustained response rates were also significantly higher in the balneotherapy group, and improvements in depression scores were also noted (89).


Metabolic conditions

Hydrotherapy may have benefits for improving circulation and insulin resistance in Type 2 diabetes mellitus (TD2M). 

Daily immersion in hot water (37.8°C to 41.0°C) for 3 weeks, as an adjunct to hypoglycaemic medication, was found to improve fasting plasma glucose levels and HbA1c in T2DM patients (94). Improvements in insulin resistance were mediated by increased blood flow to skeletal muscles, where insulin-mediated glucose uptake primarily occurs (94,95).

A single immersion in Dead Sea water produced a significant reduction in blood glucose in T2DM patients, without influencing insulin, cortisol, and c-peptide levels (96).

In type 2 diabetics with mild lower-extremity arterial, 15 weeks of hot spring thermal hydrotherapy combine with acupuncture reduced intermittent claudication symptoms, exerted anti-inflammatory effects, and improved physical function, without significant glycaemic-controlling effects (97).

Daily application of a salt foot bath (40 to 45° for 15 minutes) produced significant reductions in pain scores in patients with painful diabetic peripheral neuropathy (98).

1Arankalle D, Jincy S, Raghuraj P. Critical review on trends in hydrotherapy research. Int J Naturop Med. 2012 Dec;6:693-96.
2Devkate GV, Tate SS, Deokate SB, Bhujbal AS, Tupe AP, Patil RN. Hydrotherapy A New Trend in Disease Treatment. Ijsrm. Human. 2016 Dec;5(2):117-35.
3Falagas ME, Zarkadoulia E, Rafailidis PI. The therapeutic effect of balneotherapy: evaluation of the evidence from randomised controlled trials. International journal of clinical practice. 2009 Jul;63(7):1068-84.
4Wardle J. Hydrotherapy: A forgotten Australian therapeutic modality. Aust J Herb Med. 2013;25(1):12–7.
5Broderick K. Chapter 5 Naturopathic Hydrotherapy. In: Hechtman L, editor. Advanced clinical naturopathic medicine. Chatswood: Elsevier; 2020. p.90-108.
6An J, Lee I, Yi Y. The thermal effects of water immersion on health outcomes: an integrative review. International journal of environmental research and public health. 2019 Jan;16(7):1280.
7Mooventhan A, Nivethitha L. Scientific evidence-based effects of hydrotherapy on various systems of the body. North American journal of medical sciences. 2014 May;6(5):199.
8Huyck A, Broderick K. Hydrotherapy. Pizzorno JE, Murray MT. Textbook of natural medicine. 4th ed. Elsevier: St Louis; 2013.
9Corroon J, Pillsbury C, Wojcikiewicz A, Huyck A, Saenz C, Takakura M, Milkis S, Bradley R. Pilot clinical trial of constitutional hydrotherapy in HIV+ adults. Advances in Integrative Medicine. 2018 Apr 1;5(1):23-8.
10Chaurasia G, Patil A, Dighe S. A review on therapeutic aspects of hydrotherapy. International Journal Of Pharmaceutical Sciences and Research. 2015 Jul 1;6(7):2713.
11Gálvez I, Torres-Piles S, Ortega-Rincón E. Balneotherapy, immune system, and stress response: a hormetic strategy?. International journal of molecular sciences. 2018 Jun;19(6):1687.
12Hussain J, Cohen M. Clinical effects of regular dry sauna bathing: a systematic review. Evidence-Based Complementary and Alternative Medicine. 2018 Apr 24;2018.
13Jacoby J. Pouring water over the body--hydrotherapy prescriptions in the late Middle Ages. Sudhoffs Archiv. 2002 Jan 1;86(1):54-68.
14Ko Y. Sebastian Kneipp and the Natural Cure Movement of Germany: Between Naturalism and Modern Medicine. Korean Journal of Medical History. 2016 Dec 31;25(3):557-90.
15Baker PW. Is there a role for contrast hydrotherapy?. Journal of Lymphoedema. 2011 Oct 1;6(2):72-80.
16Municinó A, Nicolino A, Milanese M, Gronda E, Andreuzzi B, Oliva F, Chiarella F. Hydrotherapy in advanced heart failure: the cardio-HKT pilot study. Monaldi Archives for Chest Disease. 2006;66(4):247-54.
17Elmståhl S, Lilja B, Bergqvist D, Brunkwall J. Hydrotherapy of patients with intermittent claudication: a novel approach to improve systolic ankle pressure and reduce symptoms. International angiology: a journal of the International Union of Angiology. 1995 Dec 1;14(4):389-94.
18Imamura M, Biro S, Kihara T, Yoshifuku S, Takasaki K, Otsuji Y, Minagoe S, Toyama Y, Tei C. Repeated thermal therapy improves impaired vascular endothelial function in patients with coronary risk factors. Journal of the American College of Cardiology. 2001 Oct 1;38(4):1083-8.
19Kihara T, Biro S, Imamura M, Yoshifuku S, Takasaki K, Ikeda Y, Otuji Y, Minagoe S, Toyama Y, Tei C. Repeated sauna treatment improves vascular endothelial and cardiac function in patients with chronic heart failure. Journal of the American College of Cardiology. 2002 Mar 6;39(5):754-9.
20Fiscus KA, Kaminski TW, Powers ME. Changes in lower-leg blood flow during warm-, cold-, and contrast-water therapy. Arch Phys Med Rehabil. 2005 Jul;86(7):1404-10.
21Pilch W, Szygula Z, Klimek AT, Palka T, Cison T, Pilch P, Torii M. Changes in the lipid profile of blood serum in women taking sauna baths of various duration. International journal of occupational medicine and environmental health. 2010 Apr 1;23(2):167.
22Oláh M, Koncz Á, Fehér J, Kálmánczhey J, Oláh C, Balogh S, Nagy G, Bender T. The effect of balneotherapy on C-reactive protein, serum cholesterol, triglyceride, total antioxidant status and HSP-60 levels. International journal of biometeorology. 2010 May;54(3):249-54.
23Hartinah D, Sofyan A, Syafiq A. The Effect of Hydrotherapy on Blood Pressure of The Hypertensive Patients in Public Hospital of RA. Kartini Jepara. InThird International Conference on Sustainable Innovation 2019–Health Science and Nursing (IcoSIHSN 2019) 2019 Oct (pp. 96-99). Atlantis Press.
24Sella N, Erwin RN. The comparison of warm water feet-soaking hydrotherapy and acupressure massage on the blood pressure of primary hypertension patients. In Riau International Nursing Conference (RINC) 2018: p.128.
25Kihara T, Biro S, Imamura M, Yoshifuku S, Takasaki K, Ikeda Y, Otuji Y, Minagoe S, Toyama Y, Tei C. Repeated sauna treatment improves vascular endothelial and cardiac function in patients with chronic heart failure. Journal of the American College of Cardiology. 2002 Mar 6;39(5):754-9.
26Cider Å, Sveälv BG, Täng MS, Schaufelberger M, Andersson B. Immersion in warm water induces improvement in cardiac function in patients with chronic heart failure. European journal of heart failure. 2006 May;8(3):308-13.
27Michalsen A, Lüdtke R, Bühring M, Spahn G, Langhorst J, Dobos GJ. Thermal hydrotherapy improves quality of life and hemodynamic function in patients with chronic heart failure. American heart journal. 2003 Oct 1;146(4):728-33.
28Ohori T, Nozawa T, Ihori H, Shida T, Sobajima M, Matsuki A, Yasumura S, Inoue H. Effect of repeated sauna treatment on exercise tolerance and endothelial function in patients with chronic heart failure. The American journal of cardiology. 2012 Jan 1;109(1):100-4.
29Graetz B, Sullivan M, Robertson T, Reeve J. Do hydrotherapy exercise programmes improve exercise tolerance and quality of life in patients with chronic heart failure? A systematic review. New Zealand Journal of Physiotherapy. 2015:64-71.
30Laukkanen T, Khan H, Zaccardi F, Laukkanen JA. Association between sauna bathing and fatal cardiovascular and all-cause mortality events. JAMA internal medicine. 2015 Apr 1;175(4):542-8.
31Laukkanen T, Kunutsor S, Kauhanen J, Laukkanen JA. Sauna bathing is inversely associated with dementia and Alzheimer's disease in middle-aged Finnish men. Age and Ageing. 2017 Mar 1;46(2):245-9.
32Ihsan M, Watson G, Lipski M, Abbiss CR. Influence of postexercise cooling on muscle oxygenation and blood volume changes. Med Sci Sports Exerc. 2013 May 1;45(5):876-82.
33Yanagisawa OS, Niitsu MA, Takahashi HI, Goto K, Itai Y. Evaluations of cooling exercised muscle with MR imaging and 31P MR spectroscopy. Medicine and science in sports and exercise. 2003 Sep 1;35(9):1517-23.
34Puntel GO, Carvalho NR, Amaral GP, Lobato LD, Silveira SO, Daubermann MF, Barbosa NV, Rocha JB, Soares FA. Therapeutic cold: an effective kind to modulate the oxidative damage resulting of a skeletal muscle contusion. Free radical research. 2011 Feb 1;45(2):133-46.
35Yanagisawa O, Niitsu M, Yoshioka H, Goto K, Kudo H, Itai Y. The use of magnetic resonance imaging to evaluate the effects of cooling on skeletal muscle after strenuous exercise. European journal of applied physiology. 2003 Mar;89(1):53-62.
36White GE, Wells GD. Cold-water immersion and other forms of cryotherapy: physiological changes potentially affecting recovery from high-intensity exercise. Extreme physiology & medicine. 2013 Dec;2(26).
37Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW. Cold‐water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database of Systematic Reviews. 2012; 2(CD008262).
38Bleakley CM, Davison GW. What is the biochemical and physiological rationale for using cold-water immersion in sports recovery? A systematic review. British journal of sports medicine. 2010 Mar 1;44(3):179-87.
39Higgins T, Cameron M, Climstein M. Evaluation of passive recovery, cold water immersion, and contrast baths for recovery, as measured by game performances markers, between two simulated games of rugby union. Journal of strength and conditioning research. 2012 Jun 11.
40Kinugasa T, Kilding AE. A comparison of post-match recovery strategies in youth soccer players. The Journal of Strength & Conditioning Research. 2009 Aug 1;23(5):1402-7.
41King M, Duffield R. The effects of recovery interventions on consecutive days of intermittent sprint exercise. J Strength Cond Res. 2009 Sep; 23(6): 1795-1802.
42Higgins TR, Greene DA, Baker MK. Effects of cold water immersion and contrast water therapy for recovery from team sport: a systematic review and meta-analysis. The Journal of Strength & Conditioning Research. 2017 May 1;31(5):1443-60.
43Al‐Qubaeissy KY, Fatoye FA, Goodwin PC, Yohannes AM. The effectiveness of hydrotherapy in the management of rheumatoid arthritis: a systematic review. Musculoskeletal care. 2013 Mar;11(1):3-18.
44Mateen S, Moin S, Khan AQ, Zafar A, Fatima N, Shahzad S. Role of hydrotherapy in the amelioration of oxidant‐antioxidant status in rheumatoid arthritis patients. International journal of rheumatic diseases. 2018 Oct;21(10):1822-30.
45Galvão-Moreira LV, de Castro LO, Moura EC, de Oliveira CM, Nogueira Neto J, Gomes LM, Leal PD. Pool-based exercise for amelioration of pain in adults with fibromyalgia syndrome: A systematic review and meta-analysis. Modern Rheumatology. 2020 Sep 29:1-21.
46Evcik D, Kızılay B, Gökçen E. The effects of balneotherapy on fibromyalgia patients. Rheumatology international. 2002 Jun 1;22(2):56-9.
47Neumann L, Sukenik S, Bolotin A, Abu-Shakra M, Amir M, Flusser D, Buskila D. The effect of balneotherapy at the Dead Sea on the quality of life of patients with fibromyalgia syndrome. Clinical Rheumatology. 2001 Jan;20(1):15-9.
48Yurtkuran M, Celiktas M. A randomized, controlled trial of balneotherapy in the treatment of patients with primary fibromyalgia syndrome. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 1996 Aug;6(04):109-12.
49Zijlstra TR, van de Laar MA, Bernelot Moens HJ, Taal E, Zakraoui L, Rasker JJ. Spa treatment for primary fibromyalgia syndrome: a combination of thalassotherapy, exercise and patient education improves symptoms and quality of life. Rheumatology. 2005 Apr 1;44(4):539-46.
50Bartels EM, Juhl CB, Christensen R, Hagen KB, Danneskiold‐Samsøe B, Dagfinrud H, Lund H. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database of Systematic Reviews. 2016(3).
51Fatah AE, Ibrahem M, Weheida SM, Mekkawy MM. Effect of Contrast Hydrotherapy on Pain Intensity And Quality Of Life Outcomes For Patients With Knee Osteoarthritis. Assiut Scientific Nursing Journal. 2019 Mar 1;7(16):35-42.
52Forestier R, Forestier FB, Francon A. Spa therapy and knee osteoarthritis: a systematic review. Annals of physical and rehabilitation medicine. 2016 Jun 1;59(3):216-26.
53Prabhakaran B. Evaluate the Effect of Hot Affusion Bath with Epsom Salt on Pain Management in Osteoarthritis of Knee (Doctoral dissertation, Government Yoga and Naturopathy Medical College, Chennai).2019.
54Archanah T, Shashikiran HC, Shetty P, Chandrakanth KK. Effect of a hydrotherapy based alternate compress on osteoarthritis of the knee joint: a randomized controlled trial. Int J Res Med Sci. 2018 Apr;6(4):1444-9.
55Basuny NA, Zatton HK, Abo-Hashem MM. Responsiveness of Pain and Associated Health Issues of Patients with Knee Osteoarthritis to the Revulsive Compresses. Egyptian Journal of Health Care. 2020 Sep 1;11(3):114-43.
56Masiero S, Maccarone MC, Magro G. Balneotherapy and human immune function in the era of COVID-19. International Journal of Biometeorology. 2020 Apr 16:1-2.
57Brenner IK, Castellani JW, Gabaree C, Young AJ, Zamecnik J, Shephard RJ, et al. Immune changes in humans during cold exposure: Effects of prior heating and exercise. J Appl Physiol. 1999 Aug 1;87:699–710.
58Yamaguchi N, Wan W, Sakamoto D, Nurmuhammad A, Matsumoto K, Takei T, Okuzumi K, Murayama T, Takahashi T. Regulative effect for natural killer cell by hot spring hydrotherapy—Quantitative and qualitative discussion. Open Journal of Immunology. 2013 Dec 11;3:201-09.
59Blazickova S, Rovenský J, Koska J, Vigas M. Effect of hyperthermic water bath on parameters of cellular immunity. International journal of clinical pharmacology research. 2000 Jan 1;20(1-2):41-6.
60Bellometti S, Cecchettin M, Galzigna L. Mud pack therapy in osteoarthrosis: changes in serum levels of chondrocyte markers. Clinica Chimica Acta. 1997 Dec 10;268(1-2):101-6.
61Cozzi F, Carrara M, Sfriso P, Todesco S, Cima L. Anti-inflammatory effect of mud-bath applications on adjuvant arthritis in rats. Clin Exp Rheumatol. 2004 Nov 1;22(6):763-6.
62Mahboob N, Sousan K, Shirzad A, Amir G, Mohammad V, Reza M, Mansour VA, Hadi V. The efficacy of a topical gel prepared using Lake Urmia mud in patients with knee osteoarthritis. The Journal of Alternative and Complementary Medicine. 2009 Nov 1;15(11):1239-42.
63Benedetti S, Canino C, Tonti G, Medda V, Calcaterra P, Nappi G, Salaffi F, Canestrari F. Biomarkers of oxidation, inflammation and cartilage degradation in osteoarthritis patients undergoing sulfur-based spa therapies. Clinical biochemistry. 2010 Aug 1;43(12):973-8.
64Oyama JI, Kudo Y, Maeda T, Node K, Makino N. Hyperthermia by bathing in a hot spring improves cardiovascular functions and reduces the production of inflammatory cytokines in patients with chronic heart failure. Heart and vessels. 2013 Mar;28(2):173-8.
65Basili S, Martini F, Ferroni P, Grassi M, Scavalli AS, Streva P, Cusumano G, Musca A, Rini GB. Effects of mud-pack treatment on plasma cytokine and soluble adhesion molecule levels in healthy volunteers. Clinica Chimica Acta. 2001 Dec 1;314(1-2):209-14.
66Sarsan A, Akkaya N, Özgen M, Yildiz N, Atalay NS, Ardic F. Comparing the efficacy of mature mud pack and hot pack treatments for knee osteoarthritis. Journal of back and musculoskeletal rehabilitation. 2012 Jan 1;25(3):193-9.
67Anstey KH, Roskell C. Hydrotherapy: Detrimental or beneficial to the respiratory system?. Physiotherapy. 2000 Jan 1;86(1):5-13.
68Asanuma Y. Influence of water immersion on lung volumes and pulmonary diffusing capacity. A comparison of healthy subjects and patients with chronic obstructive pulmonary disease. Japanese Journal of Clinical Physiology. 1999;29(3):187-92.
69Schoenhofer B, Koehler D, Polkey MI. Influence of immersion in water on muscle function and breathing pattern in patients with severe diaphragm weakness. Chest. 2004 Jun 1;125(6):2069-74.
70Goedsche K, Förster M, Kroegel C, Uhlemann C. Repeated cold water stimulations (hydrotherapy according to Kneipp) in patients with COPD. Forschende Komplementarmedizin (2006). 2007 Jun 22;14(3):158-66.
71Matsumoto, T.; Nishiyama, T.; Nishimura, N.; Kato, M.; Inukai, Y.; Sugenoya, J.; Yamauchi, M.; Kosaka, M. Endocrine responses to heat and cold stress. In Thermotherapy for Neoplasia, Inflammation, and Pain; Kosaka, M., Sugahara, T., Schmidt, K.L., Simon, E., Eds.; Tokyo, Japan: Springer; 2001. P. 228–241.
72De la Fuente M, Cruces J, Hernandez O, Ortega E. Strategies to improve the functions and redox state of the immune system in aged subjects. Current pharmaceutical design. 2011 Dec 1;17(36):3966-93.
73Vescovi PP, Gerra G, Pioli G, Pedrazzoni M, Maninetti L, Passeri M. Circulating opioid peptides during thermal stress. Hormone and metabolic research. 1990 Jan;22(01):44-6.
74Møller N, Beckwith R, Butler PC, Christensen NJ, Ørskov H, Alberti KG. Metabolic and hormonal responses to exogenous hyperthermia in man. Clinical endocrinology. 1989 Jun;30(6):651-60.
75Weeke J, Gundersen HJ. The effect of heating and central cooling on serum TSH, GH, and norepinephrine in resting normal man. Acta Physiologica Scandinavica. 1983 Jan;117(1):33-9.
76Laatikainen T, Salminen K, Kohvakka A, Pettersson J. Response of plasma endorphins, prolactin and catecholamines in women to intense heat in a sauna. European journal of applied physiology and occupational physiology. 1988 Jan;57(1):98-102.
77Brisson GR, Peronnet F, Perrault H, Boisvert P, Massicotte D, Gareau R. Prolactinotrophic effect of endogenous and exogenous heat loads in human male adults. Journal of applied physiology. 1991 Mar 1;70(3):1351-5.
78Kubota K, Kurabayashi H, Tamura K, Kawada E, Tamura JI, Shirakura T. A transient rise in plasma β-endorphin after a traditional 47° C hot-spring bath in Kusatsu-spa, Japan. Life sciences. 1992 Jan 1;51(24):1877-80.
79Ježova D, Kvetňanský R, Vigaš M. Sex differences in endocrine response to hyperthermia in sauna. Acta Physiologica Scandinavica. 1994 Mar;150(3):293-8.
80Ortega E, Gálvez I, Hinchado MD, Guerrero J, Martín-Cordero L, Torres-Piles S. Anti-inflammatory effect as a mechanism of effectiveness underlying the clinical benefits of pelotherapy in osteoarthritis patients: regulation of the altered inflammatory and stress feedback response. International journal of biometeorology. 2017 Oct;61(10):1777-85.
81Bellometti S, Galzigna L. Function of the hypothalamic adrenal axis in patients with fibromyalgia syndrome undergoing mud-pack treatment. Int J Clin Pharmacol Res. 1999;19(1):27-33.
82Gerra G, Volpi R, Delsignore R, Maninetti L, Caccavari R, Vourna S, Maestri D, Chiodera P, Ugolotti G, Coiro V. Sex-related responses of beta-endorphin, ACTH, GH and PRL to cold exposure in humans. European Journal of Endocrinology. 1992 Jan 1;126(1):24-8.
83Glickman-Weiss EL, Nelson AG, Hearon CM, Goss FL, Robertson RJ. Are beta-endorphins and thermoregulation during cold-water immersion related?. Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc. 1993 Sep 1;20(3):205-13.
84Han EY, Kim BR, Im SH, Choi JH, Kim SM. Effects of adjuvant hydrotherapy on functional status and mental relaxation in patients with knee osteoarthritis: Preliminary study. Journal of the Korean Geriatrics Society. 2014 Sep 30;18(3):153-61.
85Mizuno K, Tanaka M, Tajima K, Okada N, Rokushima K, Watanabe Y. Effects of mild-stream bathing on recovery from mental fatigue. Medical Science Monitor. 2009 Dec 21;16(1):CR8-14.
86Sa C, Palmeira A. Results of a hydrotherapy program on balance, risk of falls, fear of falling and quality of life in older people. Physiotherapy. 2015 May 1;101:e1307.
87Antonelli M, Donelli D. Effects of balneotherapy and spa therapy on levels of cortisol as a stress biomarker: a systematic review. International journal of biometeorology. 2018 Jun 1;62(6):913-24.
88Marazziti D, Baroni S, Giannaccini G, Dell'Osso MC, Consoli G, Picchetti M, Carlini M, Massimetti G, Provenzano S, Galassi A. Thermal balneotherapy induces changes of the platelet serotonin transporter in healthy subjects. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2007 Oct 1;31(7):1436-9.
89Dubois O, Salamon R, Germain C, Poirier MF, Vaugeois C, Banwarth B, Mouaffak F, Galinowski A, Olié JP. Balneotherapy versus paroxetine in the treatment of generalized anxiety disorder. Complementary therapies in medicine. 2010 Feb 1;18(1):1-7.
90Henrique AJ, Gabrielloni MC, Rodney P, Barbieri M. Non‐pharmacological interventions during childbirth for pain relief, anxiety, and neuroendocrine stress parameters: A randomized controlled trial. International journal of nursing practice. 2018 Jun;24(3):e12642.
91Im SH, Han EY. Improvement in anxiety and pain after whole body whirlpool hydrotherapy among patients with myofascial pain syndrome. Annals of rehabilitation medicine. 2013 Aug;37(4):534.
92McVeigh JG, McGaughey H, Hall M, Kane P. The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review. Rheumatology international. 2008 Dec 1;29(2):119.
93Hägglund E, Hagerman I, Dencker K, Strömberg A. Effects of yoga versus hydrotherapy training on health-related quality of life and exercise capacity in patients with heart failure: A randomized controlled study. European Journal of Cardiovascular Nursing. 2017 Jun 1;16(5):381-9.
94Hooper PL. Hot-tub therapy for type 2 diabetes mellitus. New England Journal of Medicine. 1999 Sep 16;341(12):924-5.
95Baron AD, Steinberg HE, Brechtel GI, Johnson A. Skeletal muscle blood flow independently modulates insulin-mediated glucose uptake. American Journal of Physiology-Endocrinology And Metabolism. 1994 Feb 1;266(2):E248-53.
96Mizrahi E, Liberty I, Tsedek I, Harari M, Friger M, Sukenik S. The influence of single immersion in Dead Sea water on glucose, insulin, cortisol and C-peptide levels in type 2 diabetes mellitus patients. Harefuah. 2011 Aug 1;150(8):646-9.
97Qi Z, Pang Y, Lin L, Zhang B, Shao J, Liu X, Zhang X. Acupuncture combined with hydrotherapy in diabetes patients with mild lower-extremity arterial disease: a prospective, randomized, nonblinded clinical study. Medical science monitor: international medical journal of experimental and clinical research. 2018;24:2887.
98Vakilinia, S. R., Vaghasloo, M. A., Aliasl, F., Mohammadbeigi, A., Bitarafan, B., Etripoor, G., & Asghari, M. Evaluation of the efficacy of warm salt water foot-bath on patients with painful diabetic peripheral neuropathy: A randomized clinical trial. Complementary Therapies in Medicine. 2020 Mar 1;49:102325.