Having completed this lesson, you will be able to:

• Review the stages of the inflammatory response learned in other sub-topics.
• Match effective hot or cold applications to the correct stage of the inflammatory response (e.g., cold applications for the acute stage, hot applications for the maturation stage, etc.).
• Identify two conditions that require extra caution or adaptations to sessions using cold methods.
• Identify two conditions that require extra caution or adaptations to sessions using hot methods.
• Identify two conditions that contraindicate the use of cold methods.
• Identify two conditions that contraindicate the use of hot methods.

In Topic 16-1 you learned about the history of hydrotherapy and the characteristics of water that make it therapeutically beneficial. Topic 16-2 explained the changes that occur on both a physiological and psychological level as a result of hydrotherapy treatments. This topic now discusses how to clean and sanitize hydrotherapy equipment, how to recognize contraindications and adapt sessions to ensure client safety, and how to apply common hydrotherapy treatments.

General Guidelines for Hydrotherapy Treatments

Before you can offer hydrotherapy treatments, you should understand general guidelines for ensuring your client’s health and safety. Areas that require particular attention include the sanitation of hydrotherapy equipment and protocols that reduce the transmission of germs and disease, safety issues, and cautions and contraindications to hydrotherapy services.

Cleanliness and Sanitation Guidelines for Hydrotherapy Equipment

In Chapter 3 (Sanitation, Hygiene, and Safety), you learned how to prevent the transmission of disease by properly cleaning and sanitizing the treatment room and paying attention to your own hygiene and hand washing habits. Hydrotherapy equipment often requires rigorous cleaning and sanitation between treatments. Showers, tubs, steam rooms, wet tables, and soaking basins must be cleaned, sanitized, and dried between clients. Soaking basins without jets are simply washed with hot, soapy water, dried, sprayed with alcohol, and left to air dry. If the soaking basin has jets, it must be flushed with an approved disinfectant. Modern hydrotherapy tubs usually come with a self-cleaning function that makes sanitizing the tub jets easier. You put a concentrated disinfectant (formulated by the manufacture of the tub) into a special holder and then push a button. At the end of the cleaning cycle you simply dry the tub. Small, one-person steam cabinets should be completely wiped out with an antiseptic between clients. For larger steam rooms or steam showers, the floor and seats should be sanitized between clients, but the walls can be left until the end of the day. The floor and walls around hydrotherapy equipment must also be cleaned with an approved disinfectant and dried after each use. Pay particular attention to handrails and door handles (e.g., the handle of the steam cabinet). Bath mats, bath towels, robes, washable slippers, and hand towels are changed between clients.

Clients should shower before entering hydrotherapy treatment pools to decrease the spread of waterborne infections. The client’s hair should be secured or covered with a cap before using hydrotherapy equipment including tubs, steam rooms, wet-tables, or showers. In the event of body fluid “spills” (e.g., the client suddenly gets sick and vomits on the wet-table), follow the procedures for Universal Precautions outlined in Chapter 3.

Safety Guidelines

Specific safety issues must be considered before you offer hydrotherapy treatments:

• Equipment: Check hydrotherapy equipment regularly to ensure it is working properly. Maintain the equipment according to the manufacturer’s recommendations. Don’t allow bare electrical cords in wet-rooms or any areas where they might be exposed to water. Identify hot equipment with a sign so that clients don’t inadvertently touch it. For example, the outside of a hydrocollator can get very hot, and the heating units for saunas should be surrounded with a grate.
• Health history intake: Hydrotherapy applications cause profound physiological changes in clients’ bodies. Do not provide any hydrotherapy applications until you have conducted a thorough health history intake process, identified cautions, and ruled out contraindications.
• Preparation: Install handrails around showers, wet-tables, and hydrotherapy tubs to ensure clients have something solid to hold on to when they get into, out of, or onto and off hydrotherapy equipment. Invest in robes and disposable or washable slippers so that clients can move about in warmth and comfort. Don’t allow clients to walk around the facility barefoot. Foot funguses can be spread in this manner, and the client is more likely to slip on a tile floor and sustain an injury.
• Water spills: Water is often sloshed about during a hydrotherapy treatment. For example, the area around a wet-table usually gets wet and slippery. Before allowing clients to exit hydrotherapy equipment, take a moment and dry the floor with a hand towel.
• Oils and lotions: Clients who have had a massage or who arrive at the clinic or spa covered in body lotion, cream, or body oil should shower before using hydrotherapy tubs, saunas, pools, or steam rooms. The oil or heavy cream can block perspiration and make it more difficult for the body to detoxify. Clients are more likely to slip when getting into and out of hydrotherapy equipment when covered in lubricants. Lotions and oils might interact with a treatment product (such as mud, seaweed, essential oils) and decrease the effectiveness of the session, or the client might leave a sticky residue on seats and equipment making clean-up more difficult.
• Prevent chills: Clients who are wet and exit either cold or hot treatments may suddenly become chilled. As clients exit hydrotherapy tubs, wet-tables, steam rooms, and saunas, wrap them in towels or a robe and get them entirely dried off as soon as possible. Pay attention to the temperature of treatment rooms and the facility so that clients stay warm.
• Cold clients never respond well to cold treatments: If a client is cold, don’t put him or her into a cold treatment (e.g., cold plunge) or apply a cold application. Warm the client before applying cold.
• Dizziness and low blood sugar: Clients sometimes feel a slight dizziness at the conclusion of the session, or low blood sugar may cause shakiness. Make sure clients stay hydrated during sessions by offering them water at regular intervals. Have packaged food items like fitness bars on hand in cases of shakiness. Educate clients not to eat a heavy meal before a hydrotherapy session.
• Temperatures: Use a thermometer to check the water temperature in hydrotherapy tubs and permanently mounted temperature gauges to monitor the temperature in saunas and steam rooms. Never rely on how hot or cold an application “feels” to you. Use a thermometer to ensure you are working at the correct temperatures.
• Timers: In some situations the client should receive a particular type of treatment only for a fixed amount of time. Use timers with alarms to monitor the client’s session time. If you rely on a clock you may forget to check the start time and leave a client in an application for too long, endangering his or her health.

Cautions and Contraindications

When used properly, hydrotherapy is safe for most clients. Like massage, hydrotherapy treatments can be contraindicated completely, contraindicated without a physician’s release, contraindicated at a particular location on the client’s body, or require adaptive measures and increased therapist vigilance. For example, in many full-body hydrotherapy treatments such as immersion in a hot bath, you can decrease the cardiovascular load on the client by using warm and cool applications rather than hot and cold ones. The closer the temperature of the application to the client’s body temperature, the less intense their response will be.

In general, hydrotherapy is contraindicated for individuals who have serious heart, circulatory, nervous system, or systemic conditions. Open wounds and skin rashes are also contraindicated when using extremes of hot or cold. The length of time that the client is exposed to the treatment depends on the client’s overall state of health and vitality. Children, those in a weakened condition, the elderly, and those with mental challenges may be contraindicated for full-body treatments like saunas, steam rooms, and immersion baths. Children have thinner skin and become overheated or chilled more easily than adults. Elderly clients have less subcutaneous adipose tissue and may be burned by topical hot applications or chilled more easily as a result. Blood vessels may not function efficiently, such that repeated cycles of vasodilation and vasoconstriction may place a heavy burden on the circulatory system.

If the client seems healthy enough to benefit from such treatments, or if treatments are conducted under the supervision or direction of a physician, start slowly. Begin with 10-minute sessions and progress up to 15-minute sessions. Healthy individuals can remain in saunas, steam rooms, and baths 20-30 minutes. Very cold applications longer than 20 minutes are not recommended for any client because of the risk for tissue damage, frostbite, or even hypothermia. A client who is already cold will not benefit from a cold treatment.

If a client feels lightheaded, nauseous, headachy, or dizzy, stop the treatment and monitor him or her while they relaxing in a quiet environment at a normal temperature with a glass of water. If the client’s symptoms increase or persist, consult a physician. If symptoms increase rapidly, contact emergency services because the client might be in danger. Specific cautions and contraindications for hydrotherapy applications are outlined in Table 16-3.

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