Skilled touch and water treatments are among the most ancient and revered of all healing modalities. From the great Roman baths, Russian saunas and Indian Ayurvedic steams, to Turkish baths, sweat lodges of the Americas and Japanese hot springs, people the world over use hydrotherapy and massage together.

Skilled touch and water treatments are among the most ancient and revered of all healing modalities. From the great Roman baths, Russian saunas and Indian Ayurvedic steams, to Turkish baths, sweat lodges of the Americas and Japanese hot springs, people the world over use hydrotherapy and massage together.

Injury, pain and nervous tension have long inspired healers to relieve suffering with compassionate touch and a wide variety of treatments using water.

Benefits of Hydrotherapy

As a massage therapy student or practitioner, you may be wondering how adding hydrotherapy to your massage practice could benefit your clients. Here are some important benefits:

• Hydrotherapy is relaxing and stress-reducing.

• Hydrotherapy can relieve discomfort and pain, stimulate the flow of blood and lymph, make connective tissue easier to stretch, and help soothe many aches, pains, injuries and muscle problems.

• If your clients are uncomfortably hot or cold, you can use hydrotherapy treatments to make them more comfortable during a session. 

• Hydrotherapy is an excellent adjunct to any kind of bodywork done for rehabilitation. Cold treatments such as local baths, ice packs and ice massage can stimulate circulation and reduce spasm and pain, while heat treatments soften scar tissue and make muscle tissues easier to stretch.

• Hydrotherapy treatments can provide different types of skin stimulation. Examples include the “body-hugging” sensation of being surrounded by water, the thermal sensations ranging from hot to cold and the scratchy sensation of a salt glow, dry brush or cold mitten friction.

Hot applications can reduce stress on your hardworking hands by replacing the initial massage strokes needed to warm tissues, relax superficial muscles and increase local blood flow.

• By combining the most appropriate massage techniques and most suitable water treatments, you can fine-tune your treatments to individual clients.

• Many treatments can be performed by clients at home to help them make faster progress between sessions.

Hydrotherapy in Ancient Greece and Other Early Cultures

Because water is plentiful, easy to obtain and generally safe, some kind of water treatment is usually among the first remedies tried whenever a new health problem emerges. Thermal and mineral waters have been popular for thousands of years: the combination of warming and cleansing properties, combined with the opportunity to float free of gravity, has been almost irresistible.

The waters of Baden-Baden, Germany, have been used for over 8,000 years, and in Bath, England, 10,000 years. Hot air baths have had wide appeal as well: As early as the eighth century BC, Irish sweat houses made of sod and stone were used for rheumatism, while in the Americas, sweat lodges provided space for an important religious and physical ritual. Partial-body hydrotherapy treatments are also found in the most ancient of medical traditions: Water was used for its warming or cooling effect and as a carrier for herbs and minerals in baths, compresses, plasters and other preparations. In medieval Spain, for example, a patient with gout might be treated with an herbal foot soak, a hot poultice to draw inflammation and finally a cold foot soak with mineral salts to relieve pain.

Spiritual and Religious Function of Water

Many primitive peoples worshipped water deities who possessed the awesome power of nature. Religious leaders were often physical healers as well, performed water rituals such as baptisms, foot washing, baths before sacred events, and washing the dead to prepare them for the afterlife.

In the Bible, baths were described as being used for skin diseases, gonorrhea, leprosy and other problems. The temple of Dendera in Egypt housed an extensive hydrotherapy center with stone tanks, where the sick bathed in the hope of being cured with the help of the goddess Hathor. In the Greco-Roman tradition, pilgrimages to springs were often made in order to ask for help from a deity associated with healing, such as the Greek god of medicine, Asclepius, or the Roman goddess Minerva.

Some deities oversaw specific ailments or parts of the body: for example, at one Roman temple, foot-and-hand disorders were the special concern of the goddess Nona, and visitors to her spring hoped to find relief from problems such as fallen arches, torn ligaments, ulcerations, arthritis and clubfoot.

Modern hydrotherapy and the massage therapist

In the heyday of hydropathy (the treatment of illness with water), water treatments and massage flourished. Now, in modern times, regardless of whether massage and water treatments are part of mainstream medicine or not, there continues to be a demand for them by the public. Health clubs featuring steam baths, saunas and massage have been popular since they were first introduced, and the warm water of natural hot springs has continued to attract both sick people and healthy vacationers alike.

In Bath, England, a team of 50 massage therapists treats a seasonal tourist population of 1,000 visitors a day that come to experience water treatments and receive massage. Unfortunately, unlike Europe, where therapeutic spa regimens have always been considered legitimate therapies paid for by health insurance, fewer people in the U.S. take them seriously, and health insurance did not cover them.

Then in the 1970s, the growth of the human potential movement, a disenchantment with increasingly impersonal mainstream medicine and a renewed interest in wholistic health contributed to a revival of massage and hydrotherapy. Bodywork emerged as an independent, stand-alone therapy performed by professional massage therapists who practiced in many different environments, from athletic clubs, chiropractic offices and physical therapy clinics to private offices, hospitals and hospices. Many innovative bodywork methods emerged, and spas of all kinds began to spring up.

This growth in spas has been especially marked in the U.S., since it did not already have a strong spa tradition. Spas became a “must-have” amenity at resorts and large hotels, where they offered exotic and ever-changing menus of bodywork and water treatments. Hospital-based spas began offering massage targeted to specific complaints such as lymphedema, cancer, pregnancy, arthritis and chronic pain. 

New hydrotherapy treatments were created as well, including flotation therapy for chronic pain, innovative products to apply local heat and cold, Watsu for relaxation, water exercise baths for tiny hospitalized preemies, and hyperthermia treatments for depression.

All these trends have helped bring the massage therapist squarely back to the historical association of water treatments and massage.

Today’s massage therapist can specialize in many types of massage therapies and work with clients with a wide variety of specific needs—and use water treatments to enhance and complement the massage experience. Practitioners who are knowledgeable about the effects and benefits of these treatments have a powerful, versatile tool to complement and enhance their expertise in touch.

A 7-Step Hydrotherapy Treatment

The sensory stimulation footbath is helpful for highly sensitive persons, such as autistic children and frail elderly people who don’t tolerate whole-body massage, those new to massage or who are uncomfortable disrobing, and many others. A paraffin dip may be added at the end of the treatment. 

1. Equipment needed: Water thermometer, container for water, 1.5-2 gallons ( 5.6-7.5L) of water, a  large towel to go under the footbath and a small towel for drying the feet. If the client will be lying on the table, add anti-slip fabric (used to keep rugs from sliding) under the tub, and launder that as well. Regarding the container for water: A large rectangular container, such as a plastic dishpan, provides space for both feet without crowding them, and has enough room for water to cover the feet up to the top of the ankles. Do not use footbaths with heating elements, as burns have occurred. Foot spas with jets are difficult and time-consuming to disinfect, so they are also not recommended.

2. Lay out additional equipment on a tray covered with a clean towel: two extra washcloths, 1 cup (250 ml) of Epsom salts, a container of liquid soap, a soft brush or bath pouf, textured massage tools or small handheld massagers, a pitcher of clean warm water, massage lotion or oil, and a pillow for the therapist to sit on while facing the client. Optional: river stones on the bottom of the container.

3. Put the container of warm water on the towel and rest the client’s feet in the container. Begin by putting a little Epsom salts in your palm, moistening them slightly, and performing a salt glow of the lower legs and feet. Let the feet rest back in the water and use the brush or bath pouf and liquid soap to work up a creamy lather, then massage lower legs and feet through the lather.

4. Rinse the Epsom salts off with half of the water from the pitcher.

5. Use washable massage tools or a handheld massager to massage the client’s lower legs and feet. (Handheld massagers can be used if the client’s foot and leg are out of the water and covered with a thin towel.)

6. Use massage lotion to perform hands-on massage of the lower legs and feet.

7. Rinse each limb off with clean water, towel dry briskly with a washcloth, put the client’s socks on, and finish with tapotement. 

About the Author

This article was excerpted from “Hydrotherapy for Bodyworkers, Second Edition.” Copyright © Handspring Publishing 2020; reproduced with permission. MaryBetts Sinclair has been a massage therapist and teacher since 1975. She is interested in scientific research related to bodywork and other natural healing modalities; she believes massage therapists can combine a knowledge of hard-headed science with intuition and heartfelt compassion. She wrote “Hydrotherapy for Bodyworkers, Second Edition” for Handspring Publishing.