What is hydrotherapy?

Hydrotherapy is the use of water in the treatment of different conditions, including arthritis and related rheumatic complaints. Hydrotherapy differs from swimming because it involves special exercises that you do in a warm-water pool. The water temperature is usually 33–36ºC, which is warmer than a typical swimming pool.

You’ll normally have hydrotherapy treatment within a hospital’s physiotherapy department. Usually a physiotherapist or a physiotherapist’s assistant with specialist training will show you how to do the exercises. The focus of the exercises can be adjusted to help your range of movement or strength, depending on your symptoms.

Hydrotherapy tends to be different to aquarobics, which can be quite strenuous, as it’s generally more focused on slow, controlled movements and relaxation.

Is hydrotherapy similar to spa therapy?

Spa therapy is based on the theory that the mineral content of spa water has special health-giving properties. In many European countries, hydrotherapy often takes place in spa water. Although there’s some research that suggests the mineral content of the water may make a difference, other studies show that hydrotherapy has significant benefits regardless of the water used.

What types of arthritis is hydrotherapy used for?

Hydrotherapy is beneficial regardless of how many of your joints are affected. It’s sometimes used if you’ve had joint replacement surgery or if you have back pain, ankylosing spondylitispsoriatic arthritis and osteoarthritis, but it can be used for other types of arthritis if you’d like to try it.

You’ll normally share the pool with other people during your treatment sessions, although the exercises will usually be tailored to each individual. Sometimes group sessions are provided for people with similar conditions.

How does hydrotherapy help?

Hydrotherapy can help you in a number of different ways:

  • The warmth of the water allows your muscles to relax and eases the pain in your joints, helping you to exercise.
  • The water supports your weight, which helps to relieve pain and increase the range of movement of your joints.
  • The water can be used to provide resistance to moving your joints. By pushing your arms and legs against the water, you can also improve your muscle strength.

How effective is hydrotherapy?

Scientific studies have shown that hydrotherapy can improve strength and general fitness in people with various types of arthritis. The exercises can be tailored to your individual needs, so you can start to slowly and gradually build up your strength and flexibility.

The extra support that the water provides may make you feel like you can do more exercise than normal, so be careful not to overdo it. The exercise and the warmth of the water may make you feel tired after treatment, but this is quite normal. In general, hydrotherapy is one of the safest treatments for arthritis and back pain.

How can I access hydrotherapy?

Hydrotherapy sessions are available on the NHS, and most hospitals have access to hydrotherapy pools. Any member of the healthcare team should be able to refer you to an NHS physiotherapist if they think you might benefit from hydrotherapy. In some parts of the UK you can also refer yourself to a physiotherapist, who’ll assess whether hydrotherapy would be suitable for you. Check with your GP or call your local rheumatology department to find out if an NHS physiotherapist in your area will accept self-referrals.

You can also choose to use private healthcare, but it’s important to be aware that in rare instances private hydrotherapy may be unregulated, and so the quality of the changing areas, the water or general environment can vary enormously. Check before your treatment starts that you’re happy with the facility. A qualified physiotherapist will be registered with the Health Professionals Council (HPC), and it’s recommended that you see someone who’s a member of the Chartered Society of Physiotherapists (CSP) and who’s accredited by the Aquatic Therapy of Chartered Physiotherapists (ATACP).

Before you start hydrotherapy, you’ll be seen by the physiotherapist in your hospital’s physiotherapy department, on the hospital ward or possibly in the physiotherapist’s own surgery. They’ll ask about your general health and your arthritis, and assess your individual needs. Using this information and the information provided by your doctor, the physiotherapist will advise on whether hydrotherapy is appropriate for you. This initial assessment normally takes about 30–45 minutes.

A course of hydrotherapy usually involves five or six 30-minute sessions. Not all physiotherapy departments have a hydrotherapy pool, so you may have to travel to another hospital.

What do I need?

You should take:

  • a swimming costume
  • a towel
  • medication that you would need while exercising, for example an inhaler, GTN spray or glucose tablets if you have diabetes

What if I can’t swim?

You don’t have to be able to swim to benefit from hydrotherapy. The pool is usually quite shallow (about chest height), so you can exercise well within your depth. There will always be two members of the healthcare team present, usually a physiotherapist and an assistant, and one of them will be in the pool with you. You can also use floats.

Even if you’re nervous about being in the water it’s worth trying hydrotherapy – most people find the warm water soothing and pleasant.

How do I get in and out of the pool?

There will be a few steps down into the pool, but if you have trouble with steps there’ll also be a mechanical hoist to get you in and out of the water.

Most pools have different depths, varying from waist height to chest height, and there will be a rail around the edge of the pool for extra support.

What else do I need to consider?

There are certain situations where you may not be able to have hydrotherapy. You must tell your physiotherapist if you have any of the following:

  • a wound or skin infection
  • a virus or stomach upset
  • a raised temperature
  • high or low blood pressure
  • breathing difficulties
  • a kidney condition requiring dialysis
  • angina or heart problems
  • incontinence
  • a chest infection
  • a chlorine allergy
  • uncontrolled diabetes, asthma or epilepsy

You and your physiotherapist will decide whether hydrotherapy is suitable. The decision will be based on the severity of your condition, whether it affects more than one part of your body and your medication. Hydrotherapy isn’t advised if you have certain conditions in the list, but with others it’s just to inform the physiotherapist so they can take precautions if they need to.

What happens at the end of a course of hydrotherapy?

One of the main aims of hydrotherapy treatment is to give you confidence to continue and manage a programme of exercises on your own once the course has finished. Your physiotherapist will probably suggest that you carry on with your exercises in your local swimming pool.

Some swimming pools have special sessions when the water temperature may be increased and some sports centres offer water-based exercise classes. Ask your doctor or physiotherapist for advice before you join a class to make sure it’s suitable. You should also speak to the instructor about your arthritis and its effects so they can adapt some of the exercises for you if necessary.

It may also be possible to pay for further sessions without the physiotherapist in the hospital pool. And in some areas, local arthritis support groups (such as the National Ankylosing Spondylitis Society) hire a hospital or health club pool for hydrotherapy sessions.

If you can’t swim, it might be worth learning – swimming is an excellent form of exercise for improving your fitness and mobility without putting a lot of strain on your joints. Ask a healthcare professional for advice if you’re not sure whether it would be suitable for you.