Hydrotherapy Treatment for Fibromyalgia

Hydrotherapy is the use of water by external applications, either for its pressure effect or as a means of applying physical energy to a tissue. Hydrotherapy covers a wide variety of uses of water for health purposes, from spa therapy to water exercise to physiotherapy done with the benefit of water which eases mobility, provides safe cushioning for stressed or fragile bones, and reduces stresses and pressures on the joints and cartilage of the body.

Hydrotherapy, formerly called hydropathy involves the use of water for soothing pains and treating diseases.

Hydrotherapy was common as far back as ancient Egyptian, Greek and Roman civilizations. Egyptian royalty bathed with essential oils and flowers, while Romans had communal public baths for their citizens. Hippocrates prescribed bathing in spring water for sickness.

A Dominican monk, Sebastian Kneipp, again revived hydrotherapy during the 19th century. His book My Water Cure in 1886 was published and translated into many languages. The use of water to treat rheumatic diseases has a long history. Today, hydrotherapy is used to treat musculoskeletal disorders such as arthritis, ankylosing spondylitis, or spinal cord injuries and in patients suffering burns, spasticity, stroke or paralysis. It is also used to treat orthopedic and neurological conditions in dogs and horses and to improve fitness.

Hydrotherapy is a broad term and people install hydrotherapy tubs in their own homes, or go for hydrotherapy at a spa (which may be for pleasure rather than health reasons) or do exercise classes in the water or see a certified hydrotherapist.  All of these uses fall under the umbrella of hydrotherapy.  

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Frequently Asked Question about Hydrotherapy

What is a session usually like?

Hydrotherapy is a form of physiotherapy also known as aquatic therapy that uses water to revitalize, maintain and restore health.  A session is usually preformed in a warm water pool and can include saunas, steam baths or foot baths. There are a number of exercises that can be performed, which ones are used depends on the instructor and the patients’ illness.  The water works to ease mobility and provides safe cushioning for stressed or fragile bones.

How long does a session usually last?

A hydrotherapy session usually last about a half an hour to an hour and depending on the patients’ needs may require up to six sessions.

What are price ranges for a treatment (US / Canada)?

Hydrotherapy prices can range from $45 to $90 Canadian dollars.  It depends on the therapist and their rate schedule.  Hydroptherapy with a a qualified therapist may be covered under your insurance plan or benefit plan, particularly if it is prescribed by a doctor.

How to Select a Good Hydrotherapist

How are practitioners trained?

Hydrotherapists must first be qualified in and licensed for physiotherapy, massage therapy or naturopathy.  These practitioners will have several years of training by accredited schools and need to be licensed in order to take additional training for hydrotherapy.  This usually takes an extra two years after which they must pass an exam in order to qualify.

How would you select a practitioner?

For medical treatment, it is recommended that you select a hydrotherapist who is licensed and registered with a national organization such as the Canadian Physiotherapy Association, the Massage Therapists’ Association or The Council on Naturopathic Education (CNME).  This is because before becoming a hydrotherapist the practitioner should have at least one of those degrees.

However, if you are simply looking to try the experience (rather than have a therapeutic session), you may want to inquire at local gyms or rec centers.  Spas will also offer hydrotherapy (which in North America is more often a pleasure experience than a treatment - as opposed to Europe where spas may still be very much for treatment).  And some people install or are counselled by their doctors to install, hydrotherapy tubs or jets in their own homes.

History of Hydrotherapy

Widely practiced across the ancient world by the Egyptians, Persians, Romans, Greeks and Chinese, Hydrotherapy largely disappeared during the middle ages before being revived in the 18thand 19thcenturies.

Hydrotherapy was formalized a discipline around 1829, when Vincent Priessnitz (1801-1851), a farmer from Austria, began his public career in the paternal homestead, extended so as to accommodate the increasing numbers attracted by the fame of his cures. Priessnitzz was influenced heavily by two English works on the medical uses of water that had been translated into German around a century earlier. One of these was by Sir John Floyer (1649 1734), a physician from Lichfield who observed the use of certain springs by the neighboring locals and began investigating the history of cold bathing, and published “The History of Cold Bathing, both Ancient and Modern”. The other work was that of Dr James Currie (1756-1805) of Liverpool called Medical Reports on the Effects of Water, Cold and Warm, as a remedy in Fevers and other Diseases, published in 1797, and soon after translated into German. It proved extremely popular and was the first book which examined the subject on a scientific basis.

Hydrotherapy spread to North America vin the 19th Century when the Father Sebastian Kneipp, a Bavarian monk, began a movement to recognize the healing benefits of water. In 1886 Kneipp wrote a book, My Water Cure. Kneipp’s methods were later adopted by the German physician Benedict Lust, who successfully treated his own tuberculosis with Kneipp’s methods. When Lust moved to the United States in 1896 he founded the first American school of naturopathic medicine, which included hydrotherapy treatments. Since, the medicinal uses of hydrotherapy have expanded. Today, various forms of hydrotherapy are used in both alternative and conventional medicine.

Theory behind Fibromyalgia Treatment using Hydrotherapy

There are some obvious and some less obvious benefits of hydrotherapy or balneotherapy or spa therapy for people with fibromyalgia. The soothing and stress relieving aspects of the water, as well as the reduction in pressure on the joints from being in the water are clear. Buoyancy, immersion, resistance, and temperature all play important roles. Hot stimuli produces analgesia on nerve endings by increasing the pain threshold. It causes relief of muscle spasms through the gamma fibers of muscle spindles and activates the descending pain inhibitory system. According to the “gate theory”, pain relief may be due to the temperature and hydrostatic pressure of water on the skin.

However, there are some interesting theories about how these therapies help people with Fibromyalgia beyond the obvious. Apparently spa therapy causes a series of endocrine reactions and releases adrenocorticotropic hormone (ACTH), cortisol, prolactin and growth hormones (GH). Fibromyalgia patients have been shown to have a deregulaton of the HPA axis and these changes are believed to counteract that.

In addition, spa therapies have been shown to increase plasma levels of beta-endorphins. This increase can perhaps explain the analgesic and anti-spastic effects of spa therapy, which are very helpful to people with Fibromyalgia.
Another recent study showed a reduction in circulation levels of IL-1, PGE2 and LTB4 (all important mediators of inflammation and pain) in people with fibromyalgia taking a course of balneotherapy. This reduction in the levels could explain the clinical benefits of spa therapy in reucing pain and decreasing resting pains and reducing the sensation of pain for people with Fibromyalgia.

Research of Fibromyalgia Treatment using Hydrotherapy

There is significant research related to the benefits of different types of hydrotherapy for people with Fibromyalgia.  The benefits range from decreases in pain to improvements in quality if life to decreases on the Fibromyalgia Impact Questionnaire.  There are too many such studies to include them all here, but we have selected a small sample to give you a sense of what the researchers are looking at (and the wide range of different treatments that fall under the category of hydrotherapy).

Fibromyalgia Syndrome and Spa Therapy: Myth or Reality? (Feb 2012)

This is a systematic review of eight different studies related to fibromyalgia and a variety of different types of treatments, including spas, exercise combined with bathing and balneotherapy with a total of 314 people participating. This paper reviews the finding of each study in great detail (and is a very interesting read), and the final conclusion is that the results suggest a positive effect of spa therapy for fibromyalgia on pain, other fibromyalgia related symptoms and quality of life. Not only is there a positive impact, but the studies also assessed the medium-to-long-term effects and foudn that the clinical efficacy of spa therapy lasted for 4-6. In addition, they said taht while people with Fibromyalgia tend to have a low tolerance for physical treatments, spa therapy seems to be well tolerated and have a lower percentage of side effects (and less severe side effects) than pharmacological treatments. The authors therefore conclude that "spa therapy seems to be effective and useful in FS [Fibromyalgia], reducing pain, improving function, and ameliorating QoL. The improvement reported in some clinical studies lasts over time."

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296493/

A pragmatic community-based intervention of multimodal physiotherapy plus deep water running (DWR) for fibromyalgia syndrome: a pilot study

Summary:  The aim of this study was to assess the effectivness of pool-based exercise using deep water running as part of a motimodal physiotherapy program for people with fibromyalgai.  44 people participated and were split into a treatment group and a control group.  Results were evaluated for physical function (Fibromyalgia Impact Questionnaire, FIQ), pain, general health (Short Form-12 Health Survey) and quality of life (European Quality of Life Scale-5D) before and after the treatment.  The group receiving treatment had statistically significant results for the Fibromyalgia Impact Questionnaire total score, incorporating physical function, pain, fatigue, stiffness and psychological variables. Statistically significant differences between the experimental group and control were also found for general health and quality of life. The results of this pilot study and the high level of compliance and adherence and low level of attrition suggest that this multimodal programme incorporating deep water running is a safe and effective intervention for fibromyalgia syndrome that is acceptable to patients.

Source: http://www.ncbi.nlm.nih.gov/pubmed/21866329

Effects of thermal therapy combining sauna therapy and underwater exercise in patients with fibromyalgia

Summary:  This study was to investigate whether thermal tehrapy combining sauna therapy and underwater exercise improved pain, symptoms, and quality of life (QOL) for people with Fibromyalgia. Forty-four women with fibromyalgia received a12-week thermal therapy program comprising sauna therapy once daily for 3 days/week and underwater exercise once daily for 2 days/week. Pain, symptoms, and QOL were assessed using a pain visual analog scale (VAS), a fibromyalgia impact questionnaire (FIQ), and a short form 36-item questionnaire (SF-36), respectively. All of the patients reported significant reductions in pain and symptoms of 31-77% after the 12-week thermal therapy program, which remained relatively stable (28-68%) during the 6-month follow-up period (that is, the thermal therapy program improved both the short-term and the long-term VAS and FIQ scores). Improvements were also observed in the SF-36 score. Thermal therapy combining sauna therapy and underwater exercise improved the QOL as well as the pain and symptoms of FMS patients.

Source: http://www.ncbi.nlm.nih.gov/pubmed/21742283

The efficacy of balneotherapy and physical modalities on the pulmonary system of patients with fibromyalgia

Summary:  This study was focused on the impact of balneotherapy for people with Fibromyalgia on the respiratory symptoms of Fibromyalgia.  56 people with Fibromyalgia were dived into three groups.  Each group received a set of standard treatmetns.  One group received that set of treatments plus balneotherapy and another group received that set up treatments plus hydroptherapy.  The results "suggest that supplementation of PTM with balneotherapy is effective on the respiratory and other symptoms of FMS and these effects were better than other protocols at 6 month follow up."

http://www.ncbi.nlm.nih.gov/pubmed/21248401

Stories of Fibromyalgia Treatment using Hydrotherapy

Many people with Fibromyalgia do try different forms of hydrotherapy, whether formally or informally.  Some doctors even encourage people with Fibromyalgia to get their own hydrotherapy tubs or spas (although that can have significant costs).  Most people say that hydrotherapy is very beneficial to them, and some interesting forms are recommended such as suspended hydrotherapy.

Questions and Comments about Hydrotherapy for Fibromyalgia

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