Hot Water
Therapy and Exercise


Spas and Hot Tubs offer much more than sensations of warmth and effervescence. For many soakers, time in the spa can bring pain relief, inceased mobility and in some cases, even healing. How does this happen and what do hot water and jet action really do to the human body?

As anyone who has ever slid into a spa or hot tub can attest, things start happening from the very first moment of contact with the water. The most immediate sensation is one of buoyancy, followed soon after by enveloping warmth. It's this combination of buoyancy and sustained high heat that creats hot water therapy and brings about a fundamental shift in how the body & circulatory system operates. Any warm water will provide the benefits of buoancy, but it won't provide the circulatory and blood pressure benefits of a spa.

Once you've immersed yourself in the hot water, the temperature regulating mechanisms of your body kick into gear, trying to restore and maintain a normal temperature. Your heart works harder, pumping blood to the surface in an attempt to disperse extra body heat into the air. As this increased volume of blood courses through your veins, a temporary increase in blood pressure occurs.

In trying to cool itself down, the body also begins sweating at an increased rate to bring moisture to the surface of the body, where under normal cicumstances it would evaporate and lower the bodies temperature. Because the body is immersed in hot water, the sweat can't cool the skin through evaporation. In fact, the blood brought to the skin's surface becomes even hotter because water is more effective than air at transferring heat.

As the blood continues its cycles, gathering more warmth from the surface and transporting it deep into the body, the soaker's core (or overall) temperature rises rather rapidly. In 104 degree water, studies show, a spa user's core body temperature can rise to 102 degrees Fahrenheit in under 20 minutes.

At some point as the body's core temperature rises and ciculation is enhanced and the hot tub user is overtaken by a powerful feeling of relaxation. So what's just happened?

According to medical experts, a second change in the body's blood pressure has occurred: As the warmed blood spreads thruoghout the body, it causes the blood vessels to expand. This dilation lessens the resistance to blood flow, and blood pressure drops. By dilating the vessels, this warm blood has, in effect, created easier flow and increases the body's level of circulation. As this surge of warm, nourishing blood reaches deeper and deeper into the body, more blood vessels dilate and your muscles relax more and more.

The warmth not only stimulates activity in the bloodstream, it also has an effect on the nervous system. The spa water's heat causes the central nervous system to become depressed, which contributes to muscle relaxation as well as temporary pain relief.

The muscle relaxation that comes with using hot water also plays a significant role in relieving pain. When a muscle is tense, for whatever reason, it also pinches on particular nerves and blood vessels that run through it. This makes for an unhappy muscle. Not only is pressure exerted on the nerve, but blood flow is restricted (which creates an insufficient oxygen supply), and lactic acid and other metabolic wastes back up. These results can all contribute to pain.

Hot water and pressure both help the muscle to relax. When that happens, it means that the blood running through the vessels is able to flow more efficiently, thereby reducing pain. And furthermore, pressure is released off the nerves.

The advantage of a spa over a simple hot bath is that all of the above described benefits are enhanced when jet action enters the picture. The mechanical stimulation jets provide intensifies these bodily responses in individual, targeted areas of the body, helping to further reduce painful inflammation.

The pressure of the jetted water can also promote healing by stimulating the body's healing mechanisms, reports Mike Casey, a registered physical therapist and owner of Granada Physical Therapy in Granada Hills, CA.

Along with the increased oxygen level that the tissues enjoy in a spa, he explains, the heat and the pressure from the jets can raise the level of anti-bodies and white blood cells that provide the body's defenses. These natural bodily defenses then destroy the bad cells around an injured area and help stimulate the formation of new tissue.

Fast, heated blood flow can also stimulate the body's self-cleansing process and increased sweating allows the body to release toxins at an elevated rate. In addition, as heart rate and respiration are increased, the blood carries more oxygen to the body's tissues, allowing them in turn to increase the rate at which they can eliminate metabolic waste products.

When a muscle relaxes, its fibers become spaced far enough apart so that the blood vessels have no problems transporting the volume of blood necessary to flush out metabolic wastes and replace them with oxygen and other nutrients, says Horay.

By maintaining a healthy muscle, he continues, not only can you relieve pain, but you can also prevent pain as well as susceptibility to certain injuries. By relaxing the muscle with hot water, you can prime it for stretching exercises, range of motion exercises and other gentle exercises that help strengthen and stretch the muscles out.

For many spa users, muscle relaxation and pain relief, whether it's from the stress and aches of everyday life or from the chronic pain and stiffness experinced by those who suffer from diseases such as arthritis, are the most important benefits of soaking. Spas also can play a critical role in directed, short or long term therapy programs for the injured and the ill, offering an environment in which it is easier to exercise muscles without strain or additional injury.

The soothing water action can do more than provide relaxation and pain relief. According to Rosalind Cartwright, director of the Sleep Disorders Service and Research Center, Sleep deepens as body temperature falls. As a result, she recommends in the newsletter Bottom Line Personal, that people who suffer occasional sleeplessness, especially if it is induced by pain, can help themselves by soaking in water about 103 degrees F approximately two hours before bedtime.

The Attributes of Hot Water Therapy
Who Needs It?

Over 75 million Americans suffer from repeated attacks of back distress, a number increasing by at least 7 million per year. Many millions more suffer from stiff necks, chronic headaches, and a variety of joint and muscle problems.

There are numerous causes that keep this number increasing each year. Stress alone can be one of the biggest causes of back and neck pain, especially for those who sit in front of a desk or computer on a daily basis.

There are a number of ways to deal with back, neck and muscle problems. Pain killers and muscle relaxants may help, but they are addictive and only add short term relief at best. The only long term program that will eliminate these problems is a long-term exercise program, one that is frequently best suited for a spa or other hot water applications.


Hydrotherapy is really just a fancy name for hot water exercise. It has been used for thousands of years as an effective treatment for a variety of physical ailments. Doing hydrotherapy at home offers convenience, privacy, and conditions which more adequately suit the healing process.

Hot water from a spa can dramatically increase the therapeutic value of the effects of exercise. Using the three main components of a good exercise program (massage, exercise and stretching) with a minimal amount of time, one can begin feeling the benefits almost immediately. The following components make up a part of hot water exercise routing and improve or eliminate many of the disorders mentioned earlier:

  • Relaxation in hot water
  • Massage to locate and loosen trouble spots
  • Gentle and rhythmic exercise to work muscles, remove toxins, and improve circulation
  • Stretching to improve flexibility and muscle tone
  • Cool down

What Happens When You Exercise In Hot Water:

Initially, the body experiences a temporary increase in blood pressure as the circulatory system quickly responds to the increase in body temperature caused by the hot water of the spa. Then the blood rushes to the skin surface where it increases in temperature, causing the blood vessels to expand and the blood pressure to drop down again. The rush of warmed blood then penetrates deeper into the tissue below the skin, bringing in more oxygen.

The rise in body temperature increases the amount of oxygen your body uses and the waste material it excretes. This will also increase your heart and respiration rate, which is actually a beneficial effect, helping your body to eliminate metabolic waste products and to move toxins out of the body tissues.

The Benefits of Hot Water:

  • Sedation of sensory motor neurons and pain relief
  • Stimulation of liver chemistry and conversion of lactic acid
  • Temporarily increased blood pressure followed by decreased blood pressure
  • Weightlessness and reduced gravity stress to muscles and joints
  • Increased metabolism with more oxygen moving into the body tissues
  • Increased respiration rate
  • Promotion of perspiring and elimination of body waste and toxins
  • Increased blood volume
  • Increased blood supply to muscles
  • Increased surface circulation
  • An environment that promotes total body relaxation

Who's the Target Market:

Anyone With:
  • Back Pain
  • Arthritis
  • Neuralgia
  • Muscle spasm or muscle tension
  • Sprains and strains
  • Stiffness
  • Bruises and Contusions
  • The need for a quiet place to relax
When not to use hot water therapy:
  • Acute fever
  • Sever cardiac complications
  • Seizures
  • Acute bleeding, open wounds, pressure sores
  • Acute skin infections of contagious rashes
  • Vascular disease
  • Thermal nerve deficiency
  • Incontinence of bladder or bowel
  • Sever hydrophobia
  • Malignancy or active T.B.
When to use hot water therapy under the advise of a healthcare professional:
  • Pregnancy
  • Acute injury
  • Loss of sensation
  • postural hypertension
  • Cardiac history
  • Diabetes
  • Obesity or physical disability
  • Impaired balance

Note: Regardless of the temperature of the spa water always drink liquids to replenish the body fluid lost from perspiring. As a general rule of thumb, the average body will lose at least one pint of liquids every 20 minutes in a spa at 104 degrees.

About Your Muscles:

When you are driving, typing, or viewing a computer screen for hours on end, the muscles of your back, neck and shoulders may tend to tighten up, even if you don't consciously want them to. This process of contraction over a long period of time will have numerous effects. It will allow the build-up of waste products, especially lactic acid, and can cause pain and cramping. An average desk worker may have as much tension build-up in the neck and shoulders during each day as a marathon runner will have in his/her legs after a long race. The important difference is that a marathon runner probably has a regimented program for removing the stress and relieving the tension.

The Splinting Reflex:

Whenever a muscle is injured or in pain, the body has a natural reaction called the "splinting reflex," which acts to stiffen the muscle and prevent it from moving. When this occurs, the muscle tightens even further, clamping down on its blood vessels and nerves, and the pain increases. The greater the pain, the tighter the muscle clamps down, and the tighter the muscle gets, the more it hurts.

Note: The buoyancy provided by the hot water in a spa will decrease the pressure of gravity on a weak or injured muscle or joint. In effect, it removes much of the splinting reflex.

The Most Common Trouble Areas

  • Neck
  • Shoulders
  • Traps (trapezius muscles)
  • Upper back
  • Middle back
  • Lower back

Some Basic Spa Exercises

Shoulder Lifts:
Stand or sit comfortably but as straight and tall as possible. Try to extend your spine with your chin pointed straight head. Now, bring the shoulders straight up without crunching your neck or allowing it to contract below your normal shoulder level. Hold the raised shoulder posture for at least 6 seconds. Breathe normally during the entire process! now, slowly relax the shoulders into a normal position repeat this entire process at least 5 more times.

Shoulder Circles:
Similar to the shoulder lift, this exercise is completed by making full circles. Without raising your arms or moving the torso or head, bring your shoulders as far forwards as possible. then raise them as high as possible with out tightening or "turtling" the neck. Then bring them back as far as possible for a moment before dropping them as far down as you can go. The idea is to make full and complete rotations without crunching the neck.

Head Rock:
Stand or sit comfortably but as straight and tall as possible. Now, turn your head to the left as far as possible without pain, being sure to keep your shoulders as low as possible and hold for 6 seconds. Then move your head toward the ceiling as far as it will go while still looking to the left. After holding this position for 6 seconds, move your head slowly as low as it will go - again, with out pain. Return your head to the neutral position and repeat the same exercise to the right.

Back Arch/Back Sag:
Get down on your hands and knees with your weight evenly distributed. Gently arch your back upward and let your head drop down. Hold this posture for at least 6 seconds. Slowly begin to flatten your back and relax your stomach and back muscles so that the small of your back drops down. At the same time, slowly raise your head so that you are looking directly in front of you. Hold this position for at least 6 seconds and then repeat the exercise at least 5 times.

Standing Back Arch/Back Sag:
While standing, rest your hand and weight on your knees. Arch the small of your back upward, squeezing your stomach muscles in toward your spine. Hold this posture for at least 6 seconds. Now, drop your lower back by relaxing your stomach muscles letting the curve reverse. As you reverse the curve, raise your head to an upright position and hold for at least 6 seconds. Repeat this exercise at least 5 times.

Knee Walk:
Recline against the wall of the spa until you are nearly lying down. Depending on your body size, a lounge may be the perfect place. Now, place your left palm on your left kneecap and your right palm on your right kneecap. Slowly "walk" your knees back and forth. Breath normally and perform this exercise for at least 30-60 seconds or as many times as you like. This exercise can be performed with or without the hands and the range of knee-walking mobility can be increased as desired.

Knee Circles:
While in the same position as the knee walk, place both hands on your knees and slowly rotate your knees in a circular motion. Move at a comfortable speed for at least 30-60 seconds. The range of motion in this exercise may be as great or as limited as is comfortable. Making larger circles will increase muscular strength and also add strength to the abdominal muscles.

Pelvic Tilt:
Stand with your knees slightly bent and hands at your sides. Now, flatten the curve of your lower back by sucking your stomach in toward your back and lifting the bottom of your pelvis up. Hold this backward tilt for at least 6 seconds. Repeat this exercise at least 5 times. This same exercise can be done in a reclining position or while seated.

Stretching Helps

Stretching helps to increase the range of motion of a muscle by lengthening muscle fiber and stimulating joints. Stretching exercises can actually be quite difficult and more intense than an actual "exercise." The difference between the two is that an exercise position is usually held for only a short period of time (6 seconds), while a stretch is usually held for at least 30-60 seconds. Contrary to popular opinion, stretching is better after the body has been warmed up by exercising and should not be pushed to the point of pain. The following are a number or stretching exercises that can be performed almost anywhere.

Head-to-Side Stretch:
Sit or stand in a relaxed but upright position. Reach over your head with your right hand and place your fingers on, under, or just above your left ear, as is comfortable. Your right elbow should be pointing to your right. Do not put the weight of your arm on your head. Allow your left arm to fall down to your side while you slowly pull your head to the right. As soon as you feel tightness, hold the position for at least 30 seconds. Breathe normally, return your head to an upright position and repeat this exercise with the other hand in the other direction.

Head-Down Stretch:
Sit or stand comfortably but as straight and tall as possible. Place your fingertips of both hands at the back part of the top of your head. Keep your elbows forward and do not rest the weight of your arms on your head. Gently press forward with your fingertips while you drop your head against your chest. Continue to press until you feel some tightness, but no pain, and hold for at least 30 seconds.

Elbow Across Chest:
Stand or sit comfortably but as straight and tall as possible. Keeping your shoulders as low as possible point your left elbow straight out from your body. Grasp the outer side of your left elbow with your right hand and slowly pull your left arm straight across your chest until you feel tension (but no pain). Hold the position for at least 6 seconds and allow your left elbow to return straight out in front of your body. After repeating these steps at least 5 times, allow your left elbow to return to the neutral position. You can now repeat the same process wit h your right elbow. This exercise can be varied while the elbow is in a 90 degree or 45 degree position.

Arm-Overhead Stretch:
Stand or sit comfortably but as straight and tall as possible. Put your left arm straight above your head with the elbow nearly but not quite locked. Grab your left wrist with your right hand, then your right thumb to the front. Keeping your left arm straight and without leaning forward at all, or moving your hips from side to side, pull your left arm across to the right. Be sure to keep your arms directly overhead as they begin to move to the right. Continue to slowly move your arms, head and upper back toward the right, until you feel some tightness. Hold this position for at least 30 seconds. be sure not to crunch your head down or turtle your neck. Now, return to the upright, neutral position and repeat the exercise from the other side.

Front-to-Back Shoulder Stretch:
With your arms straight down, cross your wrists in front of you and bring your shoulders toward the front of your body. While fanning your shoulders, it is a good idea to have the jet flow on the sore spots. Hold this position for at least 6 seconds and then slowly bring your arms and shoulder to the rear of your body in the position of a swan. Try not to let your neck turtle or raise your shoulders. Remember to continue neutral breathing.

Knee Across:
Begin by reclining on your back as much as possible. Lift your right leg and cross it over your left knee, sliding the right knee down as close to the left knee as possible. Using your left hand, begin to pull your right knee to the left and slightly down. Try to keep your pelvis and shoulders as flat as possible. When you being to feel the stretch in your lower back, stop and hold it for at least 30 seconds. Now, cross your left leg over your right knee and repeat the exercise.

Begin in a seated position with you legs out in front of you. This exercise can be easily performed in a lounge or in a barrier-free area. Keeping your knees only slightly bent and holding your back straight, slow2ly begin to walk your fingers down your legs toward your knees. When leaning forward and bending at the waist as much as possible, you may wish to bend your head down if it is more comfortable. Continue the walk as far down your legs as possible toward your toes. When you feel the tightness, hold the position for at least 30 seconds. Try to relax and keep your breathing as regular as possible. This exercise is felt in different places by different people, so be gentle with yourself.

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