The use of water for therapeutic purposes is an ancient practice of civilizations, which, through new techniques, remains in constant rediscovery. The application of water can occur through its three physical states and part or all of the body can be treated. Immersion of the body in water has become the most comprehensive technique, providing physical and psychological therapeutic benefits.

Such effects can be justified by the physiological influences resulting from the physical properties of water during immersion in a therapeutic pool. The use of water to obtain a cure has been described since the Greek civilization (500 BC), with medical schools created close to the sources for the application of aquatic techniques and its use in specific physical treatments.

Before the exclusive use of Roman athletes, the baths later became centers for health, hygiene, rest and intellectual, recreational and exercise activities, of collective access. In the middle of 330 AD, the main purpose of Roman baths was to heal and treat rheumatic diseases, paralysis and injuries. Considered in the Middle Ages as a pagan act, the use of physical forces and baths suffered a decline, which persisted until the 15th century, when there was a slight resurgence.

Hydrotherapy is thus one of the oldest resources of physiotherapy, being defined as the external use of water for therapeutic purposes. When related to exercise programs, the aquatic environment has numerous advantages compared to the soil. Most of them are mediated by the physiological effects of the environment, arising mainly from the physical effects of water. This is a physiotherapeutic resource that uses physical, physiological and kinesiological effects, resulting from immersion of the body in a pool, as an auxiliary resource for rehabilitation, or in preventing functional changes. The physical forces of water acting on an immersed organism, cause extensive physiological changes, affecting almost all systems of the organism. The physiological effects can be added to those triggered by the practice of physical exercise in water, making the responses more complex. Certainly these responses and their therapeutic effects in a healthy body are different from those that occur in a sick body.

César Sá

César Sá


César is the Founder and President of IOAPT (International Organisation of Aquatic Physical Therapists), a World Physiotherapy Subgroup. He has a degree in Physiotherapy, a postgraduate degree in Water Activities and an MSc in Exercise and Wellness (Portugal). César is also board member of the Aquatic Physiotherapy Interest Group (GIFA) and works in Aquatic Physiotherapy with older people and children with several diseases and disabilities.

In addition to all the physiological benefits of the aquatic environment, the activities carried out in this environment alone, offer a moment of leisure and relaxation, which promotes social interaction and psychological well-being to its followers. Its effects on body systems have been exploited in the rehabilitation process in the most diverse areas, among them: orthopedics, neurology, pediatrics, obstetrics and gynecology.

All physical principles are clinically useful, without further modification, although they can be extended to a variety of clinical situations using additional equipment. In general, the density can be changed to facilitate or resist movements and assist in supporting and fluctuating the body. The buoyancy force can also help to achieve the above objectives, in addition to being able to assist in decubitus changing techniques and facilitate the displacement of the entire body, such as during gait. Hydrostatic pressure helps to decrease the discharge of weight on the lower limbs, to resolve edema and can serve as a breathing exercise in some respiratory diseases. Viscosity causes resistance to displacement. The variation in the aquatic environment, such as the production of turbulence, creates an interesting medium for the work of static and dynamic balance. The flow can also be modified by equipment such as handstands, which, depending on how they are used, can hinder or facilitate a certain movement.

The movement in aquatic environment, being dependent on the shape of the body when moving in the water and speed, can be modified in numerous ways, creating the most diverse therapeutic situations. The drag force can be used to facilitate the movements of both the patient and the therapist. Once the patient is positioned behind the therapist, the resistance movement is overcome by the therapist and facilitated for the patient. The reverse is also true.

The usefulness of the warm water temperature depends on its great capacity to retain and transfer heat. For the human organism it means comfort, improved peripheral circulation and pain relief. The physiotherapist must take care of the temperature of the pool water and the temperature and humidity of the air, as the excess or sharp drop in temperature can cause imbalances and even damage to the patient’s body. From a physiological point of view, countless responses are triggered by the action of physical forces acting on the body immersed in water, such as the readjustment of the circulatory, respiratory, renal systems and the activation of the thermoregulation mechanisms. These responses can be added to those triggered by physical exercise.


Becker, B. E.; Cole, A. J. (2000) – Terapia Aquática Moderna. Brasil: Editora Manole.

Bender, T. et al (2005) ¬- Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatol Int, 25 (3), 220-224.

Campion, M. (2000) – Hidroterapia: Princípios e Prática. Brasil: Editora Manole Lda. 

Geytenbeek, J. (2002) – Evidence for Effective Hydrotherapy. Physiotherapy. 88 (9), 514-529.

Routi, R. G. et al (2000) – Reabilitação Aquática. Brasil: Editora Manole.