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C h e c k o u t A B M P P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p . 75 Following are general contraindication guidelines for determining when clients should avoid hydrotherapy treatments. Contraindications to Local Heat Treatments Since heat treatments can encourage edema, applications are contraindicated when clients have acute local inflammation of any kind, from phlebitis to a fresh ankle sprain to lymphedema. Heat applications are also contraindicated over implants, pacemakers, defibrillators, medication pumps or other artificial devices, numb areas, and the feet of anyone with diabetes. Contraindications to Local Cold Treatments Local cold treatments are contraindicated for Raynaud's syndrome, a simple vasoconstriction disorder of the extremities, because cold may cause a spasm of the smallest arteries that supply the hands or feet. Local cold treatments are also contraindicated for any area that is numb. Contraindications to Whole-Body Heat Treatments High temperatures create extra demands on the circulatory system. There are changes in heart rate, how much blood the heart pumps per beat, blood pressure, and where the blood is distributed in the body. In heating treatments such as saunas, warming body wraps, steam baths, and hot showers, blood is shifted to the skin's blood vessels so heat can be radiated off the skin to prevent overheating. Therefore, unless approved by the patient's doctor, whole- body heat treatments are contraindicated for patients with high or low blood pressure, heart disease, and during pregnancy. Patients with multiple sclerosis or seizures should only have heat treatments with their doctor's permission. Hot baths are also contraindicated for anyone with diabetes because they may have cardiac problems. However, warm and neutral-temperature baths are a good choice for diabetics, as are whole-body salt glows. Contraindications to Whole-Body Cold Treatments Short, cold plunges or showers are a traditional way to stimulate and invigorate; however, they are contraindicated for clients who are chilled, have an aversion to cold, or have cardiovascular or kidney disease. Heat Treatments for Depression Heating treatments have been used for centuries to help people feel more relaxed and more invigorated at the same time. Whole-body heating treatments can also help some depressed people. According to a 2018 Psychiatric News article, heat treatments, including hot yoga, hot baths, and saunas, have shown promise for depression. 4 One study evaluated patients in a bed with infrared heat lamps that raised their core temperature to 103°F. Blood tests found that the treatment boosted levels of interleukin-6, a signaling molecule of the immune system that has inflammatory and anti- inflammatory effects. (Intense exercise can also hike interleukin-6.) While some people got no benefit from the heat treatments, those who did continued to feel less depressed throughout the six weeks of the study. 5 How might heat treatments fit into your work with depressed clients? A massage combined with a heat treatment and a brief cold exposure might just double the effect of massage alone. Exercise Baths for Preemies Neonatal intensive care units are high-stress environments for babies who often receive painful interventions, such as heel pricks. Years ago, touch was avoided until two pediatric physical therapists tried gentle exercise in warm water to reduce harmful effects of pain and stress and promote comfort and pain relief on premature babies. Using a large plastic container, babies were immersed in body-temperature warm water up to their shoulders, while the therapist performed subtle movements, mobilization, and stretching for about 10 minutes. Afterward, the babies' heart rates and levels of cortisol (a stress hormone) were reduced. 6 CONTRAINDICATIONS: KEEPING TREATMENTS SAFE Fine-tune your hydrotherapy work with clients by selecting treatments that are suited to their situation. Always take a careful health history to alert you to any contraindications before beginning treatments. Then, make sure each treatment is a good fit by presenting it to the client. Keep in mind that client comfort is critical. A client who is claustrophobic will not enjoy a body wrap, and ice massage is likely to discourage someone with a serious aversion to cold. Also, hydrotherapy treatments should not be used over skin that is infected or has rashes.