- The Washington Times - Tuesday, August 14, 2001

Water, water everywhere — and if it can be marketed, it will be. Here's Deep Blue Sea Bath Salts, a mix of "sea rocket and algae extracts" that will, we're told, "draw out the skin's impurities and relax sore muscles." Consider Creme de la Mer, or "cream of the sea," peddled as "jampacked with seaweeds, mineral, vitamins and a secret lime thing."

It's hype, of course, but it relies on a blend of art and science that's as old as civilization itself — hydrotherapy, or the use of water to soothe, relax and even cure what ails you.
The idea of improving one's health and well-being through various water treatments is especially well-established in Europe, where people long have visited such water-based spas as Vichy, France; Bath, England; and Baden-Baden, Germany. The use of sea water, called thalassotherapy (from the Greek word for "sea"), is one of the most popular forms of therapy in France.
Hydrotherapy (again from the Greek, this time from its word for "water") has established medical credentials, but the line between medicinal use and an aesthetic application of hydrotherapy frequently is blurred. Professionals in both areas who disagree about the definition of the word usually agree that treatment for a physical problem ordered by a doctor may also have "feel-good" benefits.
Medical doctors and licensed physical therapists who are trained to administer medical treatments in water often prefer the term "aquatic therapy." The difference between the use of water to heal and its use simply to soothe is the difference between a passive and an active experience, in the opinion of Dr. Thomas Schuler, an orthopedic surgeon who is founder and chief executive of the Virginia Spine Institute in Reston.
A person indulging in a warm, relaxing bath and massage enjoys the more passive form; the same person undergoing therapeutic work after an injury or to relieve arthritic pain has hydrotherapy of a more active kind, in which the limbs must be exercised if the treatment is to have any effect.
"Getting a shower and massage is fun and can make you feel good, but they aren't treating a structural problem," Dr. Schuler says. "It doesn't replace good fitness and strengthening programs. If you want to pamper yourself, fine, but don't deceive yourself into thinking this will make a big difference."
Dr. Schuler will use water therapy for the back in several situations: One is when patients are recovering from an operation for spinal fusion and need what he calls "stress on the muscles" at the same time the muscles are being soothed. This calls for moderate exercise in the water. "It takes about three months for a fusion to set up. During that time, they need some kind of aerobic conditioning to stimulate the heart and muscles," he says.
"You want to get patients in a reduced-gravity situation, which reduces stress on the fusion but increases stress on heart and muscles. For the first few weeks, such patients do walking therapy and then get into water." He asks them to do such therapy twice a week at a minimum.
Professional athletes who have injured their backs are given water therapy in order to "increase stress and move them along more aggressively."
A hand therapist, on the other hand, might use the application of sand or liquids other than water to stimulate the hand and allow it to develop motion as part of the recovery process, he points out.
Another group of patients Dr. Schuler often encourages to take water or aquatic therapy are those "who had a significant injury, say a disc tear, and aren't making progress and can't tolerate therapy on the ground."
Overall, he maintains that patients truly enjoy their sessions: "It also becomes something of a mental therapy. It's getting out and in the water and treating the whole body in a positive way."

The Arthritis Foundation promotes aquatic therapy programs — especially using heated pools, says physical therapist Tom Papke of the private Capitol Metro Physical Therapy group. Chronic arthritis sufferers benefit because the body is buoyant in water, which takes pressure off the joints, Mr. Papke says. "It allows them to move the body through a full range of motion because they are not inhibited by pain.
"In many cases, if we did not have water as an option for transition back to health, the difficulty of working against gravity on land would be too painful or difficult."
Mr. Papke trained for two years at the UCLA Medical Center, where patients who had had surgery on a hand and those with skin conditions or needing care for wounds routinely would be given water therapy. Hospital burn-treatment centers use immersion in water to help remove dead and decaying skin.
He and three other licensed therapists in his group usually work on referrals from physicians such as Dr. Schuler.
"We are trained in our medical program to recognize, evaluate and diagnose medical problems, but physicans are there to also rule out sinister pathologies that may mimic muscular-skeletal problems," Mr. Papke explains.
"We do it differently according to different state rules. Some states allow us direct access to clients, one on one, others not. In D.C., we have direct access to a client for evaluation and follow-up. In Virginia, a patient must see a physician first. In Maryland, you can see a therapist first but must get a doctor's referral. That way you get two heads instead of one."
Therapist Jill Wagner, also of Capitol Metro Physical Therapy, specializes in treating young people with moderate to severe physical disabilities — cerebral palsy being the most frequent — usually involving the parents as well.
She is working with a cerebral palsy patient who has no ability to walk but who, in spite of being spastic, can move in water. "Water also gives her confidence. She swims laps with help," Mrs. Wagner says.
Another of her regular charges is a 6-year-old girl who suffers from chronic encephalitis, a swelling of the brain. Mrs. Wagner describes the child as being of normal size physically but "who cognitively functions somewhere between 3 and 6 months of age."
"Resistance of the water gives her strength in her limbs, and I see a lot of progress. She loves the water and is able to cruise up and down the side of the pool with assistance."
Health professionals may disagree about the definition of hydrotherapy but not about its value when real need arises.
To Dr. Schuler's consternation, what constitutes real need often is not understood by certain health insurers, especially HMOs, reluctant to reimburse charges averaging $100 an hour for licensed physical therapists.
"They say it isn't necessary, but we know it ensures more rapid recovery and return to functioning," he asserts.

Beauty products marketed in the name of personal physical and mental enhancement rely on a more liberal definition of hydrotherapy when boosting the benefits of water.
Creme de la Mer, La Mer Body Lotion and a Laboratoire Remede Rehydrating Body Creme-Complex all are marketed by a company in Brooklyn, N.Y., called Blissout, which publishes a Bliss Spa Beauty Catalog. Also available through the catalog are a La Mer mist of "magnetically charged waters" and a facial made of "fermented acidic sea muds, diamond powder and polished sea quartz."
As for the sea rocket and algae extracts in Deep Blue Sea Bath Salts, put out as part of another beauty product line, never mind that few consumers would have heard of "sea rocket," which one dictionary describes as "a noxious weed" of the mustard family. How these potions work is left to the imagination, which is just as well, because their effectiveness may be largely subjective and mostly transitory.
Yet the feel-good benefits of spas and salons can't be denied — even the ancient Romans were believers.
Berkeley Springs, W.Va., lays claim to a number of full-service spas stemming from the area's proximity to warm mineral-bearing springs, in which even George Washington is said to have bathed. Publicity for Berkeley Springs, an area that boasts three times as many massage therapists as lawyers, says "bathing is a high art available year 'round" and lists "contemporary spas offering a variety of health treatments."
At the 5-month-old Serenity Day Spa in Herndon, massage therapist Bill Roman says that at least one chiropractor he knows requests that patients soak in the facility's $20,000 126-jet-equipped "hydrotub" to help relax the muscles before a session.
"The tub stimulates blood flow and encourages oxygen flow to the muscles," Mr. Roman says. "I consider it therapy because it is relief."
The so-called Vichy shower, also known as an Energy Shower and available at two Serenity Day Spa facilities locally, is a 45-minute $45 combination massage and water bath projected through seven ceiling-high jets said by on-site esthetician Carol Gambino to produce "a rain-forest feel."
"Water is a necessary agent of health and a natural source of healing," writes the author of article in the professional journal Massage and Bodyworks analyzing hydrotherapy's benefits under the headline "There's More to a Bath Than Rub-a-Dub-Dub."
"We are, after all, water beings on a water planet. The oceans cover 70 percent of the earth, and the younger we are, the more hydrated we are. Babies generally are 80 percent fluids, while an elderly person is only about 55 percent fluids. Could water indeed be the fountain of youth?" the writer asks.
Maybe yes, maybe no. But who can resist trying?

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