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Massage Today
February, 2002, Vol. 02, Issue 02

The First of the 10 Elements: Water

By Robin Zill, LMT

The 10 Elements of the Spa Experience are designed to teach the consumer and professional about the integrated nature of the spa experience. This is the second article in a 12-part series and focuses on the first of the 10 elements: Water.

(Editor's note: The graphic of the 10-Element Circle appears on line at

Everything Flows.

-- Heraclitus

Water is transformational by its very nature. The study of water in its many forms has stimulated some of the greatest thinkers and visionaries throughout time. An excellent metaphor for life and vitality, water is central to the human experience. The study of water and its many roles could actually be considered a bridge between science and art. To paraphrase C.S. Lewis, water is one part oxygen, two parts hydrogen, and the rest is magic.

In the spa environment, hydrotherapy and balneotherapy are the most common terms used to describe the use of water. Hydrotherapy is usually defined as "the use of water in any of its three forms, solid, liquid or gas, used internally or externally for the prevention and treatment of disease or trauma, or used to enhance optimal wellness through daily health programs." Balneotherapy is the art and science of bathing for therapeutic and relaxation purposes. This includes partial and full bathing practices. Crenology, not as common in the U.S., is considered the therapeutic use of waters from mineral springs for therapeutic and relaxation purposes. The chemical composition of the water is significant, as is temperature and location.

The Transforming Power of Water

Why is water so magical? Fundamentally transforming, it is used for cleansing, purifying and basic survival. Both the external use of water through compresses, showers, wraps, bathing, and swimming, and the internal uses of water through drinking and other internal cleansing procedures, are critical to the spa experience. Water therapies are homeostatic in nature - they depend upon the body's ability to maintain balance or stability in a changing environment. This process is thermaldynamic in nature: by varying the temperature, the mechanical distribution and/or the chemical composition of water, many different treatments and effects can be achieved.

Temperature variation is the most common tool used in hydrotherapy treatments, because the temperature of the water will determine the extent of the stimulation on the skin. The skin is the portal of entry for hydrotherapy treatments. It connects our outer environment to our inner environment. The nervous system responds to this thermal change, and the stimulus is transferred to the organs via nerves, lymph and blood vessels. As one of the primary functions of skin is to maintain the body's temperature at a comfortable and consistent level, it is critical to maintaining homeostasis or balance within the body. This function primarily uses the circulation of the blood and lymph system. By increasing or decreasing circulation, hydrotherapy can help to affect the body's organs, and therefore assist in natural detoxification, cleansing or elimination processes.

Water is an excellent conductor, which allows it to transfer heat effectively and quickly. Water also possesses the ability to absorb and distribute large quantities of heat.

  • Water has 27 times greater capacity than air for conducting heat.
  • It takes only one calorie of heat to raise one gram of water one degree C.
  • Water gives up its heat rapidly, but does not cool quickly.

Water, a universal solvent, can readily dissolve many other substances to form therapeutic solutions: electrolytes, sugars, salts, osmotic baths, etc.

Because the density of water is similar to that of the human body, it produces a buoyant effect upon immersion equal to the weight of the water displaced. This is particularly useful for paralyzed muscles unable to move heavy limbs. Because of the unique qualities of water, hydrotherapy can be truly therapeutic and useful in treating many diseases. The new research on hyperthermia and cancer is just one exciting example. That is why, depending on the treatment, therapists should be well-trained and have a working knowledge of the body, especially the circulatory system. Contraindication for hydrotherapy treatments are similar to those for other heat treatments: pregnancy; heart diseases; acute or inflamed conditions; high blood pressure; varicose veins; other circulatory problems; rashes; and extreme obesity. Also, treatments should not be performed if the client has just consumed alcohol or a heavy meal.

Water, a precious resource, is inexpensive in essence and available as a healing tool in many forms. In the spa setting, how and how much water is used is usually determined by the treatment protocols and equipment selection. This can range from hot towel cabis, hydrocollators, and moist heat packs to Vichy and Swiss showers, scotch hoses and hydrotherapy tubs. Generally, the basic tools the water therapist works with are water temperature; the body area immersed or exposed to water; the duration of the bath, shower or treatment; the mechanical features such as underwater massage wands or shower sprays; and chemical factors such as botanical extracts, salts, seaweeds, and other natural agents.

The environment is also an important variable of the treatment. Often this is determined ahead of time; the therapist may only be able to control temperature and ambience, but beauty and art go hand in hand with bathing. New trends that embrace the importance of environment include Watsu and water dancing pools, floating pools and the innovative liquid sound pool in Germany that combines the floating experience with light and sound.

Exploring the dimensions of water in its many forms is a great way to begin understanding the integrated nature of the spa experience. Please visit the Great Spa Conversation ( or visit the ISPA Web site at to share your insights and connections to water. The spa movement is a cultural expression of the people's new perception of optimal health. Your voice is important.

Click here for previous articles by Robin Zill, LMT.


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