Hydrotherapy (Part 2 of 4): Cold Applications


As mentioned in part 1 of this series, cold stimuli have a multitude of effects on the body. This was Father Kneipp’s most used form of water, although he was also fond of contrast (info to follow in a later blog). The easiest and most underutilized form of cold hydrotherapy is dew walking. It is exactly as it seems; walking barefoot in the dewy morning grass. It should be performed just until feet are cold but before they are painful, and always followed with warm dry socks. According to Kneipp, “The beginning of the body’s resilience is always walking barefoot”     


Basic Rules for Cold Applications:

  • The purpose is to create a reaction, so go until there is a reaction.
    • Ex. Barefoot walking in the dew.  Go until feet get cold, could be seconds to minutes or even longer.
  • Applications should not be performed immediately before or after a meal.
    • Exception: Applications the encourage digestion such as lumbar wraps
  • If you smoke, do not smoke immediately before or after application as it can completely neutralize the effect.
  • When applying a wrap or pack the patient should not be distracted by reading, listening to the radio, or watching TV, but concentrated on the sensations of their body during treatment.
  • The intensity of stimulus must always be individually adjusted. If the patient is unable to tolerate the temperature, simply reduce treatment area, not the temperature.
    • Ex. If applying a cold rinse to both full legs from the hip down, and treatment is not tolerated, then only apply to lower legs.
  • Always make sure to warm up the body prior to ANY cold application.
  • After cold water applications, the body should not be dried off completely, only wiped off with hands, so that the cooling effect of evaporation intensifies the stimulus.
    • Exceptions: Very hairy body-parts, between the toes and other places where skin lies on the skin, and if exposed to quite cold drafts.
  • Make sure to warm up the body after cold applications. This can be accomplished with clothing, blankets, or mild exercise. If you can walk, WALK!


Temperature Scale:

  • Very Cold               = 50 – 59 oF
  • Cold                         = 60 – 65 oF
  • Moderately Cold  = 66 – 72 oF
  • Cool                          = 73 – 81 oF


A rinse can be accomplished in multiple ways. The easiest way to do an at home rinse is with a detachable shower head in one’s bathtub/shower. Another great option during warmer months is a garden hose used outside. The water pressure should be enough to cover an area about a palm width without water spraying off the skin while holding the showerhead/hose approximately 8 in from the surface. In a rinse procedure, the showerhead/hose does not stop moving until the desired reaction occurs. The desired reaction in the case of cold rinses is a lovely, even, pinkening of the skin.


Rinses have an effect locally as well as systemically. For example, knee rinses can be used in the case of local injury but also to squelch a fever. All rinses have an immunologic effect and should be utilized several times per week in the case of chronic illness.

  • Procedure

    • In all rinses, both the back and front of areas are rinsed.
    • All rinses, except arm only, beginning in the back, at the outside of the right foot.
    • To intensify your rinse, complete 3 full cycles.  
    • Leg rinses, either lower or full, follow the same procedure.
      • Outside of right foot – up to the desired level – pause, sweeping back and forth for 3 second – all the way down on the inside – repeat other leg beginning at outside of left foot
      • Turn around – follow exact same procedure on front
      • Knee rinses extend to a hand-width above the knee.
      • Thigh rinses extend to the iliac crest on the back and groin on the front.
    • Lower Body rinse follows the same procedure as the thigh rinse but pauses at the lower edge of shoulder blade on the back and lower arch of ribcage on the front.
    • Arm rinses follow a similar procedure to leg rinses but begin at the back of the right hand, extend up to shoulder, sweep down the inside of the arm, and end at the front of the hand. This is then repeated on the left arm.
    • Full rinse includes the whole body except for the head.
      • Back: Water-stream begins on the outside of right foot – outside of leg – buttocks – down on the inside of the leg – repeat on left leg – right hand – upward along arm – pause at shoulder with water plane on right half of back – downright half of back to buttocks and down right leg – repeat on left side
      • Front: Bridge of right foot – outside of leg – groin – down on inside of leg – repeat on left – right hand – right arm – pause at shoulder with water plane on right half of trunk  – circle abdomen – down inside of right leg – repeat on left side



Always applied in layers. Layer 1 is a thin cloth or sheet as the wet layer applied directly to the skin. Layer 2 is a dry wool cloth or blanket wrapped on top of the wet cloth. An additional heavy blanket or comforter will be needed as the final covering for Heat-producing and perspiration wraps.


3 phases of cold wraps with differing desired effects:

  • Heat-detracting

    • For acute inflammation and reduction of high fevers.
    • Serial wraps applied over local area (Claves or feet in the case of fevers)
    • Water should be cold but not freezing
    • Wraps are removed as soon as they heat up and re-cooled with water
    • Can consist of a series of 5-7 times, but should not exceed 7 in one sitting.
  • Heat-producing

    • For joint stiffness, GI complaints, acute or chronic illness, and anxiety (amongst many others)
    • Can either be for a local limb, torso (short wrap), or entire body (full wrap)
    • There should never be any clothing touching the wet part of the wrap to avoid having a persistent chilled area. For this reason, full wraps should be done fully nude.
    • Easiest to place dry wool first on a massage table or bed then the wet cloth/sheet on top.
    • The wrap is fastened tightly around the desired area making sure that air is not seeping through, keeping the cold wet cloth cold and wet.
    • Patient is then covered with a heavy blanket and left to “cook”
    • The wrap should no longer feel cold after 10 minutes. If it does, then add a hot water bottle on top until no longer feeling cold.
    • Treatment will last for 30 – 75 min depending on ability to heat up cloth and time at which sweating begins.
    • If sweating begins, unwrap immediately and redress.
  • Increasing Perspiration

    • For chronic illness and detoxification
    • Goal is to warm core temperature
    • The application is the same as heat producing wrap but the duration is longer.
    • Once sweating begins to leave the wrapped for an additional 30 minutes of sweat time.
    • Unwrap, rinse off with a wet cloth (do not immediately get into a shower as the may neutralize the effect of the wrap), and redress.


Water walking is known to strengthen the immune system, promote venous return (toning varicose veins), relax tired legs, promote metabolic stimulation, help with headaches, help with high blood pressure, and promote deeper more restful sleep. Due to the last of those, it is best to water walk in the late afternoon or early evening.

  • Procedure

    • Can be performed in the bathtub or any other container large enough to stand in.
    • Water is to the level of covering lower leg to just above the knee. The bath can still be effective if claves are submerged but knees are left out.
    • Begin to lift one leg out at a time exposing feet.
    • Continue marching in the water until legs are cold but before they become painful.
    • Once stopped and out of the water, whisk off legs with hands and let them air dry before covering with pants or a blanket.


Cold arm baths, also known as Kneipp Coffee because of their stimulating effects, are known to strengthen the immune system, promote circulation in the arm, stimulate metabolism, improve cardiac function, refresh the system from fatigue and tiredness, and treat pain in the elbows & wrists.

  • Procedure

    • Fill a deep sink or basin large enough for both arms with cold water.
    • Submerge arms up to mid bicep until cold but not painful.
    • Whisk arms with hands and allow to air dry.


These guidelines should be sufficient for anyone to incorporate cold water hydrotherapy into their regular, at home, self-care. If there are any questions about specific use for certain conditions, please contact your doctor at SHI.

Happy Hydroing!! And don’t forget that Summer is the best time for cold applications in the beautiful outdoors.

Written By: Tara Boyd, ND Resident Physician