Hydrotherapy For Fibromyalgia

  • Charlotte Sutherland Master of Science – MSc Translational Neuroscience, Imperial College London
  • Dr. Maria Weissenbruch Doctor (Ph.D.), Cell and Developmental Biology, Karlsruhe Institute of Technology (KIT), Germany

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Fibromyalgia is a chronic pain disorder characterised by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties, along with many other symptoms, that affects millions of people worldwide. Many people who suffer from fibromyalgia can struggle to lead “normal” lives as these symptoms can affect various aspects of their everyday life. While there is currently no cure for fibromyalgia, various treatment approaches aim to ease your pain and stress and improve your quality of life.

One of the best treatment strategies is remaining physically active and doing regular exercise.1 However, this might seem impossible if you are experiencing symptoms of fatigue and muscle pain, making it difficult to start and maintain a regular exercise programme. Hydrotherapy can be an easier option for fibromyalgia patients to gently and gradually build up their strength and start an effective exercise regime. Hydrotherapy uses water-based exercises to help relieve pain, simulate exercise, and improve your energy levels.

If you want to learn more about how hydrotherapy might be able to help alleviate the symptoms of fibromyalgia, read on. In this article we will delve into the principles, what to expect, potential benefits, and considerations of hydrotherapy for fibromyalgia management.

What is hydrotherapy?

Hydrotherapy, also known as water therapy or aquatic therapy, involves the use of water for therapeutic purposes to treat a variety of symptoms you might be experiencing, such as pain and stiffness. There are many different forms of hydrotherapy which encompass a range of techniques and exercises performed in water. The most common forms of hydrotherapy include:

  • Aquatic exercise (e.g. water aerobics, swimming)
  • Aquatic physical therapy (performed by a licensed physical therapist)
  • Warm water baths
  • Saunas

Water has many properties that provide unique therapeutic benefits to help in pain management, muscle strengthening, and overall wellness, including:2

  • Buoyancy: The water supports your body, allowing it to float. This helps decrease the pressure and weight-bearing stress on your body joints, improving the strength and range of your movements. This can make performing exercises much easier than on land
  • Resistance: This is a force that acts in the opposite direction to the line of movement which can help to strengthen your muscles
  • Hydrostatic pressure: This is a force from the water that acts on a submerged object, providing support during movements, improving balance, and helping to increase circulation
  • Thermal conduction: Immersing in warm water can quickly warm up your body to the temperature of the water. This is beneficial in reducing inflammation and stiffness, alleviating muscle spasms, and improving blood flow and oxygen supply around your body

For individuals with fibromyalgia, hydrotherapy offers a promising avenue to help relieve some of the devastating symptoms due to its gentle yet effective nature. 

What to expect from hydrotherapy sessions?

Hydrotherapy sessions are usually conducted in small groups or in one-to-one sessions with a trained physical therapist or instructor to guide the sessions. These instructors will provide instructions on the proper techniques, exercises, and movements, tailored to your individual needs and abilities. This is important to ensure the safety and effectiveness of hydrotherapy. 

Warm water environment

Hydrotherapy sessions usually take place in a warm water pool, with temperatures ranging from 33-36°C. This is warmer water than is used in standard swimming pools. The warm water helps relax muscles, improve blood flow, and soothe the pain and stiffness associated with fibromyalgia.3 This is particularly important for fibromyalgia patients who are typically more sensitive to cold temperatures

Low-impact exercises

Hydrotherapy exercises are designed to be gentle on your body and joints, while still providing a beneficial workout. Common exercises performed in water include:

  • Walking or jogging
  • Gentle stretching
  • Range of motion exercises
  • Resistance training

You can also adjust your buoyancy and resistance in the water using flotation devices or ankle weights.

Progress tracking

Initially, you should start hydrotherapy with short sessions to reduce stress on your body and prevent overexertion. You can then gradually increase the duration and intensity of sessions as your strength and stamina improves. 

Progress in hydrotherapy can be monitored over time, with adjustments made to your programme as needed. You might be asked to track improvements or changes in your pain levels, range of motion, muscle strength, and fatigue. 

What are the benefits of hydrotherapy for fibromyalgia?

Hydrotherapy has been shown effective in improving a wide range of the symptoms of fibromyalgia, with beneficial effects in:2,4,5

  • Pain management: The buoyancy of water helps to reduce pressure on your joints and muscles, providing relief from the chronic pain associated with fibromyalgia. Also, water’s hydrostatic pressure can help to alleviate inflammation and improve circulation, further contributing to pain relief
  • Improved sleep quality: Regular hydrotherapy sessions have been shown to promote relaxation and improve sleep patterns (often disrupted in individuals affected by fibromyalgia). The soothing effects of warm water can help induce restful sleep and reduce insomnia symptoms
  • Reduction of fatigue: Hydrotherapy exercises, particularly low-impact activities like water walking or gentle stretching, can boost your energy levels and combat fatigue by improving your circulation and oxygenation
  • Increased range of motion and flexibility: The buoyancy of water can support your body, allowing for greater freedom of movement without exerting excessive strain on your joints. This enables people affected by fibromyalgia to engage in exercises which would otherwise be challenging or too strenuous on land, thereby improving flexibility and range of motion over time
  • Psychological benefits: Hydrotherapy can induce a sense of relaxation and well-being, reducing stress and anxiety levels which are often heightened in fibromyalgia patients. The release of endorphins (or “feel-good” hormones) during water-based activities can positively impact your mood and mental health

It is important to realise that hydrotherapy cannot cure fibromyalgia, but it can help relieve some of your symptoms and improve your quality of life.

Considerations before starting hydrotherapy

Before starting hydrotherapy sessions, you should consult with your healthcare provider to ensure it is safe for you. This may depend on your current symptoms, medical history, and any other medical conditions or physical limitations you may have. 

It is also important to choose a qualified hydrotherapist or instructor, preferably one with experience working with fibromyalgia patients to ensure you are getting an appropriate exercise plan. 


What is the best exercise for fibromyalgia?

Gentle or low-impact exercises, such as walking, swimming, or cycling, are typically recommended for people with fibromyalgia. Swimming or performing exercises in warm water has additional therapeutic benefits due to the buoyancy and warmth of water reducing stress on your joints, reducing inflammation, and relieving pain. A physical therapist might be able to give specific advice on the best exercises to reduce pain and stiffness, without causing overexertion and fatigue. 

Is cold water bad for fibromyalgia? 

People with fibromyalgia are more likely to experience symptoms of pain and stiffness when exposed to cold temperatures. Therefore, immersion or exercising in cold water could aggravate existing symptoms of fibromyalgia. Hydrotherapy involves the use of warm water for its therapeutic value in improving blood flow and reducing inflammation. This can be beneficial for fibromyalgia patients to relieve pain, reduce muscle stiffness, as well as improving other symptoms such as fatigue, stress, and anxiety. 

Who should avoid hydrotherapy? 

Some people might be more at risk of side effects or complications from hydrotherapy. You should take extra precautions if you have:

It is important to consult with your healthcare provider if you have any concerns about starting hydrotherapy or notice any problems during hydrotherapy sessions.


Fibromyalgia is a chronic condition that causes widespread pain throughout the body, among other symptoms of fatigue, problems with mental processes, and stress and anxiety. While regular physical exercise is known to be beneficial in reducing some of the devastating symptoms of fibromyalgia, exercising while experiencing symptoms of pain and fatigue can be extremely challenging. Hydrotherapy may present a potential solution to this problem, allowing fibromyalgia patients to take a crucial first step towards improved muscle strength and overall fitness. 

Hydrotherapy involves performing a range of gentle exercises in warm water. The natural properties of water enhance the therapeutic benefits of exercising, while also making exercises easier to perform and less strenuous on your body. By incorporating hydrotherapy into a comprehensive fibromyalgia management plan, you can enhance your quality of life and regain a sense of control over your health and well-being. Embracing the therapeutic power of water may offer new hope and possibilities to those living with fibromyalgia.


  • Busch AJ, Overend TJ, Schachter CL. Fibromyalgia treatment: the role of exercise and physical activity. International Journal of Clinical Rheumatology [Internet]. 2009 Jun [cited 2024 Feb 2];4(3):343–80. Available from: http://www.futuremedicine.com/doi/abs/10.2217/ijr.09.23
  • Zamunér AR, Andrade CP, Arca EA, Avila MA. Impact of water therapy on pain management in patients with fibromyalgia: current perspectives. J Pain Res [Internet]. 2019 Jul 3 [cited 2024 Feb 2];12:1971–2007. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613198/
  • Segura-Jiménez V, Carbonell-Baeza A, Aparicio V, Samos B, Femia P, Ruiz J, et al. A warm water pool-based exercise program decreases immediate pain in female fibromyalgia patients: uncontrolled clinical trial. Int J Sports Med [Internet]. 2012 Dec 20 [cited 2024 Feb 2];34(07):600–5. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0032-1329991
  • Murphy R. Exercise in water is beneficial for patients with fibromyalgia. Nat Rev Rheumatol [Internet]. 2006 Jun [cited 2024 Feb 2];2(6):290–290. Available from: https://www.nature.com/articles/ncprheum0179
  • McVeigh JG, McGaughey H, Hall M, Kane P. The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review. Rheumatol Int. 2008 Dec;29(2):119–30.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Charlotte Sutherland

Master of Science – MSc Translational Neuroscience, Imperial College London

Charlotte is a recent MSc Translational Neuroscience graduate from Imperial College London where she undertook research investigating antidepressants and Alzheimer’s disease. She has a strong interest in translational research and is aiming to pursue a PhD in the field of neurodegenerative diseases.

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