American Physical Therapy Association

View all recommendations from this society

Released September 15, 2014

Don’t use whirlpools for wound management.

Whirlpools are a non-selective form of mechanical debridement. Utilizing whirlpools to treat wounds predisposes the patient to risks of bacterial cross-contamination, damage to fragile tissue from high turbine forces and complications in extremity edema when arms and legs are treated in a dependent position in warm water. Other more selective forms of hydrotherapy should be utilized, such as directed wound irrigation or a pulsed lavage with suction.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their health care provider.

How The List Was Created

The American Physical Therapy Association (APTA) invited all 88,000 members to suggest items for the Choosing Wisely® list. Communication of this request was distributed to members via website posting, e-mail blast and social media. APTA convened an expert workgroup of physical therapists representing a broad range of clinical expertise, practice settings and patient populations. A modified Delphi technique was used to rank and prioritize the recommendations based upon the Choosing Wisely criteria. An extensive literature search was conducted on the highest rated strategies. The expert panel reviewed the literature and provided a ranking of recommendations based upon the established criteria. The final list of five strategies was selected through a survey open to all APTA members who were asked to select five items from a list of nine, all of which met the established criteria. The final list was presented to the APTA Board of Directors for final approval.

APTA’s disclosure and conflict of interest policy can be found at


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Association for the Advancement of Wound Care (AAWC) venous ulcer guideline. Malvern (PA): Association for the Advancement of Wound Care (AAWC); 2010 Dec. 7 p.

Water use in hydrotherapy tanks [Internet]. Atlanta (GA): Centers for Disease Control and Prevention. 2009 Aug 10 [cited 2014 Apr 23]. Available from:

Berrouane YF, McNutt LA, Buschelman BJ. Outbreak of severe pseudomonas aeruginosa infections caused by a contaminated drain in a whirlpool bathtub. Clin Infect Dis. 2000;31(6):1331–7.

McCulloch J, Boyd VB. The effects of whirlpool and the dependent position o n lower extremity volume. J Orthop Sports Phys Ther. 1992;16(4):169–73.