is balneotherapy more effective than hydrotherapy? m. zeki karagülle iv. turkish - hungarian...
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Is balneotherapy more effective than hydrotherapy?
M. Zeki Karagülle IV. TURKISH - HUNGARIAN BALNEOLOGICAL MEETING
18-22 January 2006 Balçova, Turkey
Confusion
• Balneotherapy
• Hydrotherapy
Water Therapies
• In fact, both hydrotherapy and balneotherapy involve the use of water in any form or at any temperature for the purpose of healing.
Balneotherapy
• Comprehensively defined as; “the therapeutic use of balneological agents (mineral and thermal waters, muds and gases);
• usually through water or gas (not so often) immersion of part or all of the body,
• through mud applications (total or local baths or packs or even tampons)
• also through drinking mineral and thermal water • but also inhaling the vaporized or dispersed
mineral and thermal water
Hydrotherapy
• Broadly defined as; “the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes”
• may include immersion in a bath (bath tube) or body of water (such as a pool), aquatic exercise (exercise in water in a pool), use of water jets, douches, application of wet towels to the skin, or water birth
What is common in balneotherapy and hydrotherapy ?
“Hot Water Immersion” in Balneotherapy and Hydrotherapy
Factors Effects
Temperature Thermal effects; analgesic, muscle relaxation, anti-inflammatory ie.
Hydrostatic Pressure
Cardiovascular and urinary effects; central blood redistribution, ANF secretion, diuresis,
Buoyancy Mechanical relaxation, ability to float, easily lying position
Viscosity Resistance of motion through water
(during walking and exercising)
What is the difference?
• Balneotherapy employs generally natural thermal mineral water, mostly at a spa
• Hydrotherapy on the other hand consists of the use of ordinary water (tap or very low mineralized), whether at a spa or not
Some provocative remarks
• Does balneotherapy using thermal mineral water offer any benefits that hydrotherapy with tap water does not?
Thermal and Mineral Waters
Mineral Water
Minimum 1g/L total mineralization
Thermal Water
Minimum 20°C natural temperature
“Specific”
Mineral Waters
Minimum levels for minerals;
Bromide, Chloride, Fluoride, Ferro, Iodide, Sodium, Sulfur
Minimum levels for dissolved gases;
Radon, Carbon dioxide, Hydrogen Sulfide
Main Ions and Combinations in Mineral waters
Main Ions
Na+ Ca++ Mg++
Cl-
HCO3-
SO4--
Specific Chemical Ingredients
ChemicalChemical IngredientIngredient Minimum concentration Minimum concentration
Sulfur (S2-) 1mg/L
CO2 500 or 1000mg/L
Radon (222Rn) 666Bq/L (α-particle)
Salt (NaCl) 1g/L (Salty), 14g/L (Brine)
Na+ 500mg/L
Cl- 800g/L
Does chemical ingredients make any sense?
ChemicalChemical IngredientIngredient Minimum concentration Minimum concentration
Thermomineral water1g/L ≤ total mineralization,
20°C ≤ natural temperature
Sulfur water 1mg/L ≤ S2-
Sulfur baths versus tap water; animal study
Artificial sulfur waterS2- concentration: 10mg/L
The chronic arthritis which developed in the non-injected left hind paws reached
maximum severity on the 9th day after CFA injection in tap water and control
groups and not before the 19th day in the sulfur group. Later on, edema in the
sulfur group decreased statistically more rapidly (p <0.001) compared to the other
two groups.
The decrease in paw volume in adjuvant injected paws at the end of
the experiment was the greatest in the sulfur group followed by tap water group.
There was not any significant difference between the two experiment and the
control groups.
Natural Sulfur WaterS2- concentration: 59.3mg/L
Sulfur water versus tap water; experimental study
Natural Sulfur Water
S2- concentration: 2.4mg/L
Sulfur baths versus tap water; clinical study
Prior to treatment, the groups were statistically similar. After treatment, there
was evidence of a statistically significant effect of spa water compared with tap
water
Testing for Association between Water Properties and Improvement in
Clinical Status
The statistical test yields an empirical chi square statistics of X2emp=40.7465 (degrees of
freedom: 1) within associated value of p < 0.0001. This proves the true association between
the two qualitative variables.
Therefore, the statistical analysis demonstrated the favorable influence of balneotherapy with
Kehidakustany mineral water on the patients' clinical status.
Sulfur baths versus control; meta-analysis of clinical studies
Natural Sulfur Water
S2- concentration: 16mg/L
Hot sulphur baths vs control for pain severity (0–10 scale: 0=none, 10=severe) and
for function (Lequesne index of knee OA severity). resulted in favor of sulphur baths,
but no statistically significant outcomes for pain and function regardless of time
frame post-treatment differences were found.
Sulfur baths versus control; meta-analysis of clinical studies
Natural Sulfur Water
S2- concentration: 16mg/L
A clinically important benefit for hot sulphur baths versus control was found for both the
improvement of swollen/tender joints (10 and 46% relative difference) and global
patient (5 and 19% relative difference) in patients with RA (definite or classical RA,
chronic stage)
Comparison of the effects of taking bath in thermomineral versus tap water on the pain threshold ; Karagülle MZ, Dönmez A, Odabaşı E, Karagülle MZ, Dönmez A, Odabaşı E, Karagülle M, Eşref AKaragülle M, Eşref A
33rd World Congress of ISMH33rd World Congress of ISMHOctober 4-11 1998, Karlovy Vary, Prague, LuhacoviceOctober 4-11 1998, Karlovy Vary, Prague, Luhacovice
Natural Thermomineral waterTotal Mineral Concentration; 2600mg/L
Thermomineral versus tap water;
Physiological study
0
5
10
15
20
25
30
% Increase inPressure Pain
Threshold
Thermalwater36ºC
Tapwater36ºC
p<0,001
Thermomineral baths versus tap water; clinical study
Natural Thermomineral waterTotal Mineral Concentration 1675mg/L
Subjective rating of therapeutic efficacy by patients reflected a significant
improvement immediately after treatment in both groups. Paradoxically, 3 months
later, this improvement was present only in the control group.
After balneotherapy, medical assessment revealed significant improvement
exclusively in the actively treated group. After 3 months, however, there was no
difference between the two groups.
Does chemical ingredients make any sense?
ChemicalChemical
IngredientIngredientMinimum Minimum cconcentrationoncentration
Effective Effective concconceentrationntration
Sulfur (H2S, S2-) 1 mg/L Higher
Total Mineral 1 g/L Higher
Biological EffectsSulfur Water
BalneotherapyThermomineral Balneotherapy
Tap Water Hydrotherapy
Immuno-modulatory,
+ + ? ?
Anti-imflammatory
+ + + + +
Antioxdidant, + + ?
Release of β endorphin
? + ?
Analgesic + + + + + +
Muscle relaxant
+ + + + + +
Therapeutic Effectiveness
Sulfur Water Balneotherapy
Thermomineral Balneotherapy
Tap Water Hydrotherapy
Rheumatoid Arthritis
↑ ↑ ↑ ↑ ?↑
Knee Osteoarthritis
↑ ↑ ↑ ↑ ↑ ↑
Low back pain
↑ ↑ ↑ ↑ ↑ ↑
Fibromyalgia↑ ↑ ↑ ↑ ↑ ? ↑
Balneotherapy (Mineral water Immersion)
Mineral composition
Causes biologic effects
Mechanisms Not completely understood
Probably Involved
“NICE” systems;
Neuro-Immuno-Cutaneous-Endocrine
There is some There is some evidence, but we evidence, but we
still can not still can not answer clearlyanswer clearly
• Does balneotherapy have any advantages over hydrotherapy?
• Is balneotherapy more effective than hydrotherapy?