Is balneotherapy more effective than hydrotherapy?

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Is balneotherapy more effective than
hydrotherapy?

• M. Zeki Karagülle
• IV. TURKISH - HUNGARIAN BALNEOLOGICAL MEETING
• 18-22 January 2006 Balçova, Turkey

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Confusion

• Balneotherapy
• Hydrotherapy

?
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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.

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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

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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

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What is common in balneotherapy and hydrotherapy ?
Water
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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)
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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

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Some provocative remarks

• Does balneotherapy using thermal mineral water
  offer any benefits that hydrotherapy with tap
  water does not?

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Thermal and Mineral Waters
Mineral Water Minimum 1g/L total mineralization
Thermal Water Minimum 20C 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
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Main Ions and Combinations in Mineral waters
Main Ions Na Ca Mg
Cl- ??? ??? ??? ??? ??? ???
HCO3- ??? ??? ??? ??? ??? ???
SO4-- ??? ??? ??? ???
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Specific Chemical Ingredients
Chemical Ingredient Minimum concentration
Sulfur (S2-) 1mg/L
CO2 500 or 1000mg/L
Radon (222Rn) 666Bq/L (a-particle)
Salt (NaCl) 1g/L (Salty), 14g/L (Brine)
Na 500mg/L
Cl- 800g/L
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Does chemical ingredients make any sense?
Chemical Ingredient Minimum concentration
Thermomineral water 1g/L total mineralization, 20C natural temperature
Sulfur water 1mg/L S2-
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Sulfur baths versus tap water animal study
Artificial sulfur water S2- concentration 10mg/L
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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 lt0.001) compared to the other two
groups.
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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.
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Sulfur water versus tap water experimental study
Natural Sulfur Water S2- concentration 59.3mg/L
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Sulfur baths versus tap water clinical study
Natural Sulfur Water S2- concentration 2.4mg/L
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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
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Testing for Association between Water Properties
and Improvement in Clinical Status
The statistical test yields an empirical chi
square statistics of X2emp40.7465 (degrees of
freedom 1) within associated value of p lt
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.
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Sulfur baths versus control meta-analysis of
clinical studies
Natural Sulfur Water S2- concentration 16mg/L
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Hot sulphur baths vs control for pain severity
(010 scale 0none, 10severe) 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.
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Sulfur baths versus control meta-analysis of
clinical studies
Natural Sulfur Water S2- concentration 16mg/L
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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)
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Comparison of the effects of taking bath in
thermomineral versus tap water on the pain
threshold Karagülle MZ, Dönmez A, Odabasi E,
Karagülle M, Esref A
33rd World Congress of ISMH October 4-11 1998,
Karlovy Vary, Prague, Luhacovice
Thermomineral versus tap waterPhysiological
study
Natural Thermomineral water Total Mineral
Concentration 2600mg/L
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plt0,001
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Thermomineral baths versus tap water clinical
study
Natural Thermomineral water Total Mineral
Concentration 1675mg/L
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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.
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Does chemical ingredients make any sense?
Chemical Ingredient Minimum concentration Effective concentration
Sulfur (H2S, S2-) 1 mg/L Higher
Total Mineral 1 g/L Higher
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Biological Effects
Sulfur Water Balneotherapy Thermomineral Balneotherapy Tap Water Hydrotherapy
Immuno-modulatory, ? ?
Anti-imflammatory
Antioxdidant, ?
Release of ß endorphin ? ?
Analgesic
Muscle relaxant
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Therapeutic Effectiveness
Sulfur Water Balneotherapy Thermomineral Balneotherapy Tap Water Hydrotherapy
Rheumatoid Arthritis ? ? ? ? ??
Knee Osteoarthritis ? ? ? ? ? ?
Low back pain ? ? ? ? ? ?
Fibromyalgia ? ? ? ? ? ? ?
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Balneotherapy (Mineral water Immersion)
Mineral composition Causes biologic effects
Mechanisms Not completely understood
Probably Involved NICE systems Neuro-Immuno-Cutaneous-Endocrine
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There is some evidence, but we still can not
answer clearly

• Does balneotherapy have any advantages over
  hydrotherapy?
• Is balneotherapy more effective than hydrotherapy?