History
In ancient times, water therapy was an integral part of the therapeutic inventory of medicine. Physicians, including Aesculapius, Hippocrates, Galen, and Celsus,frequently used water as treatment.
Patients admitted to the healing temples of Aesculapius first washed in a large pool before being accepted to the 'wards.'
Floating on water and immersion were found useful in relaxing muscles. ( Kjelllgren 2001 ) (Garrett G 1997 )
A range of varying disorders has been considered suitable for therapy, some of which are treated in contemporary spas, particularly musculoskeletal discomfort.
Roman baths and spas were centers not only for cleansing, exercising, and medical treatment but also for relaxation and meeting friends and
colleagues.
SPA Treatments
Spa therapy covers a wide range of treatments, including:
- balneotherapy,
- physiotherapy,
- mud-pack treatment,
- physical exercise.
In many European countries, as well as in Japan and Israel, this therapeutic approach has been effectively used as a remedy for multiple diseases in conventional medicine.
Thousands of years of history and the proliferation of spa facilities have undoubtedly led to
availability in many countries.
Spa treatment aims at:
- reducing pain,
- alleviating muscle spasms,
- improving muscle power
- and functional flexibility.
Mechanisms of action of spa therapy in rheumatic diseases
The term ' spa ' originates from the name of a Belgian town where, in the fourteenth century, a thermal spring has been discovered.
Spa therapy is a viable treatment for many rheumatic diseases.
The processes by which immersion in mineral or thermal water or mud application alleviates rheumatic pain is not fully grasped.
Its complexity is the culmination in evaluating the importance of spa treatment.
Probably the cumulative advantage is the direct result of a mixture of variables with mechanical, heat and chemical outcomes among the most notable. All play significant functions in buoyancy, immersion, endurance, and temperature.
According to the gate theory, warm stimuli may affect muscle tone and intensity of pain, helping to alleviate muscle spasms and boost the tolerance for pain.
Pain relief may be due to stress and temperature of the water on the skin.
Mud-bath therapy rises concentrations of plasma b-endorphin and corticotropin, cortisol, growth hormone, and prolactin secretion.
Recently, thermal mud-pack therapy has been shown to induce a decrease in circulating concentrations of prostaglandin E2 (PGE2), leukotriene B4 (LTB4), interleukin-1b (IL-1b), and
tumor necrosis factor-a (TNF-a), significant inflammatory and pain mediators.
Spa treatment has been discovered to trigger growth factor-1 (IGF1) that stimulates cartilage metabolism and transforms growth factor-b (TGF-b).
There is also proof of beneficial intervention on the oxidant / antioxidant scheme both by mud - packs and thermal baths, with the reduced discharge of reactive oxygen (ROS) and nitrogen (RNS) organisms.
Perhaps the most critical aspect of spa therapy is the psychologic effect of removal from the stress of home and work.
This effect has long been recognized in patients after admission to hospital and in rheumatoid arthritis the benefit of hospitalization, in terms of pain relief far exceeds that of antirheumatic drugs, except large doses of corticosteroids ( Lee P, 1974 ).
Besides, there is an immunosuppressive benefit in thermal stress.
The patients receiving spa therapy experienced not only reduced pain and improved function but also experienced the higher physical and mental quality of life and less anxiety and
depression (Constant F, (1995), Franke A,(2000).
The mechanism of action of these effects may be adaptive modifications in regulatory systems,
especially of autonomous functions, and behavioral changes (Gutenbrunner C, 1998, Hildebrandt
G, 1996 ).
For therapy to be effective, it should be performed in the evening, with at least 20 to 30 minutes between the end of the bath and bedtime to allow for initiation of core body temperature cooling.
A meta-analysis of balneotherapy demonstrated that it is an effective treatment for fibromyalgia, and consistently improves sleep quality for this population.
One study comparing balneotherapy to pool-based exercise noted an improvement in both groups.
Balneotherapy alone may thus be a viable option for patients unable to perform pool exercises.
Mechanism of Action of Balneotherapy
Balneotherapy is a complementary procedure that is clinically efficient in the treatment of low-
grade pathologies associated with inflammation and stress.
In medical hydrology and physical medicine, spa treatment involves various methods relying on
the therapeutic properties of water, including balneotherapy and hydrotherapy.
Balneotherapy is an incorporation of procedures which, based on scientific evidence, employs
medically and legally identified mineral-medicinal waters, muds, and natural gases from natural
springs for therapeutic reasons within thermal spa center facilities, depending on scientific
evidence..
It is noted that the mechanisms of these activities involve neuroendocrine and immunological responses — including both humoral and cell-mediated immunity.
The effectiveness undertakes anti-inflammatory, analgesic, antioxidant, chondroprotective, and anabolic activities together with neuroendocrine-immune regulation in various conditions.
Temperature plays a critical element in the efficacy of balneotherapy..
Mineral-medicinal water and mud are frequently used warm as they are excellent heat transfer vehicles — capable of holding heat and releasing it slowly.
Thus, thermotherapeutic procedures can be regarded as such.
The peculiarity of balneotherapy is that its beneficial effects on the organism are brought about not only by the physical properties of mineral-medicinal water and mud but also by their chemical and biological composition.
Conversely, in other spa treatments such as hydrotherapy—in which plain tap water is used—
only the physical properties of water (temperature, hydrostatic pressure, hydrodynamics,
buoyancy, viscosity, electric conductivity, etc.) take part in the beneficial effects of the
intervention ( Gomes C. )
Mechanism of Action of Hydrotherapy
Physiological modifications in the body appear initially to be caused by the influence of water buoyancy and heat transfer into the body.
A layer of water envelops the body in an ordinary bath, rapidly cooling to body temperature. This effect of ' wet suit ' efficiently prevents heat transfer to the body.
With its flowing currents, hydrotherapy breaks this layer and enables the instant and efficient transfer of heat, soothing tensed muscles and improving blood flow to the tissues.
The warmth has a sedative action on the nerve endings, reducing pain and distress.
The buoyancy effect removes the gravity influence and enables the free motion of joints and muscles.
The jet pressure, therefore, provides a more profound impact, while the water pressure helps eliminate edema (liquid inflammation) in the tissues.
This stress also affects the slight and profound touch receptors in the nerve cells, assisting the pain-carrying fibers in preventing from transmitting their ' painful ' signals to the brain.
Psychosomatic
The impacts are due to one's conscious awareness of hydrotherapy-induced impulses. Massage in any form is a stimulus that can refresh a stiff or fatigued limb or joint if given for a short time.
However, more extended exposure will aggravate one's response, decreasing sensory distractions, and resulting in relaxation.
It can be used before sports activities as a pre-workout activity that enhances the whole body and lessen the risk of injury.
Hydrotherapy is beneficial in encouraging rehabilitation and avoiding subsequent stiffness after intensive training.
Hydrotherapy will encourage the revert of lymph flow and purification from the body of waste products, thereby accelerating regeneration.
Hydrotherapy provides an outstanding way for a relaxed, safe, and pain-free body to recover and preserve.
A body in a state of comfort and equilibrium can assist us in dealing with a
contemporary existence that is often over-stressed. Buoyancy, immersion, resistance, and temperature all play essential roles.
According to the gate theory, pain relief may be due to the pressure and temperature of the water on the skin. ( Melzck R, Wall PD ( 1965 )
Water immersion induced an increase in methionine-encephalin plasma levels and, conversely, suppressed plasma - B endorphin, corticotropin, and prolactin levels. ( Coruzzi P, 1988 ).
Muscle relaxation ( Kjelllgren A 2001, Garrett G ( 1997 ) ) and reduced joint swelling ( Grahame R, O' Hare JP, Hall J, ) may also play a role.
Significant improvements in mood and tension may contribute to the results ( Hall J,1996). Reilly and Bird found that group therapy in a community swimming pool was more effective than individual treatment in the pool of a hospital. This was probably due to concentrating on health improvement and well being, instead of disease, and to encouraging social interaction ( Reilly KA,2001).
