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A summary of key Balneotherapy clinical studies

CLINICAL ARTICLES, STUDIES AND TRIALS ON BALNEOTHERAPY

DR. ISTVÁN FLUCK

The following document covers a summary by Dr. István Fluck of some important Hungarian clinical studies, articles and trials related to Balneotherapy and the effects of thermal mineral water.

Tefner,IK., Kovács,C., Gaál,R., Koroknai,A., Horváth,R., Badruddin,RM., Borbély,I., Nagy,K., Bender,T.

The effect of balneotherapy on chronic shoulder pain. A randomized, controlled, single-blind follow-up trial. A pilot study.
Clin. Rheumatol
(2015, June;  34(6)  1097-1082)


46 patients suffering from chronic pain of shoulder girdle were selected in a randomized manner and divided into two groups. Every patient had participated in physiotherapy and electrotherapy treatments, however members of one group had also received hydrotherapy treatments. Subsequently, during weeks 7 and 13, checkups were performed in the case of both groups (questionnaire survey with pain under load and at rest, mobility, etc.).
In both groups, a significant improvement was detected with their condition prior to the start of treatments compared to the follow-up tests. In the case of patients who had the additional hydrotherapy, this favourable impact was substantially better than in case of the control group. This difference was the most pronounced in terms of the functions of passive and active movement.

Kovács,I., Bender,T.,
The therapeutic effects of Cserkeszőlő thermal water in osteoarthritis of the knee: a double blind, controlled, follow-up study.
The effect of balneotherapy on chronic shoulder pain. A randomized, controlled, single-blind follow-up trial. A pilot study.
Rheumatol Int.
(2002. 21:201-221.)


Effect of the Cserkeszőlő thermal mineral water was examined in the case of 46 patients suffering from osteoarthritis of the knee. The patients were selected in a randomized manner, and were divided in two groups. The members of both groups, participated in bathing for 30 minutes over the course of 15 days; the members of one group, bathed in the genuine thermal water, the members of the other group in tap water with similar outward appearance. (This water was made by means of artificial scenting and colouring entirely identical to natural mineral water.) Patients underwent a detailed check-up prior to commencing the treatments, on conclusion of treatment, then subsequently three months later. The results received were analysed (pain of start-up, mobility limitations, tenderness to pressure, walking time, Visual analogue scale (VAS), etc.) The assessment was performed according to the double blind method. Except for the head of research, doctors examining the patients were unaware as to what water each patient had bathed in. In both groups, amelioration was detected, attributable to the favourable effect of hot water, however, in the case of patients treated in thermal mineral water, for all parameters examined, amelioration was significantly better than within the control group.

János Bereczki, László Görbedi, Béla Kiss jr., Judit Jász:
Analysis of the therapeutic effect of Egerszalók thermal water with double blind experiment, performed on patients with spondylosis
Balneology-Spa matters-Spa tourism
(1990, Issue 1, pp. 7-13)


The thermal mineral water of Egerszalók contains sodium and is a calcium-magnesium-hydrogen carbonated thermal water, with an equally significant content of silicic acid and sulphide ions. It therefore can be also classified as a sulphurous water. Treatments were performed in two groups, selected in a randomized manner, under identical circumstances. 21 persons bathed in the thermal mineral water, 23 persons /the control group/ bathed in heated tap water. Doctors recording the results were unaware as to who belonged to which group.
Data review was carried out prior to commencing the treatments, also following their conclusion, on day 21. A slight-scale, yet not significant change was detected during the control survey in both groups in case of the erythrocyte sedimentation, the number of white blood cells, and moreover, the examined spinal motions. In comparison, significant amelioration manifested itself in the thermal mineral water group with regard to the fixity of musculature located next to the spine, in its tenderness to pressure, furthermore, in the intensity of pains appearing upon motion or exercise. (Visual analogue scale)

Horváth,K., Kulisch,Á., Németh,A., Bender,T.
Evaluation of the effect of balneotherapy in patients with osteoarthritis of the hands, a randomised, controlled, single-blind, follow-up study
Clinical Rehabilitation
(2012. May; 26(5: 431-441.)


The tests took place at Gunaras Spa.
Three groups were formed form 63 patients suffering from degenerative deformations of the minor joints of hands, by means of randomized selection (their age ranged from 50 to 70 years).
Members of all three groups received magnetotherapy on the back of their hand. The treatment period consisted of 15 treatments: for three weeks, they were given 5 treatments per week. Those belonging to the first group, in addition, received a 36 C thermal bath of 20 minutes, members of the second group also had a bath of 20 minutes, in water of 38 C. Patients in the third group received only magnetotherapy. Detailed tests and analyses (life quality questionnaire, sensation of pain, visual analogue scale /VAS/, gripping force, tenderness to pressure, number of the swollen minor joints, duration of morning stiffness of the hand, etc.) were performed in case of members of all three groups on day 1, at the end of week 3 and 13 weeks later. Significant amelioration was detected in the two groups that  received thermal water treatment, compared with those who had just magnetotherapy, both at the end of the treatment and during the follow-ups. An interesting difference is whereby, in case of patients treated in 38 C water, the grip force of the hand showed a more pronounced improvement than in the 36 C group.

Bálint,G.F., Buchanan,W.W., Ádám,A., Ratkó,I., Poór,L., Bálint,P.V., Somos,É., Tefner,I., Bender, T.
The effect of the thermal mineral water of Nagybaracska on patients with knee joint osteoarthritis – a double-blind study
Clin. Rheumatology
(2007, 26: 890-894.)


This study took place in order to test the therapeutic effect of the Nagybaracska thermal mineral water. (A calcium-sodium-hydrogen carbonated water of 34 C degrees, with a total content of mineral substances of 1,905 mgr/litre, which contains 864 mgr/litre of free carbon dioxide (CO 2).) Two groups of respectively 32 persons were formed, based on randomized selection.
The persons involved in the survey all resided within a radius of 20 km from the spa, and were able to walk. (They were women aged between 50 and 75 years, in the menopause, and men belonging to the same age group.)
The patients had knee complaints that had existed for at least three months, however, other than the general contra-indications, they had no palpable Baker cyst, and had not received intra-articular injections in the last two months. Furthermore, they had had no other treatment than the medical exercises they had learnt and performed in their homes.
Members of both groups received a hydrotherapy of 30 minutes, for four consecutive weeks, 5 times a week (20 treatments). One of the groups, under the above-mentioned circumstances, bathed in the thermal mineral water, the other, in heated network water. In accordance with the double-blind surveys, patients were unaware as to what water they received the treatment in. Results were assessed prior to commencement of the treatments, after 20 baths and three months later. Following conclusion of the treatments, in both groups, broadly identical, favourable, significant data of improvement were obtained, in terms of all examined objective and subjective parameters. Upon the check-up performed three months later, an improvement reaching a durable, significant scale was detected only in case of those having been treated in thermal water.

Konrád,K., Tátrai,T., Hunka,A., Vereckei,E., Korondi,I.
Controlled trial of balneotherapy in treatment of low back pain
Annals of Rheumatic Diseases
(1992; 51: 820-822.)


Three groups were formed, by means of randomized selection, from 158 persons suffering from "non-specific" lower back pains, who were at the same time, capable of work-performance, and were working for the entire duration of the survey i.e. - were not on sick-leave.
2,541 persons were involved in the review having preceded selection, of them, 845 had lower back pains, yet, due to disqualifying reasons only 158 were included in the survey group. All of them were given ambulant treatment, after work.
Those belonging to group ,,A”, received calcium-magnesium-hydrogen carbonated-sulphurous baths. (37 C degrees, 15 minutes).
Members of group ,,B” were given an underwater jet massage to their lower back (37 C degrees, 1 atm, 10 cm distance, 15 minutes).
Group ,,C” received underwater traction bath, first, with no weight, then, with a weight of 3 kg respectively hung on both sides of the swimming-pool belt.
Members of all three groups received treatments for four weeks, three times a week. The thermal mineral water applied was identical in each case. The conclusion of the treatment, with regard to the reduction of pain, the dose of required painkillers and the spinal motions, showed no essential difference was detected between the three groups. All three groups experienced a reduction in pain and overall complaints. Check-up tests performed a year later obtained the same result. In the opinion of the authors, in case of chronic lower back pain, not a single form of balneo-hydrotherapy treatment should be ignored or underrated.

Géza Bálint
The biology, chemistry, physics and metaphysics of balneotherapy
Balneology-Spa affairs-Spa tourism
(2013, 32nd volume, Issues 1-2, pp. 6-13)


A summary clinical article dealing with the effect of thermal mineral waters and mud treatments. Its introduction covers the phenomena associated with the direct physical effects of spa treatments – the so-called ‘spa fatigue’ and ‘spa reaction’. The latter manifests itself on day 6-8 of a balneotherapy complex therapy stay, its symptoms being the intensification of pain, fatigue and a temporary increase in the number of white blood cells and erythrocyte sedimentation. However this phenomena ceases within 2-3 days. Spa fatigue manifests itself during continuous spa treatment after cca. 3 weeks and manifests itself in temporary fatigue, indisposition and irritability.
Subsequently, the article reviews essential domestic and overseas published materials that concern the effects of balneotherapy, highlighting especially those published in English. Regarding the chemical effects of spa treatments, it covers the important chemicals found in thermal mineral water that have an impact on skin nerve terminals and how they can reduce the sensation of pain. It also dwells upon the impact of other absorbed minerals.
Naturally, the mechanical attributes of water, the favourable effects of buoyancy, temperature, water pressure, etc. prevail in balneotherapy also.
The article goes on to highlight the importance of spa balneotherapy treatment in spa tourism, at the same time, pointing out how this is not equivalent to wellness. It simultaneously recommends establishing health clubs at the bathing resorts.

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