BALNEOTHERAPY

Dr. Öğr .Üy. Duygu AKTAR REYHANİOĞLU

 Balneotherapy - what is
it?
• Balneology
• Heliotherapy
• Mineral water
• Thermalizm
• Hydrotherapy
• Peloidotherapy
• SPA therapy
• Medical hydrology and climatology
• Despite thousands of years of definitions about
water therapy , internationally accepted definitions
do not exist
 Balneotherapy - what is
it?
• Name itself came to us from ancient Greece.

• In the literal sense, it means - bath, bathing,

treatment.

• This procedure is prescribed both as an additional

physiotherapy in the treatment of various diseases,
and during rehabilitation activities.
Balneotherapy: Bath therapy

Balneology: Bath Science

Balneum: Bath
 What is balneotherapy?
• The use of thermal and mineral waters, peloids and
gases in the treatment

Peloid : They were organic and/or inorganic substances originating from

underground and marine sources formed as a result of natural geological
and/or biological events.
• Appropriate dose----- appropriate time
• Curative effect

• Spa=Hot water resource

• Thermal Springs
• Health center established in the region where
balneological resources are located
 Thermal Spring Therapy
Balneotherapy
• It is the whole of interventions including
balneotherapy performed in spas.

• Acupuncture
• Massage
• Fitotherapy
• Health education
• Pharmacatherpy
• Electrotherapy
• Phsycotherapy
 Balneologic concept

Mineralized Water: >1gr/L mineral

Thermal Water: >20 degree tempr.

Mineralized and Thermal Water

 Mineralized water
Calcium >300 mg/L

Magnesium >100 mg/L

Flour >1 mg/L

Sulphate >800 mg/L

Bicarbonate >1300 mg/L

Sodium >500 mg/L

Using types of balneologic
agents

Bath Inhalation
Drinking cures
applications applications
 Drinking cures
• It is a cure program made by drinking natural
mineral waters for a certain period of time, in
divided doses and in certain amounts throughout
the day.

• bottled mineral waters

• Modern curative effect
 Turkiye
BOTTLED MINERAL
WATER
• 1500 mineral water source

• – 26 licensed bottled mineral water brands

• – Consumption of mineral water <5 L/year per

person
 Turkiye
BOTTLED MINERAL WATER
Chemical compositions of bottled mineral waters can have supportive /
specific effects in various health problems if used in appropriate doses.

Questions to ask:

1. Is the calcium content sufficient in bottled mineral waters?

2. Can the available calcium be effectively absorbed?

3. Is absorbed calcium effective?

 Advantages of mineral
waters
• easily accessible
• – Cholesterol – no concern of triglyceride elevation
• – No calorie
• – Does not cause polypharmacy
• – Does not cause dyspepsia
• – Drinkable in divided doses
• – High absorption and bioavailability
Bioavailability
 Attention !
• Waters with high sodium content should be used
with caution in hypertensive patients.

• Sulfated waters create an acidic environment and

increase calcium excretion.
• Therefore, water containing calcium bicarbonate
instead of calcium sulfate is more preferable
 Attention
• Magnesium absorption from mineral waters is ≈ 50%

• • Absorption increases when taken with meals.

• We can recommend bottled mineral waters high in

magnesium to every patient
• Daily need for mg 300 mg
• Requirement of pregnant and athletes can be doubled
 Bicarbonate waters
1. It can be used as a stabilizer of metabolic acidosis
during exercise and physical activity.

• Light loading before physical activity begins

• 20 minutes after the start of physical activity, every 15-20

minutes, 100-150 ml

In gout because it increases diuresis and uric acid

excretion available
 Which patient to which spa?
shall we direct?
• Pool - tub applications
• made with peloid and water

Dalyan peloid turkish bath

The most common form of
application

•From shoulder to xiphoid

•To take advantage of the
overall effects
Bath application
Pool - tub applications
• Full bath, immersing ¾ bath
• Half bath
• Local bathroom
• Showers
• Lavage - irrigations
• Peloid-pack application
 Half bath
To reduce physical effects
• Hydrostatic pressure, hyperthermia
• Up to the navel level
 Local bath
Reducing hydrostatic pressure, hyperthermia
Local application
Less contraindication
 Shower

Application of hot mineral waters with a

certain pressure

Lavage - irrigations
 Peloid-pack application
• The most commonly used method in peloids
• High temperature (>42oC)
• With bathrooms or alone
 Which patient should we
refer to which spa?
Evidence-based diseases that may benefit are ;

_ Knee osteoarthritis

– Fibromyalgia syndrome

– Rheumatoid arthritis

- Ankylosing spondylitis

– Chronic low back pain

in research

– With what kind of water

– Which balneotherapeutic applications have been made?

 Classical rules of spa treatment:

• • It is done by staying in the spa center

• • Lasts at least 3-4 weeks
• • The bath temperature should be 38-39oC, and the
duration should be 15-20 minutes.
• • It should not be done more than 1 bath per day.
• • One day a week should be spent resting.,

• Generally water rich in

• Sodium chloride
• Sodium bicarbonate
• Calcium carbonate
• Sulfur
Gains with balneotherapy
• It provides improvement in many criteria and scales
such as

• Pain duration, severity

• • Life quality
• • Functional capacity
• • Trust yourself
• • Gait pattern
• • Disease activity
• • Drug consumption ……..
 Result
• Effectiveness of balneotherapy in musculoskeletal
system diseases It is an alternative complementary
method that should not be ignored.
If the indication is appropriate
• In addition to long program cures, short programs
such as 10 days can also be effective.

• Treatments can be done every day during the cure,

4, 5 or 6 days a week.

• Bath times can be set as 15-35 minutes

 NOTE
• Baths made with heated tap water also have a thermal
effect.
• Improvements can be made with
• However, the effect is longer in natural thermomineral
waters.
• The effectiveness of balneotherapy is compared with
other treatment modalities can be increased by
combining
• • Peloid
• • Exercise
• • Land cures, climatotherapy
• • Physiotherapy agents
• • Massage (pressure water, dry)
• • sauna, in-water traction
 ATTENTION
• Active inflammation of rheumatoid arthritis
• Thermal cure crisis
o Occurs from the 3rd day of treatment
o Increased pain, insomnia, loss of appetite, palpitations, fever
elevation, nausea-vomiting
 İzmir-Balçova Thermal Facilities

NaCl, bicarbonate

• 3 indoor and 1 outdoor thermomineral pools

• 3 flat water pools

• 116 row baths

• Bathtub and thermomineral water in every room

• Peloidotherapy, Jet shower, whirlpool, jacuzzi, underwater massage

 İzmir-Balçova Thermal Facilities

• • 2 FTRs, 1 rheumatologist, 1 family physician, 1

• dermatologist, 10 general practitioners
• • 18 physiotherapists, 11 nurses, 1 laboratory
assistant, 10
• masseur
• • Physical therapy unit
• • Rehabilitation unit
• • Aromatherapy