Skip to main content
Log in

Balneotherapy in medicine: A review

  • Review Article
  • Published:
Environmental Health and Preventive Medicine Aims and scope

Abstract

Bathing in water (balneotherapy or spa therapy) has been frequently and widely used in classical medicine as a cure for diseases. This paper reviews the present literature on the use of balneotherapy in dermatologic, chronic musculoskeletal (inflammatory and non-inflammatory), metabolic and psychological conditions.

We performed a systematic review on related papers appearing in the Medline and Cochrane Library database from 1966 to 2003 that included randomized controlled and non-randomized clinical trials using balneotherapy. We also determined to reflect where possible the chemical compositions of spas.

The major dermatologic and musculoskeletal diseases that are frequently treated by balneotherapy with a remarkable rate of success are atopic dermatitis, psoriasis, rheumatoid arthritis (RA), ankylosing spondylitis, osteoarthritis and low back pain. Moreover, the effects of spa therapy on several metabolic conditions are discussed. The mechanisms by which broad spectrums of diseases respond to spa therapy probably incorporate chemical, thermal and mechanical effects.

The importance of balneotherapy either alone or as complement to other therapies should be considered after, or accompanying, orthodox medical treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Routh HB, Bhowmik KR, Parish LC, Witkowski JA. Balneology, mineral water, and spas in historical perspective. Clin Dermatol. 1996; 14: 551–554.

    Article  PubMed  CAS  Google Scholar 

  2. Matz H, Orion E, Wolf R. Balneotherapy in dermatology. Dermatol Ther. 2003; 16: 132–140.

    Article  PubMed  Google Scholar 

  3. O’Hare JP, Heywood A, Summerhayes C, Lunn G, Evans JM, Walters G, Corrall RJ, Dieppe PA. Observations on the effect of immersion in bath spa water. BMJ. 1985; 291: 1747–1751.

    PubMed  CAS  Google Scholar 

  4. Adler E. Some clinical experience with the springs at Zohar on the shore of the Dead sea. Isr J Med Sci. 1961; 20: 304–308.

    PubMed  CAS  Google Scholar 

  5. Smith JB, Knowlton RP, Agarwal SS. Human lymphocyte responses are enhanced by culture at 40°C. J Immunol. 1978; 121: 691–694.

    PubMed  CAS  Google Scholar 

  6. Inoue T, Inoue S, Kubota K. Bactericidal activity of manganese and iodide ions against Staphylococcus aureus: a possible treatment for acute atopic dermatitis. Acta Derm Venereol. 1999: 79: 360–362.

    Article  PubMed  CAS  Google Scholar 

  7. Svejgaard E. The role of microorganisms in atopic dermatitis. Semin Dermatol. 1990; 9: 255–261.

    PubMed  CAS  Google Scholar 

  8. Kubota K, Machida I, Tamura K, Take H, Kurabayashi H, Akiba T, Tamura J. Treatment of refractory cases of atopic dermatitis with acidic hot spring. Acta Derm Venereol. (Stockh) 1997; 77: 452–454.

    CAS  Google Scholar 

  9. Shani J, Seidl V, Hristakieva E, Stanimirovic A, Burdo A, Harari M. Indications, contraindications and possible side-effects of climatotherapy at the Dead sea. Int J Dermatol. 1997; 36: 481–492.

    Article  PubMed  CAS  Google Scholar 

  10. Giryes H, Friger M, Sarov B. Treatment of atopic dermatitis in the Dead sea area: biology and therapy of inflammatory skin diseases. Presented at: International Symposium at the Dead Sea; November 2–6, 1997; Dead Sea, Isreal.

  11. Halvey S, Giryes H, Friger M, Sukenik S. Dead sea bath salt for the treatment of psoriasis vulgaris: a double-blind controlled study. J Eur Acad Dermatol. 1997; 9: 237–242.

    Article  Google Scholar 

  12. Leaute-labreze C, Saillour F, Chene G, Cazenave C, Luxey-Bellocq ML, Sanciaume C, Toussaint JF, Taieb A. Saline spa water or combined water and UV-B for psoriasis vs conventional UV-B. Arch Dermatol. 2001; 137: 1035–1039.

    PubMed  CAS  Google Scholar 

  13. Hjorth N. Traditional topical treatment of acne. Acta Derm Venereol. (Stockh) 1980; 89: 53–55.

    Google Scholar 

  14. Schempp CM, Dittmar HC, Hummler D. Magnesium ions inhibit the antigen-presenting function of human epidermal Langerhans cells in vivo and in vitro. Involvement of ATPase, HLA-DR, B7 molecules, and cytokines. J Invest Dermatol. 2000: 115: 680–686.

    Article  PubMed  CAS  Google Scholar 

  15. Hartmann BR, Bassenge E, Pittler M. Effect of carbon dioxide-enriched water and fresh water on the cutancous microcirculation and oxygen tension in the skin of the foot. Angiology, 1997; 48: 337–343.

    PubMed  CAS  Google Scholar 

  16. Danesino V. Balneotherapy with arsenical-ferruginous water in chronic cervico-vaginitis. A case-control study. Minerva Ginecol. 2001; 53: 63–69 (Article in Italian)

    PubMed  CAS  Google Scholar 

  17. Dupuy P, Casse M, Andre F, Dhivert-Donnadieu H, Pinton J, Hernandez-Pion C. Low-salt water reduces intestinal permeability in atopic patients. Dermatology 1999; 198: 153–155.

    Article  PubMed  CAS  Google Scholar 

  18. Pinton J, Friden H, Kettaneh-Wold N, Wold S. Clinical and biological effects of balneotherapy with selenium-rich spa water in patients with psoriasis vulgaris. Br J Dermatol. 1995; 133: 344–347.

    Article  PubMed  CAS  Google Scholar 

  19. Sukenik S, Buskila D, Neumann L, Kleiner-Baumgarten A, Zimlichman RS, Horowitz J. Sulfur bath and mud pack treatment for rheumatoid arthritis at the Dead sea area. Ann Rheum Dis. 1990; 49: 99–102.

    PubMed  CAS  Google Scholar 

  20. Elkayam O, Wigler I, Tishler M. Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. J Rheumatol. 1991; 18: 1799–1803.

    PubMed  CAS  Google Scholar 

  21. Sukenik S, Neumann L, Flusser D. Balneotherapy for rheumatoid arthritis at the Dead sea. Isr J Med Sci. 1995; 31: 210–214.

    PubMed  CAS  Google Scholar 

  22. Kolarz G. Critical approach to spa treatment in rheumatic diseases. Rheumatol Eur. 1995; 24: 144–146.

    Google Scholar 

  23. Franke A, Reiner L, Pratzel HG, Franke T, Resch KL. Longterm efficacy of radon spa therapy in rheumatoid arthritis—a randomized, sham-controlled study and follow-up. Rheumatology. 2000; 39: 894–902.

    Article  PubMed  CAS  Google Scholar 

  24. Tubergen A, Landewe R, Heijde D, Hidding A, Wolter N, Asscher M, Falkenbach A, Ekkehard G, Goei The H, Linden S. Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: a randomized controlled trial. Arthritis Care Res. 2001: 45: 430–438.

    Article  Google Scholar 

  25. Tishler M, Brostovski Y, Yaron M. Effects of spa therapy in Tiberias on patients with ankylosing spondylitis. Clin Rheumatol. 1995; 14: 21–25.

    Article  PubMed  CAS  Google Scholar 

  26. Tubergen A, Boonen A, Landewe R, Rutten-Van Molken M, Heijde D, Hidding A, Linden S. Cost effectiveness of combined spa-exercise therapy in ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum. 2002; 47: 459–467.

    Article  PubMed  Google Scholar 

  27. Buskila D, Abu-Shakra M, Neumann L, Odes L, Shneider E, Flusser D, Sukenik S. Balneotherapy for fibromyalgia at the Dead sea. Rheumatol Int. 2001; 20: 105–108.

    Article  PubMed  CAS  Google Scholar 

  28. Nguyen M, Revel M, Dougados M. Prolonged effects of 3 week therapy in a spa resort on lumbar spine, knee and hip osteoarthritis: follow-up after 6 months: a randomized controlled trial. Br J Rheumatol. 1997; 36: 77–81.

    Article  PubMed  CAS  Google Scholar 

  29. Kovacs I, Bender T. The therapeutic effects of Cserkeszolo thermal water in osteoarthritis of the knee: a double blind, controlled, follow-up study. Rheumatol Int. 2002; 21: 281–221.

    Google Scholar 

  30. Green J, Mckenna F, Redfern EJ, Chamberlain MA. Home exercises are as effective as outpatient hydrotherapy for osteoarthritis of the hip. Br J Rheumatol. 1993; 32: 812–815.

    Article  PubMed  CAS  Google Scholar 

  31. Wigler I, Elkayam O, Paran D. Spa therapy for gonarthrosis: a prospective study. Rheumatol Int. 1995; 15: 65–68.

    Article  PubMed  CAS  Google Scholar 

  32. Guillemin F, Constant F, Collin JF, Boulange M. Short and long-term effect of spa therapy in chronic low-back pain. Br J Rheumatol. 1994; 33: 148–151.

    Article  PubMed  CAS  Google Scholar 

  33. Constant F, Collin JF, Guillemin F, Boulange M. Effectiveness of spa therapy in chronic low back pain: a randomized clinical trial. J Rheumatol. 1995; 22: 1315–1320.

    PubMed  CAS  Google Scholar 

  34. Konard K, Tatrai T, Hunka A. Controlled trial of balneotherapy in treatment of low back pain. Ann Rheum Dis. 1992; 51: 820–822.

    Article  Google Scholar 

  35. Strauss-Blasche G, Ekmekcioglu C, Leibetseder V, Melchart H, Marktl W. Seasonal variation in effect of spa therapy on chronic pain. Chronobiol Int. 2002; 19: 483–495.

    Article  PubMed  Google Scholar 

  36. Becker BE. The biologic aspects of hydrotherapy. J Back Musculoskeletal Rehabil. 1994; 4: 255–264.

    Google Scholar 

  37. Golland A. Basic hydrotherapy. Physiotherapy. 1981; 67: 258–262.

    PubMed  CAS  Google Scholar 

  38. Ohtsuka Y, Yabunaka N, Fujisawa H, Watanabe I, Agishi Y. Effect of thermal stress on glutathione metabolism in human erythrocytes. Eur J Appl Physiol Occup Physiol. 1994; 68: 87–91.

    Article  PubMed  CAS  Google Scholar 

  39. Shirakura T, Kubota K. Balneotherapy in hematology and immunology. Jpn J Biometeor. 1992; 29: 15–23. (Article in Japanese).

    Google Scholar 

  40. Kurabayashi H, Kubota K, Tamura J, Shirakura T. A glass of water at midnight for possible prevention of cerebral infarction. Stroke. 1991; 22: 1326–1327.

    PubMed  CAS  Google Scholar 

  41. Muruganandam A, Drouillard C, Thibert RJ, Cheung RM-C, Draisey TF, Mutus B. Glutathione metabolic enzyme activities in diabetic platelets as a function of glycemic control. Thromb Res. 1992; 67: 385–397.

    Article  PubMed  CAS  Google Scholar 

  42. Buczynski A, Wachowicz B, Kedziora-Kornatowska K, Tkaczewski W, Kedziora J. Changes in antioxidant enzyme activities, aggregability and malonyldialdehyde concentration in blood platelets from patients with coronary heart disease. Atherosclerosis. 1993; 100: 223–228.

    Article  PubMed  CAS  Google Scholar 

  43. Ohtsuka Y, Yabunaka N, Watanabe I, Noro H, Agishi Y. Balneotherapy and platelet glutathione metabolism in type II diabetic patients. Int J Biometerol. 1996; 39: 156–159.

    Article  CAS  Google Scholar 

  44. Ohtsuka Y, Yabunaka N, Watanabe I. Noro H, Tujisawa H, Agishi Y. Thermal stress and diabetic complications. Int J Biometeorol. 1995; 38: 57–59.

    Article  PubMed  CAS  Google Scholar 

  45. Take H, Kubota K, Tamura K, Kurabayashi H, Shirakura T, Miyawaki S, Kobayashi I. Activation of circulating platelets by hyperthermal stress. Eur J Med Res. 1996; 1: 562–564.

    PubMed  CAS  Google Scholar 

  46. Nomura E, Kohriyama T, Yamaguchi S, Kajikawa H, Nakamura S. Significance of the coagulation and fibrinolytic parameters as predictors for carotid atherosclerosis. Rinsho Shinkeigaku [Clinical Neurology] 1996; 36: 741–745. (Article in Japanese)

    CAS  Google Scholar 

  47. Tamura K, Kubota K, Kurabayashi H, Shirakura T. Effects of hyperthermal stress on the fibrinolytic system. Int J Hyperthermia. 1996; 12: 31–36.

    Article  PubMed  CAS  Google Scholar 

  48. Ay A, Yurtkuran M. Evaluation of hormonal response and ultrasonic changes in the heel bone by aquatic exercise in sedentary postmenopausal women. Am J Phys Med Rehabil. 2003; 82: 942–949.

    Article  PubMed  Google Scholar 

  49. Strauss-Blasche G, Ekmekeioglu C, Leibetseder V, Marktl W. Seasonal variation of lipid-lowering effects of complex spa therapy. Forsch Komplementarmed Klass Naturheilkd. 2003; 10: 78–84.

    Article  PubMed  CAS  Google Scholar 

  50. Kuczera M, Kokot F. The influence of spa therapy on the endocrine system. II. Erythropoietin. Pol Arch Med Wewn. 1996; 95: 21–28. (Article in Polish)

    PubMed  CAS  Google Scholar 

  51. Kuczera M, Kokot F. Effects of spa therapy on the endocrine system. I. Stress reaction hormones. Pol. Arch Med Wewn. 1996; 95: 11–20. (Article in Polish)

    PubMed  CAS  Google Scholar 

  52. Leibetseder V, Strauss-Blasche G, Holzer F, Marktl W, Ekmekeioglu C. Improving homocysteine levels through balneotherapy: effects of sulphur baths. Clin Chim Acta. 2004: 343: 105–111.

    Article  PubMed  CAS  Google Scholar 

  53. Ozkan Y, Ozkan B, Simsek B. Plasma total homocysteine and cysteine levels as cardiovascular risk factors in coronary heart disease. Int J Cardiol. 2002; 82: 269–277.

    Article  PubMed  Google Scholar 

  54. Okada M, Hasebe N, Aizawa Y, Izawa K, Kawabe J, Kikuchi K. Thermal treatment attenuates neointimal thickening with enhanced expression of heat-shock protein 72 and suppression of oxidative stress. Circulation. 2004; 109: 1763–1768.

    Article  PubMed  CAS  Google Scholar 

  55. Yamashita N, Hoshida S, Taniguchi N, Kuzuya T, Hori M. Whole-body hyperthermia provides biphasic cardioprotection against ischemia/reperfusion injury in the rat. Circulation. 1998; 98: 1414–1421.

    PubMed  CAS  Google Scholar 

  56. Benjamin IJ, McMillan DR. Stress (heat shock) proteins molecular chaperones in cardiovascular biology and disease, Circ Res. 1998; 83: 117–132.

    PubMed  CAS  Google Scholar 

  57. Latchman DS. Heat shock proteins and cardiac protection. Cardiovasc Res. 2001; 51: 637–646.

    Article  PubMed  CAS  Google Scholar 

  58. Kamioka Y, Okada S, Mutoh Y, Yazaki T. Effectiveness of comprehensive education combining hot spa bathing and lifestyle exercise education. J Jpn Assoc Phys Med Balneol Climatol. 2003; 66: 239–248 (Article in Japanese)

    Google Scholar 

  59. Kamioka H, Nakamura Y, Yazaki T, Uebaba K, Mutoh Y, Okada S, Takahashi M. Effectiveness of comprehensive hot spa bathing and lifestyle education in middle-aged and elderly women: randomized controlled trial of three- and six month interventions. J Jpn Assoc Phys Med Balneol Climatol. 2004; 67: 202–214.

    Google Scholar 

  60. Harrington L, Affleck G, Urrows S, Tennen H, Higgins P, Zautra A, Hoffman S. Temporal covariation of soluble interleukin-2 receptor levels, daily stress, and disease activity in rheumatoid arthritis. Arthritis Rheum. 1993; 36: 199–203.

    PubMed  CAS  Google Scholar 

  61. Halvey S, Sukenik S. Different modalities of spa therapy for skin diseases at the Dead sea area. Arch Dermatol. 1998; 134: 1416–1420.

    Article  Google Scholar 

  62. Turner B, Pennefather J, Edmonds C. Cardiovascular effects of hot water immersion (suicide soup). Med J Aust. 1980; 2: 39–40.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ali Nasermoaddeli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nasermoaddeli, A., Kagamimori, S. Balneotherapy in medicine: A review. Environ Health Prev Med 10, 171–179 (2005). https://doi.org/10.1007/BF02897707

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02897707

Key words

Navigation