Clinical Principles of Balneology and Physical Medicine.
Ponikowska, Przemyslaw Adamczyk, Khai Vu
of Balneology and Metabolic Diseases, Medical University in Bydgoszcz,
Lesna3; 87-720 Ciechocinek, Poland
Balneology and the physical medicine are those branches of medical sciences,
which employ the natural therapeutic methods and the physical phenomena
for healing, rehabilitation, prevention, and diagnosis.
of curing applied in the health resorts therapy and in its main part
balneology are as follows:
- natural healing sources, like mineral waters, gases, and peloids,
- natural environmental factors, like the climate, landscape, and flora,
- various forms of muscle effort,
- physical energy, like light, sound, electromagnetic field, etc.
40 statute spa cities in Poland which provide the full range service.
They act on the basis of their own statute. Every one of them has the
specific profile, natural resources, Health bath houses, professional
medical staff, unique bioclimate situation, and the technical background
indispensable for their activity. In order to receive the status of
a spa, town has to meet rigorous conditions of the climate, the environment,
and the resources of the natural healing factors.
The spa therapy is included into the Polish health care system as an
integral part. In the course of curing chronic diseases and after the
acute hospital interventions patients are directed for the health resorts
therapy. Also according to the indications patients can be directed
to a spa by their family physician. Every spa contains several health
resorts-hospitals and sanatoriums. All of them are registered at the
chief spa physician and have to meet specific medical and hotel standards.
OF ACTIVITY OF THE HEALTH RESORTS TREATMENT
curing, rehabilitation, prevention, and health education.
Curing is specialized mainly in chronic conditions called often the
civilization or "ecologic" diseases. Those which are the most
frequent death causes are best cured in spas, because of lack of the
side effects of the spa therapy, and long lasting healing effects. Not
to mention the costs which are much lower than the classical drug therapy.
Another important field of activity is spa rehabilitation, which is
different from the standard method employed by other health services.
This is because of additional influence and active usage of the natural
resources and methods specific for spas apart from the classical follow
up. It is called balneorehabilitation.
A very important field is prevention. The medicine of the 21st century
is predicted to be dominated by the preventive activities. This may
be a great chance and a very important message for spas in the future.
Another important task of the health resorts therapy is health education.
It may cause a significant decrease in the incidence of the civilization
diseases especially in the relatively young population. All the patients
in spas are simultaneously cured and educated.
ACTION MECHANISM OF THE THERAPEUTIC STIMULI IN BALNEOLOGY
methods in balneology act through stimuli. The reaction to their activity
is either adaptation or compensation. Systematic usage of the stimuli
in series leads to the gradual tuning towards recovery. The balneological
methods train and improve many physiological systems by accelerating
the regeneration processes. They work gradually, but slowly achieved
results are longer lasting than in other methods.
According to many researchers and our own observations, around the second
week of the spa therapy a specific set of symptoms, called the spa reaction
syndrome, occurs in most of the patients. The time of the outcome of
this phenomenon influences the time of recovery and the therapeutic
plans. It is dangerous to discharge the patient during the time of spa
reaction. It happens when the time of the spa therapy is shortened due
to financial causes.
While the spa reaction is present the intensity of the curing stimuli
should be decreased including even suspending the therapy for a while.
Not earlier but after the symptoms are gone the health improvement can
be observed. What was said above means that the health resorts therapy
must last the appropriate amount of time in order to be efficient. The
average for patients with not advanced disease and relatively young
is at least three weeks. For older people with more severe symptoms
it has to be prolonged to a month.
The intensity of the curing stimuli depends on numerous factors depending
both on patient's sensitivity and the character and dosage of the stimulus
itself. Various reactions developed in patients body by series of stimuli
form specific phases manifested clearly or only subclinically.
The first phase which lasts a couple of days is the adaptation of the
organism to the changed natural and social environment.
The second phase is a summarized reaction to applied balneological interventions
sometimes leading to hyperreactivity with its extreme form - the spa
reaction. As it was said before it occurs in the second week of the
therapy and causes the necessity of decrease in therapy intensity including
The third phase - clinical improvement - comes after the spa reaction
The spa therapy methods are not competitive, but complementary, supplementary,
and intensifying the drug therapy. Pharmacotherapy, where indispensable,
should be included in the curing program. It is often the case that
during spa therapy the doses of the drugs can be reduced and sometimes
some of the drugs discontinued.
In some cases however the balneotherapy is not merely additional but
alternative to other forms of therapy. Often bigger efficiency, more
physiological approach, lack of side effects, and much lower costs are
the great advantages of its method.
resorts therapy is most effective when its techniques are combined.
At least a couple of methods are applied simultaneously at the same
time. It allows to improve the efficiency. Some combinations of methods
are specially advantageous because of their superadditive outcome: the
result of the combination is better than the sum of particular methods
applied separately. For example, light, thermal, or kryotherapeutic
stimuli are very effective in combination with the following kinesitherapy.
Quicker post-effort muscle recovery is achieved when the muscle effort
is followed by underwater massage or hydromassage bath.
The positive effect is sometimes achieved by combining the physical
methods with the balneological ones. For example, galvanization with
peat therapy, phototherapy with mineral baths.
The plan of the whole therapy is essential because the results vary
according to the order of the balneophysical techniques.
Balneotherapy together with peloidotherapy and climate therapy are the
principle curing methods applied in the health resorts therapy. Their
availability determines the spa's specialization or curing profile.
The balneotherapy employs mineral waters, peloids , and gases as its
curing stimuli. Among the most important techniques used in healt resorts
therapy you can find the cure baths. The resources explored in these
techniques are curing waters. These are the natural underground waters
of proved curing properties, stable chemical composition, and natural
microbiologic purity. Waters regarded as the mineral ones must contain
at least 1000 mg of mineral ingredients per 1 liter.
Not all mineral waters however are the curing ones. This is because
the curing capabilities are determined by the concentration and the
kind of the biochemically active components.
There are rich curing water resources in Poland. The biggest of the
sodium chloride waters, carbonic acid mineral waters, sulfide - hydrogen
sulfide waters, radon waters, and thermal waters.
They are applied as baths, accordingly:
- brine baths
- carbonic acid mineral waters
- sulfide - hydrogen sulfide baths
- radon baths.
The brine baths are used mainly in orthopedic and posttraumatic conditions,
as well as rheumatic, neurological, and gynecological ones.
The carbonic acid mineral waters baths help in particular heart problems,
hypertension, lower limbs ischemia, and in organ neuroses. There ere
two mail types o this baths-: the gas bath in carbon dioxide of natural
or artificial origin. Indications and the effects are similar, although
milder and less burdening the circulation.
The sulfide - hydrogen sulfide baths are useful in the rheumatic diseases,
orthopedic - posttraumatic conditions, some dermatological ones, and
in lower limbs ischemia.
The radon baths are the therapy for the peripheral circulation problems,
upper breathing ways failures, rheumatic, and gynecological diseases.
In order to give the full idea of this branch of balneotherapy it is
necessary to mention not yet widely known oxygen - ozone baths. They
can be applied both as gas or in the water. The main indications are
as follows: diabetic and arteriosclerotic ischemia of the lower extremities,
and the varicosis ulcers of the legs.
Although peloidotherapy is included as part of the balneotherapy, it
is often separated because of its specific methods. The curing factor
employed here is the peat which should originate from a valuable and
well examined source. There are good and rich peat sources of great
therapeutic value in Poland.
The most frequent techniques of peloidotherapy follow:
- peat poultices - total and partial wraps
- peat baths
- peat sits in bath
- peat tampons
- peat paste techniques.
They are useful in curing the following diseases groups: rheumatic,
orthopedic - post traumatic, neurological, gynecological, laryngological,
and lower limbs blood vessels failures (the peat paste).
The climate therapy. This part of the spa therapy acts thanks to the
natural unique environment of a particular spa. Because it affects the
curing process of particular diseases it must be considered when the
spa curing profile is determined. The techniques employed include: sun
baths, air baths, kinesytherapy in the open air, sea baths, natural
maritime or salt graduation tower aerosol inhalations.
The specific kind of the climate therapy is talassotherapy. Its therapeutic
resource is the sea. The landscape of the spa is considered the complementary
Hydrotherapy. This method employs plain water of various temperature
and pressure. It is applied in the following way: as all kinds of shower
baths, vibro baths, underwater massage, hydgomassage baths. The groups
of the diseases treated this way follow: neurological conditions, orthopedic
- posttraumatic ones, rheumatic, peripheral circulation failure, hypertension,
Therapeutic massage. Mechanical energy used here can be applied in various
ways depending on the mediator. As it was mentioned above the mediator
can be water or as in the classical oldest form - human hands. The mechanical
stimulus acts dual way: directly on the tissues treated and generally
through the skin touch receptors, as well as the proprioceptive and
the interceptive receptors. The massage, especially the classical one
increases the perfusion and the blood outflow of the tissue, and also
improves the vein and lymphatic vessels function. The muscle relaxation
and analgesic activity are the additional advantages of massage.
It is indicated widely especially in the diseases of muscles, joints,
and the microcirculation. Massage is most often combined with other
techniques e.g. baths, peat therapy, thermotherapy, and kinesitherapy.
Kinesytherapy - is the therapy by means of various forms of the physical
activity with carefully adjusted charge. In the health resorts therapy
the most popular techniques are the following: passive, supported, resistant,
or free individual exercises, coordination exercises and walk-learning,
individual and group exercises in the water. Besides that, physical
exercises in the open air are applied with the special kinds: walking,
jogging, marching, and the bicycle rides. They play the supportive role
in kinesitherapy. Nevertheless those activities also have to be carefully
dosed and monitored. They are indicated especially in the motion system
diseases, but also in cardiologic and angiologic conditions, diabetes,
obesity, osteoporosis, respiratory failures, etc.
Physicotherapy - employs various kinds of energy present in the environment.
In the health resort therapy it is the supportive method for the other
forms of curing. When well applied it intensifies and supports the basic
Its methods include:
Electrotherapy. The stimulation is achieved by means of the direct current
for galvanization, ionophoresis, and the four chamber baths; the low
frequency (impulse) current for the diadynamic techniques, and the electrostimulation;
interference currents - like the previous ones; and the high frequency
currents for short-wave and impulse diathermy.
Magnetotherapy - employs impulses of the alternating magnetic field
to achieve analgetic, anti-inflammatory, and anti-swelling outcome as
well as the increase of the tissue perfusion.
Ultrasounds - these imperceptible acoustic waves influence the thermal,
chemical, and mechanical properties of tissues.
Diet therapy is a very important factor in most of the diseases treated
in health resorts. Special diet is indispensable especially in curing
the digestive system, diabetes, osteoporosis, arteriosclerosis, or gout.
It is however very important also in curing other diseases sometimes
with weaker regimen.
Health education. The health resorts therapy is specially predestinated
and privileged to teach the healthy lifestyle. It should be part of
every therapeutic program. The goals of this activity include: teaching
the proper eating habits, inducing the abandonment of addictions and
bad habits, and increase the physical activity in patients. The success
of this program may decrease the incidence of the civilization diseases
and the mortality in numerous other diseases.
Drug therapy. the modern spa therapy does not reject the drug therapy,
but it is treated as one of the therapeutic methods in the course of
the whole follow up. Most of the chronic diseases require systematic
drug usage. It should be properly combined with other methods and adjusted
according to the needs of the organism. The modern pharmacological knowledge
is indispensable for a spa physician.
Psychotherapy. Health resort is the place of relax and rest. They both
help the therapy. The proper psychological, social, natural surroundings
are of great importance, value, and influence on the therapy results.
Some patients need typical forms of psychotherapy e.g. after cardiac
infarct, deep injures, neurotic. It is possible to apply regular usually
short-term psychotherapy, as well as the relaxing exercises. A daily
stroll in the interesting landscape surroundings may be of great importance
for the whole result.
Phytotherapy (herbal therapy). Drinking the herb potions should be a
routine technique in spas similar to drinking mineral waters. Of course
the most efficient is the application of the herbs blend with the specific
indications. Herbal therapy is a great complement to other spa therapeutic
by Marek Runge