The Clinical Principles of Balneology and Physical Medicine.
Irena Ponikowska, Przemyslaw Adamczyk, Khai Vu
Clinic 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.
The means 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.
There are 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.
FIELDS OF ACTIVITY OF THE HEALTH RESORTS TREATMENT
These include: 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.
THE ACTION MECHANISM OF THE THERAPEUTIC STIMULI IN BALNEOLOGY
The curing 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 suspension.
The third phase - clinical improvement - comes after the spa reaction syndrome withdrawal.
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.
The health 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 value.
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, nervous hyperreactivity.
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 techniques.
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 methods.