S-2-08-01
HOT SPRINGS IN REHABILITATION
Klaus L. Schmidt (Giessen University, Bad Nauheim, Germany)
The empiric and instinctive use of hot springs for bathing and exercises belongs to the eldest kinds of rehabilitation worldwide. Also in present time, many rehabilitation centres are located in health resorts and spas and use warm springs. Warm and hot springs work by mechanical (buoyancy, viscosity, hydrostatic pressure), thermal (analgesia, muscular detonisation, antiinflammatory effects) and chemical factors (resorption and deposition of substances in the skin and elution of substances from the skin). Furthermore, repeated application of hot springs induces effects of adaptation and stimulates resistance mechanisms. Thus, warm springs are not only an ideal medium for under water exercises, but have additional effects which depend on their thermal and chemical properties. Primary point of attack is the skin, which is the largest human immune organ. Recently, increased interleukin 1- and interleukin 6-activity and increased transportation of mononuclear cells from the heated skin could be demonstrated. Thus, it seems possible, that hot springs may influence immune and other pathogenetic mechanisms. Of course, hot springs can be only a part of a modem combined rehabilitation program which comprises also physical therapy, drug treatment, dietary measures, elimination of noxious environmental influences, psychological guidance, health education and social measures. In some controlled studies value of warm springs in the rehabilitation at spas could be demonstrated.
S-2-08-02
HYDROTHERAPY IN REHABILITATION
Bernd R. Hartmann, Bernadette Drews, Achim Burger, (Univ. Fretburg, Germany)
Hydrotherapy includes thermotherapy and aqual immersion without or with exercise, receiving its scientific impetus from the space medicine (microgravity). Balneotherapy uses the serial application of natural spring water. Hydrostatic pressure, buoyancy, temperature and fluid dynamics are the agents. The pressure increases the central blood volume influencing especially the circulation and the hormon balance, including the stress reaction. The colloid osmotic pressure changes due to fluid shifts in the capillaries (Am J Physiol 269:R1068-76, 1995). Lack of gravitation decreases the O2 demand and allows a full range of motion. To apply heat or cold, water is efficient in counter-irritation and in changing the arterial, microcirculatory and venous blood flow. A warm- water bath in congestire heart failure represents a "novel" therapy even in a severe stage (Circulation 91:2582-90, 1995).
Brine, sulfur, radon and carbondioxide have additive effects. Sodium chloride enhances the antigravity and elutes leukocyte elastase, sulfur destructs oxygen radicals, Radon acts pain-reducing, CO2 dilates precapillaries, shifts the oxyhemoglobin dissociation curve rightwards, reduces the blood viscosity and acts antiseptic.
Hydrotherapy decreases symptoms, heals specific diseases and increases quality of life. The effects are well documented, often according to the "CONSORT-" Statements (J Am Med Assoc 276:649, 1996).
