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24-10-2011 | Physical rehabilitation | Article

Thermal spring-based exercise effective chronic back pain therapy


Free abstract

MedWire News: Balneotherapy - thermal spring water-based exercise - offers more therapeutic benefit for chronic low back pain (LBP) than conventional physiotherapy, research findings suggest.

"In our trial, improvements in back extensor muscle test, lumbar flexibility, functional capacity, quality of life, and reduction in the severity of the pain perceived were observed in patients with LBP receiving balneotherapy," remark the authors. The balneotherapy was carried out in thermal mineral water containing calcium carbonate and sodium chloride at Karaali thermal springs in Istanbul, Turkey for 10 days, they explain.

Writing in the journal Rheumatology International, Nur Kesiktas (Sanliurfa Balikligol Government Hospital, Istanbul, Turkey) and team explain that balneotherapy exerts its therapeutic effects by assisting the absorption of water-based minerals by body tissues. In addition, when immersed in water, body tissues can adopt the buoyancy and temperature of water, thus facilitating pain relief.

The findings arise from a study of 50 chronic low back pain patients who were randomly allocated to receive 10 daily sessions of physiotherapy plus exercise (n=25) or balneotherapy plus exercise (n=25).

Treatment effect was evaluated by measuring pain at rest and on moving (using the visual analog scale [VAS] of 0 to 100, where 0 = no pain and 100 = worst pain possible), paracetamol dose required for pain relief, manual muscle test (MMT) for lumbar muscle strength, modified Schoeber's (MS) test for spinal flexion, and Oswestry disability index (ODI). All measurements were taken at baseline, therapy end, and at 3 months post-therapy end.

All patients also completed a Short-Form (SF)-36 questionnaire at these three evaluation points to determine their pain-related physical and social functioning.

Kesiktas and team observed no difference in paracetamol use among patients in either group immediately after treatment. By 3 months post-therapy end, however, the physical therapy group used paracetamol more frequently than the balneotherapy group. Indeed, the former group took a mean paracetamol dose of 1.45 tablets per day before therapy and 1.01 tablets per day at 3 months after therapy, whereas the latter group took 1.47 tablets per day before therapy and 0.35 tablets per day at 3 months post-therapy end.

Pain determined by VAS score showed similar improvement in each group before and after therapy, as did MMT and MS scores, which increased significantly after treatment compared with before treatment.

In the physical therapy group, ODI scores only showed improvement from baseline at 3 months. By contrast, ODI scores of the balneotherapy group showed improvement immediately after therapy.

Furthermore, the balneotherapy group had greater improvements in SF-36 scores relating to energy vitality, social function, role limitations, and general health than the physical therapy group.

Kesiktas and team conclude that on the basis of these encouraging findings, the "demonstration of the efficacy of different mineral containing thermal springs at different indications in controlled trials would offer a choice of treatment both for physicians and in reimbursement by social security institutions."

By Lauretta Ihonor

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