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Spa Therapy for Chronic Low Back Pain and Lumber Osteoarthritis in Turkey: 

Spa Therapy for Chronic Low Back Pain and Lumber Osteoarthritis in Turkey Prof. Dr. M. Zeki Karagülle

Spa Therapy: 

Spa Therapy

Spa: 

Spa “Spagere” ; Latin word “to scatter, sprinkle, moisten” “Espa” ; Walloon word meaning fountain “Spa” ; Belgian town near Liege, where a curative, thermal spring was discovered in 14th century Place with thermal baths; “Health resort” “Salus Per Aquam”; Health through water

Spa Therapy: 

Spa Therapy “Bathing in thermal water for therapeutic purposes has several descriptions (for example, taking the waters, balneotherapy, spa therapy, hydrotherapy), which will all be used throughout this paper, and are more or less interchangeable.” A brief history of spa therapy: A van Tubergen, S van der Linden, Ann Rheum Dis 2002;61:273–275

Spa Therapy: 

Spa Therapy Has frequently been used interchangeably with balneotherapy and hydrotherapy by patients and health care workers alike.

Spa Therapy: 

Spa Therapy We profoundly disagree with the authors, that "taking the water, balneotherapy, spa therapy, hydrotherapy are more or less interchangeable". We are certain that they are not. MATTERS ARISING: A brief history of spa therapy T Bender, P V Balint and G P Balint Ann Rheum Dis 2002;61:949-950

Spa Therapy: 

Spa Therapy “Bathing in thermal water for therapeutic purposes has several descriptions (e.g. taking the waters, balneotherapy, spa therapy), which are more or less interchangeable. Spa and exercise treatment in ankylosing spondylitis: fact or fancy?  Best Practice & Research Clinical Rheumatology, 2002; 16: 653-666 A.van Tubergen and A. Hidding

Spa Therapy: 

Spa Therapy “Nowadays, spa therapy comprises a wide range of strategies among which are balneotherapy (bathing in mineral water), hydrotherapy (immersion of the entire body or parts of the body in thermal water), massages, physical exercises, mud applications and relaxation” Spa and exercise treatment in ankylosing spondylitis: fact or fancy?  Best Practice & Research Clinical Rheumatology, 2002; 16: 653-666 A.van Tubergen and A. Hidding

Hydrotherapy, balneotherapy, and spa treatment in pain management: 

Hydrotherapy, balneotherapy, and spa treatment in pain management Tamás Bender, Zeki Karagülle, Géza P. Bálint, Christoph Gutenbrunner, Péter V. Bálint and Shaul Sukenik Original Article

Hydrotherapy, balneotherapy, and spa treatment in pain management: 

Hydrotherapy, balneotherapy, and spa treatment in pain management Confusion persists regarding hydrotherapy and balneotherapy. The former employs simply water, while the latter uses natural thermal mineral water. Spa therapy employs a number of different treatment modalities, including hydrotherapy and balneotherapy, and creates a special therapeutic atmosphere of its own through the change in environment and lifestyle.

Balneotherapy: 

Balneotherapy “balneum” Latin word for bath “terapium” Latin word for treatment

Spa Therapy: 

Spa Therapy The terminology “spa therapy” should be reserved for balneotherapy that is mostly combined with massage, exercise, physical therapy or rehabilitation.

Balneotherapy: 

Balneotherapy “The therapeutic use of mineral and thermal waters, usually through water immersion of part or all of the body, but also through drinking certain amount of water and inhaling the vaporized or dispersed water’’

Hydrotherapy?: 

Hydrotherapy? Hydrotherapy at the spas is usually administered in the form of underwater massage, Scottish douche, showers and hydro-kinesitherapy (aquatic exercise in tap water) in the pool.

Alternative approaches to LBP [Erlich GE 2003]: 

Alternative approaches to LBP [Erlich GE 2003] Chiropractic “adjustment” Osteopathic manipulation Yoga Acupuncture Herbals Spa therapy and other terms of moist heat and physical therapy

Spa therapy for LPB: 

Spa therapy for LPB Spa therapeutic methods (baths, mud applications, exercises, massages and water therapies) are given according to established empiric practice and on the assumption that they benefit patients with LBP

Slide17: 

Mud applications Carbon dioxide baths Classic massage Exercise therapy Spinal traction The Clinical Journal of Pain, Vol. 18, No. 5, 2002

Slide18: 

Hydrotherapy (used in combination with massages, exercise therapy, and spinal traction) Electrotherapy (short-wave diathermy, inferential therapy ultrasound) The Clinical Journal of Pain, Vol. 18, No. 5, 2002

Spa Therapy modalities in Central Europe: 

Spa Therapy modalities in Central Europe Balneotherapy Climatotherapy Mud therapy Exercise therapy Hydrotherapy Massage therapy Electrotherapy

Use of Spa Therapy To Improve the Quality of Life of Chronic Low Back Pain Patients Constant, F; Guillemin, F; Collin, JF; Boulangé, M Med Care. 1998 Sep;36(9):1309-14. : 

Use of Spa Therapy To Improve the Quality of Life of Chronic Low Back Pain Patients Constant, F; Guillemin, F; Collin, JF; Boulangé, M Med Care. 1998 Sep;36(9):1309-14. 1. A 10-minute bath at 36°C with underwater flow; 2. A local application of mud at 45°C for 15 minutes; 3. A 20-minute massage under flowing water at 36°C.

Spa Therapy modalities in Southern Europe: 

Spa Therapy modalities in Southern Europe Balneotherapy Mud therapy Massage under flowing water (Vichy Shower) Hydrotherapy Showers Underwater high pressure showers (massages)

Balneotherapie und Kurorttherapie rheumatischer Erkrankungen in der Türkei: Ein systhematischer Review M.Z Karagülle. M.Karagülle Forsch Komplementärmed Klass Naturheilkd 2004;11:33-41: 

Balneotherapy Exercise therapy Patient education (Back school) Balneotherapie und Kurorttherapie rheumatischer Erkrankungen in der Türkei: Ein systhematischer Review M.Z Karagülle. M.Karagülle Forsch Komplementärmed Klass Naturheilkd 2004;11:33-41

Spa Therapy modalities in Turkey: 

Balneotherapy Mud therapy Massage therapy Exercise therapy Spa Therapy modalities in Turkey

Complex(ed) Spa therapy: 

Complex(ed) Spa therapy Electro-therapy Others ?? Exercise Therapy Mud therapy Spinal Traction Hydrotherapy Massage therapy Balneotherapy

Spa therapy for LPB: 

Spa therapy for LPB In general, they consisted of a mixed bag of balneotherapeutic and/or peloidotherapeutic, hydrotherapeutic and physiotherapeutic interventions

Studies; Spa therapy for LBP in Turkey: 

Studies; Spa therapy for LBP in Turkey

Studies; Spa therapy for LBP in Turkey: 

Studies; Spa therapy for LBP in Turkey

Studies; Spa therapy for Lumber OA in Turkey: 

Studies; Spa therapy for Lumber OA in Turkey

Studies; Spa therapy for Lumber OA in Turkey: 

Studies; Spa therapy for Lumber OA in Turkey

Studies; Spa therapy for LBP in Turkey: 

Studies; Spa therapy for LBP in Turkey

Studies; Spa therapy for LBP in Turkey: 

Studies; Spa therapy for LBP in Turkey

Spa therapy for low back pain - French RCT’s: 

Spa therapy for low back pain - French RCT’s

Spa therapy for low back pain - French RCT’s: 

Spa therapy for low back pain - French RCT’s

Spa therapy for low back pain - French RCT’s: 

Spa therapy for low back pain - French RCT’s

Spa therapy for low back pain - French RCT’s: 

Spa therapy for low back pain - French RCT’s

Spa therapy for LBP observational studies: 

Spa therapy for LBP observational studies

Spa therapy for LPB: 

Spa therapy for LPB Review of clinical trials on spa therapy for LBP conducted in Turkey and elsewhere has yielded remarkable short and medium term improvements in pain, functional status, lumber mobility and psychological and general well-being

Spa therapy for LPB: 

Spa therapy for LPB Regardless of the underlying mechanisms, the breadth of the benefits attributable to spa therapy in the management of LBP are remarkable

Why is spa therapy effective?: 

Why is spa therapy effective? A combination of various factors inherited in the spa therapy concept; may contribute to the beneficial effects of spa therapy may be independent and important contributors to the overall effect of spa treatment

Why is spa therapy effective?: 

Why is spa therapy effective? Balneotherapy, spa water (thermal-mineral water), peloidotherapy, mud and other specific spa techniques Other treatment modalities (massage, exercise, traction etc.)

Why is spa therapy effective?: 

Why is spa therapy effective? The temporary change of climatic exposure and social and physical environment A change in the lifestyle during the stay at the spa resort

Why is spa therapy effective?: 

Why is spa therapy effective? the natural history of chronic LBP regression to the mean the nonspecific effects of spa therapy (placebo effect)

Effective components of Spa therapy for LPB: 

Effective components of Spa therapy for LPB Balneotherapy Passive immersion in thermal water Immersion in thermal water with under water high-pressure shower or underwater flow or a stream of hot water on effected part or underwater traction

Effective components of Spa therapy for LPB: 

Effective components of Spa therapy for LPB Mud application; peloidotherapy Local application on low back Exercise therapy Dry Aquatic

Effective components of Spa therapy for LPB: 

Effective components of Spa therapy for LPB Massage Classical under or with water Hydrotherapy Pressure shower Spinal Traction (under water)

Complex(ed) Spa therapy: 

Complex(ed) Spa therapy Electro-therapy Others ?? Exercise Therapy Mud therapy Spinal Traction Hydrotherapy Massage therapy Balneotherapy

Spa therapy for LPB: 

Spa therapy for LPB It remains impossible to identify the most effective component of a spa therapy package and the most effective combination of spa treatments for LPB

Spa for LPB: 

Spa for LPB Let us look at the results of the efforts to examine the contribution of specific spa therapy interventions to the overall effectiveness of spa therapy for chronic (low-back) pain

Contribution of Individual Spa Therapies in the Treatment of Chronic Pain: 

Contribution of Individual Spa Therapies in the Treatment of Chronic Pain On a short-term basis, mud packs and exercise were found to be associated with a greater improvement in mood On a long-term basis, exercise therapy and spinal traction were associated with a greater reduction in back pain Strauss-Blasche et al 2002,

The best combination of Individual Spa Therapies in the Treatment of Chronic Low Back Pain ?: 

The best combination of Individual Spa Therapies in the Treatment of Chronic Low Back Pain ? Yet, there is no data on the most effective combination of specific spa therapy interventions for chronic (low-back) pain

Slide51: 

Let us attempt to prescribe a spa therapy regimen for chronic low-back pain with a evidence based approach rather than empiricism and tradition

A 3-week Spa therapy regimen for LBP Austrian-style: 

A 3-week Spa therapy regimen for LBP Austrian-style

Prescription a 3-week Spa therapy for LBP French-style: 

Prescription a 3-week Spa therapy for LBP French-style

A 3-week Spa therapy regimen for LBP Turkish-style: 

A 3-week Spa therapy regimen for LBP Turkish-style

Slide55: 

A balneotherapy session for LBP Hungarian-Turkish-style

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