Crenotherapy 23-24.pdf

CRENOTHERAPY General Intervention Methods Degree in Physiotherapy USP-CEU SCHEME CONCEPT TYPES CLASIFFICATION APPLICATIONS 2  CRENOTHERAPY CRENOTHERAPY is the medical use of medicinal or mineral water as a fo...

CRENOTHERAPY General Intervention Methods Degree in Physiotherapy USP-CEU SCHEME CONCEPT TYPES CLASIFFICATION APPLICATIONS 2  CRENOTHERAPY CRENOTHERAPY is the medical use of medicinal or mineral water as a form of therapy (including for both external and internal use) Crenotherapy or balneotherapy or thermal waters or spring waters, 3  CRENOTHERAPY MEDICINAL/MINERAL WATER includes any type of natural water to be used for therapeutic purposes due to its temperature and mineralization. CRENOTHERAPY vs HYDROTHERAPY. – In HYDROTHERAPY the use of water is limited to the water effects depending on its temperature and forms of application (baths, showers, jets). – In CRENOTHERAPY we use the water that flows to the surface with certain properties due to its mineral content, radioactivity or organic residues. 4  ORIGIN OF MINERAL WATER SURFACE OR INFILTRATION WATER GROUND OR PRIMITIVE WATER Water on the surface of the planet: These waters well up from the depth, stream, river, lake, wetland, ocean. when rainfall and snow/ice travel through the soil and into cavities and fractures 5  SURFACE OR INFILTRATION WATER They come from water infiltrations of rain or from the sea/stream/lake/wetland/ocean through the fissures of the geological strata. They return minerals to the surface of the soil under the form of springs. It has a superficial / meteoric / marine origin and can emerge hot or cold. They spring from faults and bear no relation to the underground metal veins nor to volcanic eruption. 6  SURFACE OR INFILTRATION WATER The water level is variable, increasing with rains and snow, changing from one year to the next. The composition of these waters is in proportion to their flow, the mineralization diminishing if the flow increases and vice versa. The water temperature does not rise above 25-30ºC, changing especially in Winter and Summer. 7  GROUND OR PRIMITIVE WATER They spring from faults and are related to the metallic veins or provoked by volcanic eruption (igneous origin) The water temperature is hot and may rise above 80ºC, but sometimes it emerges cold or warm due to the mixture with infiltration waters. Its water level is rhythmic with long or short pulsations, changing between several minutes to several hours. 8  GROUND OR PRIMITIVE WATER The flow remains unalterable to stations, rains or thaws. Its temperature and composition remain also the same and is not influenced by seasons, rains or thaws. 9 TYPE SURFACE PRIMITIVE ORIGIN Superficial Deep: ground faults TEMPERATURE Hot and cold when emerge; no more Hot (up to 80ºC) but also warm than 25-30ºC and cold WATER LEVEL Variable (rain/snow) Rhythmic SPRING FROM Faults no relation to metallic veins Faults with relation to metallic or eruption veins or eruption FLOW Related to the composition: the Unalterable like the mineralization diminishing if the flow temperature increases and viceversa. MINERALS Boron, phosphorus, arsenic, Boron, phosphorus, arsenic, iodine, bromine, fluorine, copper, iodine, bromine, fluorine, nitrogen. copper, nitrogen, silicon, clorine, iron, ammonia, argon, neon, helium, hydrogen. (radiactive elements) 10 MEDICINAL/MINERAL WATERS (WHO) Characteristics: ▪ No bacterial contamination ▪ With a minimum of certain components (iodine, iron, sulphur, arsenic, radiactivity or free CO2) ▪ Groundwater. ▪ Unalterable composition ▪ More than 1gr of mineralization per 1kg of water ▪ Temperature more than 20ºC ▪ Therapeutical effects ▪ Declared of public usage. 11  MEDICINAL/MINERAL WATERS Classified depending on their composition defined as the number of dissolved ions and the fixed residue (salt content after evaporating the liquid at 180ºC) Mineral Table Water Medicinal / Mineral Water 12  MINERAL TABLE WATER Water containing at least 250 parts per million total dissolved solids (TDS), originating from a geologically and physically protected underground water source. No minerals may be added to these waters. Depending on the amount of calcium and magnesium ions dissolved: ▪ High concentration: hard mineral water ▪ Low concentration: soft mineral water 13  MINERAL TABLE WATER “Mineral water” used for any bottled still or carbonated water (soda water) as opposed to tap water. In the European Union, bottled water may be called mineral water when it is bottled at the source and has undergone no or minimal treatment. Carbonated water (soda water, sparkling water, setlzer Waters or fizzy Waters) is water into which carbon dioxide gas has been disolved under pressure. Table waters must be free from organic matter in suspension and pathogenic bacteria. 14  MEDICINAL / MINERAL WATERS CLASSIFICATIONS: ▪ Temperature ▪ Global mineralisation ▪ Hardness ▪ Chemical composition ▪ Therapeutical usage 15  MEDICINAL / MINERAL WATERS TEMPERATURE: Cold waters, under 22 ºC. Warm waters, between 23-32ºC. Hot waters, between 33-42ºC. Very hot waters, more than 43ºC. 16  MEDICINAL / MINERAL WATERS GLOBAL MINERALISATION: Composition defined as the number of dissolved ions and the dry residue (the salt content after evaporating the liquid at 180 º C) Oligometallic: less than 100 mg/l Very Weak: 100-250 mg/l Weak: 250-500 mg/l Average: 500-1500 mg/l Strong: More than 1500 mg/l 17  MEDICINAL / MINERAL WATERS HARDNESS: Very Soft (low mineral content) Soft Hard Very Hard Extremely Hard (high mineral content) 18  MEDICINAL / MINERAL WATERS CHEMICAL COMPOSITION SIMPLE WATERS: 1 main element. MIXED WATERS: 2 main elements. COMPLEX WATERS: 3 main elements. 19  SIMPLE WATERS ▪ Sulphur-rich ▪ Chloride-rich ▪ Iron-rich ▪ Bicarbonated ▪ Radioactive ▪ Sodim-rich ▪ Carbon dioxide-rich ▪ Magnesium-rich ▪ Oligometal ▪ Calcium-rich 20  CHLORIDE-RICH WATERS These waters are characterized by the content of chloride. Transparent, odorless and salt water (Seawater). ✓ INTERNAL USE: Antidiuretic and stimulate gastric and bile secretions ✓ EXTERNAL USE: Antiseptic, Anti-inflammatory, Stimulate cicatrization. ✓ MAIN TREATMENTS: Surgical trauma, rheumatological, dermatological, respiratory, neuralgias and gynaecological. 21  CHLORIDE-RICH WATERS These waters are characterized by the content of chloride. Transparent, odorless and salt water (Seawater). ✓ Baths are indicated in weak patients due to recent illnesses, bone and joint problems, joint rheumatism, menstrual problems, uterine fibroids. ✓ Inhalation and spraying applications are used in respiratory illnesses, nose cavity/nasal problems, chronic nose cold, flu-like and catarrhal congestion. ✓ Oral administration: To increase intestinal and biliary motility (drink between meals). 22  BICARBONATED WATERS Carbonate-rich waters. These waters are mostly carbonated waters due to the free carbonic gas content. ✓ ORAL ADMINISTRATION: ✓ Table water: comfortable flavour and less sodium ✓ Fasting, several times per day. ✓ EXTERNAL APPLICATION. ✓ MAIN TREATMENTS: Digestive, rheumatological and endocrinological 23  BICARBONATED WATERS Carbonate-rich waters. These waters are mostly carbonated waters due to the free carbonic gas content. ✓ Oral administration: effects on the stomach including an anti-mucus and antiacid effect. They are also indicated in gout, obesity, urolithiasis, diabetes and certain rheumatisms. (alkalizing). ✓ Table water: comfortable flavour and less sodium ✓ Fasting, several times per day. ✓ External application. 24  SODIUM-RICH WATERS ✓ ORAL ADMINISTRATION ✓ EXTERNAL APPLICATION ✓ MAIN TREATMENTS: Antiseptic, antotoxic, cholagogue effects, liver protection: ✓ Infected wounds ✓ Catarrhal processes ✓ Liver disorders: colics, congestión ✓ Biliar disorders: biliary lithiasis 25  MAGNESIUM-RICH WATERS ORAL ADMINISTRATION: Purgative effect causing peristalsis, with a quick laxative effect (3-6 h). Patient should be fasting (empty stomach) ✓ MAIN TREATMENTS: Digestive, Hepatic, Renal problems and to prevent cardiovascular disorders. 26  CALCIUM-RICH WATERS Low mineralization, less purgative and laxative effect. Oral administration: diuretic waters Indications: urinary tract illnesses (lithiasis, nephritic colics, cystitis), digestive and biliary illnesses (gastritis, dyspepsia, enteritis, liver congestion, biliary lithiasis, hepatic colics), uric acid, arthritis, gout, cardiovascular disorders. 27  SULPHUR-RICH WATERS Characteristic strong odor (rotten eggs). Must be used next to the spring or surroundings to keep properties Frequently with organic elements: algae and saprophyte bacteria (cutaneal disorders and cosmetic effects). Oral administration, inhalations, baths, showers and jets. Indications: Chronic lung and bronchial illnesses (rhinitis, pharyngitis, sinusitis, laryngitis, bronchitis, asthma), skin ilnesses (psoriasis, eczema), antiacid and hepatoprotector effect, chronic locomotor illnesses (arthrosis, arthritis) , gout 28  IRON-RICH WATERS They emerge cold and are used as drinking waters but also have effect on skin disorders (topic application). Indications: For nervous states caused by weakness such as neurasthenia, anaemia, digestive atony and weakness conditions. 29  RADIOACTIVE WATERS Waters with radioactive components such as emanations or radium and thorium salts. These waters are taken from springs where radioactivity is weak. Inhalations, oral and topic application: baths, showers, jets, irrigations. Effects: sedative effect on the neurovegetative system and facilitate the neuroendocrine balance. Analgesic Antispasmodic 30  RADIOACTIVE WATERS Indications: chronic arthritis, gout obesity, hypertension menstrual cramps, menopause, allergy, asthma stress, psychiatric disorders, diabetes 31  CARBON-DIOXIDE RICH WATERS Waters containing more than 250 mg of carbon dioxide or free gas. Oral administration, topic (France and Germany) or dry gas. Indications: appetite stimulant, gastric disorders, hypertension, coronary artery disease. Carbonic baths (coronary artery disease) 32  OLIGOMINERAL WATERS Waters with little mineralization less than one gram of solid substances per liter, with no predominance of any of the components. Oral administration (Diuretic waters) and topic (baths) Indications: Lithiasis, urethritis, cystitis, painful locomotor disorders. 33  MIXED WATERS ▪ Chloride– Carbonic ▪ Sulphurous- Arsenical ▪ Chloride-– Sulphurous ▪ Ferruginous-Arsenical ▪ Chloride– Sulphate ▪ Ferruginous- Copper ▪ Chloride– Bicarbonated ▪ Alkaline-Bicarbonated ▪ Bicarbonated-Sulphurous ▪ Sodium- Bicarbonated 34  COMPLEX WATERS ▪ Bicarbonated-Sulphate- Chloride-containing. ▪ Bicarbonated- Chloride-containing-Arsenic. 35  THERAPEUTICAL APPLICATIONS Drinking Water Mineral waters are well tolerated and do not alter the digestive system. Way of drinking: Specific quantity and rhythm. Digestive and renal disorders. Several times per day, first fasting in the morning and several times separated 10-20 min. 36  THERAPEUTICAL APPLICATIONS Drinking Water Cold waters need to be warmed up. Very hot waters need to be cooled. Sulphurous waters are difficult to drink. Chloride-containing waters: dose controlled/fasting Minimun doses: diuretic. Higher doses: laxative. 37  THERAPEUTICAL APPLICATIONS Gargling With warm water. Cold Sulphurous Waters are warmed up before drinking. Nasal Breathing/Nasal Shower Patient must breathe first by one nostril and expel water by the other one. Very useful in nose colds and chronic respiratory diseases 38 NASAL SHOWER 39 40  THERAPEUTICAL APPLICATIONS Vaporization: Very useful in order to modify larynx and bronchus mucosae using a special tube to introduce gas and steam directly from the spring. 41  Pharynx Showers To project a stream of hot water against the tonsils using a special cannula and performing a soft massage 42  THERAPEUTICAL APPLICATIONS Inhalations Dry and cold: Patient must breathe in a room saturated with the gas released from the spring. These are used for colds. Wet and warm inhalations: The gas is sprayed with fine water droplets causing a mist in the room. Used in bronchial diseases. 43  THERAPEUTICAL APPLICATIONS Topical application: Hot Baths The water temperature 35-40 ºC Spas usually mix waters that rise at different temperatures to obtain suitable temperature. There are 2 types of hot baths: running water baths and still water baths. 44  THERAPEUTICAL APPLICATIONS Topical application: Underwater jets/spouts: Projecting a hot pressurized jet inside the pool and under the water. Showers and jets. Steam baths with medicinal/mineral waters. 45  THERAPEUTICAL APPLICATIONS Topical application: Mud baths: Natural or artificial muds. First the patient enters a bathtub filled with black mud at 32-33ºC black mud for 15-30 minutes. After he/she enters a bathtub with clean water. After drying him/herself the patient lies down in decubitus for half an hour. 46 REFERENCES Pérez R. Principios de balneoterapia y balneoterapia. McGraw-Hill Interamericana, Madrid: 2005 Cole AJ, Becker BE. Comprehensive Aquatic Therapy. 3rd edition, USA. Washington State University Publishing, Pullman WA. 2011. Brody LT, Geigle PR. Aquatic Exercise for Rehabilitation and Training. Champaign, IL, USA. Human Kinetics Publishers. 2009. Güeita J, Alonso M, Rodríguez C. Terapia acuática: Abordajes desde la fisioterapia y la terapia ocupacional. Elsevier. España. 2015. 47