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Healing Waters and Spa Therapy
Are There Benefits to Soaking in a Hot Tub?

Enjoying a relaxing hot tub soak.
Enjoying a relaxing hot tub soak.

After a hard workout, a friend of mine likes to soak in her hot tub. She says it reduces stress and keeps her healthy. It made me wonder, are spa treatments a good thing?

Let me explain the idea. It's called balneotherapy. (The Latin word for bath is balneum.) The water can be hot or cold, may involve massage and can be moving or still.

Many spas that offer balneotherapy, claim restorative benefits because of the high mineral contents of their waters. There's no single standard of accepted minerals, or ideal concentrations. You'll find arsenic, bromine, calcium, iodine, iron, lithium, manganese, magnesium, potassium, selenium, silica, sodium, sulfur and radium.

To make it even more confusing, balneotherapy also includes treatments with mud, clay or simple sand and water mixtures. Balneotherapy as a term is specifically used when spas claim medical benefits with ANY of these therapies as opposed to purely recreational uses. So let's look at those two things my friend mentioned. 

Stress reduction. The answer to this is YES.

Dozens of studies show spending time in a spa is a great way to relax and unwind. But you don't have to visit a luxury resort. Soaking in a hot tub or even taking a long bath can produce similar results.

Reduce disease progression. MAYBE.

The most difficult part of evaluating treatments is that you can't do a true double-blind test, because it's kind of obvious if you're soaking in a pool or not.

Are people doing better because they're relaxing? Is it because of minerals in the water? Is it the temperature of the water? I would like to see experiments where people soaked in water, where one pool had special minerals in it while the other did not. Then researchers could figure out if what was in the water made any difference or not.

An example of a relatively successful treatment was a study of 425 patients with chronic venous insufficiency. (That's a problem with blood flow from veins of the legs back to the heart.) 214  of the subjects were in the treatment group and got spa therapy for three weeks, while 211 were in the control group and did not.

"Treatment consisted of four balneotherapy sessions per day for 6 days a week. Follow up was performed at 6, 12 and 18 months by independent blinded investigators." Here's what the researchers said.

"In this study, the incidence of leg ulcers was not reduced after a three week spa therapy course. Nevertheless, our study demonstrates that spa therapy provides a significant and substantial improvement in clinical status, symptoms, and quality of life of patients with advanced venous insufficiency for at least 1 year."

So the researchers said there was "substantial improvement in clinical status [and] symptoms..." But the specific clinical outcome they were looking to improve, the incidence of leg ulcers, was NOT reduced. Further studies need to be done to see exactly what part of the process led to an improved quality of life and clinical status.

Those results are similar when looking across dozens of available studies on balneotherapy.

When researchers looked at 9 studies involving 579 participants with rheumatoid arthritis, they concluded, "Overall evidence is insufficient to show that balneotherapy is more effective than no treatment, that one type of bath is more effective than another or that one type of bath is more effective than mudpacks, exercise or relaxation therapy."

Another study looking at balneotherapy for osteoarthritis concluded, "...the scientific evidence is weak because of the poor methodological quality and the absence of an adequate statistical analysis and data presentation. Therefore, the noted "positive findings" should be viewed with caution."

There seem to be promising outcomes, for small groups of people, but researchers can't rule out the placebo effect and independent testing hasn't been able to verify the conclusions.

Using balenotherapy to relax and unwind is a proven winner. For other ailments, you should only consider balneotherapy when used along with conventional treatments, and then only under the advice of a doctor.

Journal of Vascular Surgery - Volume 59, Issue 2, February 2014, Pages 447–454.e1
A multicenter randomized controlled trial evaluating balneotherapy in patients with advanced chronic venous insufficiency - Abstract

The Cochrane Library - Published April 11, 2015
Balneotherapy (or spa therapy) for rheumatoid arthritis

The Cochrane Library - Published in 2008
Balneotherapy or spa-therapy for Osteoarthritis

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