Rehabilitation in the Thermal Environment in the Osteo-Articular Pathology

WHAT IT IS

riabilitazione_1The valorization of thermal resources with rehabilitative objectives is still a rare event, but it is very interesting for Rehabilitative Medicine and for a possible future development of the Spa in Italy (1). A Centre of Thermal Rehabilitation should be designed and developed to allow the treatment and accommodation of disabled subjects and, at the same time, it should have been possible to offer thermal and rehabilitative treatments (kinesitherapy, respiratory re-education, lymphodrainage, laser therapy, electrotherapy, etc.). Kinesitherapy and all its main techniques (passive or active mobilization, functional re-education, hydro-kinesitherapy, respiratory re-education) have a leading role among all the previous therapies; kinesitherapy should not be defined in the traditional sense as a limitative definition of “therapy by movement,” but as a technique that aims at “preserving or recovering movement” (2).

HYDROKINESITHERAPY

riabilitazione_2 Within kinesitherapy, a special mention should be made for thermal hydrokinesitherapy, which allows the combination of the chemical-physical effects of thermal mineral water with the advantages of the therapeutic exercise performed while the patient is immersed (3-6); this rehabilitative method is largely used for treating the osteo-articular pathologies. Generally, the session of hydro-kinesi-therapeutic treatment for a patient with muscle-skeleton disabilities lasts from 40 to 60 minutes according to the patient’s conditions; the main objectives are to make the patient move, reduce pain and muscular contracture, strengthen muscles, re-educate the functional recovery of the voluntary movement and finally stimulate coordination and balance. The thermal therapeutic effect caused by the immersion in thermal water reduces the muscular contracture and pain through a specific action on the sensitive cutaneous receptors, causing vessel dilation at the cutaneous and muscular level, which facilitates oxygenation and cellular metabolism. The higher hydrostatic pressure, due to immersion, facilitates the centripetal drainage of swollen and/or edematous areas. The increase of the tactile and proprioceptive afferences produced by the mobilization increases the perception of the limb position and stimulates coordination and balance. The floating push, which supports the body, relaxes the muscles and relieves pain; this allows patients to move more easily and increase the series and duration of therapeutic movements. Even walking can be re-educated successfully in water: taking advantage of the alternation of the forces that act on the centre of gravity and on the centre of floating, it is possible to reproduce efficient walking without weighing on the limbs; this is particularly useful when it is necessary to “save” a joint as well as increase muscular trophism. As concerns the use of physical therapies (electrotherapy, magneto-therapy, ultrasound therapy, etc.), it should be remembered that they can complete the effects of the thermal therapy during the rehabilitation process that happens, for example, during the new acute phases during which the thermal therapy is contra indicated but is necessary to keep the therapeutic continuity.

INDICATIONS

riabilitazione_3
Among the main pathological conditions of osteo-articular origins, which can be treated in a Thermal Rehabilitation Centre, we should mention degenerative pathologies (osteo-arthrosis), rheumatic pathologies (ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, etc.), post traumatic pathologies (fractures, distortions, etc.) and post-surgical pathologies (prosthesis, etc.), osteoporosis, muscular hypotrophy, articular rigidity, postural and functional alterations. Each pathology needs a specific therapeutic program; the choice of treatments and how they are applied will depend on the pathology and the targets to achieve. The possibility to take advantage of the relaxing, pain-killing and anti-inflammatory effects of thermal treatments can favor the kinisitherapy exercises with the desired final result and favor a faster and more complete recovery of function and movement of many muscular-skeleton pathologies as well as prevent these pathologies from worsening.

Finally we should not neglect the psychological effects due to a stay in a peaceful and relaxing environment, which is available at the Thermal Centers.


THERMAL REHABILITATIVE MEDICINE

riabilitazione_4On the basis of the experience in treating the osteo-articular pathology in the thermal environment, we can state that a physic-rehabilitative intervention is an essential complement of traditional thermal treatments applied to several osteo-articular pathologies; this integration between Thermal Medicine and Rehabilitative Medicine is now defined as Thermal Rehabilitative Medicine. The search for a synergy between crenotherapy and rehabilitation is the logic for the performance of the rehabilitation treatments in the Thermal Centers. The more and more diffusion of Thermal Rehabilitation Centers could also represent an opportunity for the National Sanitary Service (5, 7); in fact, the thermal premises equipped with suitable rehabilitation standard could be included within the sanitary structures of the territory and that would contribute to decongest the rehabilitation wards in hospitals.

Dc. Stefano Masiero

Physiatrist

BIBLIOGRAPHY

1. De Fabritis M, Groppi M, Gigante G. La riabilitazione in ambiente termale in Italia. Indagine sullo stato delle attività riabilitative nelle stazioni termali italiane. Eur Med Phys 2004;40(Supp.1 to No.3):24-30.

2. Ortolani M, Masiero S, Gottardo A, Buoso S, Sergi R, Ortolani L, et al. Idrocinesiterapia e rieducazione funzionale nella coxartrosi in ambiente termale. La Ginnastica Medica 1998; XLVI (fasc.1-2): 49-55.

3. Buja S, Masiero S, Ortolani S. L’idrochinesiterapia termale nel trattamento della lombalgia:una revisione sistematica. Eur Med Phys 2005;41(Suppl.1 to No.4):899-901.

4. Foley A, Halbert J, Hewitt T, Crotty M. Does hydrotherapy improve strength and physical function in patients with osteoarthritis: a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme. Ann Rheum Dis 2003;62:1162-7.

5. Masiero S. Thermal rehabilitation and osteoarticular diseases of the elderly. Aging Clin Exp Res 2008; 20: 189-194

6. Meyer CL, Hawley DJ. Characteristics of participants in water exercise programs compared to patients seen in a rheumatic disease clinic. Arthritis Care Res 1994;7:85-9.

7. Fioravanti A, Valenti M, Altobelli E, Di Orio F, Nappi G, Crisanti A, Cantarini L, Marcolongo R. Clinical efficacy and cost-effectiveness evidence of spa therapy in osteoarthritis. The results of “Naiade” Italian Project. Panminerva Med 2003; Sep;45:211-7.



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