Use of hot springs and spas on the territories of country for purposes of health and treatment is a tradition going all the way for a thousand years and still continuing. In reality this tradition exists in almost all of the civilizations. Today it maintains its existence and spread in all continents mainly South, Middle and Eastern Europe, Asia (Middle East, Japan, China, Turkic Republics) and South America (Argentina, Mexico, Colombia) and North Africa (Morocco, Tunisia). Spa treatment in Turkey have advanced to a high quality standard.Spa treatment tradition has also developed the spa tourism phenomenon.

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Balneotherapy

Balneotherapy is stimulation - adaptation treatment method applied in forms of bathing, drinking and inhalation cures performed with natural healers. Natural therapeutic factors used in balneotrherapy are underground sources of natural "therapeutic" waters, mud and seasonal agents. "Therapeutic waters", thermal and mineral waters in other words are the most widely used among natural healing agents. Natural peloides (mud) and gasses (CO2, radon and H2S) are also other agents used in spa treatment besides waters.

"Therapeutic Waters", Thermo mineral Waters, Thermal Waters and Mineral Waters Natural "therapeutic" waters which are the most widely used natural healing agents of Balnetherapy are classified according to their physical and chemical qualities. Therapeutic waters according to classification of generally and internationally recognized German Spa Union are;
 
Thermal Waters: waters that have natural temperatures over 20 ºC,
Mineral Waters: waters containing over 1gr. of dissolved minerals in one liter of water, Thermo Mineral Waters: Waters that have both the natural temperatures over 20 ºC and contain over 1gr of dissolved minerals in one liter of water. Classification of Special Balneologic Waters containing certain special minerals over specific threshold values (minimum) is also in question. And according to this they are classified as follows;

Carbon-dioxide containing waters: waters containing dissolved free carbon dioxide over 1 g/L, Sulfide containing Waters: waters containing sulfides in value of -2 over 1 mg/L, Radon containing waters: waters containing over 666 Bq/L of radon radiations.

Salt waters: waters containing over 14 g/L of sodium chloride, Iodine containing waters: waters containing over 1mg/L of iodine, Fluoride containing waters: waters containing over 1 mg/L of fluoride.

Healing waters having total mineralization under 1g /L that doesn't belong under any one of the group in the above classification yet having natural temperatures above 20 ºC are referred to as Akrato Thermal Waters.

Peloides, "Therapeutic Mud", "Therapeutic Clay"

Peloides (therapeutic clay) used in pelo-idotheraphy which is one of the unique treatment methods of spa cure are organic or inorganic substances formed as result of geological and/or biological events. They are found in form of grains in nature or they can be turned into grains with certain preparation processes. They can naturally contain water or have no water at all in their structures. They come to appropriate thickness and temperature by adding adequate amount of thermal or regular water during use. They are used in forms of mud baths and mud packages in serious of diseases. Treading effects in certain diseases over human organism must have been proven.

Methods of Balneotherapy

Balneotherapy is simulation-adaptation treatment applied in form of cure at certain periods of time with repeated and regular use in series in manner of bathing, packaging, drinking and inhaling thermal and/or mineral waters, healing clay and gasses at specific dosages and in specific methods. Main balneotherapy methods are as follow;

1.    Baths: Thermo mineral water, peloid and gas baths and regional applications of these agents.
2.    Drinking cures: drinking cures made with mineral waters or applied to living areas.
3.    Inhalation applications: inhaling applications performed with thermo mineral water drops.
4.    Peloidotherapy: applications in method of bathing in healing mud and clay, packaging and padding.
5.    Applications of hydrotherapy: Taking shower, bathing, washing and these types of applications performed with thermo mineral waters.

Baths

Baths are classified as cold (hypothermal; under 34ºC of water temperatures, sea baths are included into this classification), warm (isothermal; indifferent; in 34-35 ºC of water temperatures), hot (thermal; in 36-38 ºC and 38-40 ºC of water temperatures). Duration of bathing is usually 20 minutes. While this time is reduced to 10 minutes in hyper thermal baths it can be extended to 25-30 minutes in isothermal baths. Bathing applications can be administered in forms of complete baths, half baths and bathing in sitting position and arm-leg bathing. Bathing is usually administered for the period of 2 to 4 weeks either as everyday bathing (only one day without bathing for week) or once every other day. Bathing frequency can be readjusted towards the end of cure by spa physician.

Other than the carbon dioxide baths; patient must be in a position to be able to move freely especially in full baths. This condition is especially very important for patients who are suffering from rheumatoid arthritis, post traumatic distress or orthopedic discomfort and peripheral neurological disorders. In baths with carbon dioxide containing water; it is recommended for patient to remain immobile during the time of bathing in order not to place an additional load onto the heart and artery system of patient.

Patient gets thoroughly dried after bath and relaxes and rest about half an hour to an hour inside a room with a pleasant temperature. After the stage of relaxation and resting the patient can be given a massage to or exercise or can attend sporting activities. In the mean time again a physical treatment can be applied to patient.

Peloid (therapeutic mud and clay) applications

Healing mud and clay baths are used in forms of full, half body or arm-leg baths or mostly in forms of packages. Package form application is the method often used. In this method packages are applied to specific areas of the body.

After application the body gets freed of mud with the assistance of a warm shower (taken under the water in temperatures of 37-38 ºC). Following this body is freed from mud; patient gets dried of immediately and rests for half an hour to an hour. Afterwards patient either takes a light walk or receives a massage or is taken into a regional exercise program if necessary. Mud treatment is the best preparer for exercise since it brings tissues and muscles into soft and flexible condition.

Drinking Cures

Most often used method after baths with thermo mineral waters in balneotherapy is "drinking cures carried out by intake of waters containing natural minerals for certain period of time during the day at specific hours and in specific amounts". Direct effects over the digestive system organs and functions and indirect effects over the kidneys and urinary tracts occur in connection to the chemical compound of mineral water used here. Beside all that has been stated above a general positive effect develops over the organism with drinking mineral waters in specific amount and at specific times in manner of cure. This effect makes itself noticeable with series of positive and meditative changes in physiological and pathological courses.

Inhalations

Inhalation is a method of treatment administered with the inhalation of drops of mineral water. Goal in the inhalation applications is for drops of mineral water inhaled to reach to the desired area of respiratory system and have direct effect by means of separating from the gas that carries them and be dropped off into the environment. Lung functions are positively affected and blood gas levels becomes normal with the effects of natural inhalation solutions.

Spa Treatment, Spa Cure

Spa treatment is a method of treatment developed with intuitional use in treatment of various diseases by mainly the agency of bathing in spas, which are places where thermal and mineral ("Therapeutic") waters naturally come to surface on earth, and reached to present by becoming a tradition. Modern spa cure, especially in European countries, is in the condition of a complex treatment opportunity where some other treatment methods and applications are practiced beside balneotherapy. Methods such as medical and physical treatment are among these and they are especially widespread in Europe.

Supplementary and alternative treatments in spa treatment on the other hand, more accurately in spa cure (since it is administered with application of certain treatment methods, for certain period of time in a series in form of a cure) are also used in many countries. Especially exercise and massage mainly; acupuncture, herbal treatments and aroma therapies are found among these methods. Finally series of supporting methods are also allowed in spa cure programs in some countries again. For example, health education and social medical preventions are also being added to spa cure in Germany. Other support methods such as regulation of diet and daily living and psychological support may also be used.

Arrangement of Spa Cure

First of all a spa, which is known to help discomforts and complaints of patient, is chosen when decided upon a spa cure. In other words, a spa that is equipped to provide this type of an opportunity is determined if a specific mineral water cure or healing mud treatment has been prescribed for the disease. Practically, differences between the climate of the chosen spa's region and the climate in which the patient continues his/her daily life and used to must be considered while arranging a spa cure. Approach here is elimination of the harmful climatic factor, if any, over the ailment of person so to keep patient away from these negative effects for the duration of cure.

Also the climate of chosen spa should not contain negative agents for that ailment. For example, spas found located in high humidity areas during summer months can create harmful affects in blood circulation disorders.

Doctor advising patient to receive a spa treatment sends a report to spa physician citing the history of the disease, treatments performed and informing about the recent condition of patient and providing the latest lab results.

Patient coming to spa rests for certain period of time. Following that receives a check-up from the specialist here. Certain additional laboratory analyses get performed if it is considered necessary for diagnosis and treatment. Consequently, Spa and cure medical specialist organizes (prescribes) a cure program to patient. Balneotherapy and other treatments in a spa cure are organized and arranged according to the condition and ailment of patient and according to the natural treatment resources unique to that spa and are modified and changed during cure according to responds they provide to treatment.

Finally, information on the subject of his/her treatment and rules to comply by from now on is given to patient before his/her leave and a report containing the course of ailment, results of treatment and suggestions is written to the doctor, who recommended him/her to seek remedy from a spa.

Factors affective in spa treatment:

Factors affective in spa treatment can be listed as treatment methods applied, change of environment, climatic agents, placebo effect, psychological agents, irregularities in daily life, not having any negative environmental agents and supportive methods.

SUPPLEMENTARY TREATMENTS

Spas are also integrated with balneotherapeutic methods within the framework of such complex cure treatment with series of additional treatment methods. Treatment methods administered by hands are the most spread among these. Massage and exercise have earned the quality of being irreplaceable components of cure in modern European Spas as Such two methods. Their significance is still maintained the same as two additional treatment methods applied the most.

Exercise Treatment

Exercise treatment is traditionally being used in the treatment of orthopedic, rheumatologic and neurological diseases. In recent years especially in cure centers area of this therapy has been widened by multi variety. Exercise of strength capacity of heart and lungs, breathing and relaxation treatments and general mobilization in geriatrics and becoming more active are some of these.

In addition to all of these various organizations towards patient's body and position education and information can also take place in thermal spring, spa, and cure centers. In illnesses where posture and movement of the body is important especially in terms of quality and quantity (for example, chronic back pain, diabetes mellitus) in order for the correction of function and function disorders by the patients it is a prerequisite for patients feel them knowingly and consciously. A patient suffering from an intervertebral disc disorder will not be able to correct this as long as he/she is unaware of faulty or wrong positioning of his/her body in his daily life. Practices of feeling and understanding the body administered by a specialist who is competent on the subject that he/she teaches form an important portion of patient education programs used in many illnesses at modern cure centers in European countries.

Underwater exercise

Underwater exercises are intense muscle and circulation system works targeting on minimizing the load of muscle and skeleton belonging especially to back and lower extremities and parallel to this on minimizing the neural load at these areas. In other words, long lasting endurance exercises of limbs and organs having difficulty during exercises performed outside of water due to gravity and lower extremities and lumbal portion of spine before everything else can be performed in an intense and effective manner in water. Affects of underwater exercises are also being benefited from with purpose of treating neurological illnesses.

These exercises may be practiced much more intensely in a meaningful fashion than exercises performed outside of water and they are especially indicated for patients who are disabled to walk. In addition, it can be used as a unique treatment method in multimorbidity through benefiting from mutual interaction of water environment with active movements.

As a rule, waters inside the exercising pools must be in the same quality of drinking water. By means of cooling the hyperthermal waters or warming the cold mineral waters, pool water temperatures are kept rather near thermo neutral (34-35ºC) temperatures.

Existence of additional effects is in question here according to exercises performed outside of water due to physical agents such as water pressure, buoyancy of water and water viscosity. Buoyancy of water is more in waters containing salt and minerals. For that reason, such additional factors in exercise baths can provide significant therapy in the extremities and joints in spine. This on the other hand means that there are special indications for muscle and skeleton system ailments.

Massage

Classic massage is applied to skin, under skin, fascias and muscles. Massage treatment still depend on clinical experience in first stage. Even so its place in cure center treatment cannot be argued about and such as relaxing baths; massage is also a pleasant and relaxing cure treatment modality. Psychological affects also play an important role besides the local affects in success of massage treatment. Often, a mutual trust that cannot be damaged may raise from the tight somatic contact between the patient and his/her therapist.

Experiences have shown that patients discuss their problems with a masseur more freely and naturally than a spa physician and psychologist. Some critics who believe that massage only enables patient to feel better are not accepting it as a method of treatment. Together with this, even though it's sole affect is psychological therapy it is an affect that cannot be underestimated, because people who are chronically ill have gone through only negative experiences concerning their own bodies for years. Positive experience that massage brings to patient enables patient to feel confident about his/her body and contributes for patient's motivation for active rehabilitation measures.

Physical treatment and rehabilitation

In reality, existence of physical treatment and rehabilitation units in spa facilities is in rather optional quality than a prerequisite. Physical treatment measures in spas must be arranged special to the individual and in cases when it is medically necessary and not to fill-up a cure program. Physical treatment methods have began being practiced mostly in European spas as an addition to balneotherapy methods. Certain European cure centers today have earned a special place for themselves in treatment and rehabilitation of ailments primarily associated with rheumatism, orthopedics, neurological, cardiovascular and geriatrics followed by chronic illnesses that receive spa indication.

Hydrotherapy

Finally in connection with the equipments of spas; hydrotherapy means such as Jacuzzis, jet showers, whirlpools, underwater pressured massages, filiform showers, walking tracks, steam showers and baths etc. from the other treatment methods performed with natural therapeutic agents in spa centers must be listed as equipments towards the methods.

Note: Quoted from the book of "Balneology and Thermal Spring and Spa Medicine" of Ph. D. M. Zeki Karagülle

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