Alternate Names

Bath Therapy; Hot Springs Immersion; Hydrotherapy; Spa Therapy

Principal Proposed Uses

Arthritis ( Rheumatoid Arthritis, Osteoarthritis and Ankylosing Spondylitis) ; Low Back Pain


The use of hot and cold baths (balneotherapy) for treating illnesses goes back to the dawn of civilization. In recent centuries, the use of hot springs and water in other forms was popularized by early practitioners of what later would become naturopathy. Out of these practices, a formal system of medicine known as hydropathy developed. Today, mud packs, saunas, and steam baths are often included along with water baths under the general name of balneotherapy.

Certain types of water are often particularly prized by practitioners of balneotherapy. These include sulfur springs and the concentrated salty water of drying lakebeds, such as the Dead Sea (in Israel). Interestingly, hot springs high in the radioactive substance radon are also said by some proponents to possess particular healing properties.

What Is the Scientific Evidence for Balneotherapy?

Although various forms of balneotherapy have undergone some scientific study, none of this evidence is reliable. There are many causes of the inadequacies in the research record, but one is intrinsic and probably not correctable. This is the problem of "blinding."

For the results of a study to be reliable, participants and researchers must be kept in the dark ("blind") regarding who received the treatment under study (the "active group") and who received a placebo treatment (the "control group"). If practitioners and/or researchers know who is in which group, numerous confounding factors take over and produce misleading results. These factors include observer bias, reporting bias, and the placebo effect. The many ways in which these confounders reliably skew the results of unblinded studies are discussed in detail in Why Does This Database Rely on Double-blind Studies? To briefly summarize this complex issue: unblinded studies usually mean little to nothing.

Unfortunately, it's difficult to keep study participants in the dark regarding whether they've taken a hot bath! Some researchers have used ordinary tap water as a comparison against special mineral water. Unfortunately, if, (as was the case in some studies) the active treatment smelled of sulfur, or (as in other studies) it was so dense with minerals that it made the skin tingle and the body float high in the water, participants would have no doubt guessed which group they were in. This would effectively destroy blinding, and, as noted above, fundamentally compromise the study results.

Given these caveats, there is some evidence that balneotherapy of various kinds might be helpful for:

Balneotherapy is also said to be helpful for eczema, Parkinson's disease, and numerous other conditions, but for these conditions it lacks even unreliable supporting evidence.

How Might Balneotherapy Work?

If indeed it does work, balneotherapy could act through the effects of heat, both locally (on muscles, joints and skin), and systemically, through absorption of substances, such as sulfur through the skin.

Safety Issues

Excessive immersion in hot baths can be dangerous for pregnant women, young children, those with a heart condition or other serious medical illness, and people under the influence of alcohol or other intoxicating substances.

There are concerns that hot springs high in radon might present cancer risk, though this has not been proven.


1. Altan L, Bingol U, Aslan M, Yurtkuran M. The effect of balneotherapy on patients with ankylosing spondylitis. Scand J Rheumatol. 2006;35:283-289.

2. Yurtkuran M, Ay A, Karakoc Y. Improvement of the clinical outcome in Ankylosing spondylitis by balneotherapy. Joint Bone Spine. 2005;72:303-308.

3. Codish S, Dobrovinsky S, Abu Shakra M et al. Spa therapy for ankylosing spondylltis at the Dead Sea. Isr Med Assoc J. 2005;7:443-446.

4. Donmez A, Karagulle MZ, Tercan N, et al. SPA therapy in fibromyalgia: a randomised controlled clinic study. Rheumatol Int. 2005;26:168-172.

5. Pittler MH, Karagulle MZ, Karagulle M, et al. Spa therapy and balneotherapy for treating low back pain: meta-analysis of randomized trials. Rheumatology (Oxford). 2006;45:880-884.

6. Balogh Z, Ordogh J, Gasz A, et al. Effectiveness of balneotherapy in chronic low back pain—a randomized single-blind controlled follow-up study. Forsch Komplementarmed Klass Naturheilkd. 2005;12:196-201.

7. Yurtkuran M, Yurtkuran M, Alp A, et al. Balneotherapy and tap water therapy in the treatment of knee osteoarthritis. Rheumatol Int. 2006 Jul 11. [Epub ahead of print]

8. Tishler M, Rosenberg O, Levy O, et al. The effect of balneotherapy on osteoarthritis. Is an intermittent regimen effective? Eur J Intern Med. 2004;15:93-96.

9. Fioravanti A, Valenti M, Altobelli E, et al. Clinical efficacy and cost-effectiveness evidence of spa therapy in osteoarthritis. The results of "Naiade" Italian Project. Panminerva Med. 2003;45:211-217.

10. Guillemin F, Virion JM, Escudier P, et al. Effect on osteoarthritis of spa therapy at Bourbonne-les-Bains. Joint Bone Spine. 2002;68:499-503.

11. Sukenik S, Flusser D, Codish S, et al. Balneotherapy at the Dead Sea area for knee osteoarthritis. Isr Med Assoc J. 2000;1:83-5.

12. Gambichler T, Tomi NS, Kreuter A. Controlled clinical trials on balneophototherapy in psoriasis. Br J Dermatol. 2006;154:802-3.

13. Dawe RS, Yule S, Cameron H, et al. A randomized controlled comparison of the efficacy of Dead Sea salt balneophototherapy vs. narrowband ultraviolet B monotherapy for chronic plaque psoriasis. Br J Dermatol. 2005;153:613-9

14. Verhagen AP, Bierma-Zeinstra SM, Cardoso JR, et al. Balneotherapy for rheumatoid arthritis. Cochrane Database Syst Rev. 2003;(4):CD000518.

15. Codish S, Abu-Shakra M, Flusser D, et al. Mud compress therapy for the hands of patients with rheumatoid arthritis. Rheumatol Int. 2005;25:49-54.

16. Mancini S Jr, Piccinetti A, Nappi G, et al. Clinical, functional and quality of life changes after balneokinesis with sulphurous water in patients with varicose veins. Vasa. 2003;32:26-30.

17. Karagulle M, Karagulle MZ, Karagulle O, et al. A 10-day course of SPA therapy is beneficial for people with severe knee osteoarthritis : a 24-week randomised, controlled pilot study. Clin Rheumatol. 2007 Apr 13. [Epub ahead of print]

18. Fioravanti A, Perpignano G, Tirri G, et al. Effects of mud-bath treatment on fibromyalgia patients: a randomized clinical trial. Rheumatol Int. 2007 May 23.

19. Cozzi F, Podswiadek M, Cardinale G, et al. Mud-bath treatment in spondylitis associated with inflammatory bowel disease—a pilot randomised clinical trial. Joint Bone Spine. 2007 May 30. [Epub ahead of print]

20. McVeigh JG, McGaughey H, Hall M, et al. The effectiveness of hydrotherapy in the management of fibromyalgia syndrome: a systematic review. Rheumatol Int. 2008 Aug 27.

21. Carpentier PH, Satger B. Evaluation of balneotherapy associated with patient education in patients with advanced chronic venous insufficiency: A randomized controlled trial in the spa resort of La Lechere. J Vasc Surg. 2008 Sep 30.

Last reviewed September 2014 by EBSCO CAM Review Board

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