Physiological effects of hydrotherapy and Clay Therapy

about hydrotherapy and its physiological effect on body

1. Dr. Satyendra Singh BNYS, MD PHYSIOLOGICAL EFFECTS OF HYDROTHERAPY & CLAY THERAPY

2. CONTENTS: Introduction Properties of water Classification of temperatures Physiological basis of hydrotherapy Temperature regulation Effects of water on different organ systems

3. INTRODUCTION:- Hydrotherapy is the external or internal use of water in any of its forms (water, ice, steam) for health promotion or treatment of various diseases with various temperatures, pressure, duration, and site. Mooventhan A, Nivethitha L. Scientific Evidence-Based Effects of Hydrotherapy on Various Systems of the Body.  North American Journal of Medical Sciences . 2014;6(5):199-209. doi:10.4103/1947-2714.132935.

4. PROPERTIES OF WATER: Density Hydrostatic pressure Buoyancy Viscosity

5. QUALITIES OF WATER RESPONSIBLE FOR ITS PHYSIOLOGICAL EFFECTS: As a nutrient As a means of communicating heat to the body As a means of abstracting heat from the body by contact and by evaporation As a means of producing some percuitent effects

6. HOW IT ACTS Vascular area of skin – Internal vascular area associated with it. Intensity differs Additional effect- mechanical effect. Real effect = Sum of two effects

7. EFFECTS OF WATER DEPENDS UPON: Temperature Duration Mode of application Site of application Condition of the subject

8. CLASSIFICATION OF TEMPERATURES: Water may be used therapeutically over a wide range of temperatures; VERY COLD 32 To 55 F COLD 55 To 65 F COOL 65 To 80 F TEPID 80 To 92 F NEUTRAL 92 To 95 F WARM 92 To 98 F HOT 98 To 104 F VERY HOT 104 F And above

9. PHYSIOLOGICAL BASIS OF HYDROTHERAPY: 1. SKIN:

10. 2. CIRCULATORY SYSTEM:

11. 3. NERVOUS SYSTEM:

12. THERMAL REGULATION:

13. GENERAL EFFECTS:- PRIMARY EFFECT SECONDARY EFFECT COLD Sedative Restorative & tonic HOT Excitant Depressant, sedative, atonic

14. PHYSIOLOGICAL EFFECTS OF HYDROTHERAPY ON DIFFERENT ORGAN SYSTEMS

15. SKIN:- 1. Effect of cold: Contraction of small BV- Primary effect Secondary effect Short cold applications( 32 to 65 F) produces Pallor & coldness of the skin( due to contraction of small BV) Prolonged application- blue or purplish color of the skin Pallor/ blueness quickly gives place to redness ( as a result of active dilatation of small BV)

16. b) Decreased heat elimination & Increased heat production: In action, cold applications causes contraction of BV lessens the cutaneous circulation thus diminish the heat elimination Reflex stimulation of accelerator centers takes place resulting in heat production

17. In reaction, accelerated cutaneous circulation exposure of increased quantity of blood to cooling influences increased heat elimination thus maintaining normal body temperature

18. c) Diminished tactile sensibility: Applications of a temperature lessens the acuteness of tactile below 92 to 98 F sense Very brief/prolonged application of ice/ very cold water abolish tactile sensibility

19. 2. Effects of hot: Dilatation of capillary vessels: Primary effect Secondary effect Moderate heat ( 100 to 104 F) produces reddening of skin surface At the end of application ( 15 to 30mins) vasoconstriction phenomenon occurs

20. CURRIE- Moderate hot applications ( 99 to 101 F) - vasodilatation Very hot applications ( 104 F and above) – vasoconstriction Application of higher temperature( 104 to 130 F) pallor of the skin( due to stimulation of vasoconstrictors) due to contraction of involuntary muscle fibers connected with hair bulbs skin is roughened/ goose flesh appearance + Shivering

21. b) Increase of cutaneous secretion and respiration: A general hot bath/ hot application activity of both perspiratory to small surface & sebaceous Ordinary rate of perspiration- 1 to 1 1 / 2 ounce per hour Application of heat ( 110 to 115 F)- perspiration is increased to 50- 60 times the ordinary rate. SKIN- 1% of the total respiratory work done by the body Under the influence of heat – the proportion of work done is doubled. ( increased cutaneous circulation facilitation of interchange of gases between skin and air)

22. c) Increased heat elimination: By dilating the surface vessels By increasing the rate of blood current in the skin By increased amount of evaporation from surface By increasing the conductivity of the skin d) Decrease of tactile sensibility : Normal temperature of the surface – increased tactile sensibility Very hot applications( 113 F & above)- lessens tactile sensibility At a temperature of 130 F & above - abolished

23. TITLE AUTHORS CONCLUSION Effect of regular sauna on epidermal barrier function and stratum corneum water-holding capacity in vivo in humans: a controlled study . Kowatzki et al, J of Dermatology June 5 th 2008 Sauna (80°C) produced stable epidermal barrier function; increase in stratum corneum hydration; faster recovery of both elevated water loss and skin pH; decrease in casual skin sebum content on skin surface of forehead; increase in ionic concentration in sweat and epidermal blood perfusion in volunteers. It suggests protective effect of ST on skin physiology

24. RESPIRATORY SYSTEM 1. Effects of cold: Respiratory movements CO 2 Elimination Rate

25. 2. Effects of Hot: Respiratory movements Respiratory frequency CO 2 Elimination

26. TITLE AUTHOR CONCLUSION Adjustments in oxygen transport during head-out immersion in water at different temperatures. Choukroun et al, Pulmonary tissue volume was not affected by any of the temperatures. Increase in o2 absorption was observed in CWI The effect of cold exposure on the respiratory function in children suffering from inflammatory lung diseases Kurortol et al,  Local cold procedures improve bronchial patency while the exposure to heat results in its worsening

27. TITLE AUTHOR CONCLUSION Effects of water temperature on pulmonary volumes in immersed human subjects Choukroun et al, The variations of the pulmonary volumes as a function of Tw are estimated to be mainly due to alterations in respiratory muscles functioning. Repeated cold water stimulations (hydrotherapy according to Kneipp ) in patients with COPD Goedsche K et al, Repeated cold stimulations ( affusions ) can influence the frequency of respiratory infections and improve subjective well-being. It may cause an immunological modulation in terms of the Th1-type pattern.

28. CIRCULATORY SYSTEM:- 1. Effects of cold: Heart: ( ROEHRIG) Very short applications activity Prolonged application activity b) Blood vessels: Short, very cold application( 40 to 55 F) vasoconstriction vasodilation

29. Cold applications made across the trunk of an artery cause contraction in its distal portions Ice bag applied to axilla -- circulation in the arm Ice / cold compress to throat -- cerebral circulation Ice bag over the femoral artery -- circulation in leg c) Pulse rate :(WINTERNITZ) compensatory effect Snow rubbed on the inside of the arm at the bend of elbow in height of pulse tracing OR ice applied to subclavian region …. Contraction of distal portion . of radial artery

30. Cold applications to a limited surface of skin increased pulse rate for 3 minutes , after which the frequency is gradually diminished Cold water drinking lessens the pulse rate 10 to 15 beats/ minutes

31. 2. Effects of hot: Heart: effect of general force + temporary slowing of heart application of heat action Final effect Arterial tension b) Pulse: 1 st effect of very hot application to skin vasoconstriction of surface BV sudden force & tension of pulse

32. Hot application cardiac + vascular . activity

33. TITLE AUTHORS CONCLUSION Effect of repeated sauna treatment on exercise tolerance and endothelial function in patients with chronic heart failure Ohori T et al, J of American cardiology Sep 23 rd 2011 Repeated sauna therapy in patients with chronic heart failure improves exercise tolerance in association with improvement in endothelial function. Effect of immersion in CO2-enriched water on free radical release and total antioxidant status in peripheral arterial occlusive disease Dogliotti G et al, International J of Angiology Feb 30 th 2011 CO(2)-enriched water immersion has a positive effect, reducing free radical plasma levels and raising the levels of antioxidants, suggesting an improvement in the microcirculation.

34. TITLE AUTHORS CONCLUSION Effects of immersion in water containing high concentrations of CO2 (CO2-water) at thermoneutral temperature on thermoregulation and heart rate variability in humans Sato M et al, International J of Biometeology Oct 24 th 2008 The present study contributes evidence supporting the hypothesis that CO2-water immersion activates parasympathetic nerve activity in humans. What is the biochemical and physiological rationale for using cold-water immersion in sports recovery? A systematic review. Bleakley et al, British journal of sports medicine Cold water immersion (CWI) induces significant physiological and biochemical changes in the body such as increase in HR, BP, metabolism, and peripheral catecholamine concentration; and decrease in cerebral blood flow.

35. TITLE AUTHORS CONCLUSION Changes in the lipid profile of blood serum in women taking sauna baths of various duration. Pilch W et al, After 2 weeks of repeated sauna session some changes in total cholesterol and concentration of LDLC were observed, while concentration of HDLC increased after 7th sauna bath in group I. Those kinds of changes may be good prognoses of ischemic heart disease prevention Repeated sauna therapy attenuates ventricular remodeling after myocardial infarction in rats by increasing coronary vascularity of noninfarcted myocardium. Sobajima M et al, American J of physiology May 27 th 2011 ST attenuates cardiac remodeling after MI, at least in part, through improving coronary vascularity in the noninfarcted myocardium. Repeated ST might serve as a novel noninvasive therapy for patients with MI.

36. MUSCULOSKELETAL SYSTEM:- Effects of cold: a) The voluntary muscles : Prolonged of low temperature water - muscular irritability of voluntary muscles EX. – stiffness & clumsiness of fingers as the result of exposure to low temperature b) The muscular tone: A short cold bath ( douche/ spray)- augments muscular energy and tone Short cold bath( 1- 2 secs ) powerful restorative in fatigue resulting from with much pressure( 25- 35lbs) severe muscular effort

37. c) The involuntary muscles:- Cold- activity of smooth muscle fibers of skin goose- flesh appearance When applied to feet/ abdomen- excites involuntary muscles of bowels & bladder, causing evacuation of these cavities Cold water to feet( spray)- goose flesh appearance over entire body Cold spray/ douche to one side of body- goose flesh appearance on opposite side

38. Effects of hot: Lessened irritability of voluntary muscles : Water bath at a temperature of rapid in muscular irritability 120 F & above This effect of very hot application is utilized therapeutically in, Deformities resulting from muscular contraction Relief of vaginismus In cases of contraction of anal muscle b) Increased irritability of involuntary muscles: Very hot application irritability

39. TITLE AUTHORS CONCLUSION An Electromyographic Study of Human Gait both in Water and on Dry Ground Alain Chevutschi etal, J of physical anthropology 2007 Walking in water at an umbilical level increases the activity of the erector spinae and activates the rectus femoris to levels near to or higher than walking on dry ground Leg immersion in warm water, stretch-shortening exercise, and exercise-induced muscle damage Skurvydas et al, J of Athletic training 2008 Leg immersion in warm water before stretch-shortening exercise reduced most of the indirect markers of exercise-induced muscle damage.

40. TITLE AUTHORS CONCLUSION Contrast water immersion hastens plasma lactate decrease after intense anaerobic exercise Morton et al, J of science & medicine in sport 2007 Contrast water immersion is a valid method of hastening plasma lactate decrease during recovery after intense anaerobic exercise for both males and females Effect of Contrast Water Therapy Duration on Recovery of Running Performance Versey et al, Int J of sports physiology performance Dec 12 th 2011 CWT for 6 min assisted acute recovery from high-intensity running Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise Bleakley et al, J of health & rehabilitation sciences 15 th Feb 2012 cold-water immersion reduces delayed onset muscle soreness after exercise compared with passive interventions involving rest or no intervention

41. TITLE AUTHORS CONCLUSION Effects of thermal therapy combining sauna therapy and underwater exercise in patients with fibromyalgia Matsumoto et al, J of Complementary Therapies in Clinical Practice Sep 24 th 2010 Thermal therapy combining sauna therapy and underwater exercise improved the QOL as well as the pain and symptoms of FMS patients

42. BLOOD:- 1. Effect of cold: WINTERNITZ - Cold applications No. of blood corpuscles + amount of Hb white corpuscles than red corpuscles Phenomenon, cold applications contraction of visceral vessels corpuscles collected in vessels of liver, spleen, kidneys & other internal viscera are driven into circulation

43. HENOCQUE - Rate of reduction in oxyhemoglobin CRAWFORD- Cold bath - the contrast of color between arterial & venous blood ( indicates increased tissue activity & oxidation) STRASSER - General cold applications- the alkalinity of blood , diminution in acid phosphate

44. 2. Effects of hot: WINTERNITZ- Hot baths- No. of blood corpuscles + amount of Hb , increase in leukocytes loclly HENOCQUE- Rate of reduction in oxyhemoglobin locally STRASSER- General hot applications- the alkalinity of blood by increasing the amount of acid phosphate

45. TITLE AUTHORS CONCLUSION Immune changes in humans during cold exposure: effects of prior heating and exercise Brenner et al, J of applied physiology Aug 1999 acute cold exposure has immune stimulating effects that, with thermal clamping, pre-treatment with physical exercise can enhance this response. Leukocytosis , granulocytosis . Inc. NK cells The use of warmed water treatment to induce protective immunity against the bacterial cold-water disease pathogen Flavobacterium psychrophilum in ayu fish ( Plecoglossus altivelis ) Sugahara K et al, J of fish immunology Dec 23 rd 2011 Warmed water treatment could not only cure BCWD( bacterial cold water disease) but also immunize the fish against the causative agent F. psychrophilum .

46. TITLE AUTHORS CONCLUSION Effect of hyperthermic water bath on parameters of cellular immunity. Rovensky et al, Int J of clinical pharmacology 2000 Wholebody hyperthermic water bath reduced relative total Tlymphocyte counts; increased relative CD8+ lymphocyte; NK cell counts and its activity, which were probably dependent on increased somatotropic hormone production

47. EXCRETORY SYSTEM:- 1. Effect of cold: Skin: Short cold applications cutaneous vasodilatation & favors perspiration ( in reaction ) b) Kidneys: In animals, very cold prolonged applications appearance of albumin in urine Fever treated by cold bath toxicity of urine is increased by 6 times Cold application to lower 1/3 rd excites renal activity of sternum/ renal douche

48. c) Lungs: Short cold applications elimination of CO2 + absorption of O 2 Prolonged cold applications CO2 elimination d) Bowels: Cold application to feet/ excites involuntary muscles of bowels abdomen

49. TITLE AUTHORS CONCLUSION Role of warm water bath in inducing micturition in postoperative urinary retention after anorectal operations . Shafik et al, Int J of Urology The urethral pressure in both the normal and retention subjects showed significant reduction which increased with higher-temperature baths. Micturition on sitting in a warm water bath seems to be initiated by reflex internal urethral sphincter relaxation. A thermo-sphincter reflex is likely to be involved.

50. NERVOUS SYSTEM:- 1. Effects of cold: HELMHOLTZ: Cold application to a nerve trunk, Short cold application to head, Action- brief depression Reaction- increased cerebral activity Prolonged cold applications – lessens cerebral activity + stupidity, drowsiness & unconsciousness ACTION REACTION Diminishes the rate of transmission of nervous impulses by 1/6 th of the normal rate Nerve quickly recovers Pain in the part to which it is distributed Benumbing effect

51. 2. Effects of hot: Heat may excite/ exhaust nervous system depending upon the mode of application Exciting effect- direct influence of heat upon the nerve filaments.

52. Exhausting effect- Certain forms of hot applications Excitation of protoplasmic/ vital activities of the body accumulation of tissue wastes/ excrementitious elements diminished oxidation of the wastes by the body accumulation of tissue poisons within the body

53. REFLEX EFFECTS: Reflex areas in relation to internal viscera: Brain head, face, neck hands & feet Nasal mucus membrane Neck, face, upper dorsal spine, hands & feet Stomach Lower dorsal spine & epigastrium Kidneys Lower 1/3 rd of sternum & feet Bowels Feet & abdomen Bladder Feet & lower abdomen Liver Lower right chest Spleen Lower left chest Lungs Upper dorsal region Uterus Lumbar region, abdomen, breasts, inner surface of thighs & feet

54. TITLE AUTHORS COCLUSION Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Herrera et al, J of physical therapy Feb 25 th 2010 All 3 modalities were effective in reducing skin temperature and changing sensory conduction at a physiological level that is sufficient to induce a hypoalgesic effect, CWI is the most indicated modality for inducing therapeutic effects associated with the reduction of motor nerve conduction.

55. GASTRO-INTESTINAL SYSTEM:- 1. Effects of cold: Salivary secretion- [ 2000 Nov;45(11):957-61.The effect on human salivary flow rate of the temperature of a gustatory stimulus. Dawes C 1 ,  O'Connor AM ,  Aspen JM .] Gastric & pancreatic secretions – Initial reduction followed by increased secretion [  1983 Apr; 24(4): 277–283.Perturbation of upper gastrointestinal function by cold stress. D G Thompson ,  E Richelson , ]

56. Short & very cold douche secretory activity over stomach & liver Cold douche/ ice bag / compress HCL secretion to stomach

57. 2. Effects of hot: Hot douche over stomach & spine HCL secretion Fomentation to stomach HCL secretion Hot compress/ fomentation flow of bile & all other activities to liver

58. TITLE AUTHORS CONCLUSION Effect of steam bath on gastric secretion and some endocrine changes of athlete-fighters Fiziol cheloveka et al, March 2011 Concluded that there was significant increase in gastric secretions, aldosterone level and decrease in the concentrations of cortisol after steam bath. Warm water irrigation for dealing with spasm during colonoscopy: simple, inexpensive, and effective Church J M et al, J of gastrointestinal endoscopy Nov 2002 The results of this study suggest that warm water is also effective in treating the spasm. It has no side effects and costs practically nothing.

59. TITLE AUTHORS CONCLUSION Random control trial of hot compresses for women those who used laxatives on severity of constipation and quality of life Izumi et al, Japan J of Nursing science 15 th July 2015 The lumbar application of a 40°C hot compresses in female adults with constipation improved their conditions of defecation and QOL, even though it did not reduce the amount of laxatives.

60. REPRODUCTIVE SYSTEM:- TITLE AUTHORS CONCLUSION Post episiotomy pain: warm versus cold sitz bath . Lafoy J et al, J of Obstetrics & gynecology of neonatal nursing Sep 1989 Both therapies were found comparable, with the exception that the cold bath was significantly more effective in reducing oedema. A randomised controlled trial evaluating the effect of immersion bath on labour pain Silva et al, J of midwifery July 25 th 2007 An immersion bath is a suitable alternative form of pain relief for women during labour The effect of immersion baths on the length of childbirth labor Oliviera et al, Mar 2006 The results showed that immersion baths did not have any influence on the length of labor and on the frequency of uterine contractions. However, the length of contractions was statistically shorter in the experimental group

61. TITLE AUTHORS CONCLUSION Warm sitz bath: are there benefits after transurethral resection of the prostate? Park et al, Korean J of Urology Nov 17 th 2010 Warm water sitz bath treatment reduced postoperative complications such as urethral stricture A comparison of cold and warm sitz baths for relief of postpartum perineal pain . Ramler et al, Cold sitz baths were significantly more effective in relieving perineal pain when compared to warm sitz bath Immersion in water in labour and birth Cluett et al, Apr 15 th 2010 water immersion during the first stage of labour reduces the use of epidural/spinal analgesia

62. PHYSIOLOGICAL EFFECTS OF MUD THERAPY ON DIFFERENT ORGAN SYSTEMS

63. TITLE AUTHORS CONCLUSION EFFECT OF MUD BATH ON AUTONOMIC AND RESPIRATORY VARIABLES IN NORMAL HEALTHY VOLUNTEERS- A RANDOMIZED CONTROL TRIAL Dr. N V Gnanadeep T Journal of Dental and Medical Sciences 2016 Application of full mud bath on the body enhances the sympathetic activity and has a role in maintaining the cardiac tone and preventing various cardiovascular ailments. Whereas a cold wet wrap enhances parasympathetic activity and can be applied effectively to treat stress, insomnia and anxiety

64. TITLE AUTHORS CONCLUSION Beta-endorphin and Stress Hormones in Patients Affected by Osteoarthritis Undergoing Thermal Mud Therapy A Pizzoferrato et al, 2000 Oct, J of Minerva Medica Thermal mud - a significant reduction in levels of hormones of the pituitary- adrenal such as ACTH, Cortisol levels The effect of peat components on endocrine and immunological parameters and on trace elements--results of two pilot studies. Beer AM 2001 Clinical Laboratory. Shown to be beneficial in post-menopausal women, as it increases the levels of estradiol significantly. Evaluation of the permeation of peat substances through human skin in vitro. M. Beera A 2003 International Journal of Pharmaceutics. Thermal mud stimulation is proven to increase the extensibility of collagen rich tissues and to reduce the matrix metalloproteinase – 3 plasma levels in osteo -arthritic patients.

65. TITLE AUTHORS CONCLUSION Effects of mud pack treatment on skin microcirculation. Poensin D et al, 2003 J of Joint Bone Spine increase in the blood flow and stimulation of vasomotion as measured by the Laser-Doppler flowmetry . Mud bath therapy influences nitric oxide, myeloperoxidase and glutathione peroxidase serum levels in arthritic patients. Bellometti S 2000 Int J Clin Pharmacol Res. exerts beneficial effect on cartilage homeostasis and on inflammatory reactions in the body influencing nitric oxide and decreasing the serum levels of myeloperoxidase . Evaluation of the permeation of peat substances through human skin in vitro. Beer A, 2003 International Journal of Pharmaceutics. The fulvic and the ulmic acids along with other water-soluble compounds of mud has a stimulatory effect on the contractile activity of the smooth muscle.

66. TITLE AUTHORS CONCLUSION A study on the efficacy of treatment with mud packs and baths with Sillene mineral water ( Chianciano Spa Italy) in patients suffering from knee osteoarthritis. Fraioli A,. 2010 Rheumatology International Increase in the serum levels of glutathione peroxidase Shown to activate the osteoblasts without the suppression of osteoclast activity which is a beneficial result in osteoporotic condition Effects of spa therapy on serum leptin and adiponectin levels in patients with knee osteoarthritis. Fioravanti A 2011 Rheumatology International. Local mud application along with bicarbonate- sulphate mineral water is shown to modify plasma levels of the adipocytokines including leptin and adiponectin which are the important mediators of cartilage metabolism.

67. TITLE AUTHORS CONCLUSION Hypothalamic–pituitary–adrenal axis dysregulation in healthy subjects undergoing mud-bath applications..;38(5):724-725 Cozzi F, et al 1995 Arthritis & Rheumatism An increase in the serum levels of opioid peptides such as encephalins & endorphins Mud application also increases the synthesis of beta endorphins Environment, health resorts, tourism. Drivers for a good quality of life and local development.. Yerevan Jermuk Thermal Center (Armenia) 2016 After the balneological treatment there was a change in the ionic composition of venous blood which showed increased solubility of oxygen, increase in haemoglobin , and decrease in the glucose concentration.

68. TITLE AUTHORS CONCLUSION Effect of naphthalan and therapeutic mud applications on clinical and roentgenological characteristics in patients with protracted pneumonia. Rassulova MA, Vopr Kurortol Fizioter Lech Fiz Kult . 2009 application of naphthalan and therapeutic mud reduces the activity of inflammatory processes, improve airway patency and the state of bronchial mucosa in patients with protracted pneumonia Effect of complex rehabilitation by physical factors (therapeutic mud, waves of millimeter range) on the indices of inflammation process and immune status in patients with traumas of peripheral nervous system. Tarkhan-Muuravi ID Georgian Med News 2006 therapeutic mud and electromagnetic therapy decreases the inflammation process and body sensitization in patients with traumas of peripheral nervous trunks almost to disappearance of inflammation process and body sensitization. Such rehabilitation increased nonspecific resistance and normalizes the indices of immune reactivity

69. TITLE AUTHORS CONCLUSION A multidisciplinary approach to study the effects of balneotherapy and mud-bath therapy treatments on fibromyalgia. Laura Bazzichi   2013 Clin Exp Rheumatol . In fibromyalgia patients mud pack therapy is shown to produce beneficial effects by reducing the Brain Derived Neurotrophic Factor (BDNF). Bone mineral density in women on long-term mud-bath therapy in a Salus per Aquam (SPA) environment Loi A, 2013. Reumatismo . Mud therapy increased the bone mineral density in women even in a long term when given for 45 to 60 minutes with bicarbonate alkaline water.

70. TITLE AUTHORS CONCLUSION Serum levels of a prostaglandin and a leukotriene after thermal mud pack therapy. Bellometti S, J Investig Med. 1998 significantly decreased the levels of Prostaglandin E2 (PGE2) and Leukotriene B4 (LT-B4) in the serum which indicates the protective response on the cartilage and helps in pain relief by reducing the inflammation Bone remodelling in osteoarthrosic subjects undergoing a physical exercise program. Bellometti S, Clinica Chimica Acta . 2002 mud pack therapy when combined with exercise stimulated the physiologic bone metabolism and favours the skeletal health.

71. TITLE AUTHORS CONCLUSION Effects of mud-pack treatment on plasma cytokine and soluble adhesion molecule levels in healthy volunteers. Basili S, Clinica Chimica Acta . 2001 The mature thermal mud therapy is proven to reduce the Inter Leukin (IL- 6) and Tumour Necrosis Factor (TNF - α) which are the inflammatory markers. Effect of peloid applications of different temperatures on the function of the cardiovascular system in patients with osteoarthrosis and concomitant hypertensive disease and ischemic heart disease. L'vova NV, Vopr Kurortol Fizioter Lech Fiz Kult . 2009 low-temperature peloidotherapy should be included as a major component in the treatment of patients with hypertensive disease and coronary heart disease since it has the most beneficial effect on general and intracardiac hemodynamics .

72. TITLE AUTHORS CONCLUSION Comparison of inta-articular hyaluronic acid injections and mud-pack therapy in the treatment of knee osteoarthritis. Bostan B Acta Orthopaedica et Traumatologica Turcica . 2010; Research studies also show that mud pack therapy is equally efficient as that of intra articular hyaluronic acid injections in short term functional improvement and pain relief in osteoarthritis patients. Oxidative stress, hemoglobin content, superoxide dismutase and catalase activity influenced by sulphur baths and mud packs in patients with osteoarthritis. Jokic A, Vojnosanitetski pregled . 2010 The sulphur baths and mud packs has shown to cause a significant decrease in plasma melondialdehyde concentration in osteoarthritis patients. Sulphur and mud therapy also decrease the lipid peroxidation in plasma as well as causes alterations in the plasma activity of superoxide dismutase and catalase activity along with a significant increase in the haemoglobin levels

73. TITLE AUTHORS CONCLUSION Clinical improvement and serum amino acid levels after mud-bath therapy. Bagnato G, Int J Clin Pharmacol Res. 2004. an increase in the serum concentration of tryptophan, cysteine and citrulline in gonarthrosis patients which helps in alleviating the pain. Effect of hyperthermic and isothermic mud application on hormonal function of normal and insufficient corpus luteum in women Bromirska D. Ann Acad Med Stetin . 1993 The use of hyper and isothermic mud has led to a transient increase in the concentration of progesterone and estradiol in blood sera of women with the normal and insufficient corpus luteum hormonal function. There was also a significant rise in the excretion of adrenaline and nor adrenaline in urine following the hyperthermic mud application.

74. TITLE AUTHORS CONCLUSION The in-vitro percutaneous migration of chemical elements from a thermal mud for healing use. Tateo Applied Clay Science. 2009 a transfer of chemical elements from mud to the skin. Matured mud was applied for 20 minutes and a significant transfer of Lithium (Li), Strontium ( Sr ), Boron (B), Iodine (I), Rubidium ( Rb ), Bromine (Br), Sodium (Na), Chlorine ( Cl ), Selenium (Se), and Calcium (Ca) was observed

75. REFERENCES Rational hydrotherapy by Dr. J H Kellogg Essentials of medical physiology by Dr. Sembulingam Mooventhan A, Nivethitha L. Scientific Evidence-Based Effects of Hydrotherapy on Various Systems of the Body.  North American Journal of Medical Sciences . 2014;6(5):199-209. doi:10.4103/1947-2714.132935 Becker B. Aquatic Therapy: Scientific Foundations and Clinical Rehabilitation Applications. PM&R. 2009;1(9):859-872. PUBMED

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