Review of the Head of the Department of Physical Therapy and Kurortologie SPb MAPO, President of physiotherapists Association of St. Petersburg and North-West Prof. Dr. med. Habil. Kiryanova Vera Vasilyevna "applying the healing baths with unrefined Crimean sea salt in gerontological practice"
Biochemical mechanisms of action of hydrotherapy (water treatment)
There are two types of water treatment:
Actual water treatment or hydrotherapy where mainly fresh water is applied in the form of casting, attrition, shower, baths and other procedures;
Balneotherapy, where the water is applied from mineral or gas-containing water sources, salt lakes, the sea and the salt water artificially produced.
The water has important physical properties. It has a large heat capacity of 1 cal To compare: The heat capacity of iron is 0,113 cal, mercury - 0,033 cal and the heat capacity of the sludge - from 45 to 0.6 cal Thus, the water stored in heating a large amount of heat... The water has large thermal conductivity, 13 or even 28 times larger in comparison with the thermal conductivity of the air, depending on the details of the different authors. This allows one into the water submerged body with the lower temperature than that of water, a large amount of heat to get the water. At the same time the body is subject to a higher temperature than the water in a cooling effect. Thanks to the large heat capacity and high thermal conductivity of water exerts a strong thermal warming and cooling effect on the body.
Unlike the fresh water when the water is mineral salts, biological active substances, microelements, and gas connections are, then such water has except thermal properties as well as significant chemical effect factors. Due to the laws of osmosis and diffusion out of the water in the body through the skin and into the blood found various gaseous substances. According to a series of authors (A.E.Sherbak, P.L.Slynko) some minerals can penetrate the body of bathing people from the true solution through the skin and sweat glands.
The third impact factor, when performing a water treatment is the mechanical action or factor of the hydrostatic pressure. The mechanical factor is particularly useful for a high-pressure shower to advantage where the water pressure 2.5-3.0 bar is reached. When prescribing a spa he acts less because of the water layer (20-30 cm) above the organs in the abdominal cavity is the pressure of 0.03 to 0.05 bar. Nevertheless, this pressure can change the state of the diaphragm, causing redistribution of the blood, an effect on the function of the broncho-pulmonary system. Not to mention the body weight reduction is when submerged and consequently facilitating the movement in the water in the implementation of Kinesiotherapeutischen procedures (exercise therapy, therapeutic exercise in water). Thus, the hydrotherapeutic procedures can exert through their thermal, chemical and mechanical factors a pronounced effect on the human organism.
Sodium chloride baths from the unrefined sea salt Crimea
Sodium chloride baths (salt baths) are usually prepared from the natural mineral water to many spas at sea and balneological health resorts. In these cases, the water of the sea, the sea-Limane, inland salt lakes and the natural salt springs used. The Balneotherapy is performed in the context of spa treatment. In many therapeutically-prophylactic institutions of large towns with a hydrotherapy department sodium chloride baths (salt baths) are artificially prepared. To this end, the refined rock-salt is used as fine powders. The amount is selected according to the desired concentration of sodium chloride in water. The water of such artificial baths containing mainly the ions of sodium and chlorine at a very low mineral inventory compared to natural seawater.
For this reason, it is interesting and practically useful, to use the unrefined, natural sea salt of the highly saline Limane the Black and Azov seas for the preparation of artificial sodium chloride baths. This salt is harvested by hand in September-October of each year in the ecologically clean coast and is dried to the old natural way. The sea salt is the large irregularly shaped crystals. Sometimes the salt crystals have a pink tinge. In its crystal lattice, the biologically active substances are incorporated, formed during the blooming of microalgae in seawater. The essential oils, iodine, natural wax, beta carotene and other natural materials. One kilogram of unrefined sea salt crystals from the Crimea contains the following elements:
Etherextrahierbare substances 3.4g
Potassium 0.21 g
Calcium 7.5 g
Magnesium 3.6 g
Manganese 1.1 g
Copper 1.15 g
Sulfur 1.5 g
Zinc 0.7 g
Iodine 6.54 g
Natural sodium chloride water has a wide range of mineralization: From 2 to 600 g / l. Waters with a mineralization of 50 g / l and more hot brine and will not be used undiluted for the prevention, treatment and rehabilitation.
Specific properties of the salt bath effect by the sodium chloride content as a chemical factor as opposed to fresh water to emerge from a water mineralization near 10 g / l. Therefore the amount of unrefined sea salt Crimean 600-800 g for bath 150-200 l volume will not be sufficient, since the mineralization of the water in this case, 4 g / l and 5.35 g / l (150 l Bathtub ) or 3 g / l and 4 g / l (bath 200 l) is reached. Consequently, to achieve the strong healing effect by the chemical factor that distinguishes this procedure from the effect of the fresh water to the amount of salt up to 1 kg for 150 l bath, increases with the water-mineralization of 6.6 g / l will. By using the bath with 200 l volume, it is useful to use 1.5 kg of salt for a procedure. This results in the mineralization of 7.5 g / l. Certainly the diverse composition of sea salt should be considered because other than sodium chloride in calcium, magnesium, etherextrahierbare substances sulfur. In addition, the sea salt contains a number of trace elements: manganese, copper, zinc and in large quantities bromine and iodine. These chemical elements enhance the effect of the sodium chloride.
The impact area of the mineral water for hydrotherapy is the skin surface, where there are different receptors, including those that respond differently to different temperatures of the surrounding water (Krause end bulbs, Ruffini corpuscles and other). In their irritation may develop multimodal bioelectric impulses through the nerve fibers go to the center of the nervous system (hypothalamus, midbrain area), where the analysis, synthesis and other processes running that cause the particular thermal sensation. According to the temperature sensitivity of the water around the water treatment can be divided as follows:
1. Cool, fresh water has temperature of ЗЗ ° C to 20 ° C;
2. Cold water - below 20 ° С;
3. Hot water - 37 ° C to 39 ° С;
4. Hot water - temperature 40 ° С and higher.
The indifferent temperature of the water within 34-36 and to 37 ° C. It causes in which people no heat or cold sensation, and is not considered a temperature-stimulator.
Use of water, and the sodium chloride water of different temperatures leads to changes in the function of the cardiovascular system, central nervous system and metabolic processes. Application of cold, cool, warm and hot baths cause unwanted phase-like vascular reactions. Significant reaction of vascular spasm of 20-30 seconds to 2-3 minutes, which is replaced by the advantageous phase of active arterial hyperemia.. This can in turn pass on longer procedures in an undesirable phase of venous hyperemia (congestion). Thus, in patients suffering from cardiovascular-Erkrankugen with seizure susceptibility, and in the elderly (65-70-79 years and) we can prescribe no cold, hot, cold and warm water treatments, as these vascular spasms and prolonged use (15 minutes and even 10 min..) - congestion. We can take the sodium chloride baths with sea salt in gerontological practice at the indifferent water temperature (34-36 ° C, sometimes 37 ° C). In this case we will have no phase of vascular spasms, but get a longer active hyperemia of the vessels, which is characterized by vasodilatation and better circulation. In advanced age, the procedures have to be short. That to 10 min., to avoid the congestion.
Salt water baths at the sodium chloride concentration of 6.6 g / l may show a more significant thermal effect than the fresh water at the same temperature. This can manifest itself in the subjective perception of the patient. It may be a reaction vessel clearer arise due to a stronger skin vasodilatation and acceleration of the blood circulation. You can see that a slight reddening of the skin. This is a gentle reaction of the vessels, which leads to the blood stream and to reduce the peripheral resistance of vessels. As a result, the fall of blood pressure at the elevated baseline blood pressure may be. Elderly patients usually falls irrelevant the systollische arterial blood pressure. When prescribing the mineral baths with the indifferent temperature and not high mineralization sodium chloride, the number of heartbeats does not change. The occurrence of tachycardia (heart acceleration) and the Extrasystolie (palpitations) during bathing or immediately after talking about a negative effect of the spa treatments to the sick and calls for a change in the method of treatment in the direction of reducing the treatment time or adjust the appropriate water temperature.
Because of the improved blood circulation and slight thermal effect the sodium chloride baths have an anti-inflammatory effect and because of the effect on the skin receptors by thermal and chemical irritation can lead to alleviate the painful conditions. Chronic venous insufficiency, the salt baths have a better effect than other baths to improve the tonic properties of the vein wall, which leads to the relief of the blood return flow from the limbs with venous congestion. The combination of this effect with the moderate increase in the inflow of arterial blood gives the optimal agent for improving peripheral circulation in the limbs.
The content of the unrefined sodium chloride is by other existing minerals and many microelements (see above) supplemented, strengthen the healing effect of the bath. Several authors report that such elements as iodine, bromine, sulfur and others can enter the body through intact skin. And the research of P.P.Slynko evidence of the penetration of other chemical compounds from the true solution through the sweat glands in the body. This makes the mechanism of healing effects of mineral baths because of the important chemical factor complex. The sedative (calming) effect of the salt bath is increased not only because of the indifferent temperature but also because of the existing micro-doses of bromine and magnesium.
The existing in seawater calcium improves the function of the muscle tissue, the myocardium (heart muscle), nervous system and prevents the development of osteoporosis. The considerable amount of sulfur in the sea salt has a positive effect on the condition of the skin surface and the cartilage. Incidentally, patients who take baths with sea salt, report a significant improvement of the skin: The skin is not as dry, flaking is reduced, the elasticity and suppleness of the skin increase, pathological elements on the skin disappear.
A very great significance have different microelements and especially iodine. The main memory of iodine is the ocean. Iodine is the main element of the thyroid hormones and ensures its proper functioning. Iodine deficiency states are known throughout the world (endemic goiter, mental retardation, increased risk of cancer, etc.). The iodine and other microelements enhance the effect of many enzymes (enzymes), which leads to the activation of the metabolic processes, especially in relation to the phase of the cells oxidative respiration. This refers to the mineral baths and other procedures with the low or high temperature. The bathrooms with the indifferent temperature show no particular effect on the metabolic processes. However, there is information in the literature about the disturbances in lipid metabolism (cholesterol metabolism) with use of salt baths. That refers to the sodium chloride baths having a concentration of 50 g / l and more. However, the recommended sea salt baths from the Crimean salt have a very low mineralization (6.6 g / l, 7.5 g / l). The salt baths slow down the development of atherosclerosis, which show the researches of doctors from Ekaterinburg.
Recommendations for therapeutic treatments
Thus, due to the top versions, the following recommendations for the therapeutic application of salt baths can be made:
- Therapeutic treatments can be performed in the bathrooms to the neutral temperature 34-36 ° C. It is desirable in the winter (cold season) to select a temperature of 36 ° C and in summer (warm season) - 34-35 °.
- For bathtubs with 150 l volume, it is necessary to take 1 kg of the sea salt (mineralization 6.6 g / l). For the bath with 200 l volume should be 1.5 kg take (mineralization 7.5 g / l).
- The salt is placed in a gauze bag, which is suspended under the faucet with hot water. After the dissolution of the salt, the salt bath solution is brought to the required temperature by the cool water.
- The duration of treatment is 10-15 min for the elderly -. 10 min.
- The spas are prescribed every other day. In extreme demand and good tolerability of the salt bath procedures, the salt baths in succession prescribed two days of the third day off.
- The treatment course is 8-10 to 15 treatments.
- After bathing in salt bath, the salt crystals are not washed off or removed with the cloth. The body is dried by gently dabbing with the cloth.
- After swimming follows a recovery in the bed of the duration 20-30 min Older people rest at a little longer..
Ads for the application of sodium chloride baths with unrefined sea salt from the Crimea
.. 1st stage diseases of the cardiovascular system (high-pressure disease 1.-2, ischemic heart disease - stable angina the 1st-2 functional class, circulatory insufficiency not higher 1st stage; essential hypotension in the early stages; first symptoms of the disease of the vessels of members; chronic venous insufficiency as a result of thrombophlebitis (thrombosis), 2-3 months after the end of the acute inflammatory process with elevated temperature; varicose no ulcer);
2. Diseases of the musculoskeletal system (arthritis and polyarthritis of non-tubercular origin: rheumatoid arthritis, brucellosis, dysenteric arthritis, etc.); deforming osteoarthritis; Spine diseases (spondylosis, spondylarthritis, ankylosing spondylitis, etc.);
3. diseases and consequences of traumatic injuries of bones and tendons;
4. disorders of the central nervous system; Consequences of spinal cord injury and brain effects of polio, neuroses (neurasthenia, psychasthenia, hysteria, etc.), autonomic dysfunction;
5. diseases of the peripheral nervous system: spinal osteochondrosis with neurological symptoms, plexitis, radiculitis;
6. Chronic inflammatory diseases of the female reproductive organs: the uterus, appendages, adhesions after surgery, functional ovarian failure;
7. Some skin diseases (psoriasis, eczema);
8. kidney diseases: primary or secondary chronic pyelonephritis at the stage of remission or the latent process; chronic pyelonephritis complicated by renal insufficiency in the latent stage.
1. The general contraindications for physiotherapy treatments: Malignant and benign formations with a tendency to grow; Blood disorders in the acute phase, bleeding and tendency to repeated bleeding, pulmonary tuberculosis in active stage, severe cardiovascular disease (high-pressure disease in the 3rd stage, ischemic heart disease - unstable angina 4th functional class, serious complications of acute myocardial infarction, circulatory insufficiency the 2nd degree; pronounced atherosclerosis of the cerebral arteries and the heart.
2. Acute inflammation or severe exacerbation (worsening) of chronic inflammatory processes.
3. infectious diseases.
4. Moist skin diseases (oozing eczema, pemphigus).
5. period earlier than 2-3 months after the end of thrombophlebitis (thrombosis), which is accompanied by the temporary temperature increases; recurrent thrombophlebitis; postthrombotic syndrome with sepsis (blood poisoning), or suppurative, sooner than 2-3 years mach reaching the normal temperature; chronic venous insufficiency accompanied by recurrent erysipelas.
6. Second Pregnancy half.
7. Glaucoma in the progression of the process.
8. Individual intolerance of the procedure.
The age of the patient is not among the contraindications for hydrotherapy, except for patients with progressive senile frailty and pronounced weakness. The decision on the application of a water treatment should be taken individually, depending on the cardiovascular system. Important is the appropriate selection of the necessary procedure, technique and method of implementation. It must be noted that the weakened and elderly sometimes have a paradoxical and cardiovascular reactions that worsen the condition of the patient. To avoid this, there should be a weak exposure, which is then slowly increased in the first procedures.