Abstract
This study systematically reviews the current state of aquatic treatment of neck pain and assesses the scientific evidence of its benefits. The databases PubMed, Scopus, Web of Science and PEDro were searched for relevant reports published from January 1, 2008, to November 7, 2017, using the keywords “neck pain” in addition to “balneotherapy”, “spa treatment”, “spa”, “thalassotherapy”, “hydrotherapy”, “aquatic therapy” or “aquatic”. Inclusion criteria were full-text articles published in journals included in Journal Citation Reports in English and Spanish describing human studies. Case studies, letters to the editor and meeting presentations or other contributions were excluded. Of 367 articles identified, only 13 fulfilled the inclusion criteria: 5 randomized trials, 1 single blind controlled study, 2 pilot studies, 2 observational retrospective studies, 1 prospective study, 1 clinical study and 1 not specified. Participants were 658 subjects with chronic neck pain. Main symptoms and signs treated were neck pain, disability, cervical disc herniation and compromised quality of life. Evidence that aquatic treatment improves quality of life in affected individuals was good in four studies, fair in eight and weak in one. Treatment of neck pain using different waters and techniques reduced pain and disability, and improved functional capacity, quality of life, joint mobility, balance, relaxation and mood.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aker PD, Gross AR, Goldsmith CH, Peloso P (1996) Conservative management of mechanical neck pain: systematic overview and meta-analysis. BMJ 313:1291–1296. https://doi.org/10.1136/bmj.313.7068.1291
Altan L, Bingöl U, Aslan M, Yurtkuran M (2006) The effect of balneotherapy on patients with ankylosing spondylitis. Scand J Rheumatol 35:283–289. https://doi.org/10.1080/03009740500428806
Antonelli M, Donelli D (2018) Effects of balneotherapy and spa therapy on levels of cortisol as a stress biomarker: a systematic review. Int J Biometeorol 62:913–924. https://doi.org/10.1007/s00484-018-1504-8
Ayán C, Carvalho P, Varela S, Cancela JM (2017) Effects of water-based exercise training on the cognitive function and quality of life of healthy adult women. J Phys Act Health 14:899–904. https://doi.org/10.1123/jpah.2017-003
Bautista-Aguirre F, Oliva-Pascual-Vaca Á, Heredia-Rizo AM, Boscá-Gandía JJ, Ricard F, Rodriguez-Blanco C (2017) Effect of cervical vs. thoracic spinal manipulation on peripheral neural features and grip strength in subjects with chronic mechanical neck pain: a randomized controlled trial. Eur J Phys Rehabil Med 53:333–341. https://doi.org/10.23736/S1973-9087.17.04431-8
Becker BE (2009) Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R 1:859–872. https://doi.org/10.1016/j.pmrj.2009.05.017
Becker BE (2011) Biophysiologic aspects of hydrotherapy. In: Becker BE, Cole AJ (eds) Comprehensive aquatic therapy, 3rd edn. Washington State University Publishing, Pullman WA, pp 23–75
Bender T, Karagülle Z, Bálint GP, Gutenbrunner C, Bálint PV, Sukenik S (2005) Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatol Int 25:220–224. https://doi.org/10.1007/s00296-004-0487-4
Bender T, Bálint G, Prohászka Z, Géher P, Tefner IK (2014) Evidence-based hydro- and balneotherapy in Hungary-a systematic review and meta-analysis. Int J Biometeorol 58:311–323. https://doi.org/10.1007/s00484-013-0667-6
Benelli P, Zanazzo M (2015) Idrochinesi Terapia – Manuale di riabilitaziones in acqua. Milano: edi ermes
Blain H, Bernard PL, Canovas G, Raffort N, Desfour H, Soriteau L, Noguès M, Camuzat T, Mercier J, Dupeyron A, Quéré I, Laffont I, Hérisson C, Solimene H, Bousquet J (2016) Combining balneotherapy and health promotion to promote active and healthy ageing: the Balaruc-MACVIA-LR(®) approach. Aging Clin Exp Res 28:1061–1065. https://doi.org/10.1007/s40520-016-0596-4
Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK (2017) Neck pain: revision 2017. J Orthop Sports Phys Ther 47(7):A1–A83. https://doi.org/10.2519/jospt.2017.0302
Cantarero-Villanueva I, Fernández-Lao C, Fernández-de-Las-Peñas C, López-Barajas IB, Del-Moral-Ávila R, de la Llave-Rincón AI, Arroyo-Morales M (2012) Effectiveness of water physical therapy on pain, pressure pain sensitivity, and myofascial trigger points in breast cancer survivors: a randomized, controlled clinical trial. Pain Med 13:1509–1519. https://doi.org/10.1111/j.1526-4637.2012.01481.x
Cantarero-Villanueva I, Fernández-Lao C, Caro-Morán E, Morillas-Ruiz J, Galiano-Castillo N, Díaz-Rodríguez L, Arroyo-Morales M (2013) Aquatic exercise in a chest-high pool for hormone therapy-induced arthralgia in breast cáncer survivors: a pragmatic controlled trial. Clin Rehabil 27:123–132. https://doi.org/10.1177/0269215512448256
Chary-Valckenaere I, Loeuille D, Jay N, Kohler F, Tamisier JN, Roques CF, Boulange M, Gay G (2018) Spa therapy together with supervised self-mobilisation improves pain, function and quality of life in patients with chronic shoulder pain: a single-blind randomised controlled trial. Int J Biometeorol 62:1003–1014. https://doi.org/10.1007/s00484-018-1502-x
Ciprian L, Lo Nigro A, Rizzo M, Gava A, Ramonda R, Punzi L, Cozzi F (2013) The effects of combined spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors. Rheumatol Int 33:241–245. https://doi.org/10.1007/s00296-011-2147-9
Cole AJ, Johnson J, Alford JM, Hardy K, Moschetti M, Fredericson M, Eagleston RA, Stratton SA (2011) Spine pain: aquatic rehabilitation strategies. In: Becker BE, Cole AJ (eds) Comprehensive aquatic therapy, 3rd edn. Washington State University Publishing, Pullman WA, pp 219–244
Corvillo I, Varela E, Armijo F, Alvarez-Badillo A, Armijo O, Maraver F (2017) Efficacy of aquatic therapy for multiple sclerosis: a systematic review. Eur J Phys Rehabil Med 53:944–952. https://doi.org/10.23736/S1973-9087.17.04570-1
Cozzi F, Podswiadek M, Cardinale G, Oliviero F, Dani L, Sfriso P, Punzi L (2007) Mud-bath treatment in spondylitis associated with inflammatory bowel disease—a pilot randomised clinical trial. Joint Bone Spine 74:436–439. https://doi.org/10.1016/j.jbspin.2006.12.003
Cozzi F, Ciprian L, Carrara M, Galozzi P, Zanatta E, Scanu A, Sfriso P, Punzi L (2018) Balneotherapy in chronic inflammatory rheumatic diseases-a narrative review. Int J Biometeorol 62:2065–2071. https://doi.org/10.1007/s00484-018-1618-z
Cuesta-Vargas AI, González-Sánchez M, Casuso-Holgado MJ (2013) Effect on health-related quality of life of a multimodal physiotherapy program in patients with chronic musculoskeletal disorders. Health Qual Life Outcomes 11:19. https://doi.org/10.1186/1477-7525-11-19
Cuesta-Vargas AI, White M, González-Sánchez M, Kuisma R (2015) The optimal frequency of aquatic physiotherapy for individuals with chronic musculoskeletal pain: a randomised controlled trial. Disabil Rehabil 37:311–318. https://doi.org/10.3109/09638288.2014.918191
Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52:377–384. https://doi.org/10.1136/jech.52.6.377
Engstrom JW, Deyo RA (2015) Back and neck pain. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J (eds) Harrison’s principles of internal medicine. McGraw Hill Education, New York, pp 111–123
Fejer R, Kyvik KO, Hartvigsen J (2006) The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J 15:834–848. https://doi.org/10.1007/s00586-004-0864-4
Fernández García R, Sánchez Sánchez L d C, López Rodríguez M d M, Sánchez Granados G (2015) Effects of an exercise and relaxation aquatic program in patients with spondyloarthritis: a randomized trial. Med Clin (Barc) 145:380–384. https://doi.org/10.1016/j.medcli.2014.10.015
Fioravanti A, Cantarini L, Guidelli GM, Galeazzi M (2011) Mechanisms of action of spa therapies in rheumatic diseases: what scientific evidence is there? Rheumatol Int 31:1–8. https://doi.org/10.1007/s00296-010-1628-6
Fioravanti A, Karagülle M, Bender T, Karagülle MZ (2017) Balneotherapy in osteoarthritis: facts, fiction and gaps in knowledge. Eur J Integr Med 9:148–150. https://doi.org/10.1016/j.eujim.2017.01.001
Forestier R, Erol-Forestier FB, Francon A (2017) Current role for spa therapy in rheumatology. Joint Bone Spine 84:9–13. https://doi.org/10.1016/j.jbspin.2016.05.003
Fortunati NA, Fioravanti A, Seri G, Cinelli S, Tenti S (2016) May spa therapy be a valid opportunity to treat hand osteoarthritis? A review of clinical trials and mechanisms of action. Int J Biometeorol 60:1–8. https://doi.org/10.1007/s00484-015-1030-x
Francon A, Forestier R (2018) Rhumatologie. In: Queneau P, Roques C (eds) (coord.)La médicine thermale. Données scientifiques. John Libbey Eurotext, Montrouge, pp 179–195
Gálvez I, Torres-Piles S, Ortega-Rincon E (2018) Balneotherapy, immune system, and stress response: a hormetic strategy? Int J Mol Sci 19:1687. https://doi.org/10.3390/ijms19061687
Gálvez I, Torres-Piles S, Ortega E (2019) Innate/inflammatory bioregulation and clinical effectiveness of whole-body hyperthermia (balneotherapy) in elderly patients with osteoarthritis. Int J Hyperth 35:340–347. https://doi.org/10.1080/02656736.2018.1502896
Getz M, Hutzler Y, Vermeer A (2006) The relationship between aquatic independence and gross motor function in children with neuro-motor impairments. Adapt Phys Act Q 23:339–355. https://doi.org/10.1177/0269215506070693
Gutenbrunner C, Bender T, Cantista P, Karagülle Z (2010) A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology. Int J Biometeorol 54:495–507. https://doi.org/10.1007/s00484-010-0321-5
Guzman J, Hurwitz EL, Carroll LJ, Haldeman S, Côté P, Carragee EJ, Peloso PM, van der Velde G, Holm LW, Hogg-Johnson S, Nordin M, Cassidy JD (2009) A new conceptual model of neck pain: linking onset, course, and care: the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. J Manip Physiol Ther 32(2 Suppl):S17–S28. https://doi.org/10.1016/j.jmpt.2008.11.007
Hoy DG, Protani M, De R, Buchbinder R (2010) The epidemiology of neck pain. Best Pract Res Clin Rheumatol 24:783–792. https://doi.org/10.1016/j.berh.2011.01.019
IASP (2017) Musculoskeletal pain fact sheets. Neck pain. American International Association for the Study of Pain. https://www.iasp-pain.org/Advocacy/Content.aspx?ItemNumber=1101. Accessed 15 Jan 2019
Kamioka H, Tsutani K, Okuizumi H, Mutoh Y, Ohta M, Handa S, Okada S, Kitayuguchi J, Kamada M, Shiozawa N, Honda T (2010) Effectiveness of aquatic exercise and balneotherapy: a summary of systematic reviews based on randomized controlled trials of water immersion therapies. J Epidemiol 20:2–12. https://doi.org/10.2188/jea.JE20090030
Karagülle M, Kardeş S, Dişçi R, Gürdal H, Karagülle MZ (2016) Spa therapy for elderly: a retrospective study of 239 older patients with osteoarthritis. Int J Biometeorol 60:1481–1491. https://doi.org/10.1007/s00484-016-1138-7
Karagülle M, Kardeş S, Karagülle MZ (2017) Real-life effectiveness of spa therapy in rheumatic and musculoskeletal diseases: a retrospective study of 819 patients. Int J Biometeorol 61:1945–1956. https://doi.org/10.1007/s00484-017-1384-3
Koyuncu E, Ökmen BM, Özkuk K, Taşoğlu Ö, Özgirgin N (2016) The effectiveness of balneotherapy in chronic neck pain. Clin Rheumatol 35:2549–2555. https://doi.org/10.1007/s10067-016-3199-8
Lambeck JF, Gamper UN (2011) The Halliwick Concept. In: Becker BE, Cole AJ (eds) Comprehensive aquatic therapy, 3rd edn. Washington State University Publishing, Pullman WA, pp 77–107
Lin IH, Chang KH, Liou TH, Tsou CM, Huang YC (2018) Progressive shoulder-neck exercise on cervical muscle functions in middle-aged and senior patients with chronic neck pain. Eur J Phys Rehabil Med 54:13–21. https://doi.org/10.23736/S1973-9087.17.04658-5
Machado M, Bajcar J, Guzzo GC, Einarson TR (2007) Sensitivity of patient outcomes to pharmacist interventions. Part II: systematic review and meta-analysis in hypertension management. Ann Pharmacother 41:1770–1781. https://doi.org/10.1345/aph.1K311
Maraver F, Michán A, Morer C, Aguilera L (2011) Is thalassotherapy simply a type of climatotherapy? Int J Biometeorol 55:107–108. https://doi.org/10.1007/s00484-010-0382-5
Maraver F, Fernández-Torán MA, Corvillo I, Morer C, Vázquez I, Aguilera L, Armijo F (2015) Pelotherapy, a review. Med Naturista 9:38–46
Marinho-Buzelli AR, Bonnyman AM, Verrier MC (2015) The effects of aquatic therapy on mobility of individuals with neurological diseases: a systematic review. Clin Rehabil 29:741–751. https://doi.org/10.1177/0269215514556297
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, PRISMA-P Group (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1. https://doi.org/10.1186/2046-4053-4-1
Mooventhan A, Nivethitha L (2014) Scientific evidence-based effects of hydrotherapy on various systems of the body. N Am J Med Sci 6:199–209. https://doi.org/10.4103/1947-2714.132935
Morer C, Roques CF, Françon A, Forestier R, Maraver F (2017) The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials. Int J Biometeorol 61:2159–2173. https://doi.org/10.1007/s00484-017-1421-2
Nechvatal P, Takac P, Stehlikova B (2014) Effect of spa therapy after intervertebral disc surgery in the cervical spine. Bratisl Lek Listy 115:238–242. https://doi.org/10.4149/BLL_2014_050
Ökmen BM, Eröksüz R, Altan L, Aksoy MK (2017a) Efficacy of peloid therapy in patients with chronic lateral epicondylitis: a randomized, controlled, single blind study. Int J Biometeorol 61:1965–1972. https://doi.org/10.1007/s00484-017-1386-1
Ökmen BM, Kasapoğlu Aksoy M, Güneş A, Eröksüz R, Altan L (2017b) Effectiveness of PELOID therapy in carpal tunnel syndrome: a randomized controlled single blind study. Int J Biometeorol 61:1403–1410. https://doi.org/10.1007/s00484-017-1317-1
Oláh M, Molnár L, Dobai J, Oláh C, Fehér J, Bender T (2008) The effects of weightbath traction hydrotherapy as a component of complex physical therapy in disorders of the cervical and lumbar spine: a controlled pilot study with follow-up. Rheumatol Int 28:749–756. https://doi.org/10.1007/s00296-008-0522-y
Ortega E (2016) The “bioregulatory effect of exercise” on the innate/inflammatory responses. J Physiol Biochem 72:361–369. https://doi.org/10.1007/s13105-016-0478-4
Ortega E, Gálvez I, Hinchado MD, Guerrero J, Martín-Cordero L, Torres-Piles S (2017) Anti-inflammatory effect as a mechanism of effectiveness underlying the clinical benefits of pelotherapy in osteoarthritis patients: regulation of the altered inflammatory and stress feedback response. Int J Biometeorol 61:1777–1785. https://doi.org/10.1007/s00484-017-1361-x
Özkuk K, Gürdal H, Karagülle M, Barut Y, Eröksüz R, Karagülle MZ (2017) Balneological outpatient treatment for patients with knee osteoarthritis; an effective non-drug therapy option in daily routine? Int J Biometeorol 61:719–728. https://doi.org/10.1007/s00484-016-1250-8
Özkuk K, Uysal B, Ateş Z, Ökmen BM, Sezer R, Dilek G (2018) The effects of inpatient versus outpatient spa therapy on pain, anxiety, and quality of life in elderly patients with generalized osteoarthritis: a pilot study. Int J Biometeorol 62:1823–1832. https://doi.org/10.1007/s00484-018-1584-5
Paoloni M, Bernetti A, Brignoli O, Coclite D, Fraioli A, Masiero S, Napoletano A, Quirino N, Rengo F, Ruosi C, Viora U, Vitale M, Santilli V (2017) Appropriateness and efficacy of Spa therapy for musculoskeletal disorders. A Delphi method consensus initiative among experts in Italy. Ann Ist Super Sanita 53:70–76. https://doi.org/10.4415/ANN_17_01_13
Pille V, Tuulik VR, Saarik S, Tint P, Vare T, Sepper R (2015) Work-related musculoskeletal symptoms in industrial workers and the effect of balneotherapy. Agron Res 13:820–828
Pittler MH, Karagülle MZ, Karagülle M, Ernst E (2016) Spa therapy and balneotherapy for treating low back pain: meta-analysis of randomized trials. Rheumatology (Oxford) 45:880–884. https://doi.org/10.1093/rheumatology/kel018
Roques C-F, Queneau P (2018) Doleur chronique. In: Queneau P, Roques C (eds) (coord.)La médicine thermale. Données scientifiques. John Libbey Eurotext, Montrouge, pp 147–156
Saeterbakken AH, Nordengen S, Andersen V, Fimland MS (2017) Nordic walking and specific strength training for neck- and shoulder pain in office workers: a pilot-study. Eur J Phys Rehabil Med 53:928–935. https://doi.org/10.23736/S1973-9087.17.04623-8
Schoedinger P (2011) Watsu in aquatic rehabilitation. In: Becker BE, Cole AJ (eds) Comprehensive aquatic therapy, 3rd edn. Washington State University Publishing, Pullman WA, pp 137–153
Stier-Jarmer M, Frisch D, Oberhauser C, Immich G, Kirschneck M, Schuh A (2017) Effects of single moor baths on physiological stress response and psychological state: a pilot study. Int J Biometeorol 61:1957–1964. https://doi.org/10.1007/s00484-017-1385-2
Tenti S, Cheleschi S, Galeazzi M, Fioravanti A (2015) Spa therapy: can be a valid option for treating knee osteoarthritis? Int J Biometeorol 59:1133–1143. https://doi.org/10.1007/s00484-014-0913-6
Türel A, Solak Ö, Dündar Ü, Toktaş H, Demirdal US, Subaşi V, Kavuncu V (2015) Evaluation of the efficacy of spa therapy on pain and quality of life in patients with chronic mechanical neck pain. Arch Rheumatol 30:298–306. https://doi.org/10.5606/ArchRheumatol.2015.5445
Useros AI, Collado S (2010) Effects of an hydrotherapy program in the treatment of cervical dystonia. A pilot study. Rev Neurol 51:669–676
van der Heijden GJ, Beurskens AJ, Koes BW, Assendelft WJ, de Vet HC, Bouter LM (1995) The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods. Phys Ther 75:93–104. https://doi.org/10.1093/ptj/75.2.93
Zão A, Cantista P (2017) The role of land and aquatic exercise in ankylosing spondylitis: a systematic review. Rheumatol Int 37:1979–1990. https://doi.org/10.1007/s00296-017-3829-8
Funding
This study was funded by grant UCM-911757 awarded to the research group of the Universidad Complutense de Madrid (Medical Hydrology).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Corvillo, I., Armijo, F., Álvarez-Badillo, A. et al. Efficacy of aquatic therapy for neck pain: a systematic review. Int J Biometeorol 64, 915–925 (2020). https://doi.org/10.1007/s00484-019-01738-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00484-019-01738-6