Definition of crenotherapy 

Crenotherapy is the scientific term for treatment with thermal spring water, or hydrotherapy. It is based on the use, for therapeutic purposes, of the alleged chemical or physical properties of these thermal waters.

In France, there are more than 700 mineral water sources whose virtues are recognized by the Academy of Medicine.

The main principles of crenotherapy

Crenotherapy takes advantage of the therapeutic benefits of natural mineral waters. Coming from aquifers or underground deposits, this water has a specific chemical composition in bicarbonates, sulphides, sulphates, minerals (calcium, magnesium, sodium, potassium), halogens (bromine, iodine, fluorine, etc.), metalloids (trace elements) and radioactive elements, as well as a temperature which gives them therapeutic virtues. Depending on its composition, thermal water is used for its decongestive, anti-inflammatory, anti-oedomatous, relaxant, sedative, healing action, etc. 

Thermal water is available in different forms – water, steam, mud, gas – so that the curist can benefit from the so-called crenotherapeutic agents via the cutaneous, digestive and / or respiratory tracts, through different hydrotherapy treatment techniques. :

• penetrating showers (sweeping the body with a fine jet of thermal water), jet showers (high pressure thermal water jet, directed by a hydrotherapist), filiform showers (very fine jets);
• baths, immersion shower baths, aerobics (sweeping the body by fine jets of pressurized air, immersed in a thermal water bath);
• mud wraps;
• dry massages or under thermal water;
• inhalations, aerosol therapy, gargles, nebulizations;
• steam in an oven;
• drink cures.

The therapeutic orientations of crenotherapy

Depending on their chemical composition and method of administration, thermal waters act on pain, muscle relaxation, joint and dermal flexibility, the respiratory system or overall, mental and physical health. Different orientations have thus been defined for thermal cures:

• rheumatology: chronic low back pain, cruralgia, discophaties, osteoarthritis, ankylosing spondylitis, rheumatoid arthritis, fibromyalgia, neck pain, sciatica, scoliosis, sequelae of osteoporotic fracture, tendonitis, chronic musculoskeletal disorders;
• digestive disorders and metabolic diseases: overweight, obesity, diabetes or irritable bowel syndrome;
• urinary and metabolic diseases: recurrent cystitis, lithiasis, urinary tract infections;
• dermatology: scar and after-effects of burns, atopic dermatitis, psoriasis, erythrosis, ichthyosis, lichen planus, after-effects of cancer treatments, following plastic surgery and reconstruction;
• gynecology: endometriosis, chronic pelvic pain, dysmenorrhea, menopause, sequelae of uterine and ovarian cancer;
• psychosomatic disorders: generalized anxiety disorder, moderate reactive depression, burn-out, relationship disorders of fibromyalgia, sleep disorders, addiction to benzodiazepines;
• cardio-arterial diseases: Raynaud’s syndrome, obliterating arterial disease of the lower limbs (PAD);
• neurology: Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, sequelae of stroke;
• phlebology: chronic venous affections, lymphedema, following phlebitis;
• oral mucosal disorders: recurrent aphtosis, lichens, bruxism, gingivitis, oral sequelae of cancer treatments

Each spa is approved by Social Security for one or more of these indications, after strict water controls.

Studies on the benefits of crenotherapy

Scientific research around crenotherapy is very active. Recent studies have confirmed the actual benefit (SMR) of crenotherapy in different indications:

• the Maâthermes study demonstrated the SMR of spa treatment in the management of overweight and obesity and its effectiveness in comparison to usual treatments;
• the Thermarthrosis study demonstrated the SMR of spa treatment in the treatment of osteoarthritis of the knee;
• the Stop-Tag study demonstrated the effectiveness of psychosomatically oriented hydrotherapy in generalized anxiety disorders compared to the reference molecule, paroxetine;
• the Rotatherm study demonstrated the AB of crenotherapy in the treatment of rotator cuff tendinopathies of the shoulder;
• the Therm & veins study demonstrated the AB of thermal therapy in the treatment of venous insufficiency.

The specialist

The spa treatment is prescribed by the attending physician or specialist physician. It is reimbursed by Social Security. It must be carried out in a spa having approval for orientation, or both orientations if it is a dual-orientation cure.

Spa treatments are prescribed by the spa doctor at the start of the treatment. The curist benefits from multidisciplinary medical monitoring: doctor, hydrotherapist, nurse, physiotherapist, dietitian, etc. 

Course of a spa treatment

A thermal cure reimbursed by Social Security lasts 18 days.

Thermal treatments are generally concentrated over half a day. The rest of the time, the curist can participate in activities and workshops around the resumption of a physical activity, diet, stress management, etc. 

Health education is indeed an important axis of thermal cures, and this comprehensive care actively contributes to the actual benefit of hydrotherapy. It is a question of knowing better its pathology and of acquiring the gestures to live it better on a daily basis. More and more, spas are thus setting up therapeutic prevention programs approved by regional health agencies (ARS).

Contraindications 

There are a number of general contraindications to crenotherapy:

• severe changes in general condition or debilitating conditions;
• severe heart failure, labile arterial hypertension;
• venous insufficiency (contraindication to hot water balneotherapy);
• unhealed skin lesions (wounds, bedsores, eczema);
• contagious or progressive diseases;
• recent cancers.

Other contraindications are specific to the direction of the treatment. In rheumatology, for example, it may be an inflammatory outbreak or an ongoing immunomodulatory or immunosuppressive treatment.

Crenotherapy dates back to High Antiquity. The Greeks then considered these thermal waters to be divine. 

It is then the turn of the Romans to adopt this practice, and to extend it to all the conquered territories. Mineral water is already used in different forms: baths, ovens, fumigations, showers, poultices, mud baths. At the same time, the thermal baths become real places of socialization. 

Under the influence of the Church, which did not take a favorable view of the pagan, even carnal, character of these thermal baths, the baths were rarely visited during the Middle Ages. During the Renaissance, medicine was again interested in the therapeutic benefits of thermal water. Under Henri IV, in 1605, the General Superintendence of the Baths and Fountains of the Kingdom was created. Research continued under Louis XV, and during the Revolution, the thermal baths experienced a real boom with this project: to provide free care to the indigent and wounded soldiers.

The Second Empire and the Third Republic mark the true golden age of hydrotherapy.

In 1919, the French Thermal Federation was created. In 1947, thermal cures were recognized by Social Security.