2. The use of plain water (tap water) for therapy is called hydrotherapy, and the use of climatic factors for therapy is called climatotherapy. The temperature of thermal water require that the natural spring or welled water is 20 C or higher. The name of Spa may origin from the Belgian town where a thermal spring was discovered in the fourteenth century but may orgin the expression of Salus Per Aquam. The problem in assessing the value of spa therapy is its complexity. Patients receive treatment not only with thermal mineral water but also other modalities such as massage, electrotherapy, and exercise. Balneology has been developed mainly in Roman (France, Italy, Spain, Portugal) in German speaking(Germany, Austria, Switzerlandand and in eastern european (Hungary,Poland, Czech Republic, Romania, Russia and others) countries and in some non european countries like Japon or Israel. Balneotherapy means the use of natural mineral waters, natural peloids and muds, natural sources of different gases (CO2, H2S Radon) for medical purposes: prevention, treatment and rehabilitation.

3. During wellness therapy (used generally by healthy subjects) people spend a short period in a wellness hotel using thermal facilities(and other paramedical or medical treatments) while balneotherapy (or spa treatment??) means a 2 or 3 weeks long lasting cure. For reaching a therapeutical effect, it is reasonable a daily 20-40 minutes immersion with 10-15 consecutive treatments. Head out water immersion(in vertical position to xyphoid) in water(33-35C) may cause lot of physiological changes in the human body(depending on the duration of bath).It is the consequence of the hydrostatic pressure. Besides the hydrostatic pressure other physical factors,such as buyoncy and temeperature play also an important role in physiological changes,such as Cardiac changes, Renal changes, Endocrin changes, Haematological effects, Pnumonological effects.

4. . Balneotherapy can be used as out of head immersion in mineral water, mud, peloid or the therapeutically used gases, bathing, inhalation or taking mineral waters orally as drinking cures. Balneotherapy is an ancient, traditional treatment both in Europe and other parts of the world treating musculoskeletal, gynecological, dermatological, central and peripheral vascular, and other diseases. Lack of scientific evidences ? Search in the medical databases(in Pubmed,Scopus,PEDro) more and more evidences (including reviews and meta analysis) prove the effect of balneotherapy in some locomotor and other diseases by hungarian, turkish,french,italian,japanese and israelian authors. In these countries balneotherapy is an accepted form of treatment. Lack of financial background for further research…

5. It seems that Balneology in Europe is recovering from a certain lethargy state. After a less active period we witnessed lately the publication of quiet a good number of quality papers reflecting more scientific research work. Journal editors are more open to accept balneology articles. International guidelines include now balneology modalities in the therapy of some conditions namely osteoarthritis. Many medical students and young doctors are interested in learning Medical Hydrology. Both healthy and ill people maintain their choice for thermal care. Simultaneously investments appears. New facilities are built. In other cases old units were renewed. Modern equipment is available allowing the development of new balneotherapy techniques. Congresses, seminars and other scientific meetings are now more frequent.

6. Evidence based Balneotherapy in locomotor diseases Osteoarthritis (Knee, Hand ) Rheumatoid Arthrtis Fibromyalgia Low back Pain Spondylarthritis Ankylopeotica Evidence based Balneotherapy in other diseases Dermatology Psychiatry Cardiovascular disorders Gynaecology

7. In many of the of the European Union countries, Balneology integrates the field of PRM or is highly related with its daily practice. The use of water as a natural physical agent or as a mean of body immersion to help kinesiotherapy techniques by buoyancy, hydrostatic pressure or hydrodynamic resistance is widely known. With the approval of the WHO International Classification of Functioning, Disability and Health (ICF) in 2001, the relevance of the “Contextual Factors” (both personal and environmental) in the development of a defined health condition was definitively recognized. These personal and environmental factors interact with the considered domains of the ICF Model (Body Structures and Function, Activities and Participation) and determine the true “state of health”. If we think of the Balneology principles, we immediately may link them with the ICF model. In fact, probably there is no better example of interaction of our body structures and functions with the environment that what happens in a thermal spa ambience. In such an “environment” that interaction may lead to an increment of “activities” and facilitate “participation”.

8. Circumstantial factors such as specific climate characteristics (temperature, humidity, winds), geographic influence (altitude and atmospheric pressure, sun radiation exposure), thermal water treatments, adequate health behaviour and social interaction, may modify the final results of a therapeutic strategy allowing better outcomes. For these reasons we conclude that there are a lot of common aspects between PRM and Balneology. Facing this reality PRM has taken Balneology in consideration and implement its scientific research, good practice and education. In the framework of European UEMS a “Balneology subdivision” chaired by Prof. Tamás Bender has been established. The main goals are: to implement scientific knowledge, to improve clinical practice and to spread balneology care to our patients. Facing very different realities among the European countries it is of crucial relevance to know the situation of each one of them and to look for the establishment of international standards as a tool for a good quality level of medical care.

9. The situation of Balneotherapy in Europe: a survey In 27 of the 35 countries Balneology exists as a medical practice – 77%. Balneology and/or Medical Hydrology is officially recognized by authorities in more than 2/3 of the countries.. In at least 60% of the countries Balneology is part of the undergraduate medical education in at least 60% post-graduate courses exist. Balneology and Medical Hydrology is still widely used in Europe and is part of the medical system (both on the level of medical specialties and the health insurance systems). Medical spa units using thermal water for therapeutic purposes exist in 77% a reimbursement of costs by health insurances is possible in 72% of the countries Research units exist in 54% of the countries The collected data of the survey show a significant medical activity within the field of balneology. There is a clear geographic distinction on balneology activity. Main regions being the south of Europe and the east countries.

10. Conclusion The available evidences suggest that balneotherapy is a useful method in rehablitation medicine. The number of published articles gradually grows but still there is a lot of methological deficiency. Therefore a coordinated further scientific work is needed.

11. And what about Balneology in GREECE???We have to join forces between Medical and Balneology and arrive to a successful MEDICAL BALNEOTHERAPY