Spa Therapy holds significance in history as a cultural, social, recreational and healing pursuit throughout ancient civilisations around the globe. Hippocrates (400BC), known as the Father of Western Medicine proposed that all disease stemmed from the imbalance of bodily fluids, and to restore balance he prescribed a regimen of exercise in nature, bathing in warm mineral water (Balneotherapy), followed by massage with oils.

Bathing has continued to be intertwined with healing, wellness, tourism and travel. The history is a beautiful story of its own. Today there is compelling scientific research to support Mineral Pool Bathing and its benefits to our wellbeing. Thermal Mineral Bathing (and other spa treatments such as muds) show their effects through bodily changes creating adaptive responses in the musculoskeletal, circulatory, autonomic nervous, endocrine and immune system.

Balneotherapy and Musculoskeletal Inflammatory Conditions

In recent decades high quality studies have reported beneficial effects of Balneotherapy (and also Mud Therapy) on conditions such as Osteo-arthritis, Fibromyalgia and some Rheumatic conditions. This research points to the ability for bathing to reduce inflammatory cytokines within the body. Findings have shown that the main clinical outcomes are a reduction in analgesic drug consumption, reduced stiffness and pain and improvements in function and quality of life. Guidelines from the Osteo-arthritis Research Society International state that Balneotherapy is appropriate for Osteo-Arthritis patients with co-morbidities. Combining the thermotherapeutic effects (such as heat shock proteins) and the absorption of minerals permeating through the skin, with the relaxing effect of bathing allowing the body to shift into parasympathetic drive may help explain the neuro-endocrine, immunologic and chondroprotective effects that have been found. (As reviewed By Galvez 2018)

Balneotherapy and Stress

A review by Anonelli and Donelli (2018) looked at 10 studies investigating the effect of balneotherapy and spa therapy on levels of cortisol (a stress biomarker). Their findings suggest that Balneotherapy may improve stress resilience by modulating cortisol levels in both healthy subjects and also in patients with a diagnosed disease. They concluded that Balneotherapy and spa therapies may be considered as a useful intervention for stress conditions and also used as a method to improve the performance and capacity of healthy individuals when faced with increased demands.

Balneotherapy and Sleep

A number of studies have looked at the effects of Thermal Mineral Pool Bathing (Balneotherapy) on Sleep Quality. Sleep is characterised by the total or partial suspension of consciousness and is vital to restoring the body, impacting psycho-physical abilities and health. Sleep experts go on to say that good sleep can transform your life!

A recent study by Rapoline and colleagues (2020), recruited subjects with Musculoskeletal Pain. Some subjects bathed in hot thermal water with different mineral concentrations (20, 40 and 60 g/ L). All groups who bathed in Thermal Mineral Pools (20 mins/ day for 10 days) showed visible and sustainable (at a 2 month follow up) improvements in sleep quality. Concomitantly with sleep, pain and inflammation (CRP) markers also improved in the mineral bathing group. Authors hypothesised that the decreased pain sensitivity with lower inflammatory levels may have been influential in improving sleep quality.

Yang and colleagues (2018), researched the effects of a more extended Balneotherapy protocol, 1-3 immersions lasting 30 minutes for 5 months. There were 223 subjects in the control group and 139 in the intervention group. The subjects chosen to participate in bathing had poorer sleep quality than the control group at baseline. Sleep Quality was assessed on the presence or not of four sleep problems, 1. Difficulty Falling Asleep 2 Easy Awakening, 3. Dreaminess 4. Nightmare Suffering. All four parameters improved significantly in the intervention (bathing) group and they showed better sleep quality than the control group by the end of the protocol.

When reviewing multiple studies, Castelli and colleagues (2022) predicts that the improvements in self perceived sleep quality from Balneotherapy consisting of Thermal Mineral Bathing could be explained by reduced pain, inflammation and stress, better body temperature regulation, and the relaxing atmosphere of the thermal centres (Spa Retreats). All these factors promote balanced cortisol (stress hormone levels) and melatonin (our sleep hormone).

Balneotherapy with Spa Therapies and Sleep

The synergy of Thermal Water Immersion with other Spa Treatments at Spa Retreats has also been studied and reviewed.

Evcik et al (2007) found benefits from Balneotherapy and Mud applications. Again, sleep improved along with pain relief. Furthermore, researches concluded that mud applications could positively influence inflammation (by reducing stress on macrophages and stimulating anti-inflammatory components) and body temperature, two factors involved in sleep regulation.

In addition to physical illness, Balneotherapy and Spa Therapies are often used to alleviate psychological stress. Blasche and colleagues (2010) looked at the impact of a balneotherapy protocol, including massage, bathing in thermal mineral water, hot mudpacks, and relaxation exercise 3-4 treatments per day for 18 days on 65 subjects suffering from occupational burnout. I’m sure it was easy to find subjects for this intervention!! Choose me!! Improving sleep was the main goal of this study since sleep deficiency is a symptom of burnout. Sleep assessed from the Recovery Stress Questionnaire significantly improved after treatment. Subjects were reassessed after 3 months and the effects were sustained even after subjects returned to their occupational workload.

If you ever needed an excuse to visit a Spa Retreat for therapy more often you could refer to this study by Latorre-Romain and colleagues (2015). The study aimed to find a correlation between the frequency of spa visits during the past 3 years (never, 1-2 times, 3-4 times or more than 5 times) and sleep. As you would imagine, the jury has come to clear a verdict, those with a higher frequency of spa use were more likely to show better sleep quality. This was an extensive study with a sample of 3341. Book your next visit to a Spa Retreat now (disclosure writers bias) !!

In conclusion

The biological mechanisms by which immersion in mineral rich water and how it may alleviate symptoms of multiple pathologies or enhance wellbeing are still to be completely revealed. Further studies on objective measures and physiological mechanisms will bring light on this. It is known that Neuro-Endocrine and Immunologic responses to Balneotherapy are involved, leading to a myriad of proven benefits. The synergistic effects of Warm Mineral Pool Bathing along with other modalities offered in a Spa Retreat such as nature, massage, essential oils, mud wraps, steam therapy, seasonal foods, herbal teas, supplements and simply allowing the self to have time to slow down could have profound effects on health and wellbeing.

It may not be possible to visit a Retreat and Spa every week, however taking a holistic approach to health in between visits with good nutrition, exercise in nature, pursuing passions and practising home spa therapy such as baths with mineral salts, body scrubs and self-massage with oils, may be a step towards a healthier more resilient self.


Blasche G., Leibetseder V., Marktl W. (2010). Association of spa therapy with improvement of psychological symptoms of occupational burnout: A pilot study. Forsch. Komplementmed. 17, 132–136

Evcik D., Kavuncu V., Yeter A., Yigit İ. (2007). The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis. Jt. Bone Spine 74, 60–65.

Galvez, Torres Piles and Efuardo, Balneotherapy, Immune System, and Stress Response: A Hormetic Strategy

Rapolienė L., Razbadauskas A., Mockevičienė D., Varžaitytė L., Skarbalienė A. (2020). Balneotherapy for musculoskeletal pain: Does the mineral content matter? Int. J. Biometeorol. 64, 965–979.

Serena Gianfaldoni, Georgi Tchernev, Uwe Wollina, Maria Grazia Roccia Massimo Fioranelli, Roberto Gianfaldoni, Torello Lotti2017 Medical History, History of the Baths and Thermal Medicine Open Access Maced J Med Sci, published on July 23, 2017

Michele Antonelli 1, Davide Donelli 2 2018 Effects of balneotherapy and spatherapy on levels of cortisol as a stress biomarker: a systematic review Int J Biometeorol J2018 un;62(6):913-924.

Latorre-Román P. Á., Rentero-Blanco M., Laredo-Aguilera J. A., García-Pinillos F. (2015). Effect of A 12-day balneotherapy programme on pain, mood, sleep, and depression in healthy elderly people. Psychogeriatrics. 15, 14–19

Lucia Castelli, 1 Letizia Galasso, 1 Antonino Mulè, 1 ,* Andrea Ciorciari, 1 Francesca Fornasini, 2 Angela Montaruli, 1 , 3Eliana Roveda, 1 , 3 , † and Fabio Esposito (2022) Sleep and spa therapies: What is the role of balneotherapy associated with exercise? A systematic review, Front Physiol

Yang B., Qin Q. Z., Han L., Lin J., Chen Y. (2018). Spa therapy (balneotherapy) relieves mental stress, sleep disorder, and general health problems in sub-healthy people. Int. J. Biometeorol. 62, 261–272