1. The use of balneology in prevention of MSD in working age people
V-R.Tuulik1 V.Tuulik 1 , M.Tamm 2, V. Pille³, P. Tint³, M. Tilk1, S. Saarik 1, T. Vare 1
Tallinn University Haapsalu College The Centre of Excellence in Health Promotion and Rehabilitation1,
SPA Laine 2 , Tallinn University of Technology³
Riga 2015

2. An introduction
The work related musculo-skeletal disorders (MSD) affecting the upper body and limbs are now recognized as one of the leading causes of pain and disability in the occupational health.

3. The goal of the study
Repetitive tasks with hands often cause the loss of work capacity in long term practice.
We need good tools to prevent and rehabilitate the musculosceletal overuse disease before the permanent loss of work capacity appears.

4. The impairment in circulation- one of the explanations for musculoskeletal disorders
In static muscles work, when muscle contracts, the intramuscular pressure increases and the blood flow worsens.
Insufficient flow can lead to oxygen deficiency in the muscle and in this way to a number of biochemical processes, that can produce a pain
/Allan Toomingas et al, Occupational Physiology, Published:December 20, 2011 by CRC Press/
An information about the the circulatory system is very valuable because perfusion abnormalities are often an early stage in different malfunctions (eg overuse syndroms)

5. There is a long tradition of using of spa treatment in case of musculosceletal problems.

6. Outpatient mud therapy
The goal of this study is to detect the effect of outpatient mud and spa therapies on the perfusion in the upper limbs in case of the professional overuse.
We are looking for the new health promotion and treatment methods that could help prevent MSDs

7. Purpose of the study
to understand the effects and efficacy of the balneology treatment in the prevention and treatment of the overuse syndromes
of working age persons on the professional overuse of the upper extremities.

8. Materials and Methods
Two factories where the previous work place risk analyses showed the upper extremities overuse for the workers were chosen into the study by the occupational medicine unit.
The study included 85 factory workers with upper extremities professional overuse balneology treatment in outpatient clinic 10 times.

9. Medium and strong pain subgroups
Medium pain subgroup
35 persons (24 F, 10 M),
An average age 53 y
the length of service 18 y
the pain VAS was not more than 5
The average pain VAS was in the
neck 3,
shoulder 3,
elbow 2
hand 3.
Strong pain subgroup
40 persons (33 F, 7 M),
An average age 50 y ,
the length of service 17 y
the pain VAS at least in one of the region more than 5
An average pain VAS was in the
neck 5
shoulder 5
elbow 4,3
arm 6,2.

10. Painfree group and others
In the painfree group: 10 persons (9 woman, 1 man) .
An average age 51, the length of service 15 y
perfusion was quite high already in the beginning and there had not any significant changes after balneology treatment in perfusion measurements

11. Methods
The standardised questionnaires for the musculoskeletal symptoms were used by the occupational medicine doctor to measure the individual level of MS pain of the upper extremities.
Work Ability Index and Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Applied Ergonomics 1987, 18.3,

12. http://www.perimed-instruments.com/ An objective measurements
Perimed laser show us the effect of balnetherapy on the blood circulation in the treated regions/hands.
The perfusion measurements on the forearms with laser Doppler before and in the end of spa treatments were done by the PMR doctor.   
Provocations tests like post occlusive reactive hyperemia (PORH) involves blood perfusion measurements before, during and after occlusion.

13. Table 1. The perfusion in the three groups.
Perfusion before 9 spa therapies
Perfusion after 9 spa therapies
t-test
No pain
287.3
317.3
9.5 %
p< 0.4
Medium pain
(VAS 2-5)
258.9
300.7
14.0 %
p< 0.05
Strong pain
302.0
301.7
p< 0.3

15. Mud therapy group
There were 10 women and 8 men in medium pain group, who passed body mud therapy 9 times.
The average age was 51,6 y., the length of service 31,4 y. And average BMI 28,3.
The perfusion rose 19.1 % , rest flow 20.58% and peak flow 13.74% in the medium pain group after 9th mud therapy

16.  Medium pain group
before 9 mud therapies
after 9 mud therapies
t-test
Perfusion
253.6
313.5
19.1 %
p< 0.04
Rest flow
257.3
324.0
20.6 %
p< 0.01
Peak flow
335.8
389.3
13.7 %
p< 0.02

18. Conclusion
The better understanding of physiological background of the work-related musculoskeletal pain syndrome (e.g. microcirculation status) could help to prevent the musculoskeletal health problems on the workplaces with the ergonomic risks or plan an appropriate treatment for the persons with overuse syndromes.

19. A Centre of Excellence in Health Promotion and Rehabilitation
Mud laboratory
The mission: to promote the research based rehabilitative methods of the working-age population. 
Database on curative mud
Clinical studies
New mud products