It is a delight to read research that adds scientific understanding to something that one instinctively thinks is correct, and then poses a great many more questions. Such is the experience of reading the report by Mosti and colleagues1 on the effects of hydrostatic pressure on leg venous haemodynamics.
In ancient Greece and Rome, the restorative powers of Balneotherapy (treatments involving water) and Thalassotherapy (treatments involving seawater) were well known, and the use of private and public baths was widespread.2
In more modern times, the beneficial effects of Balneotherapy for chronic venous insufficiency have been demonstrated,3 but few have investigated the underlying science. Apart from one report from 1967 that has proved impossible for the reviewer to track down,4 there appears to be no modern scientific study into this area, until this group published their ultrasound findings of how leg veins changed when standing in water compared with air.5
Therefore, this paper by Mosti and colleagues is welcome and illuminating. They have shown that calf volume when standing in water, as measured by strain gauge plethysmography, is less than when lying supine out of water. Also, that standing in water virtually collapses the superficial veins, hence reducing the volume, and most interestingly, a further reduction in volume on walking in water. This measurable ejection fraction, even when the superficial veins are almost closed, shows that the deep veins must maintain a significant blood volume, when standing in water.
As with all great studies, this report poses even more questions. For instance, is there any accommodation in the venous system after being in the water for 30 minutes or more? Do different water temperatures have any effect? What difference does the specific gravity of the water make, if changed by the addition of minerals and salts? What is the effect on local tissues in patients with fasciocutaneous inflammation secondary to chronic venous insufficiency, and is any effect maintained after emerging from the water?
I am certain that answers to these and many other questions will be found and interest in Balneotherapy for chronic venous disease will be re-ignited. Moreover, future findings may lead to the development of innovative products and treatments for patients with chronic venous disease.
References
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