The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis

One of the few trials that tests balneotherapy and mud-pack therapy side by side against the same control. Published in Joint Bone Spine, this three-arm RCT is valuable precisely because it can distinguish the contribution of immersion (balneotherapy) from topical application (mud-pack) — two delivery routes that are often grouped together in reviews but deliver peat bioactives differently.

Study Design

80 patients with knee osteoarthritis were randomized into three groups:

• Balneotherapy (n=25) — immersion in peloid bath
• Mud-pack (n=29) — topical peat pack applied to the knee
• Hot-pack control (n=26) — heat only, no bioactive content

All groups received 10 sessions, 20 minutes each, once daily, 5 days per week over 2 weeks. This matched protocol isolates the effect of the peat itself rather than differences in treatment intensity.

What Was Measured

• Pain: VAS (Visual Analogue Scale) and WOMAC pain subscale
• Function: WOMAC functional capacity and global index
• Quality of life: Nottingham Health Profile (NHP)

Using three independent instruments for pain and function strengthens confidence in the findings.

Key Findings

Both the balneotherapy group and the mud-pack group showed significant improvements in pain, functional capacity, and quality of life compared to the hot-pack control group. Neither peat-based treatment was clearly superior to the other — both outperformed heat alone. This is the central result: whether you immerse a joint in peat or apply a peat pack topically, the outcome in knee OA exceeds what heat alone achieves.

What It Adds to the Evidence Base

Most mud/peat therapy trials test a single delivery method. This trial’s three-arm design confirms that the chemical benefit of peat is not delivery-route-specific — it manifests whether peat contacts the skin through immersion or direct pack application. That finding is relevant to product development: topical peat products can legitimately claim the same mechanism as clinical balneotherapy, even if the intensity differs.