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Journal of Chinese Integrative Medicine ›› 2013, Vol. 11 ›› Issue (1): 17-25.doi: 10.3736/jintegrmed2013004

• Research Article • Previous Articles     Next Articles

A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis: A pilot trial

Martin Schencking(), Stefan Wilm, Marcus Redaelli   

  1. Institute for General Practice and Family Medicine, University Witten/Herdecke, 58448 Witten, Germany
  • Received:2012-05-26 Accepted:2012-07-18 Online:2013-01-10 Published:2013-01-15


An increasingly aging population implies an increasing prevalence of osteoarthritis (OA) of hip or knee. It has been ascertained that unspecific hydrotherapy of OA according to Sebastian Kneipp not only improves the range of mobility but also reduces pain significantly and increases the quality of life of the patients affected. 


The main aim of this pilot study was to determine the effects of hydrotherapy in comparison to conventional physiotherapy, and to analyze the feasibility of the study design under clinical circumstances.

Design, Setting, Participants and interventions

The study design is a prospective randomized controlled three-arm clinical pilot trial, carried out at a specialist clinic for integrative medicine. Thirty patients diagnosed with symptomatic OA of hip or knee and radiologic findings were randomly assigned to one of two intervention groups and a control group: hydrotherapy (group 1), physiotherapy (group 2), and both physiotherapy and hydrotherapy (group 3, control group) of the affected joint.

Main Outcome Measures

Primary outcome: pain intensity of the affected joint in the course of inpatient treatment; secondary outcome: health-related quality of life, joint-specific pain and mobility in the course of the study. 


Concerning the main outcome, intervention group 1 showed most beneficial effects in the course of inpatient treatment, followed by groups 3 and 2, and also the indirect flexion ability of hip or knee together with the general patient mobility through the “timed up and go” test were mainly improved within group 1 followed by groups 3 and 2. 


The results of this pilot study demonstrate beneficial effects of hydrotherapy. The study design is feasible. For statistically significant evidence and a robust conclusion of efficacy of Kneipp’s hydrotherapy, a larger sample size is necessary.

Trial Registration Number

NCT 00950326.

Key words: Hydrotherapy, Physical therapy, Osteoarthritis, Pain measurement, Pilot study

Figure 1

Alternate thigh affusions according to Kneipp — flow direction (repeated cold/warm water stimulation)The thigh affusion is poured starting from the back of the foot up the outer aspect of the back of the leg, slowly over the buttocks (“starting away from the heart going towards the heart”), from there moving to the front aspect of the leg, lingering in the groin, and finally pouring the water over the inner aspect of the leg downwards."

Figure 2

Flowchart of the recruitment process"






[1] Buckwalter JA, Saltzman C, Brown T . The impact of osteoarthritis: implications for research. Clin Orthop Relat Res. 2004; ( 427 Suppl):S6-S15.
[2] Aigner T, Rose J, Martin J, Buckwalter J . Aging theories of primary osteoarthritis: from epidemiology to molecular biology[J]. Rejuvenation Res, 2004,7(2):134-145
doi: 10.1089/1549168041552964
[3] Lohmander LS , Gerhardsson de Verdier M, Rollof J, Nilsson PM, Engstrm G.Incidence of severe knee and hip osteoarthritis in relation to different measures of body mass: a population-based prospective cohort study[J]. Ann Rheum Dis, 2009,68(4):490-496
doi: 10.1136/ard.2008.089748
[4] Bijlsma JW, Knahr K . Strategies for the prevention and management of osteoarthritis of the hip and knee[J]. Best Pract Res Clin Rheumatol, 2007,21(1):59-76
doi: 10.1016/j.berh.2006.08.013
[5] Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P . OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence[J]. Osteoarthritis Cartilage, 2007,15(9):981-1000
doi: 10.1016/j.joca.2007.06.014
[6] Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP, Hauselmann HJ, Herrero-Beaumont G, Jordan K, Kaklamanis P, Leeb B, Lequesne M, Lohmander S, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Swoboda B, Varatojo R, Verbruggen G, Zimmermann-Gorska I, Dougados M; EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT).EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics(ESCISIT)[J]. Ann Rheum Dis, 2005,64(5):669-681
doi: 10.1136/ard.2004.028886
[7] Leardini G, Mascia MT, Stisi S, Sandri G, Franceschini M . Sanitary costs of osteoarthritis[J]. Reumatismo, 2001,53(4):316-322
[8] Solignac M . COART France 2003 report on new socioeconomic data on osteoarthritis in France[J]. Presse Med, 2004,33(9 Pt 2):S4-S6
[9] Zochling J, March L, Lapsley H, Cross M, Tribe K, Brooks P . Use of complementary medicines for osteoarthritis — a prospective study[J]. Ann Rheum Dis, 2004,63(5):549-554
doi: 10.1136/ard.2003.010637
[10] Biggee BA , McAlindon T.Glucosamine for osteoarthritis: part I, review of the clinical evidence[J]. Med Health R I, 2004,87(6):176-179
[11] Ernst E . Complementary and alternative medicine in rheumatology[J]. Baillieres Best Pract Res Clin Rheumatol, 2000,14(4):731-749
doi: 10.1053/berh.2000.0110
[12] Bartels EM, Lund H, Hagen KB, Dagfinrud H, Christensen R , Danneskiold-Samse B.Aquatic exercise for the treatment of knee and hip osteoarthritis[J].Cochrane Database Syst Rev, 2007,(4):CD005523
[13] Verhagen AP, Bierma-Zeinstra SM, Cardoso JR, de Bie RA, Boers M , de Vet HC.Balneotherapy for rheumatoid arthritis[J].Cochrane Database Syst Rev, 2003,(4):CD005518
[14] Brosseau L, Yonge KA, Robinson V, Marchand S, Judd M, Wells G , Tugwell P.Thermotherapy for treatment of osteoarthritis[J].Cochrane Database Syst Rev, 2003,(4):CD004522
[15] Fransen M , McConnell S.Exercise for osteoarthritis of the knee[J].Cochrane Database Syst Rev, 2008,(4):CD004376
[16] Katz P, Lee F . Racial/ethnic differences in the use of complementary and alternative medicine in patients with arthritis[J]. J Clin Rheumatol, 2007,13(1):3-11
doi: 10.1097/01.rhu.0000255579.59597.d2
[17] Doering TJ, Thiel J, Steuernagel B, Johannes B, Konitzer M, Niederstadt C, Schneider B, Fischer GC . Changes of cognitive brain functions in the elderly by Kneipp therapy[J]. Forsch Komplementarmed Klass Naturheilkd, 2001,8(2):80-84
[18] Goedsche K , Frster M, Kroegel C, Uhlemann C.Repeated cold water stimulations(hydrotherapy according to Kneipp) in patients with COPD[J]. Forsch Komplementmed, 2007,14(3):158-166
[19] Franke K . The value of minor hydrotherapy(Kneipp method) for the prevention and rehabilitation of arthritis and vascular collagen diseases[J]. Hippokrates, 1961,32:92-94
[20] Koeppen S, Kostka F . Hydrotherapy of cardiovascular diseases in the hospital and in practice(Kneipp therapy)[J]. Med Klin, 1960,55:185-188
[21] Koeppen S, Kostka F . Kneipp therapy of cardiovascular diseases in clinics[J]. Hippokrates, 1959,30(5):201-205
[22] Ring J, Teichmann W . Immunological changes during hydrotherapy[J]. Dtsch Med Wochenschr, 1977,102(45):1625-1630
doi: 10.1055/s-0028-1105548
[23] Kreutzfeldt A, Albrecht B, Müller K . Einfluβ des Wassertretens nach Kneipp auf die immunregulation[J]. Phys Med Rehab Kuror, 2003,13(4):208-214
doi: 10.1055/s-2003-41367
[24] Bachmann RM, Schleinkofer GM . Nat rlich gesund mit Kneipp. Stuttgart: Thieme. 2000.
[25] Lange AK, Vanwanseele B, Fiatarone Singh MA . Strength training for treatment of osteoarthritis of the knee: a systematic review[J]. Arthritis Rheum, 2008,59(10):1488-1494
doi: 10.1002/art.v59:10
[26] Bulthuis Y, Mohammad S, Braakman-Jansen LM , Drossaers-Bakker KW, van de Laar MA.Cost-effectiveness of intensive exercise therapy directly following hospital discharge in patients with arthritis: results of a randomized controlled clinical trial[J]. Arthritis Rheum, 2008,59(2):247-254
doi: 10.1002/(ISSN)1529-0131
[27] Jamtvedt G, Dahm KT, Christie A, Moe RH, Haavardsholm E, Holm I, Hagen KB . Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews[J]. Phys Ther, 2008,88(1):123-136
doi: 10.2522/ptj.20070043
[28] Schencking M, Otto A, Deutsch T, Sandholzer H . A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis of the hip or knee: protocol of a prospective randomised controlled clinical trial[J]. BMC Musculoscelet Disord, 2009,10:104
doi: 10.1186/1471-2474-10-104
[29] Zwarenstein M, Treweek S, Gangier JJ, Altmann DG, Tunis S, Haynes B, Oxman AD, Moher D . Improving the reporting of pragmatic trials: an extension of the CONSORT statement[J]. BMJ, 2008,337:a2390
doi: 10.1136/bmj.a2390
[30] Collins SL, Moore RA , McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain. 1997; 72(1-2): 95-97. German.
doi: 10.1016/S0304-3959(97)00005-5
[31] Maxwell C . Sensitivity and accuracy of the visual analogue scale: a psycho-physical classroom experiment[J]. Br J Clin Pharmac, 1978,6(1):15-24
doi: 10.1111/j.1365-2125.1978.tb01676.x
[32] Lequesne M . Clinical and roentgenologic follow-up of hip and knee arthrosis — methods and results[J]. Z Rheumatol, 1994,53(4):243-249
[33] Grimmig H, Melzer C, Ludwig FJ, Daalmann HH . Using the Lequesne questionnaires for patients with hip and knee disabilities in daily routine to reflect the quality of outcome in rehabilitation[J]. Z Orthop Ihre Grenzgeb, 2002,140(4):452-459
doi: 10.1055/s-2002-33399
[34] Maurischat C , Ehlebracht-Knig I, Kühn A, Bullinger M.Structural validity of the Short Form 36(SF-36) in patients with rheumatic diseases[J]. Z Rheumatol, 2005,64(4):255-264
doi: 10.1007/s00393-005-0676-x
[35] Bullinger M. Assessment of health related quality of life with the SF-36 Health Survey. Rehabilitation (Stuttg). 1996; 35(3): XVII-XXVII; quiz XXVII-XXIX.
[36] Botolfsen P, Helbostad JL, Moe-Nilssen R, Wall JC . Reliability and concurrent validity of the Expanded Timed Up-and-Go test in older people with impaired mobility[J]. Physiother Res Int, 2008,13(2):94-106
doi: 10.1002/(ISSN)1471-2865
[37] Arnold CM, Faulkner RA . The history of falls and the association of the timed up and go test to falls and near-falls in older adults with hip osteoarthritis[J]. BMC Geriatr, 2007,7:17
doi: 10.1186/1471-2318-7-17
[38] Elders MJ . The increasing impact of arthritis on public health[J]. J Rheumatol Suppl, 2000,60:6-8
[39] Zentralinstitut für die Kassenrztliche Versorgung in Deutschland (ZI). ADT-Panel 2008. Berlin, 2009.
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