BANGALORE KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

JOMON JOY
1 year M.Sc (Nursing)
MASTER IN MEDICAL-SURGICAL NURSING
YEAR 2009-2010
St

CAUVERY COLLEGE OF NURSING

# 42/2B, 2C, TERESIAN CIRCLE
SIDDARTHA LAYOUT
MYSORE.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

NAME OF THE CANDIDATE

AND ADDRESS

JOMON JOY
1st YEAR M.SC NURSING,
CAUVERY COLLEGE OF NURSING,
MYSORE.

NAME OF THE INSTITUTION

CAUVERY COLLEGE OF NURSING,

MYSORE.

COURSE OF THE STUDY

AND SUBJECT

MASTER IN NURSING,
MEDICAL SURGICAL NURSING

DATE OF ADMISSION TO
COURSE

15.06.2009
2

TITLE OF THE STUDY

EVALUATE THE EFFECTIVENESS OF

EPSOM SALT HOT APPLICATION
ON
JOINT PAINAMONG THE ELDERLY IN
SELECTED AREAS OF MYSORE

5.1

STATEMENT OF THE
PROBLEM

A STUDY TO EVALUATE THE

EFFECTIVENESS OF HOT WATER
APPLICATION WITH EPSOM SALT
AND PLAIN WATER AMONG OLD
AGE WITH JOINT PAIN AT
SELECTED AREAS AT MYSORE

6. BRIEF RESUME OF THE INTENDED WORK

3

6.1 INTRODUCTION
The medical surgical nursing, one of the major branch of dealing with all
the adult health problems. Most of the adult health problem manifested through
pain .The article 2008 reported especially the pain is the major symptom of most
musculoskeletal disorders. The pain may be mild or severe, local or diffuse,
depending on where the injury occurred. Although pain may be acute and shortlived, as is the case with most injuries, pain may be ongoing with chronic
illnesses, such as arthritis. 1
Crook J, Rideout E, Browne G in 1984 reported that almost all joint injuries
and diseases produce a stiff, aching pain, often referred to as "arthritis" pain. The
prevalence of persistent pain increases with age. 2 The old age is a incurable
diseases. In old age physiological process aging produces many changes in our
body. These changes produce health problems and disabilities. Among the
disabilities the problem in loco motor function makes the old age person slow,
4

immobile and falls. The joint pain in old age mainly associated with osteoarthritis,
gout, joint stiffness and injuries.1
Yung R 2001 reported that osteoarthritis is primarily due to the high
incidence of osteoarthritis in the elderly. The socio-economic burden of this
disease is substantial. Knee osteoarthritis, a problem that is much more
prevalent in India than in the West, accounts for at least as much disability as
any other chronic conditions including congestive heart failure, diabetes, heart
disease, chronic obstructive airway disease or depression. 3
Hutton CW in 1996 explained that Primary osteoarthritis (OA) is almost a
disease of elderly population while secondary osteoarthritis e.g. Pagets disease,
osteopetrosis etc. can affect any age. OA presents as loss of cartilage and
accompanying periarticular bone response. Age related changes in articular
cartilage are distinct from those of OA, but give clues to increasing susceptibility

of cartilage to damage in old age.4

Osteoarthritis was earlier described as a disease of wear and tear, a
degenerative disorder but recent advances show that it represents a dynamic
process, which involves uncoupling of balance between cartilage degeneration
and regeneration. Changes in cartilage in osteoarthritis some what differs from
normal aging changes. It usually presents as joint pain with structural changes,
crepitus, bony enlargements, deformity, instability and restriction of movements
may occur. Associated muscular weakness and wasting may also occur. Morning
stiffness is a common complaint but brief in duration usually 5-15 minutes but not
exceeding 30 minutes. It is seen most commonly in clinical practice usually one
of the compartments of knee joint bears the brunts of attack of the disease,
obesity and female sex are common risk factors.4Although there is no known
cure for most forms of arthritis, treatment designed for individual patient can
reduce/eliminate symptoms and limit functional impairment. The goals of
contemporary management of arthritis extend beyond pain control to the
6

enhancement of patients functional status and health-related quality of life(

Chaturvedi VP 2001).
Since elderly patients are more prone to develop complications of Non
steroidal anti-inflammatory drugs, physicians should be careful in selecting proper drugs
on individual basis looking into the cost, efficacy and toxic profile. However,
paracetamol may be tried initially as an analgesic in osteoarthritis. Other NSAIDs can
be used especially newer selective cyclooxygenase II (Cox-II) inhibitors. Locally applied
NSAIDs are also useful but the drugs have severe side effects.5
The article from the home remedies for arthritis reported in 2005 that:
Boswellia serrata also known as shallaki improves blood circulation and relieves
joint painandswelling, take 5 grams of Ashwagandha powder twice a day with
lukewarm water, guduchi juice is also beneficial in relieving joint pain,
take bath with Epsom salt warm water. it will relieve joint pains, strengthen
bones, and improves blood circulations, some common herbs used in arthritis are
7

Saunth (dried ginger), guduchi (Tinospora cordifolia), rasna, errand (ricinus

communis), shallaki (boswellia serrata) and guggulu (commiphora mukul)

21

Non-pharmacological treatment includes the patient education regarding

joint protection and avoidance of excessive joint loading is important for these patients.
Physical measures like hot pack, paraffin bath, clove oil massage, topical application of
goggalu

6.2 NEED FOR THE STUDY

Srivastava in 2007 reported that the elderly (people above the age of 60
years) comprise 7.5 percent of Indias total population, and making health care
available and accessible to them is one of the health priorities of the country. 6
The epidemiological data on health problems in elderly reported that in
2007 as follows: Poor Vision (45.4%), Hypertension ( 38.2%), Arthritis ( 36.1%),
Bowel complaints ( 31.6%), Depression ( 23.6%), Difficulty in Hearing ( 20.5%),
8

Weight Loss (19.6%), Anaemia (16.8%), Urinary complaints (13.4%), Diabetes

(13.3%), Fall ( 8.7%),
IHD ( 7.7%), Asthma ( 6.6%), COPD ( 4.8%), and Tuberculosis (3.1%) were the
common health problems highlighted by the study.6
According to the findings of the 60th National Sample Survey Round in
2006 reported that, the proportion of aged persons who cannot move and are
confined to their bed or home ranges from 77 per 1000 in urban areas to 84 per
1000 in rural areas Morbidity7. It is currently estimated that adults over 60 years
make up 8 per cent of India's population and by 2021 that number will be 137
million. India now has the second largest aged population in the world. The
small-family norm means that fewer working, younger individuals are called upon
to care for an increasing number of economically unproductive, elderly persons.
In India 75% population living in the rural ares. 7

Shanthi G.S in 2005 conducted the prospective study evaluated among

100 patients above 60 years with falls a comprehensive geriatric assessment
including detailed history of fall, ADL using Barthel index, underlying medical
disorders, and medication history was elicited. Examination included assessment
of all the system. Results show that the 100 patients, 68% were females. Among
the causes for falls, intrinsic causes for falls were more prevalent in people >70
years. Among the medical conditions causing falls, musculoskeletal problems
(72%) and visual defects (54%) were common. 46% had 3 or more risk factors
for falls. Drug induced falls accounted for 42% of which 20% were due to
sedatives. Conclusion shows that Falls due to intrinsic causes such as joint pain
and recurrent falls were common in people >70 years. Of the medical conditions
predisposing to falls, musculoskeletal problems and visual defects were
common.9
Mathur.A2007 reported that home health service, entailing home visits to
detect health problems and also, a community-based health centre for the aged
10

for educational and preventive activity will be initiated. This will be integrated with
the National Rural Health Mission and an allocation made specifically for geriatric
care. The Accredited Social Health Activist (ASHA) will be trained in geriatric care
and the out-patient medical service, which serves as the base for home health
service, will be enhanced. One of the aspects of home health service for the
geriatrics is health education about the home remedies.

10

The study conducted by Brosseau L, Yonge KA, Robinson V et.al in 2003

to determine the effectiveness of thermotherapy in the treatment of OA of the
knee. The outcomes of interest were relief of pain, reduction of edema, and
improvement of flexion or range of motion (ROM) and function. Two independent
reviewers selected randomized and controlled clinical trials with participants with
clinical and/or radiological confirmation of OA of the knee; and interventions
using heat or cold therapy compared with standard treatment and/or placebo.
The results shows that three randomized controlled trials, involving 179 patients,
were included in this review. In one trial, administration of 20 minutes of ice
massage, 5 days per week, for 3 weeks, compared to control demonstrated a
11

clinically important benefit for knee OA on increasing quadriceps strength (29%

relative difference) and another trail with hot application. There was also a
statistically significant improvement. Result showed that cold packs decreased
knee edema. The thermotherapy reduces the pain. The study concluded that
more well designed studies with a standardized protocol and adequate number of
subjects is needed to evaluate the effect of thermotherapy in the treatment of OA
of the knee.11
Applying the heat by general or local which produce the physiological
change in the body such as vasodilatation and relaxation of muscles which
produce the beneficial therapeutic effect of relieving the pain.
In the hot water application for the joint pain is Epsom salt hot water bath
very effective in the treatment of joint pain. Epsom salt can act topically and
immediately reduce the pain in joint. The 200 mg of Epsom salt mixed in hot
water the painful joints can be bathed for 20 mins .It can be used for thrice a
week. It is very effective to relieve morning stiffness in joints (html- Cached- Sim
updated 2006)1
12

From the above review and by the researcher's own observation, the
researcher found that the hot water application is very effective in relieving pain
in the joints. Very few studies supporting the benefit of Epsom salt hot water
application. In this study the

investigator plan to conduct the study to evaluate

the effectiveness of Epsom salt hot water application and plain hot water
application for joint pain.

6.3 STATEMENT OF THE PROBLEM

A study to evaluate the effectiveness of hot water application with Epsom salt
and plain water among old age with joint pain at selected areas at Mysore.

6.4 OBJECTIVES
1. Assess the pre test level of pain in both experimental and control
group.
13

2. Evaluate the effectiveness of Plain and Epsom salt hot application

by comparing the pretest and post test scores of pain in both
experimental and control group.
3. Associate the post test level of pain among experimental group and
control group with selected socio demographic variables such as
age, sex, occupation, duration of illness, using other home
remedies.

6.5 HYPOTHESES
1. There is a significant mean difference in the pretest pain score
and posttest among experimental group.
2. There is a significant mean difference in the pretest pain score
and posttest among control group.
3. There is a significant mean difference in the post test pain score
between experimental group and control group.

14

4. There is a significant association between experimental group and

control group with their demographic variables such as age, sex, occupation,
duration of illness, using other home remedies

6.6 OPERATIONAL DEFINITIONS

1. Evaluate: Measure the level of joint pain before and after the hot
applications
2. Effectiveness: Outcome of the intervention measured with numerical
pain scale.
3. Plain Hot Water Application: Applying the heat by local which produce the
physiological change in the body such as vasodilatation and relaxation of
muscles which produce the beneficial therapeutic effect of relieving the joint
pain.
4. Epsom Salt Hot Water Application: Epson salt is the one of the home
remedy which is rich in magnesium. This is very helpful for relieving the joint
pain.
15

5. Joint Pain- discomfort of the joints due to stiffness of the joint, tendons,
ligaments and muscles. It may be due to degenerative disease of the joint that is
Arthritis
6. Elderly: Those who fall in the age group of 60 years and above.

6.7 ASSUMPTION
1. Hot application relives pain, inflammation and congestion.
2. Epsom salt has analgesic properties.
3. Epsom salt easy to avail in low cost

6.8 DELIMITATION
1. The sample size is limited to 60 elderly person
2. Prescribed data collection period is only 4 to 6 wks.

6.9 CONCEPTUAL FRAME WORK

16

The Ludwig Open system model planned for the conceptual framework.
The components are input, throughput and output.
1. The input describes the sample characteristics and existing health
condition.
2. Through put describes the intervention.
3. The output refers to the outcome of the intervention.

6.10 REVIEW OF LITERATURE

Review of literature is key step in research process. Review of
literature refers to an extensive, exhaustive and systemic examination of
publications relevant to the research project. Review of literature is
defined as a broad, comprehensive in-depth, systematic and critical
review of scholarly publications, unpublished scholarly print materials,
audiovisual materials and personal communications.
The review of literature will discussed based on the following headings:
17

1) Studies related to joint pain in elderly

Bartels EM, Lund H, Hagen KB, 2007,The coherent study conducted to
compare the effectiveness and safety of aquatic-exercise interventions in the
treatment of knee and hip osteoarthritis. Results show that there is a lack of highquality studies in this area. In total, six trials (800 participants) were included. At
the end of treatment for combined knee and hip osteoarthritis, there was a smallto-moderate effect on function (SMD 0.26, 95% confidence interval (CI) 0.11 to
0.42) and a small-to-moderate effect on quality of life (SMD 0.32, 95% CI 0.03 to
0.61). A minor effect of a 3% absolute reduction (0.6 fewer points on a 0 to 20
scale) and 6.6% relative reduction from baseline was found for pain. Aquatic
exercise appears to have some beneficial short-term effects for patients with hip
and/or knee OA while no long-term effects have been documented. Based on
this, one may consider using aquatic exercise as the first part of a longer
exercise programme for osteoarthritis patients.12
18

Basar S, Uhlenhut K, Hogger. P. 2009 M. citrifolia is a tropical plant with a

long tradition of medicinal use in Polynesia and tropical parts of eastern Asia and
Australia. One of its favorite uses is the treatment of painful inflammatory
conditions, such as arthritis. The analgesic activity of Non fruit puree on mice
was investigated using the hot plate test. A 10% solution of freeze concentrated
Noni fruit puree in the drinking water of mice reduced the pain sensitivity
comparably to the central analgesic drug tramadol. This effect was only partly
reversed by the application of the morphine antagonist naloxone. An alcohol
extract of noni fruit puree also caused an inhibition of MMP-9 release from
human monocytes after stimulation with LPS. This effect was comparable to
hydrocortisone (10(-5) m). The findings suggest that preparations of noni fruits
are effective in decreasing pain and joint destruction caused by arthritis.

13

Men'shikova IV, Babyre VV. 2008;Pain in the knee joint is one of the
commonest complaints for which people seek an advice of different medical
specialists. The aim of this study was to elucidate the cause of pain in patients
19

with the alleged diagnosis of "osteoarthrosis" and to develop the relevant

diagnostic algorithm. The study included 214patients aged from 35 to 85 years
with a pain level of at least 40 mm by the visual analog scale (VAS). Results of
physical and X-ray examination provided indications for further studies that were
performed by ultrasonographic (40.1%), arthroscopic (52.3%), and MRT(64.2%)
techniques. One third of the patients were aged women with the body mass
index > 40.1 and stage 3 osteoarthrosis (OA) in whom pain was attributable to
primary osteoarthrosis. The remaining patients had pain of other origin. There
was excellent (98.6%) agreement between MRT diagnosis and arthroscopic data
on lesioned intra-articular structures, articular cartilage, and subchondral bone.
Arthroscopy revealed traumatic and degenerative meniscal tear in 85% patients,
injured anterior cruciate ligament in 8%, signs of synovitis in 52.6%,
chondromalacia of the femoral condyle in 57.6%, and isolated pathology of
patellofemoral articulation in 33% of the patients. 14

20

The study conducted Thyberg I, Dahlstrm O,and Thyberg 2009

explored whether there are differences between women and men with regard to
the reported level of fatigue, to explore the strength of the relations between
fatigue and disease activity, pain, sleep disturbance, mental health, and activity
limitation in early rheumatoid arthritis, and to explore the consistency of such
findings. Analyses and comparisons of cross-sectional data. Two hundred and
seventy-six patients, 191 women and 85 men, with early rheumatoid arthritis
were included. Aliments were examined with respect to 28-joint count disease
activity score, and disability variables reflecting pain, sleep disturbance, fatigue,
mental health, and activity limitation, at follow-ups at 1, 2 and 3 years after
diagnosis. Results show that Women reported somewhat more fatigue than men.
Fatigue was closely and rather consistently related to disease activity, pain and
activity limitation, and also to mental health and sleep disturbance. Although this
study does not permit conclusions to be drawn about causal directions, statistical
relationships may be related to clinical conceptions about causation: when
21

disease activity can be significantly reduced by pharmacological treatment this

may have a positive effect on fatigue.

15

2) Studies related to hot water application and joint pain

In USA Aksan A, McGrath JJ, 2003 medical engineering department
conducted study on heat-induced thermo mechanical response characteristics of
collagenous tissues are quantified by means of in vitro experimentation with a
representative model tissue (New Zealand white rabbit patellar tendon). Three
distinct heat-induced thermomechanical response regimes (defined by the rate of
deformation and the variation of material properties) are identified. Arrhenius
damage integral representation of collagenous tissue thermal history is shown to
be adequate in establishing the master response curves for quantification of
thermomechanical response for modeling purposes. The trade-off between the
improved kinematical stability and compromised mechanical stability of the

22

heated collagenous tissue is shown to be the major challenge hindering the

success of subablative thermotherapies.16
3) Studies related to effectiveness of epsom salt hot application and Joint
pain
The e news paper of Neha Arora in 2008 on personal health posted about
the home Remedies for joint pain .Joint pain is a very common problem
encountered by many people. As in a day-to-day life because of more work and
less by aggravation of vata in the body.Home Remedies for Leg Pain and joint
pain is a warm water bath of Epsom salt .Warm water bath of Epsom salt, which
is rich in magnesium, is a good pain reliever. This is very helpful for arthritis.17

Health & Wellness Common ailments 2007 the e article reported

that.Add half-a-teaspoon of salt to a glass of warm water and rinse out your
.Apply an ice bag to the side of the face where the pain is felt. Add one
23

tablespoon of Epsom salts and an equal amount of ordinary salt to a pint of

boiled water. A hot foot bath for about 20 minutes will often relieve the headache,
joint pain ,leg pain and other joint muscle alientmsnts.Fill the tub with warm water
and Epsom salts and just sink right in. This will relieve the pain related to muscle
and joint injury. 19
One of the net by Matthew Lewis in 2008 reported that There are dietary
supplement of magnesium everyone can not use these effectively. Scientists
have learned that the best way to get magnesium into the body is topically
through the skin. A hot Epsom Salt bath is the old New England home remedy for
arthritis pain. Just the heat of the bath itself is able to increase circulation and
reduce swelling. The Epsom Salt, then, adds properties which reduce pain and
joint discomfort. To take an Epsom Salt bath, start by filling your bathtub with
water that is as hot as you can tolerate. Then add two cups of Epsom Salt and
dissolve them in the water. Stay in the bath for at least a half hour. Add hot water
in order to keep the temperature very warm. Feel free to repeat this treatment
24

often whenever required. Commercial lotions which contain Epsom Salt also
available. They can be used to provide temporary, spot treatment on knees, legs,
backs, and other body parts. You can massage this cream into your hands to
help relieve the pain and reduce the swelling and stiffness of arthritic fingers. It
can also be used to soothe achy, burning feet

20

7. MATERIALS AND METHODS OF STUDY

7.1 SIGNIFICANCE OF THE STUDY
The purpose of the study is to assess the effectiveness of hot water
application with Epsom salt and plain water among old age with joint pain

7.2 SOURCE OF DATA

Elderly those who are living in the selected areas of Mysore

25

7.3 RESEACH DESIGN

The research design adopted for the study was true experimental ( two
group pre test and post test design ) with manipulation, randomization
and control group.
Experiment
al group

O1

X1

O2

O1

X2

O2

Control
group

O1-Pretest level of pain

O2-Posttest level of pain
X1- Epsom salt hot water application.
X2-Plain hot water application

7.4 METHOD OF DATA COLLECTION

26

Numerical pain scale

7.5 SAMPLING PROCEDURE

7.5.1 INCLUSION AND EXCLUSION CRITERIA
Inclusion Criteria
1. Samples are elderly people living in selected areas of Mysore.
2. Elderly people who complaints joint pain.
3. Those who can able to understand Kannada.
4. Both male and female elderly person are included.
Exclusion Criteria
1. Those who are absent during the period of study.
2. Those who are not willing to participate in the study.

27

7.5.2 POPULATION
Elderly people those who are living in the selected areas at Mysore
7.5.3 SAMPLES
Elderly persons those who are fulfilling the sampling criteria
7.5.4 SAMPLE SIZE
Sample comprises of 30 elderly persons. Thirty in experimental group and
thirty in control group.
7.5.5 SAMPLING TECHNIQUE
Probability Simple random sampling.
7.5.6 SETTING:
The study will be conducted in selected rural areas at Mysore

28

7.5.7 PILOT STUDY

Pilot study is planned with the 10% of sample size.

7.6 VARIABLES
Independent Variable
The independent variable in the study is Epsom hot water applications and
plain hot water applications.
Dependent Variable
The dependent variable in the study is joint pain

7.7 PLAN FOR DATA ANALYSIS

The data analysis will be done by descriptive statistics and inferential
statistics. The descriptive statistics are the percentage, mean and
standard deviation and inferential statistics are paired t test and chi
square test
29

7.8 PROJECTED OUTCOME

The findings of the study would reveal:
1. The effectiveness of hot water application or the Epsom salt hot application
for patient with joint pain.
2. The study will motivate the elderly patients to use the most effective and safe
method of hot application for their joint pain.
3. The study will helps to educate the nurses to use effective method of hot
application in nursing practice.

7.9 ETHICAL CONSIDERATION30

1.

Has ethical clearance been obtained from institution or concerned

authority?
Yes.
2.

Whether ethical committee suggestions and opinions will be taken

into consideration?
Yes.

31

8. REFERENCES
1) www.arthritis-treatment-and-relief.com/causes-for-joint-and-muscle-pain.html - Cached - Sim
updated 2006
2) Crook J, Rsideout E, Browne G: The prevalence of pain complaints in a general population.
Pain 18:299-314, 1984 www.medscape
3) Yung R. Management of the patient with osteoarticular problems. In : Geriatrics Update.
Proceedings, Indo-US Conference of Geriatrics Delhi Feb 2001, OP Sharma (ed) Geriatric
Society of India.; 105-6.
4) Hutton CW. Osteoarthritis in oxford text book of Medicine, JGG, Warrell DA (eds) Oxford
University Press 3rd ed. 1996; 2975-83.
5) Chaturvedi VP. Musculoskeletal problems in Geriatric populations In : Geriatrics Update 2001.
Proceedings of Indo-US conference on Geriatrics Feb 2001, New Delhi. OP Sharma (ed)
Geriatric Society of India. 2001; 97-106.
6) Srivastava RK. Multicentric study to establish epidemiological data on health problems in
elderly: a Govt. of India and WHO collaboration programme. Ministry of Health & Family
Welfare, Government of India 2007.

32

7) Health Care and Condition of the Aged. National Sample Survey 60th Round (January to
June 2004). Government of India, March 2006. p. 54-65
8) http://www.thehindu.com/2007/12/27/stories
9) GS Shanthi .Risk actors for Falls in Elderly.madras medical college. Journal of The Indian
Academy of Geriatrics, 2005; 2 : 57-60
10) Mathur.A.Action Begins.Journal of The Indian Academy of Geriatrics, Vol. 3, No. 4,
December, 2007
11) Brosseau L, Yonge KA, Robinson V et.al Thermotherapy for treatment of osteoarthritis.
Cochrane Database Syst Rev. 2003;(4):CD004522.
12) Bartels EM, Lund H, Hagen KB et al.Aquatic exercise for the treatment of knee and hip
osteoarthritis. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005523.
13) Basar S, Uhlenhut K, Hgger P et al.Analgesic and antiinflammatory activity of Morinda
citrifolia L. (Noni) fruit. Phytother Res. 2009 Jun 22.
14) Men'shikova IV, Babyre VV.Causes of pain in the knee joint. Klin Med (Mosk). 2008;86(8):6770.
15) Thyberg I, Dahlstrm O,and Thyberg M.Factors related to fatigue in women and men with
early rheumatoid arthritis: the Swedish TIRA study. J Rehabil Med. 2009 Nov;41(11):904-12.
16) Aksan A, McGrath JJ.Thermomechanical analysis of soft-tissue thermotherapy. J Biomech
Eng. 2003 Oct;125(5):700-8.

33

17) Posted in Personal Health by neha arora at 2:11 AM on September 17, 2008s
www.medscape .com
18) www.homeopathictreatment4u.com/gout.html dated on june2006
19) helpgetridof.com/category/beauty/ - Health & Wellness Common ailments - sitagita.com
dated may 2007
20) Matthew Lewis The Epsom Salt Remedy for Arthritis Emed. com. Au /Bioceutical_
ArthroGuard Published: 7/9/2008
21) Homeremedies .guide.com dated 2005

Epsom Salt for Pain

Last Updated: Oct 24, 2013 | By Michelle Lawson
Epsom salt may be used with warm water as a soaking solution for pain and stiffness. According to
Arthritis Cures, the effects of the water and heat stimulate circulation that aids in soothing painful joints.
The magnesium found in Epsom salt may reduce inflammation. Additionally, soaking in Epsom salt is the
most effective way to making the magnesium your body needs available states Epsom Salt Council. Salt
Works recommends adding 2 cups of Epsom salt to a bathtub of warm water as warm as you can tolerate
and soak for 30 minutes. This can be done up to three times each week for pain and inflammation.

Dead Sea Salt Research and Studies

Many clinical research studies have been carried out to establish the
therapeutic properties of Dead Sea salts. Below are extracts from some of
these.

34

From the Department of Dermatology, University of Kiel, Germany.

Proksch E, Nissen HP, Bremgartner M, Urquhart C
Abstract Magnesium salts, the prevalent minerals in Dead Sea water, are
known to exhibit favorable effects in inflammatory diseases. We examined
the efficacy of bathing atopic subjects in a salt rich in magnesium chloride
from deep layers of the Dead Sea. Volunteers with atopic dry skin submerged
one forearm for 15 min in a bath solution containing 5% Dead Sea salt. The
second arm was submerged in tap water as a control. Before the study and at
weeks 1-6, trans-epidermal water loss (TEWL), skin hydration, skin roughness,
and skin redness were determined. We found one subgroup with a normal
and one subgroup with an elevated TEWL before the study. Bathing in
the Dead Sea salt solution significantly improved skin barrier function
compared with the tap water-treated control forearm in the subgroup with
elevated basal TEWL. Skin hydration was enhanced on the forearm treated
with the Dead Sea salt in each group, which means the treatment moisturized
the skin. Skin roughness and redness of the skin as a marker for inflammation
were significantly reduced after bathing in the salt solution. This
demonstrates that bathing in the salt solution was well tolerated, improved
skin barrier function, enhanced stratum corneum hydration, and reduced skin
roughness and inflammation. We suggest that the favorable effects of
bathing in the Dead Sea salt solution are most likely related to the high
magnesium content. Magnesium salts are known to bind water, influence
epidermal proliferation and differentiation, and enhance permeability barrier
repair.

35

Balneotherapy in dermatology.
Dermatology Unit, Kaplan Medical Center, Rechovot, Israel.
Matz H, Orion E, Wolf R.
On The Therapy of Rheumatic Illness with Medical Bathing Salts from
the Dead Sea
Sanatorium clinic in the City of Mayenbad, Germany
Dr. P. Engel
The study was performed with 60 patients whose rheumatic discomfort could
not be substantially reduced by the customary balneotherapy of their clinic.
The baths with Epsom Salts were then prescribed in lieu of additional
medicinal therapy. Each patient was treated for a duration of 2
weeks, with three baths per week. Salt concentration was 2.5%, duration of
bath 20 minutes, temperature of water 37 C. Parameters examined
included: Pain at rest, spontaneous pain, kinesalgia, pain on pressure and
reduced mobility.
A summary of the results shows that in 76.2% of the cases, very good
therapeutic results were obtained, 10.2% responded moderately well and
only 13.6% no success was noted.

36

A study was conducted to determine the effectiveness of thermotherapy in the

treatment of osteoarthritis of the knee. The outcomes of interest were relief of pain,
reduction of oedema, and improvement of flexion or range of motion (ROM). Two
independent reviewers selected randomized and controlled clinical trials with participants
with clinical and/or radiological confirmation of osteoarthritis of the knee; and
interventions using heat or cold therapy compared with standard treatment and/or
placebo. The results shows that three randomized controlled trials, involving 179 patients,
were included in this review. In one trial, administration of 20 minutes of ice massage, 5
days per week, for 3 weeks, compared to control demonstrated a clinically important
benefit for knee osteoarthritis on increasing quadriceps strength (29% relative difference)
and another trail with hot application. There was also a statistically significant
improvement. Result showed that cold packs decreased knee oedema and the
thermotherapy reduces the pain.

37

Warm Water Works

Wonders on Pain
Turn your bath into a powerful weapon against aches,
stiffness and fatigue.

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38

Soaking in warm water is one of the oldest forms of medicine, and theres
good reason why this practice has stood the test of time. Research has
shown warm water therapy works wonders for all kinds of musculoskeletal
complaints, including fibromyalgia, arthritis and low back pain.
The research shows our ancestors got it right. It makes you feel better. It
makes the joints looser. It reduces pain and it seems to have a somewhat
prolonged effect that goes beyond the period of immersion, says Bruce E.
Becker, MD, director of the National Aquatics & Sports Medicine Institute
at Washington State University in Spokane.
There are many reasons soaking in warm water works. It reduces the force
of gravity thats compressing the joint, offers 360-degree support for sore
limbs, can decrease swelling and inflammation and increase circulation.
So, how long should you soak? Dr. Becker says patients hes studied seem
to reach a maximum benefit after about 20 minutes. And make sure you
drink water before and afterward to stay well hydrated.
Here are some other simple steps to make the most of your next bath.
Go warm, not hot. Water temperatures between 92 and 100 degrees are
a healthy range. If you have cardiovascular problems, beware of water

39

thats too hot because it can put stress on the heart. The U.S. Consumer
Product Safety Commission says anything over 104 degrees is considered
dangerous for everyone.
Dont just sit there. Warm water is great for relaxing, but it is also good
for moving. Warm water stimulates blood flow to stiff muscles and frozen
joints, making a warm tub or pool an ideal place to do some gentle
stretching. To ease low back pain, trap a tennis ball between the small of
your back and the bottom or back of the tub, then lean into it and roll it
against knotted muscles. The flexibility lasts even after you get out, says
Ann Vincent, MD, medical director of the Mayo Clinics Fibromyalgia Clinic
in Rochester, Minn. Patients report that soaking in a warm bath and
stretching after that seems to help.
Add some salts. Data collected by the National Academy of Sciences
show most Americans dont get enough magnesium, a mineral thats
important for bone and heart health. One way to help remedy that:
bathing in magnesium sulfate crystals, also known as Epsom salts.
Theyre relatively inexpensive, can be found at grocery and drug stores
and can boost magnesium levels as much as 35 percent, according to
researchers at the University of Birmingham in the United Kingdom. But
dont go overboard; the National Institutes of Health warns these salts

40

should only be for occasional use. People with diabetes should be aware,
too, that high levels of magnesium can stimulate insulin release.

are super fantastic for relaxing your whole body and getting the benefits of
magnesium, but if you dont have time to take a bath you can pretty much get
the same benefits by doing an Epsom salt foot soak. You dont need a tub, so
its very convenient to do anytime and anywhere.

Why Use Epsom Salt:

MAGNESIUM
Epsom salts provide many health benefits. When added to water, the minerals
are easily absorbed through your skin. Which is the best way to boost your
magnesium (aside from through food). Sometimes getting the
magnesium transdermally can be a good way because it is less affected by
activity in your gut, from things like stomach acids and digestive enzymes.

41

When the liver and stomach are bypassed more of the magnesium can go
directly into the bloodstream.

How To Do An Epsom Salt Foot Soak:

What You Need:

A large container of any kind big enough to soak your feet in (I use a
plastic bin)

1/4 cup of Epsom salts

Warm water (Not too hot, or you wont get the optimum benefits)

For Additional Benefits You May Also Want To Add ( I Only Add These
Occasionally, Once A Month)

You can add essential oils, like a drop or two of lavender . Lavender
gives a soothing and calming effect which aids in relaxation. This is
especially helpful to use near bed time. Many find it help them get to
sleep easier.

Some like to add in ginger or cayenne to help boost the detoxifying

benefits.

42

A few tablespoons of baking soda can also be added to help with

detoxification and also soften your skin.

Steps:
1. Add the Epsom salt to your container and add warm water from your sink or
tub (enough so that the water will come up to your ankles when you put your
feet in).
2. Find a comfy spot to do the Epsom salt foot soak because you need to do it
for at least 30 minutes. I like to sit in a comfy chair and watch TV while
soaking my feet.

How Long Should You Do It And How Often?

I typically soak my feet for 30 to 45 minutes every night or at least a few times
a week. Some recommend doing it for at least a full 40 minutes in order to
allow your body time to get rid of the toxins and fully absorb the magnesium.

43

Epsom salts provide many health benefits. When added to water, the minerals
are easily absorbed through your skin. Which is the best way to boost your
magnesium (aside from through food). Sometimes getting the
magnesium transdermally can be a good way because it is less affected by
activity in your gut, from things like stomach acids and digestive enzymes.
When the liver and stomach are bypassed more of the magnesium can go
directly into the bloodstream.

Epsom salt baths are a convenient, non medicinal form of arthritis knee pain
relief. Rather than taking another pill or using another ointment, sufferers can
relax in a warm bath and allow the Epsom salts to work their magic on sore joints
and muscles. The magnesium in Epsom salts provides the arthritis knee pain
relief as it is absorbed through the skin. Magnesium is an essential mineral
needed by the body and has both an anti-inflammatory as well as an anti-arthritic
effect which provides arthritis knee pain relief naturally. The hot water increases
circulation and reduces swelling, providing additional benefits to the magnesium
in Epsom salt.

44

For the maximum arthritis knee pain relief with epsom salt baths, use
water as hot as you can tolerate combined with two to three cups of Epsom salt.
Sit back and relax for 30 minutes as the magnesium and warm water work to
provide arthritis knee pain relief. Since this particular medium is none
medicinal, you can soak in an Epsom salt bath as often as you require
for the level of arthritis knee pain relief you need. You can take such a
bath daily, or even several times per day, depending on the severity of your pain.
Epsom salt baths can provide even more pain relief when combined with other
arthritis knee pain relief remedies.

45

9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

RECOMMENDED AND FORWARDED

11. NAME AND DESIGNATION OF

(IN BLOCK LETTERS)

11.1 GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE (IF ANY)

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11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE

12.1 REMARKS OF THE CHAIRMAN

AND PRINCIPAL

RECOMMENDED AND FORWARDED

12.2 SIGNATURE

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