MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Kneipp therapy goes back to Sebastian Kneipp (1821-1897), a catholic priest who was convinced to have cured himself of tuberculosis by using various hydrotherapies. Kneipp is often considered by many to be ‘the father of naturopathy’. Kneipp therapy consists of hydrotherapy, exercise therapy, nutritional therapy, phototherapy, and ‘order’ therapy (or balance). Kneipp therapy remains popular in Germany where whole spa towns live off this concept.

The obvious question is: does Kneipp therapy work? A team of German investigators has tried to answer it. For this purpose, they conducted a systematic review to evaluate the available evidence on the effect of Kneipp therapy.

A total of 25 sources, including 14 controlled studies (13 of which were randomized), were included. The authors considered almost any type of study, regardless of whether it was a published or unpublished, a controlled or uncontrolled trial. According to EPHPP-QAT, 3 studies were rated as “strong,” 13 as “moderate” and 9 as “weak.” Nine (64%) of the controlled studies reported significant improvements after Kneipp therapy in a between-group comparison in the following conditions:

  • chronic venous insufficiency,
  • hypertension,
  • mild heart failure,
  • menopausal complaints,
  • sleep disorders in different patient collectives,
  • as well as improved immune parameters in healthy subjects.

No significant effects were found in:

  • depression and anxiety in breast cancer patients with climacteric complaints,
  • quality of life in post-polio syndrome,
  • disease-related polyneuropathic complaints,
  • the incidence of cold episodes in children.

Eleven uncontrolled studies reported improvements in allergic symptoms, dyspepsia, quality of life, heart rate variability, infections, hypertension, well-being, pain, and polyneuropathic complaints.

The authors concluded that Kneipp therapy seems to be beneficial for numerous symptoms in different patient groups. Future studies should pay even more attention to methodologically careful study planning (control groups, randomisation, adequate case numbers, blinding) to counteract bias.

On the one hand, I applaud the authors. Considering the popularity of Kneipp therapy in Germany, such a review was long overdue. On the other hand, I am somewhat concerned about their conclusions. In my view, they are far too positive:

  • almost all studies had significant flaws which means their findings are less than reliable;
  • for most indications, there are only one or two studies, and it seems unwarranted to claim that Kneipp therapy is beneficial for numerous symptoms on the basis of such scarce evidence.

My conclusion would therefore be quite different:

Despite its long history and considerable popularity, Kneipp therapy is not supported by enough sound evidence for issuing positive recommendations for its use in any health condition.

15 Responses to Kneipp therapy: popular but not truly evidence-based

  • Increased activity, irrespective of type or accompanying ideology, will increase well-being in most but not all subjects. If you drag a person suffering from any of the listed vaguely defined disorders out of their couch-potato sac, cheer them on and have them excercise and frolick in water, go hiking, frisbee throwing or whatever encouraging and exertion-inducing pastime, you are guaranteed to receive positive net results in your post-intervention survey or trial. Calling it therapy is a bit thick in my view but I guess it is not altogether wrong?
    You will also find that some poblems are not amenable to such life-interventions due to their chronicity and serious nature. The list of “non-positive” groups is not surprising at all, I think.

  • For me, what is ‘wrong’ is the marketing of perfectly good advice and encouragement of lifestyle as a ‘therapy’ to treat specific conditions.

    The former is ‘good’: “Eat sensibly, exercise (in or out of water), don’t smoke…etc.”.
    Calling it ‘therapy’ and suggesting such programmes can affect specific conditions requires more evidence than provided by this review – and it is ‘wrong’ (morally corrupt) to market Kneipp therapies (or sell Kniepp bread) on the basis that they have specific effects.

    Marketing spas as providing enjoyable experiences and theatrical placebos is one thing – encouraging folks to believe specific pathology can be affected by the experience is another. Except, of course, for psychopathology.

    The lessons and of the Power and Effects of Fresh Water in the bodies of the people was published by Johann Hahn in 1738, taken up by Victor Priessnitz in a system which came to be known as ‘the Nature Cure’, and many health resorts and spas developed throughout Europe (20 in the UK). Others piled in and Sebastian Kniepp had his ‘Kniepp Kur’ recognised for health reimbursement in Germany during the late nineteenth century. The Kniepp Group sells more than 200 different phytomedicines, nutritional supplements, body care and health products – without any accepted evidence of benefit for any specific condition (though I do not doubt they are ‘nice’).

    Benedict Lust sought a cure for TB from Kneipp and was persuaded to promote Kniepp merchandise in the US. Homeopath John Scheel had trademarked the term Naturopathy in 1895 – Lust purchased the rights to the name in 1902 and set up the American School of Naturopathy to train homeopaths, osteopaths and chiropractors in these ‘nature cures’ – and buy Kniepp products! The school had a Department of Astrology to explore the effects of astrological determinants on disease.

    Which is where we are today. Sigh.

    For me, what is ‘wrong’ is the marketing of perfectly good advice and encouragement of lifestyle as a ‘therapy’ to treat specific conditions.

    The former is ‘good’: “Eat sensibly, exercise (in or out of water), don’t smoke…etc.”.
    Calling it ‘therapy’ and suggesting such programmes can affect specific conditions requires more evidence than provided by this review – and it is ‘wrong’ (morally corrupt) to market Kneipp therapies (or sell Kniepp bread) on the basis that they have specific effects.

    Marketing spas as providing enjoyable experiences and theatrical placebos is one thing – encouraging folks to believe specific pathology can be affected by the experience is another. Except, of course, for psychopathology.

    The lessons and of the Power and Effects of Fresh Water in the bodies of the people was published by Johann Hahn in 1738, taken up by Victor Priessnitz in a system which came to be known as ‘the Nature Cure’, and many health resorts and spas developed throughout Europe (20 in the UK). Others piled in and Sebastian Kniepp had his ‘Kniepp Kur’ recognised for health reimbursement in Germany during the late nineteenth century. The Kniepp Group sells more than 200 different phytomedicines, nutritional supplements, body care and health products – without any accepted evidence of benefit for any specific condition (though I do not doubt they are ‘nice’).

    Benedict Lust sought a cure for TB from Kneipp and was persuaded to promote Kniepp merchandise in the US. Homeopath John Scheel had trademarked the term Naturopathy in 1895 – Lust purchased the rights to the name in 1902 and set up the American School of Naturopathy to train homeopaths, osteopaths and chiropractors in these ‘nature cures’ – and buy Kniepp products! The school had a Department of Astrology to explore the effects of astrological determinants on disease.

    Which is where we are today. Sigh

  • Richard-while agreeing with all you wrote is it possible that if subjected to vigorous hot/cold hydrotherapy that the adaptive physiological responses, hormonal, neurological and more, could occasionally affect some pathological processes in the direction of improvement or healing? That direction can occur spontaneously without any specific ‘therapy’.

  • Certainly that is a possibility.
    And the evidence is…?

    (Apologies for italics in my earlier posting- I’ve forgotten how to remove them!)

    • Richard- the evidence resides in the numerous accounts of spontaneous remission s in all sorts of illnesses and the knowledge of homeostatic processes. I assume , without studying Kneipp, that there have been plenty of anecdotal accounts of improvement or remissions.They are likely not all worthless.

      • few would claim they are worthless, but the notion that they prove anything is bonkers!

        • Edzard- Proof is not be proposed, just that some clients may benefit due to effect of the hydrotherapy on their physiological system and they make the claim that they have so benefitted, and the causes may reside in the mechanisms I have alluded to. Allowing that all claims are not worthless implies some may be of worth i.e there is something in it! We may have to remain ignorant for a while before we have any proof There is more in heaven and earth than dreamed of in your philosophy.

          • the value lies mainly in the fact that it alerts us to a research question that might need answering – not in speculating about cause and effect.

          • Edzard-it certainly could result in a research question and that research question may well involve speculation about whether there is a causative effect on the recipient of the said treatment. That speculation is at the very heart of forming a hypothesis on which to research. Isn’t this imaginative speculation at the beginning of much scientific research? Peter Medawar, for one, thinks it is thus.

          • I don’t!
            A research question requires a solid foundation and not speculation.

          • Edzard- this is potentially a huge subject of scientific philosophy and psychology. A complex mix of many factors. From where does the ‘solid foundation’ arise? Consider the speculation about the cause(s) of scurvy in those early days of profound ignorance. There were great amounts of speculation about causes and Captain Lind decided to test a few on his ship which as we know resulted in some very positive results. Similar approaches were made for several nutritional deficiency diseases with similar results. No solid foundations just ‘suck it and see’.

          • charming, the way you lecture me on research methodology.
            but guess what!
            since the 18th century, science has moved on a little.

          • Edzard- I lecture you not- just putting a point of view which contests a little of what you say. Lets get more up to date then. As I understand it there has been a great deal of speculation, conjecture about the benefits in these Covid times of the use of Ivermectin as a beneficial therapy. It’s testing has demonstrated it has no benefit to humans and may be dangerous. Going back a little a reading of Watson’s account of the structure of DNA involved massive amounts of daily speculation about how the ‘pieces’ fitted together. The solid foundation may be necessary to satisfy those who provide the funds for research but it is not necessary for how all scientific research proceeds.

          • Lets get more up to date then.
            Yes, please – but do it on your own.

          • Edzard-Houdini does it again! Do you ever concede anything that significantly challenges your view? Oh I forgot- you don’t answer my questions.

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