Peloid Therapy: Healing Peat from Marienbad

What is peloid therapy?

The term peloid comes from the Greek pelos (mud) and refers to natural substances such as peat, moor, mud or fango that are used in balneotherapy, heated, as wraps, baths and packs. In Mariánské Lázně (Marienbad) the material used is peat from the bogs of the Slavkov Forest, which the spa has extracted and processed since the 19th century. Together with the mineral springs and natural carbon dioxide (CO₂ therapy) it is one of the local natural healing resources.

Peat consists of partly decomposed plant remains and contains humic acids, fulvic acids and mineral salts. Before the procedure it is mixed with local mineral water to the prescribed consistency and heated to a temperature of 38–42 °C. A detailed description of the peat's origin and processing, and a comparison with other peloids, can be found in the article Peat therapy — Marienbad's natural treasure.

How the procedure works

Peat releases heat slowly and evenly because it has low thermal conductivity. A bath or wrap at around 40 °C therefore feels pleasantly warm, whereas a water bath of the same temperature would be uncomfortable for most people. Warming the tissues widens the vessels in the skin and subcutaneous tissue and releases muscle tension. Three forms are used in Marienbad:

1. Peat wraps

Warm peat (38–42 °C) is applied to larger areas of the body or targeted at particular joints and sections of the spine. The patient is then wrapped in foil and blankets to retain the heat. After 20–30 minutes the peat is washed off and a rest on a couch follows. The spa physician prescribes wraps above all for chronic muscle tension and for rheumatic diseases in a quiescent phase.

2. Peat baths

A full-body bath in a tub filled with a mixture of finely processed peat and warm mineral water at 38–42 °C. The procedure lasts 20–30 minutes, followed by a shower and at least 30 minutes of rest wrapped in warm towels. Peat is denser and heavier than water, so buoyancy is lower and the sensation of warmth more intense.

3. Peat packs

Local application of warm peat paste directly to the affected spot, typically the knee, shoulder or back; the site is covered with foil and towels. The application time is 20 to 40 minutes. This targeted form is used for local complaints, for example osteoarthritis of individual joints or painful tendon insertions.

A practical note: allow extra time for the rest after the procedure and do not plan strenuous activities afterwards; procedures follow one another during the day and the body needs time to adapt to the heat.

How long a course usually lasts

Peat procedures are as a rule scheduled every other day, so that the body has time to recover between applications. The number of applications is set by the spa physician; controlled studies in osteoarthritis worked with 9 to 12 peat applications over two to three weeks (see below). The length of a covered stay is determined by the Czech indication list for the specific diagnosis: for osteoarthritis of the knee and hip (VII/7) and chronic back pain (VII/9) the basic stay is 21 days in both comprehensive and contributory care, for rheumatoid arthritis (VII/1) 28 days in comprehensive and 21 days in contributory care, for conditions after joint replacement (VII/10) 28 days; for atopic eczema (X/1) 21 days and for psoriasis (X/2) 28 days in comprehensive care. Self-paying guests agree the length of their stay with the spa physician.

Which conditions it is used for

Peloid procedures form part of the treatment programmes for diagnoses that are among the official indications for spa treatment in Marienbad under the Czech indication list (Decree No. 2/2015 Coll.):

• Diseases of the musculoskeletal system (group VII): osteoarthritis of the knee and hip (VII/7) and osteoarthritis in other locations (VII/8), chronic vertebrogenic pain syndrome — back pain of functional origin (VII/9), painful syndromes of the tendons, tendon sheaths, bursae and muscle insertions (VII/6), rheumatoid arthritis (VII/1), ankylosing spondylitis (VII/2) and other seronegative spondyloarthritides (VII/3) treated in a quiescent phase, conditions after orthopaedic surgery with joint replacement (VII/10) and after injuries and operations of the musculoskeletal system including disc surgery (VII/11). The complete overview is on the page musculoskeletal system in the indication list.
• Skin diseases (group X): atopic eczema (X/1) and generalised or arthropathic psoriasis (X/2). For these, peat wraps form part of the programme alongside mineral baths, climate therapy and phototherapy; they are treated in a stable phase of the disease, not during an acute flare. More in the article on spa treatment of skin conditions.

How the individual musculoskeletal diagnoses are treated in Marienbad, and how peat is combined with mineral baths and physiotherapy, is described in the article Treatment of the musculoskeletal system.

When it is not suitable

Peat baths, wraps and packs are not given in acute inflammation and infectious diseases, with fever and in the acute stage of any disease, with clinical signs of circulatory failure or malignant arrhythmias, in the first months after deep vein thrombosis, with open wounds in the treated area and in pregnancy. Malignant tumours with clinically detectable signs of disease activity are a general contraindication to spa care. In rheumatic diseases peat is not used during a flare. The complete list is on the indications and contraindications page.

Who decides on inclusion

Whether peat procedures are included in the treatment plan, and their form, temperature, duration and number, is decided by the spa physician after the initial examination. They take into account the diagnosis, current condition, other illnesses and the medicines taken. Spa treatment supplements the care of your orthopaedist, rheumatologist or dermatologist; it does not replace it.

What a patient can realistically expect

The most controlled studies exist for osteoarthritis of the knee, where peloids were studied together with baths:

• In an Italian randomised trial of 80 patients with knee osteoarthritis, a two-week cycle of peloid packs and baths reduced pain, improved joint function and reduced the use of painkillers, and did so for 9 months; the control group did not change (Fioravanti et al., 2010, Am J Phys Med Rehabil). The study took place at a single centre and was only single-blind.
• A systematic review of spa therapy for knee osteoarthritis (baths, peloids, exercise) reports an improvement in pain and function that is clinically relevant 3 to 6 months, sometimes up to 9 months after the cure (Forestier et al., 2016, Ann Phys Rehabil Med). Many of the included studies had low internal validity.
• A German randomised trial of 52 patients with knee osteoarthritis observed, after nine peat wraps over 21 days, a fall in the pro-inflammatory interleukin 1β and a rise in the anti-inflammatory interleukin 10; the common inflammatory marker CRP did not change, while pain and function improved at the same time (Klemm et al., 2020, Phys Med Rehab Kuror). This was a small sample.

Peat does not restore cartilage and does not halt the course of osteoarthritis; according to the studies cited it eases pain and stiffness for months and may reduce the need for painkillers. For the other indications (back pain, fibromyalgia, rheumatic diseases, skin diseases) peat is part of the traditional spa programme; the studies on these diagnoses are summarised in the article on peat therapy.

Practical information

Peloid procedures are available at most Ensana spa hotels in Marienbad. A single procedure lasts 20–40 minutes depending on the form, plus the rest period. Individual peat baths can also be booked without a comprehensive spa stay; within a treatment programme they are usually included in the package. In the treatment plan, peat is usually combined with the drinking cure, CO₂ baths and exercise therapy.

Frequently asked questions about peloid therapy

What is Marienbad healing peat?

A natural peloid from the bogs of the Slavkov Forest, made up of partly decomposed plant remains and containing humic acids, fulvic acids and mineral salts. The spa has extracted and processed it, and used it for wraps, baths and packs, since the 19th century.

What is the difference between a peat wrap and a peat bath?

For a wrap, warm peat at 38–42 °C is applied to individual parts of the body and washed off after 20–30 minutes. A peat bath is a full-body bath in a mixture of peat and mineral water at the same temperature; it lasts 20–30 minutes and is followed by at least half an hour of rest.

Why does peat warm differently from a hot bath?

Peat has low thermal conductivity, so it releases its stored heat slowly and evenly. That is why a bath at around 40 °C is pleasant, whereas a water bath of the same temperature would be uncomfortable for most people.

Which conditions is peloid therapy used for?

Above all for diseases of the musculoskeletal system in indication group VII — osteoarthritis, chronic back pain, painful tendon and muscle insertions, rheumatic diseases in a quiescent phase and conditions after injuries and orthopaedic surgery — and for skin diseases in group X, namely atopic eczema and psoriasis.

Is peloid therapy suitable for everyone?

No. The spa physician decides on inclusion at the initial examination. Heat procedures are not given, for example, in acute inflammation, fever, circulatory failure, shortly after deep vein thrombosis, with open wounds and in pregnancy.

Where is peloid therapy offered?

Peat wraps, baths and packs under medical supervision are offered in Marienbad by the Ensana Centrální Lázně hotel; peloid procedures are also available at the other Ensana spa hotels.