Aquatic Exercise Better for Chronic Back Pain

Lena Weib

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Experts say aquatic exercise such as walking underwater can help ease back pain. Getty Images
  • Researchers say water-based exercise can be more beneficial for easing back pain than some traditional physical therapies.
  • They say aquatic exercise, such as walking underwater and using floatation devices, can relieve the strain on certain muscles and strengthen them.
  • Experts say you can begin with simple aquatic exercises before advancing to more complex ones and eventually return to land-based activities.

If you live with chronic back pain, aquatic exercise may provide the relief you’re seeking.

That’s according to a randomized control trial study of 113 participants with chronic back pain published in JAMA Network Open.

Researchers said that after 3 months, therapeutic aquatic exercise was found to have a greater influence than physical therapies on:

  • pain levels
  • functioning
  • quality of life
  • sleep quality
  • mental state

Physical therapies in the study included electrical nerve stimulation applied across the skin (TENS) and infrared ray thermal therapy.

Participants performed their allocated intervention for 60 minutes twice a week. Researchers said the benefits were present at the 12-month follow-up.

Christopher Bise, PT, DPT, PhD, an assistant professor at the University of Pittsburgh and clinical analyst at the UPMC Health Plan, says he’s not surprised by the study results because the authors compared an active intervention (aquatic exercise) with a passive intervention (TENS and Infrared).

“The physical therapy literature is rife with examples of the benefits of active versus passive treatments and the need to shift from those passive treatments to active interventions as quickly as possible,” Bise told Healthline.

He explained that the increased buoyancy and resistance provided by water are additional ways for therapists to alter the load to those areas experiencing pain.

Bise noted that the goal should eventually be to move from aquatic treatments as quickly as possible and move the person to land-based exercise interventions.

“Once on land, patients experience the true forces required by their activities of daily living,” he said.

Dr. Daniel F. O’Neill, an orthopaedic surgeon, sport psychologist, and author of “Survival of Fit,” agreed.

“Since we live on land, a transition will need to be made, but the water is the ideal place tostarta rehab program and to return periodically for training,” O’Neill told Healthline.

As someone who has been a big proponent of aquatic exercise for many years, O’Neill said he was surprised when the authors noted this study was, to their knowledge, one of the few to compare water to a land program for low back pain.

“Aquatic exercise has been a mainstay in many physical therapy departments for years,” he said.

Bise noted that many people don’t have access to a physical therapist with a pool or other aquatic environment.

O’Neill said research like this study helps provide additional data to present to insurance companies to gain approval for this often more expensive mode of treatment.

“I love aquatic exercise for rehabilitation of all body parts, not just the back,” said O’Neill, who describes water exercises in his book, “Knee Surgery: The Essential Step-by-Step Guide to Total Knee Recovery,” as the “ultimate soft workout.”

O’Neill says the concept of soft workouts is an essential consideration with overworked tissue.

“Water has the quality of eliminating weight-bearing with buoyancy and allows for natural traction of the vertebral segments as the spine elongates in the deeper water,” he explained. “This results in relaxation of the tissues, helping eliminate muscle tightness and spasm, which is one of the main culprits in chronic low back pain.”

O’Neill added that he also thinks the comfort found in water has a positive effect on a primitive brain level.

“We start our existence floating in amniotic fluid. Recreating this environment can make a profound difference in how the body responds and heals,” he said. “Water is also completely safe. Movement patterns can be learned and practiced in the water without fear of falling or causing more trauma.”

For those considering aquatic exercise for low back pain (acute or chronic), Bise says, “Go for it.”

“We all know exercise is medicine, and anything that’s an increase over what we did yesterday is a win,” he said.

“Aquatic exercise is a great option for those just beginning exercise, in the acute stages of an injury, or suffering from the lingering effects of previous injuries,” Bise added. “The ability to quickly increase or decrease load using buoyancy or resistance tools (paddles or floats) isn’t found in any other medium.”

Bile said this exercise is beneficial for everyone, from elite athletes recovering from knee surgery to older adults with daily aches and pains.

O’Neill’s tips for beginning aquatic exercise:

  • Warm water: A warm therapeutic pool is ideal, but really any water immersion is going to have positive effects.
  • Flotation device: Start with some type of flotation (e.g., pool noodles) in the deep water so your feet are dangling, you are not working to stay afloat, and you can relax.
  • Gentle leg movement: Swing your legs a bit and feel the entire spine straighten and open up, releasing pressure on those nerves and discs.
  • Walking motion: Try some knees to chest and a slow, exaggerated walking motion.
  • Go deeper: As things calm down, you can move to neck-deep water, giving your spine more stress. If things go well, proceed from there.

Eventually, you can then slowly lower the water levels and start that transition to dry land exercises, O’Neill says.

“Ultimately, for low back patients, a consistentcombination of water and land would be the ideal to keep this incredibly common malady at bay,” he said.

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