Pool-based Exercise Effective for Chronic Back Pain

Key Takeaways

  • Researchers compared aquatic exercise to physical therapy and found time in the pool was more effective for back pain.
  • The aquatic results continued even months after participants stopped doing the exercise.
  • These findings do not mean physical therapy is a waste of time—simply moving more often can have meaningful results.

People with chronic back pain may want to invest in a new swimsuit. A recent clinical trial published in JAMA Network Open finds that aquatic exercise had a greater effect on pain, quality of life, sleep quality, and mental state than physical therapy (PT) after 3 months. Plus, the effect remained 1 year later.

About the Study

Researchers recruited 113 men and women with diagnosed chronic back pain, ranging in age from 18 to 65, and split them into two groups. Half did therapeutic aquatic exercise, and the other half did a form of physical therapy.

After the initial study period of 90 days, those who did pool-based exercise showed greater alleviation of disability, even months later. They also reported lower pain levels, which had a ripple effect of improving sleep and mood.

These findings are in line with previous research that highlights the benefits of aquatic exercise. For example, a meta-analysis in the American Journal of Physical Medicine & Rehabilitation looked at eight studies on the effectiveness of this type of movement and found it significantly reduces pain and increases physical function.

The benefits of being in a pool include decreased load-bearing thanks to buoyancy provided by water—lessening the pull of gravity on the spine—and natural resistance that causes the muscles to work harder than they would normally. Aquatic exercise also eliminates fall risk, which can be a major consideration for those with limited mobility.

Importance of Movement

Although the recent study highlighted the advantages of aquatic therapy over several types of physical therapy interventions, that does not mean you should avoid PT in favor of pool time. One of the main reasons for the effectiveness of aquatic exercise was gentle movement.

Researchers compared gentle movements to PT modalities focused on passive relaxation. Specifically, the PT group received electrical nerve stimulation or infrared ray thermal therapy for 30 minutes each session.

By contrast, those in the aquatic group followed a more rigorous protocol with session twice a week for 12 weeks. For instance, they did a 10-minute warmup to enhance neuromuscular activation and a 40-minute exercise at 60% to 80% of maximum heart rate. This was followed by a 10-minute cooldown.

Carol Mack, DPT, CSCS

Even a small amount of movement is beneficial when it comes to back pain.

— Carol Mack, DPT, CSCS

Even if you do not live close to a pool or have a therapist offering aquatic exercise, you can still simulate the results by focusing on gentle movement, particularly if you put a tailored program together with a physical therapist or physician.

“Even a small amount of movement is beneficial when it comes to back pain,” says Carol Mack, DPT, CSCS, doctor of physical therapy at CLE Sports PT & Performance in Cleveland. “Many people think back pain can be alleviated by stretching or relaxation, but often, moving in smarter and pain-free ways is more beneficial.”

Overcoming Fear of Exercise

When incorporating more movement into a treatment for chronic back pain, it is common for people to be hesitant about exercise, according to Amir Mahajer, DO, assistant professor of orthopedics at Mount Sinai in New York.

That is especially true if back pain may have been caused by playing sports. But it is an incredibly important part of pain management, he notes.

Amir Mahajer, DO

Maintaining a healthy body mass index, larger muscle mass, flexibility, and mobility will lead to a protected musculoskeletal system.

— Amir Mahajer, DO

“Maintaining a healthy body mass index, larger muscle mass, flexibility, and mobility will lead to a protected musculoskeletal system,” Dr. Mahajer says. “The mainstay of treatment for many orthopedic conditions is a rehabilitation treatment plan with a physician-guided home exercise program at its core.”

Another crucial component for better back health is staying motivated, he adds. People with back pain often have a much better outcome if they are engaged in their treatment plan and willing to do the kind of progressive, gentle movement that gets them back on track.

“There’s often not a single procedure or treatment plan that will ameliorate a patient’s back pain in the long run,” says Dr. Mahajer. “I always endorse active participation versus passive therapies.”

What This Means For You

Researchers found that gentle movement in an aquatic exercise program helped those with chronic back pain by boosting their quality of life, sleep, mood, pain level, and mobility. If you are experiencing chronic back pain, talk to a healthcare provider about incorporating an aquatic element into your treatment plan. They can help you determine if it is right for you.


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