February 2017: Low Back Pain



The water offers a unique therapeutic environment which can be harnessed by a skilled provider to permit activities unachievable on land. This is especially true for the patient suffering from low back pain. In water, weight bearing of the lower extremities and spine can be reduced or eliminated by buoyancy, pain can be reduced by the application of superficial heat, proprioceptive input can be enhanced by viscosity and turbulence, and the pain cycle can be interrupted by offloading the spine and buffeting the body with sensory input. It is both difficult and clinically impractical to achieve these same effects on land.

Archimedes' principle states: "when a body is wholly or partially immersed in a fluid, it experiences an upthrust equal to the weight of fluid displaced." The human body has elements which tend to sink (dense muscle) and elements which tend to float (fatty tissue and air-filled lungs). This tendency for the body to float offsets gravity and supports the body, resulting in relief from compressive forces on the back. In the water, it becomes possible for a person to stand, walk, and even simulate work with reduced pain without needing help and without creating abnormal protective mechanisms in the water. 

In short, the patient with back pain can initiate "normal" tasks such as walking, rolling, bending forward and balance drills in the water without pain. This allows the patient to offset any deconditioning effects of immobility or reduced movement that usually accompany a back injury. The articles below show a sampling of the research which has been published of late on this very compelling topic.

Recent publications: systematic reviews and meta-analysis

Learn more at Aquatic Therapy Day on October 18 at NSPF's World Aquatic HealthTM Conference in Denver, Colorado. Click here to learn more.

Asta, M. (2015). Application Of A Short-Term Aquatic Physical Therapy Program For A Patient With Chronic Low Back Pain And Radiculopathy: A Case Report. University of New England. Thesis. Retrieved from http://dune.une.edu/pt_studcrpaper/38/?utm_source=dune.une.edu%2Fpt_studcrpaper%2F38&utm_medium=PDF&utm_campaign=PDFCoverPages

Baena-Beato, P. P. Á. P., Delgado-Fernández, M., Artero, E. G., Robles-Fuentes, A., Gatto-Cardia, M. C., & Arroyo-Morales, M. (2014). Disability Predictors in Chronic Low Back Pain After Aquatic Exercise. American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists, 93(7), 615–23. http://doi.org/10.1097/PHM.0000000000000123

Baena-Beato, P. Á. A. P. Á. A. Á., Artero, E. G., Arroyo-Morales, M., Robles-Fuentes, A., Gatto-Cardia, M. C. M. C. M. C. M. C., Delgado-Fernández, M., … Delgado-Fernandez, M. (2014). Aquatic therapy improves pain, disability, quality of life, body composition and fitness in sedentary adults with chronic low back pain. A controlled clinical trial. Clinical Rehabilitation, 28(4), 350–360. article. http://doi.org/10.1177/0269215513504943

Bressel, E., Dolny, D. G., Vandenberg, C., & Cronin, J. B. (2012). Trunk muscle activity during spine stabilization exercises performed in a pool. Physical Therapy in Sport, 13(2), 67–72. http://doi.org/10.1016/j.ptsp.2011.06.002

Burr, J., Shephard, R., Cornish, S., Vatanparast, H., & Chilibeck, P. (2012). Arthritis, osteoporosis, and low back pain: evidence-based clinical risk assessment for physical activity and exercise clearance. Canadian Family Physician Médecin de Famille Canadien, 58(1), 59–62. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3264014&tool=pmcentrez&rendertype=abstract

Cacia, B., & Grzeskowiak, E. (2016). Improving Chronic Pain and Limited Mobility with Water-Based Therapy . Physical Therapy Products. Retrieved from http://www.ptproductsonline.com/2016/01/improving-chronic-pain-limited-mobility-water-based-therapy/

Camilotti, B., Leite, N., & Alberti, D. (2015). Effects of Ai Chi and Yamamoto new scalp acupuncture on chronic low back pain. Fisioterapia em Movimento. 28(4). Retrieved from http://www.scielo.br/scielo.php?pid=S0103-51502015000400723&script=sci_arttext&tlng=en

Cuesta-Vargas, A. I., Adams, N., Salazar, J. A., Belles, A., Hazañas, S., & Arroyo-Morales, M. (2012). Deep water running and general practice in primary care for non-specific low back pain versus general practice alone: Randomized controlled trial. Clinical Rheumatology, 31(7), 1073–1078. http://doi.org/10.1007/s10067-012-1977-5

Cuesta-Vargas, A. A. I., White, M., González-Sánchez, M., Kuisma, R., Gonzalez-Sanchez, M., Kuisma, R., … Kuisma, R. (2015). The optimal frequency of aquatic physiotherapy for individuals with chronic musculoskeletal pain: a randomised controlled trial. Disability and Rehabilitation, 37(4), 311–318. http://doi.org/10.3109/09638288.2014.918191

Cuesta-Vargas, A., & González-Sánchez, M. (2015). Changes in Disability, Physical/Mental Health States and Quality of Life during an 8-Week Multimodal Physiotherapy Programme in Patients with Chronic Non-Specific Neck Pain: a prospective cohort study. PloS One. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339981/

Cuesta-Vargas, A., García-Romero, J. C., Arroyo-Morales, M., Diego-Acosta, Ã. M., & Daly, D. J. (2011). Exercise, Manual Therapy, and Education with or Without High-Intensity Deep-Water Running for Nonspecific Chronic Low Back Pain. American Journal of Physical Medicine & Rehabilitation, 90(7), 526–611. http://doi.org/10.1097/PHM.0b013e31821a71d0

Ericsson, A., Bremell, T., Cider, Å., & Mannerkorpi, K. (2016). Effects of exercise on fatigue and physical capacity in men with chronic widespread pain - a pilot study. BMC Sports Science, Medicine and Rehabilitation, 8(1), 29. http://doi.org/10.1186/s13102-016-0054-9

Fritz, J. M., Rundell, S. D., Dougherty, P., Gentili, A., Kochersberger, G., Morone, N. E., … Weiner, D. K. (2016). Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part VI: Lumbar Spinal Stenosis. Pain Medicine, 17(3), 501–10. http://doi.org/10.1093/pm/pnw011

Gunsoo, H. A. N., Minhaeng, C. H. O., Gitaek, N. A. M., Taeyoung, M., Jeehee, K. I. M., Seonrye, K. I. M., … Cho, B. (2011). The Effects on Muscle Strength and Visual Analog Scale Pain of Aquatic Therapy for individuals with Low Back Pain. Journal of Physical Therapy Science, 23(1), 57–60. http://doi.org/10.1589/jpts.23.57

Haupenthal, A., Ruschel, C., Hubert, M., De Brito Fontana, H., & Roesler, H. (2010). Loading forces in shallow water running at two levels of immersion. Journal of Rehabilitation Medicine, 42(7), 664–669. http://doi.org/10.2340/16501977-0587

Hawamdeh, M., Hawamdeh, Z., Ermely, Z., Qaddah, I., & Soud, D. A. (2015). Comparison between the effects of Aquatic Exercises and Land Based Exercises in the Treatment of Chronic Low Back Pain. Indian Journal of Physiotherapy and Occupational Therapy - An International Journal, 9(1), 5–10. http://doi.org/10.5958/0973-5674.2015.00002.7

Homayouni, K., Naseri, M., Zaravar, F., Zaravar, L., Karimian, H., K., H., … Karimian, H. (2015). Comparison of the effect of aquatic physical therapy and conventional physical therapy in patients with lumbar spinal stenosis (a randomized controlled trial). Journal of Musculoskeletal Research, 18(1). http://doi.org/10.1142/S0218957715500025

Intveld, E., Cooper, S., & van Kessel, G. (2010). The Effect of Aquatic Physiotherapy on Low Back Pain in Pregnant Women. International Journal of Aquatic Research & Education, 4(2), 147–152. http://scholarworks.bgsu.edu/cgi/viewcontent.cgi?article=1198&context=ijare

Karagülle, M. Z. M. M., & Karagülle, M. Z. M. M. (2015). Effectiveness of balneotherapy and spa therapy for the treatment of chronic low back pain: a review on latest evidence. Clinical Rheumatology, 34(2), 207–14. http://doi.org/10.1007/s10067-014-2845-2

Khanjari, Y., & Garooei, R. (2015). The effect of a period of aquatic therapy exercise on the quality of life and depression in aged males suffering from chronic physical pains. International Letters of Social and Humanistic Sciences, 56.  http://www.scipress.com/ILSHS.56.127.pdf

Kim, Y.-S. S., Park, J., & Shim, J. K. (2010). Effects of aquatic backward locomotion exercise and progressive resistance exercise on lumbar extension strength in patients who have undergone lumbar diskectomy. Archives of Physical Medicine and Rehabilitation, 91(2), 208–214. http://doi.org/10.1016/j.apmr.2009.10.014

Koyuncu, E., Ökmen, B. M., Özkuk, K., Taşoğlu, Ö., & Özgirgin, N. (2016). The effectiveness of balneotherapy in chronic neck pain. Clinical Rheumatology, Epub ahead of publication. http://doi.org/10.1007/s10067-016-3199-8

Lombard, M., & Pretorius, W. (2015). Hydrotherapy and its effects on chronic pain intensity, physical functionality and quality of life in the elderly. Physical Health Education, Recreation and Dance, 21(4.1). http://reference.sabinet.co.za/sa_epublication_article/ajpherd_v21_n4_1_a4

Łubkowska, W., Paczyńska-jędrycka, D. M., Eider, D. J., & Lubkowska, W. (2014). The significance of swimming and corrective exercises in water in treatment of postural deficits and scoliosis. Central European Journal of Sport Sciences and Medicine. 6(2), 93–101. Retrieved from http://agro.icm.edu.pl/agro/element/bwmeta1.element.agro-7b31168e-0005-49ee-afbd-40913a296161/c/THE_SIGNIFICANCE_OF_SWIMMING_AND_CORRECTIVE....pdf

Pires, D., Cruz, E. B. E. E. B., Caeiro, C., Diogo Pires, Eduardo Brazete Cruz, Carmen Caeiro, … Caeiro, C. (2015). Aquatic exercise and pain neurophysiology education versus aquatic exercise alone for patients with chronic low back pain: a randomized controlled trial. Clinical Rehabilitation, 29(6), 538–547. http://doi.org/10.1177/0269215514549033

Searle, A., Spink, M., Ho, A., & Chuter, V. (2015). Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials. Clinical Rehabilitation. Epub ahead of print. Retrieved from http://cre.sagepub.com/content/early/2015/02/04/0269215515570379.abstract

Sujan, M. U., Rao, M. R., Kisan, R., Abhishekh, H. A., Nalini, A., Raju, T. R., & Sathyaprabha, T. N. (2016). Influence of hydrotherapy on clinical and cardiac autonomic function in migraine patients. Journal of Neurosciences in Rural Practice, 7(1), 109–113. http://doi.org/10.4103/0976-3147.165389

Taheri, M., Irandoust, K., Ph, D., & D, K. I. P. (2014). The effects of water-based exercises on depressive symptoms and non-specific low back pain in retired professional athletes: a randomized controlled trial. Intl J Sport Std, 4(4), 434–440. Retrieved from http://conf.ikiu.ac.ir/public_files/profiles/items/090ad_1403688712.pdf

Tanakietpinyo, S. (2014). Effects of underwater lumbar traction with aquatic exercises for chronic low back pain clients. Bulletin of Chiang Associated Medical Sciences, 46(3). Retrieved from http://journal.ams.cmu.ac.th/index.php/j/article/view/65

VandenBerg, J. P. (2011). Role of an Aquatic and Non Aquatic Environment on Trunk Muscle Activation (misc). All Graduate Theses and Dissertations. Retrieved from http://search.proquest.com.ezproxy.library.yorku.ca/docview/881645036?accountid=15182\nhttp://sfx.scholarsportal.info/york?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&genre=dissertations+&+theses&sid=ProQ:ProQuest+Dissertations+&+The

Wiażewicz, A., & Zawadzki, M. (2014). Chosen organizational questions about corrective swimming and in-water corrective exercises in case of scoliosis. Central European Journal of Sport Science and Medicine, 7(3), 91-98. Retrieved from http://yadda.icm.edu.pl/yadda/element/bwmeta1.element.psjd-61f4d616-ee79-4a7d-90d6-bd4feed28912

Zameni, Leila; Haghighi, M. (2011). The Effect of Aquatic Exercise on Pain and Postural Control in Women with Low Back Pain. International Journal of Sport Studies, 1(4), 152–156. http://www.academia.edu/8460582/THE_EFFECT_OF_AQUATIC_EXERCISE_ON_PAIN_AND_POSTURAL_CONTROL_IN_WOMEN_WITH_LOW_BACK_PAI