Aquatic exercise trumps common physical therapies for low back pain

People with chronic low back pain finds greater relief from therapeutic aquatic exercise than common physical therapy modalities and the benefits are sustained through 12 months, reveals a study. 

“This finding may prompt clinicians to recommend therapeutic aquatic exercise to patients with chronic low back pain as part of treatment to improve their health through active exercise rather than relying on passive relaxation,” said the researchers.  

Compared with physical therapies such as infrared ray thermal therapy and transcutaneous electrical nerve stimulation, therapeutic aquatic exercise led to greater alleviation of disability — assessed using the Roland-Morris Disability Questionnaire. The differences between treatment groups grew larger over time, with adjusted mean differences of -1.77 (p=0.006) at 3 months, -2.42 (p=0.006) at 6 months, and -3.61 (p=0.001) at 12 months. [JAMA Network Open 2022;5:e2142069]   

Improvements were also seen across the secondary outcomes of pain intensity (p<0.001), quality of life (p=0.03), sleep quality (p=0.04), and kinesiophobia (p=0.02) in the aquatic exercise group vs the physical therapy group at 12 months. Again, the benefits with therapeutic aquatic exercise grew more prominent over time from 3 months to 12 months.

“Our findings showed that the improvement in pain and dysfunction in the therapeutic aquatic exercise group was not only statistically significant but was also clinically significant,” the researchers reported.

Among the patients who achieved the minimal clinically important difference in pain (≥2-point improvement on the numeric rating scale), significantly greater improvements were seen in favour of therapeutic aquatic exercise over physical therapy modalities across different pain levels (53.57 percent vs 21.05 percent for most severe pain, 25 percent vs 19.30 percent for average pain, and 39.29 percent vs 17.54 percent for current pain).

Similar results were also seen in those who met the minimal clinically important difference in disability (46.43 percent vs 7.02 percent).

The single-blind study randomized 113 participants (mean age 31.0 years, 52.2 percent women) with chronic low back pain to intervention with either the therapeutic aquatic exercise or physical therapy modalities, which comprised infrared ray thermal therapy and transcutaneous electrical nerve stimulation. Both interventions lasted for 60 minutes each time, conducted twice a week for 3 months.

“Clinical practice guidelines recommend therapeutic exercise and physical therapy modalities ... [to] relieve pain intensity and alleviate back disability in patients with low back pain,” said the researchers.

“Transcutaneous electrical nerve stimulation and infrared ray thermal therapy are common modalities that are frequently used for treatment of chronic low back pain; [while] therapeutic aquatic exercise is often prescribed ... among the numerous therapeutic exercises available,” they added.

In the study, participants who underwent therapeutic aquatic exercise were more likely to recommend it to other patients suffering from low back pain compared with those treated with the physical modalities (92.9 percent vs 77.2 percent; p=0.01).

Only one participant assigned to therapeutic aquatic exercise had experienced low back pain or other pains related to the intervention compared with two participants in the physical therapy group.

“Water is an ideal environment for conducting an exercise program given its various properties, including buoyancy pressure, density, thermal capacity, and conductivity,” explained the researchers.