Exercising in water is better for relieving lower back pain, study suggests

Physical therapy exercises performed in water can bring better results than traditional treatment for chronic low back pain. The conclusion is from a study published in the scientific journal JAMA Open, which followed 113 individuals with the condition for three months.

During the period, the participants were divided into two groups: half did the physical therapy exercises in the water and the other half received a more traditional treatment, such as transcutaneous electrical nerve stimulation and application of infrared light. In both cases, the interventions were conducted for 60 minutes, twice a week.

In the results, the researchers observed that 3.5% of patients who underwent traditional therapy still had back pain, while only 1.8% of individuals who exercised in water had the same complaint. Improvement was observed even 12 months after the intervention.

Also called low back pain, chronic low back pain affects about 4.2% of people between 24 and 39 years old and can reach almost 20% between 20 and 59 years old. In Brazil, the prevalence among the elderly can reach 25.4%, according to a review published in the Revista de Saúde Pública in 2020.

Data from the Ministry of Health indicate that more than 55,000 workers requested leave between January and July 2021 due to back problems – it was the second largest cause of sick leave that year, second only to layoffs caused by Covid-19.

Water Therapy Has Benefits, But It Is Not “Savior”

Hydrotherapy, as physiotherapy performed in water is called, has several benefits, since the liquid medium promotes an important gain in muscle strength due to the natural resistance that water offers.

“Other beneficial factors are an improvement in balance, reduced impact, no risk of falls and muscle relaxation when the water temperature is adequate”, says Diego Leite, specialist in Exercise Physiology and physiologist at HCor (Hospital do Coração).

However, it should not be seen as the only solution or better than all other therapies for chronic back pain.

“Each treatment requires an individual assessment and specific recommendation. Just as water activities can be good for a certain group, they may not be the best alternative for others”, explains the specialist, who is also director of DLB ​​Assessoria Esportiva.

Two factors that must be considered in this case are the cost, since hydrotherapy is usually more expensive, and the exposure of the body, which may not be indicated for some more fragile patients.

“The recommendation of which treatment should be followed is based on the diagnosis and protocol for a specific lesion. Hydrotherapy can be the main or complementary therapy, for example, or not recommended, but what prevails is always medical advice.”

What causes low back pain?

Low back pain can be caused by several factors and is considered chronic when it persists for more than three months in a row. The most common causes are:

• Heredity;
• Degenerative and inflammatory diseases;
• Muscle weakness;
• Overweight and obesity;
• Muscle imbalance.

The main factor that usually triggers low back pain, however, is poor posture – an issue that became even more evident during the pandemic, when the home office scheme was widely adopted by companies.

When is physical therapy recommended?

According to the sports physiologist, the lumbar region is usually a sensitive area and, when it is in an inflammatory state, it can limit the individual’s movements. Therefore, physiotherapy sessions are usually recommended if the pain does not stop even with rest. The diagnosis of the degree of injury and the duration of treatment should only be made by the orthopedic doctor.

At first, physiotherapy work is usually focused on pain relief, using electrostimulation and heat therapy (such as infrared light). In a second moment, stretching is performed to gain range of motion and exercises for muscle strengthening.

Leite reinforces, however, that there is no “cake recipe” and that each case is unique and must be evaluated in a particular way.

“Depending on the degree of inflammation and the person’s profile, we recommend physiotherapy as a first treatment and then Pilates exercises to maintain the acquired gain”, says the specialist.