As we age, low back pain becomes more common. Between the ages 20 and 59, persistent low back pain (lasting more than three months) affects nearly one in five .
Authors
- Mark Hancock
Professor of Physiotherapy, Macquarie University
- Deborah Wareham
Postdoctoral Research Fellow, Spinal Pain Research Centre, Macquarie University
While you may be tempted to reach for heat packs, medication or a massage, new evidence suggests that the common advice to go for a swim is much more effective.
Until recently, there was no research to back up this advice. Our new trial shows for the first time that swimming can improve low back pain.
What we did
We recruited 76 adults aged 26 to 74 who experienced persistent and bothersome low back pain for more than three months. They needed to be able to swim 25 meters independently, but didn’t swim regularly.
The participants were randomly allocated to receive either a swimming and education program (the intervention group) or education only (the control group).
The intervention involved an eight-week individualised swimming program, supported by four telehealth sessions with a physiotherapist, and free access to a local indoor or outdoor swimming pool.
The amount of swimming was tailored to each participant’s ability and fitness level, with the goal of completing three 30-45 minute swimming sessions per week by the end of the program. Participants were encouraged to continue swimming after the program completed.
The education, provided by a physiotherapist, aimed to help them better understand their pain, reduce the fear associated with movement and exercise, and increase confidence to manage their back pain.
While many people with back pain believe they should avoid activity to protect their back, a large body of evidence shows remaining active is better.
Participants in the education-only (control) group had one to two sessions with a physiotherapist to cover the same key messages about back pain, but otherwise continued their usual treatment and activity.
What did we find?
Participants in the swimming group reported improved function, less pain and more confidence to manage future back pain.
Their disability reduced by more than 50% at the end of the eight-week program. This could mean that a person improved their ability to do daily activities such as standing from a chair, walking or sleeping.
The swimming group’s improvements were 30% greater than those who received education only (control) group.
Participants told us swimming appealed to them because it was low-impact, it reduced weight-bearing and strain, and it enabled them to exercise more confidently and with less pain. They also reported additional health benefits, including better mood.
Swimming can be used as a way for people with back pain to start exercising and break the cycle of pain and limited activity.
What happened after the program ended?
At the end of the eight-week program, some people kept swimming, others swapped to another form of exercise and some stopped exercising.
Although most participants reported enjoyed swimming, some found accessing a pool and the time required a barrier to keep going in the longer term.
Twelve months after starting the program, there were still benefits for the swimming group for disability, function and confidence. But the difference between groups became smaller over time.
What were the limitations?
Our study’s sample size was relatively small, so these findings need to be confirmed in future, larger studies.
Further trials are also needed to test whether the results still hold for people with more severe or disabling back pain.
Finally, the volunteers in our study knew we were investigating swimming and had positive expectations of swimming before starting. This is a limitation that could affect the findings.
How does swimming compare to other exercises for back pain?
A range of different exercises – including Pilates, functional exercises (a type of strength training that helps you perform daily activities) and structured walking – have been shown to be beneficial for treating disability and preventing low back pain recurrences.
While we didn’t compare swimming to another type of exercise, the benefits we identified were as large or larger than previously reported for other exercises.
People with chronic low back pain can now consider swimming as an evidence-based exercise option and be more confident in choosing it as part of their long-term management.
But if you find it a hassle to get to a pool, or don’t like swimming, it may help get your back pain under control before moving to a type of exercise you prefer or can more easily access.
