Low back pain is a common, multifaceted disorder that directly affects diverse aspects of people’s lives in terms of health, personal and social lives. A variety of pathological disorders, including low back pain, may benefit from hydrotherapy.
Objective
This study aimed to systematically analyze the efficacy of aquatic exercise on pain intensity, disability, and quality of life among adults with low back pain.
Data sources
A systematic search was conducted in PubMed, Web of Science, Medline, and Scopus up to February 2023 for randomized controlled trials (RCTs) that which examined the impact of aquatic exercise. The most relevant articles were selected based on research criteria. The PEDro scale was applied to assess the quality of the included studies. Review Manager 5.3 was used for conducting all analyses.
Study selection
Out of 856 articles, 14 RCTs (n = 484 participants; 257 in the experimental groups and 227 in the control groups) met our inclusion criteria.
Results
Pooled results illustrated that aquatic exercises significantly reduced pain (mean differences (MD): −3.82; p < 0.00,001), improved disability (standardized mean differences (SMD): 1.65; p < 0.00,001), and improved quality of life in both the physical component score (mean difference (MD), 10.13; p < 0.00,001) and the mental component score (MD, 6.45; p < 0.0001) when compared with a control group.
Conclusion
The current review showed that aquatic exercise regimens were effective among adults with low back pain. High-quality clinical investigations are still needed to support the use of therapeutic aquatic exercise in a clinical setting.
AlikhajehY.BarabadiE.RahimiM. G. R. (2020). A comparison of 6 weeks of aquatic exercise and kinesio taping in patients with chronic nonspecific low back pain. Journal of Sport Rehabilitation, 30(1), 37–42. https://doi.org/10.1123/jsr.2019-0185
2.
AllegriM.MontellaS.SaliciF.ValenteA.MarchesiniM.CompagnoneC.BaciarelloM.ManferdiniM. E.FanelliG. (2016). Mechanisms of low back pain: A guide for diagnosis and therapy. F1000Research, 5(F1000 Faculty Rev-1530). https://doi.org/10.12688/f1000research.8105.2
3.
AnsariS.ElmiehA.AlipourA. (2021). The effect of aquatic exercise on functional disability, flexibility and function of trunk muscles in postmenopausal women with chronic non-specific low back pain: Randomized controlled trial. Science and Sports, 36(3), Article e103–e110. https://doi.org/10.1016/j.scispo.2020.07.003
4.
AriyoshiM.SonodaK.NagataK.MashimaT.ZenmyoM.PakuC.TakamiyaY.YoshimatsuH.HiraiY.YasunagaH.AkashiH.ImayamaH.ShimokobeT.InoueA.MutohY. (1999). Efficacy of aquatic exercises for patients with low-back pain. The Kurume Medical Journal, 46(2), 91–96. https://doi.org/10.2739/kurumemedj.46.91
5.
Baena-BeatoP. A.Arroyo-MoralesM.Delgado-FernándezM.Gatto-CardiaM. C.ArteroE. G. (2013). Effects of different frequencies (2–3 days/week) of aquatic therapy program in adults with chronic low back pain. A non-randomized comparison trial. Pain Medicine, 14(1), 145–158. https://doi.org/10.1111/pme.12002
6.
Baena-BeatoP. Á.ArteroE. G.Arroyo-MoralesM.Robles-FuentesA.Gatto-CardiaM. C.Delgado-FernándezM. (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. https://doi.org/10.1177/0269215513504943
BayraktarD.Guclu-GunduzA.LambeckJ.YaziciG.AykolS.DemirciH. (2016). A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: A pilot study. Disability and Rehabilitation, 38(12), 1163–1171. https://doi.org/10.3109/09638288.2015.1075608
9.
BeckerB. E. (2009). Aquatic therapy: Scientific foundations and clinical rehabilitation applications. PM and R: The Journal of Injury, Function, and Rehabilitation, 1(9), 859–872. https://doi.org/10.1016/j.pmrj.2009.05.017
10.
BelloA. I.KaluN. H.AdegokeB. O. A.Agyepong-BaduS. (2010). Hydrotherapy versus land-based exercises in the management of chronic low back pain: A comparative study. Journal of Musculoskeletal Research, 13(04), 159–165. https://doi.org/10.1142/s0218957710002594
11.
BernsteinI. A.MalikQ.CarvilleS.WardS. (2017). Low back pain and sciatica: Summary of NICE guidance. Bmj, 356, i6748. https://doi.org/10.1136/bmj.i6748
12.
CarvalhoR. G.SilvaM. F.DiasJ. M.OlkoskiM. M.BelaL. F. D.PelegrinelliA. R.BarretoM. S.CamposR. R.GuenkaL. C.FacciL. M. (2020). Effectiveness of additional deep-water running for disability, lumbar pain intensity, and functional capacity in patients with chronic low back pain: A randomised controlled trial with 3-month follow-up. Musculoskeletal Science and Practice, 1(49), 102195. https://doi.org/10.1016/j.msksp.2020.102195
13.
ChouR.DeyoR.FriedlyJ.SkellyA.HashimotoR.WeimerM.FuR.DanaT.KraegelP.GriffinJ.GrusingS.BrodtE. D. (2017). Nonpharmacologic therapies for low back pain: A systematic review for an American college of physicians clinical practice guideline. Annals of Internal Medicine, 166(7), 493–505. https://doi.org/10.7326/M16-2459
14.
ChristakouA.BoulntaF. (2020). The effectiveness of hydrotherapy in patients with chronic low back pain. Physiotherapy Quarterly, 28(3), 32–38. https://doi.org/10.5114/pq.2020.95772
15.
CostantinoC.RomitiD. (2014). Effectiveness of back school program versus hydrotherapy in elderly patients with chronic non-specific low back pain: A randomized clinical trial. Acta Bio-Medica: Atenei Parmensis, 85(3), 52–61.
16.
Cuesta-VargasA.AdamsN.SalazarJ.BellesA.HazañasS.Arroyo-MoralesM. (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. https://doi.org/10.1007/s10067-012-1977-5
17.
Cuesta-VargasA. I.García-RomeroJ. C.Arroyo-MoralesM.Diego-AcostaÁ. M.DalyD. J. (2011). Exercise, manual therapy, and education with or without high-intensity deep-water running for nonspecific chronic low back pain: A pragmatic randomized controlled trial. American Journal of Physical Medicine and Rehabilitation, 90(7), 526–538. https://doi.org/10.1097/PHM.0b013e31821a71d
18.
DueñasM.OjedaB.SalazarA.MicoJ. A.FaildeI. (2016). A review of chronic pain impact on patients, their social environment and the health care system. Journal of Pain Research, 9(28), 457–467. https://doi.org/10.2147/JPR.S105892
19.
DundarU.SolakO.YigitI.EvcikD.KavuncuV. (2009). Clinical effectiveness of aquatic exercise to treat chronic low back pain: A randomized controlled trial. Spine, 34(14), 1436–1440. https://doi.org/10.1097/BRS.0b013e3181a79618
20.
EggerM.SmithG. D.SchneiderM.MinderC. (1997). Bias in meta-analysis detected by a simple, graphical test. Bmj, 315(7109), 629–634. https://doi.org/10.1136/bmj.315.7109.629
21.
ElkinsM. R.HerbertR. D.MoseleyA. M.SherringtonC.MaherC. (2010). Rating the quality of trials in systematic reviews of physical therapy interventions. Cardiopulmonary Physical Therapy Journal, 21(3), 20–26. https://doi.org/10.1097/01823246-201021030-00005
22.
FoleyA.HalbertJ.HewittT.CrottyM. (2003). Does hydrotherapy improve strength and physical function in patients with osteoarthritis—a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme. Annals of the Rheumatic Diseases, 62(12), 1162–1167. https://doi.org/10.1136/ard.2002.005272
23.
GabrielsenA.VidebaekR.JohansenL. B.WarbergJ.ChristensenN. J.PumpB.NorskP. (2000). Forearm vascular and neuroendocrine responses to graded water immersion in humans. Acta Physiologica Scandinavica, 169(2), 87–94. https://doi.org/10.1046/j.1365-201x.2000.00680.x
24.
GranathA. B.HellgrenM. S. E.GunnarssonR. K. (2006). Water aerobics reduces sick leave due to low back pain during pregnancy. Journal of Obstetric, Gynecologic and Neonatal Nursing, 35(4), 465–471. https://doi.org/10.1111/j.1552-6909.2006.00066.x
25.
HanG.ChoM.NamG.MoonT.KimJ.KimS.HongS.ChoB. (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. https://doi.org/10.1589/jpts.23.57
26.
HigginsJ. P. T.ThompsonS. G.DeeksJ. J.AltmanD. G. (2003). Measuring inconsistency in meta-analyses. Bmj, 327(7414), 557–560. https://doi.org/10.1136/bmj.327.7414.557
27.
HondaT.KamiokaH. (2012). Curative and health enhancement effects of aquatic exercise: Evidence based on interventional studies. Open Access Journal of Sports Medicine, 3(29), 27–34. https://doi.org/10.2147/OAJSM.S30429
28.
Hossein AbadiF.ChooL.ElumalaiG.SankaravelM.RazliA. (2019). Does aquatic exercise improve quality of life in obese low-back pain population?International Journal of Physiotherapy, 6(4), 128–133. https://doi.org/10.15621/ijphy/2019/v6i4/185415
29.
HuskyM. M.Ferdous FarinF.CompagnoneP.FermanianC.Kovess-MasfetyV. (2018). Chronic back pain and its association with quality of life in a large French population survey. Health and Quality of Life Outcomes, 16(1), 1–9. https://doi.org/10.1186/s12955-018-1018-4
30.
IrandoustK.TaheriM. (2015). The effects of aquatic exercise on body composition and nonspecific low back pain in elderly males. Journal of Physical Therapy Science, 27(2), 433–435. https://doi.org/10.1589/jpts.27.433
31.
JamisonR. N.WanL.EdwardsR. R.MeiA.RossE. L. (2019). Outcome of a high-frequency transcutaneous electrical nerve stimulator (hfTENS) device for low back pain: A randomized controlled trial. Pain Practice, 19(5), 466–475. https://doi.org/10.1111/papr.12764
32.
JanyacharoenT.ChaichanawongsaJ.NamsiriS.ThongduangY.ArayawichanondP.KanpittayaJ. (2012). Effects of aquatic exercise on trunk flexibility, back muscle strength, and pain scale in chronic nonspecific low back pain patients. Chulalongkorn Medical Journal, 56(4), 433–445.
33.
JaureguiJ. J.CherianJ. J.GwamC. U.ChughtaiM.MistryJ. B.ElmallahR. K.HarwinS. F.BhaveA.MontM. A. (2016). A meta-analysis of transcutaneous electrical nerve stimulation for chronic low back pain. Surgical Technology International, 1(28), 296–302.
34.
JohnsonS. R.KeyanZ.RosarioE. R. (2016). Effects of aquatic therapy on functional mobility and strength, fall risk, and self-reported disability in individuals with low back pain. The Journal of Aquatic Physical Therapy, 24(1), 22–31.
35.
KanitzA. C.MachadoB.RodriguesD.ZambelliG.IvaniskiA.CarvalhoN.ReichertT.PereiraE.RochaR.SudattiR.MartinsL. (2021). Deep-water running training at moderate intensity and high intensity improves pain, disability, and quality of life in patients with chronic low back pain: A randomized clinical trial. Archivos de Medicina del Deporte, 38(1), 28–35. https://doi.org/10.18176/archmeddeporte.00023
36.
KatzJ. N. (2006). Lumbar disc disorders and low-back pain: Socioeconomic factors and consequences. JBJS, 88(suppl_2), 21–24.
37.
KeaneL. G. (2017). Comparing AquaStretch with supervised land based stretching for chronic lower back pain. Journal of Bodywork and Movement Therapies, 21(2), 297–305. https://doi.org/10.1016/j.jbmt.2016.07.004
38.
KentP. M.KeatingJ. L. (2005). The epidemiology of low back pain in primary care. Chiropractic and Osteopathy, 13(1), 1–7. https://doi.org/10.1186/1746-1340-13-13
39.
KhodaveisiH.SazvarA.AnbarianM. (2018). The effect of 12-week aquatic exercises on core stability of women with low back pain. Physical Treatments-specific Physical Therapy Journal, 8(3), 161–168. https://doi.org/10.32598/ptj.8.3.161
40.
KisnerC.ColbyL. A.BorstadJ. (2017). Therapeutic exercise: Foundations and techniques. Fa Davis.
41.
LahartI. M.MetsiosG. S. (2018). Chronic physiological effects of swim training interventions in non-elite swimmers: A systematic review and meta-analysis. Sports Medicine, 48(2), 337–359. https://doi.org/10.1007/s40279-017-0805-0
MannionA. F.BalaguéF.PelliséF.CedraschiC. (2007). Pain measurement in patients with low back pain. Nature Clinical Practice Rheumatology, 3(11), 610–618. https://doi.org/10.1038/ncprheum0646
44.
McIlveenB.RobertsonV. J. (1998). A randomised controlled study of the outcome of hydrotherapy for subjects with low back or back and leg pain. Physiotherapy, 84(1), 17–26. https://doi.org/10.1016/s0031-9406(05)65898-1
45.
MirmoezziM.IrandoustK.H’midaC.TaheriM.TrabelsiK.AmmarA.ParyabN.NikolaidisP. T.KnechtleB.ChtourouH. (2021). Efficacy of hydrotherapy treatment for the management of chronic low back pain. Irish Journal of Medical Science (1971-), 190(4), 1413–1421. https://doi.org/10.1007/s11845-020-02447-5
46.
MiyamotoG. C.FrancoK. F. M.van DongenJ. M.FrancoY. R. D. S.de OliveiraN. T. B.AmaralD. D. V.BrancoA. N. C.da SilvaM. L.van TulderM. W.CabralC. M. N. (2018). Different doses of pilates-based exercise therapy for chronic low back pain: A randomised controlled trial with economic evaluation. British Journal of Sports Medicine, 52(13), 859–868. https://doi.org/10.1136/bjsports-2017-098825
47.
MoreiraN. B.da SilvaL. P.RodackiA. L. F.RodackiA. L. F. (2020). Aquatic exercise improves functional capacity, perceptual aspects, and quality of life in older adults with musculoskeletal disorders and risk of falling: A randomized controlled trial. Experimental Gerontology, 1(142), 111135. https://doi.org/10.1016/j.exger.2020.111135
48.
MoseleyA. M.HerbertR. D.SherringtonC.MaherC. G. (2002). Evidence for physiotherapy practice: A survey of the Physiotherapy evidence database (PEDro). Australian Journal of Physiotherapy, 48(1), 43–49. https://doi.org/10.1016/s0004-9514(14)60281-6
49.
Najafi GhagholestaniB.GandomiF.AssarS.Richard SpearsL. (2022). Effects of dynamic neuromuscular stabilization and aquatic exercises on the pain, disability, lumbopelvic control, and spinal posture of patients with non-specific low back pain. Iranian Rehabilitation Journal, 20(3), 333–344. https://doi.org/10.32598/irj.20.3.1319.2
50.
OlsonD. A.KolberM. J.PatelC.PabianP.HanneyW. J. (2013). Aquatic exercise for treatment of low-back pain: A systematic review of randomized controlled trials. American Journal of Lifestyle Medicine, 7(2), 154–160. https://doi.org/10.1177/1559827612457323
51.
PageM. J.McKenzieJ. E.BossuytP. M.BoutronI.HoffmannT. C.MulrowC. D.ShamseerL.TetzlaffJ. M.AklE. A.BrennanS. E.ChouR.GlanvilleJ.GrimshawJ. M.HróbjartssonA.LaluM. M.LiT.LoderE. W.Mayo-WilsonE.McDonaldS.MoherD. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Systematic Reviews, 10(1), 89. https://doi.org/10.1186/s13643-021-01626-4
52.
PengM.-S.WangR.WangY.-Z.ChenC.-C.WangJ.LiuX.-C.SongG.GuoJ.-B.ChenP.-J.WangX.-Q. (2022). Efficacy of therapeutic aquatic exercise vs physical therapy modalities for patients with chronic low back pain: A randomized clinical trial. JAMA Network Open, 5(1), Article e2142069–e2142069. https://doi.org/10.1001/jamanetworkopen.2021.42069
53.
PiresD.CruzE. B.CaeiroC. (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. https://doi.org/10.1177/0269215514549033
54.
PrabhuC.DadmiP. (2019). Effect of aquatic therapy v/s relaxation therapy in chronic low back pain. International Journal of Orthopaedics Sciences, 5(1), 279–284. https://doi.org/10.22271/ortho.2019.v5.i1e.49
PsycharakisS. G.ColemanS. G. S.LintonL.KaliarntasK.ValentinS. (2019). Muscle activity during aquatic and land exercises in people with and without low back pain. Physical Therapy, 99(3), 297–310. https://doi.org/10.1093/ptj/pzy150
57.
QaseemA.WiltT. J.McLeanR. M.ForcieaM. A.Clinical Guidelines Committee of the American College of Physicians (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American college of physicians. Annals of Internal Medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367
58.
RagiaM. K.NasarH. M.Abedl-AalP.NabilM. (2021). Aquatic versus land-based exercise in treatment of chronic mechanical low back pain. The Medical Journal of Cairo University, 89(6), 753–760. https://doi.org/10.21608/mjcu.2021.168009
59.
RezaiV.Mahdavi-NejadR.ZolaktafV. (2020). Comparing the effects of different types of aquatic walking on endurance and electrical activities of spine extensor muscles in men with nonspecific chronic back pain. International Journal of Preventive Medicine, 11, 168. https://doi.org/10.4103/ijpvm.IJPVM_403_19
60.
Rivas NeiraS.Pasqual MarquesA.Pegito PérezI.Fernández CervantesR.Vivas CostaJ. (2017). Effectiveness of aquatic therapy vs land-based therapy for balance and pain in women with fibromyalgia: A study protocol for a randomised controlled trial. BMC Musculoskeletal Disorders, 18(1), 1–10. https://doi.org/10.1186/s12891-016-1364-5
61.
SauverJ. L. S.WarnerD. O.YawnB. P.JacobsonD. J.McGreeM. E.PankratzJ. J.MeltonL. J.IIIRogerV. L.EbbertJ. O.RoccaW. A. (2013). Why patients visit their doctors: Assessing the most prevalent conditions in a defined American population. Mayo Clinic Proceedings, 88(1), 56–57. https://doi.org/10.1016/j.mayocp.2012.08.020
62.
ShiZ.ZhouH.LuL.PanB.WeiZ.YaoX.KangY.LiuL.FengS. (2018). Aquatic exercises in the treatment of low back pain: A systematic review of the literature and meta-analysis of eight studies. American journal of physical medicine and rehabilitation, 97(2), 116–122. https://doi.org/10.1097/phm.0000000000000801
63.
SjogrenT.LongN.StorayI.SmithJ. (1997). Group hydrotherapy versus group land-based treatment for chronic low back pain. Physiotherapy Research International, 2(4), 212–222. https://doi.org/10.1002/pri.107
64.
TaheriM.IrandoustK. (2014). The effects of water-based exercises on depressive symptoms and non-specific low back pain in retired professional athletes: A randomized controlled trial. International Journal of Sport Studies, 4(4), 434–440.
65.
TaylorJ. B.GoodeA. P.GeorgeS. Z.CookC. E. (2014). Incidence and risk factors for first-time incident low back pain: A systematic review and meta-analysis. The Spine Journal, 14(10), 2299–2319. https://doi.org/10.1016/j.spinee.2014.01.026
66.
WallerB.LambeckJ.DalyD. (2009). Therapeutic aquatic exercise in the treatment of low back pain: A systematic review. Clinical Rehabilitation, 23(1), 3–14. https://doi.org/10.1177/0269215508097856
67.
WangX.-Q.GuW.ChenB.-L.WangX.HuH.-Y.ZhengY.-L.ZhangJ.ZhangH.-Y.ChenP.-J. (2019). Effects of whole-body vibration exercise for non-specific chronic low back pain: An assessor-blind, randomized controlled trial. Clinical Rehabilitation, 33(9), 1445–1457. https://doi.org/10.1177/0269215519848076
68.
WongC. H.LinL. C.LeeH. H.LiuC.-F. (2012). The analgesic effect of thermal therapy after total knee arthroplasty. The Journal of Alternative and Complementary Medicine, 18(2), 175–179. https://doi.org/10.1089/acm.2010.0815
69.
YozbatiranN.YildirimY.ParlakB. (2004). Effects of fitness and aquafitness exercises on physical fitness in patients with chronic low back pain. The Pain Clinic, 16(1), 35–42. https://doi.org/10.1163/156856904322858684
70.
ZampognaB.PapaliaR.PapaliaG. F.CampiS.VastaS.VoriniF.FossatiC.TorreG.DenaroV. (2020). The role of physical activity as conservative treatment for hip and knee osteoarthritis in older people: A systematic review and meta-analysis. Journal of Clinical Medicine, 9(4), 1167. https://doi.org/10.3390/jcm9041167
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