A new Concordia study suggests that aquatic therapy for individuals with chronic low back pain can do more than strengthen the muscles around the spine. It can also have a beneficial impact on the negative psychological factors that are often associated with the disabling disease.
The study used a randomized controlled trial involving two groups of chronic low back pain patients. It found that participants who took part in aquatic therapy reported improvements in pain-related fear and sleep disturbance compared to those who followed standard care programs.
The authors believe that this study shows preliminary evidence that links aquatic therapy with improved psychological outcomes for individuals with low back pain. Their findings were published in the Nature journal Scientific Reports.
“Getting into water makes people feel better right away, because it takes away loading on the spine,” says corresponding author Maryse Fortin, an associate professor in the Department of Health, Kinesiology and Applied Physiology.
“This made aquatic therapy an interesting medium to study people who have pain-related fear like kinesiophobia (the fear of movement stemming from a fear of pain or injury) and pain catastrophizing, and how those relate to spinal musculature.”
Stronger backs and healthier lives
The study looked at two groups of 17 participants (34 total) with chronic low back pain. They were randomly assigned to either an aquatic exercise program or to a standard treatment program for low back pain. Both were supervised by graduate students who are also certified athletic therapists, at Concordia’s SwimEx pool or the School of Health Athletic Therapy Centre.
Participants attended two sessions weekly for 10 weeks where they engaged either in a standard treatment (which included land-based exercises) or in a standardized aquatic therapy strengthening program focusing on exercises targeting the torso and hips. They also completed questionnaires about pain, disability, quality of life, pain-related fears, depression, anxiety and sleep quality.
All participants completed their questionnaires and underwent strength tests and MRI scanning before their first session and again after the last one following the 10-week program.
The aquatic therapy group showed significant increase in muscle size in the multifidus and the erector spinae in the upper spine, two sets of spinal muscles that are crucial to spinal stabilization. However, the increases were not noted in the lower lumbar spine, which is most subject to muscle fatty intrusions and degradation and is considered the most problematic area for people with low back pain.
Both the aquatic and standard care groups showed marked improvements in mean and maximum lumbar strength.
“Combined with the reduction in anxiety, pain-based fears and sleep disturbances, these make for really interesting findings, and we definitely need to look at that relationship more closely,” Fortin says. “The changes were clinically significant, not just statistically significant, meaning they have a true impact on how the participants feel.”
The study’s lead author is Brent Rosenstein, PhD 25. Co-authors include Chanelle Montpetit, Nicolas Vaillancourt, Geoffrey Dover, Christina Weiss, Lee Ann Papula and Antonys Melek.
The study received support from the Fonds de recherche du Québec – Santé and from the R. Howard Webster Foundation.
