“Swimming is a commonly recommended exercise for low back pain, but it had almost no evidence to support its recommendation,” says the lead study author, Deborah Wareham, a researcher at the Spinal Pain Research Centre at Macquarie University in Sydney, Australia. For adults living with chronic low back pain, she says, the findings show that “Anyone considering swimming can be more confident with choosing it.”
The Study Combined Swimming With Education to Ease Fears About Back Pain
For the study, researchers recruited 76 adults ages 26 to 74 who had low back pain lasting at least 12 weeks. At the study start, participants self-reported how low back problems affected their life, including disability level, pain, daily functioning, and fear of exercise. Participants answered the same questionnaires five times over the following year.
As a control group, half the participants received one or two sessions with a physiotherapist to learn about back pain, including key concepts like:
- Pain does not always equal harm.
- The back is made for movement.
- Flare-ups are likely.
- The best management is to keep moving.
The other half received eight weeks of personalized swimming instruction and four educational sessions with a physiotherapist.
The educational component wasn’t random. “Combining education and exercise has been beneficial in previous research,” Wareham says. “Education can help people understand the benefits of exercise and reduce their fears, and then the swimming helps them experience the benefits.”
Adults in the swimming group weren’t regular swimmers when the study started, but they could swim about 25 yards and felt confident in the water. The program was adjusted to each person’s swimming ability and fitness level. The goal was for participants to be able to swim for 30 to 45 minutes, three times per week, by the end of their swimming lessons.
Swimming Cut Reported Low Back Pain Disability in Half
At the end of the eight weeks, researchers found that adults in the swimming group reported a 50 percent drop in disability levels compared with before they started swimming. Compared with the education-only group, the swimmers scored an average of 2.5 points, or 30 percent lower, on the disability scale.
The researchers also found that swimmers reported lower pain intensity, less functional limitation, and less fear of movement than the control group — although the difference between the two groups decreased over time. While the trial itself lasted just eight weeks, the swimmers reported continued back pain improvement when researchers followed up at 26 weeks and 52 weeks. Again, though, the differences between the two groups decreased over time.
How Swimming Might Ease Chronic Back Pain
Swimming offers several benefits for people with low back pain. One is that water helps to reduce force on the spine, says Nancy R. Kirsch, DPT, PhD, the chair of rehabilitation and movement sciences at Rutgers, the State University of New Jersey, who wasn’t involved with the new study. “Buoyancy supports body weight, allowing people to move with less compression on the spine and less pain than they might experience on land,” she says.
Swimming also works the muscles that support the trunk, says Mark Slabaugh, MD, a sports medicine orthopedic surgeon at the Orthopaedic Specialty Hospital at Mercy in Baltimore also not involved in the Australian research. “Swimming is a good core-strengthening exercise that also contributes to more stability of the spine and allows individuals to focus on improving lower body function,” he says.
Strokes like freestyle help keep the back in an extended position, Dr. Slabaugh says. “This has been shown to help decrease pressure on the spinal cord and the exiting nerves,” which may help to reduce pain, he explains.
But movement in general has been linked to a drop in low back pain, Dr. Kirsch points out. “Exercise reduces pain and disability in chronic low back pain,” she says.
Finally, swimming may feel like a “safer” form of movement for people with low back pain who may be worried about the impact of exercise on their discomfort, according to Kirsch. Wareham echoes that, noting that some participants said they liked that swimming was a low-impact, non-weight-bearing exercise option. “For some people, it helped them feel like they could do more exercise than in other exercise types,” she says.
The Study Has a Few Strengths and Limitations
The study had more than a 95 percent follow-up rate, which allowed the researchers to track the participants over time. The researchers also got regular feedback from participants on how they were feeling.
But the trial was relatively small, and most participants were women. The participants were also more likely to be physically active and to have some level of past swimming experience, making it unclear if this intervention would be as helpful for people who were less physically fit or skilled at swimming.
It’s difficult to know how much of the impact on pain and disability in the swimming group was tied to the extra health coaching sessions, too.
The Best Way to Start Swimming for Low Back Pain, According to Doctors
Doctors agree that swimming is a good option to consider if you have low back pain. A key factor in this study was that each program was tailored to the individual and got progressively more challenging. “Similarly, starting slow and within a comfortable range for yourself, and then slowly increasing the distance or intensity would be a good start,” Wareham says.
Slabaugh points out that the biggest obstacle to a swimming routine is access to a pool. He suggests looking into a community fitness center with a pool, if you’re able.
“Swimming should start with one lap, followed by a short resting period, and then increasing the number of laps as their aerobic capacity improves,” Slabaugh says. “Within two to three weeks, swimmers should be able to swim for 20 to 30 minutes. Don’t worry about the distance; it is the duration that is important.”
Kirsch suggests choosing a stroke that feels comfortable and doesn’t aggravate your symptoms. Over several weeks, try to build up to 30 to 45 minutes per session, three times a week. “Anticipate some soreness, but not severe pain,” Kirsch says. “Pick swimming activities you enjoy, so you will continue.”
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