Physiotherapy in Toronto for Lower Back

What's one exercise that can reduce pain, improve balance and coordination, while supporting your body weight and giving you a warm, fuzzy feeling all over? How does aquatic therapy in a pool of 90-degree water sound?

Water-based exercise has many potential advantages over land-based exercise programs. The warmth and buoyancy combined with elimination of gravity eases joint pain and improves range-of-motion. And because the water gives resistance to movement, you can vary how much or how little resistance by standing in shallow versus deeper water and/or by moving slower or faster through the water.

To use one of today's more common expressions, What's not to like? But here's the real question researchers in physical medicine and rehabilitation are asking: is aquatic exercise more effective than land-based exercise? And in this study, that question is posed with a specific patient population in mind: those who suffer from chronic low back pain.

Two groups of patients with chronic low back pain without leg pain were compared. One group participated in a pool-based exercise program. They met five days a week for a month in a swimming pool heated to about 90-degrees Fahrenheit. Each session lasted one hour and consisted of 15-minutes of warm-up exercises, 40 minutes of aquatic exercises, and a five-minute cool-down period. All exercises were done in the water.

The second group was given instructions by a physiotherapist on exercises to do at home. Written instructions were also provided. The program was designed to take approximately one-hour and included a warm-up period followed by stretching and strengthening exercises. There was an aerobic component (jogging and running) and cool-down exercises. Everyone in the home-based land exercise program received an encouraging/supportive phone call once a week.

Before starting the exercise treatment, everyone had a basic spine X-ray taken, routine lab work done, and a physical exam by a physician. Spinal mobility, pain level/intensity, disability, and quality of life were also measured and recorded. Everyone was asked to stop taking antiinflammatory or other pain relieving medications for one week before starting the exercise programs.

In order to compare the groups, evaluations were also performed twice after treatment. The first assessment took place at the end of the four-week exercise program. The second evaluation was done eight weeks later (a total of 12 weeks after treatment ended). They looked at the details of pain (at rest, with movement, at night) and used two well-known research tools (Oswestry Low Back Disability Questionnaire, Short-Form 36 Health Survey) to assess function and disability.

Patients in the groups were very similar in their characteristics (age, sex, duration of symptoms). Everyone had normal results on their blood tests. There was significant improvement after treatment in both groups. This was true at the end of four weeks and again at the end of three months. However, statistical analysis showed that the patients in the aquatic exercise group did much better than the land-based exercise group.

Although aquatic-exercise requires supervision of a physiotherapist, the added benefits over an independent home-based program may be well-worth it. More study is needed to determine the optimal level of intensity and type of aquatic program for patients with chronic low back pain. This study involved a fairly intense program. The results support the use of a daily program for a medium-length of time.

When aquatic therapy is not available, a land-based home program can work well. Results may be better than usual because of the follow-up phone calls. But phone calls don't assure patient compliance or good technique in doing the exercises. And it's not clear yet if one type of exercise is better than another when treating chronic low back pain.

The optimal approach may be to start patients out in a water-based exercise program and then progress them to a home-based land program. This might get the best of both approaches and make it possible for people who couldn't exercise otherwise to get started. Aquatic therapy makes it possible to reduce joint loading while still getting an aerobic workout. What's not to like?

Reference: Umit Dundar, MD, et al. Clinical Effectiveness of Aquatic Exercise to Treat Chronic Low Back Pain. In Spine. June 15, 2009. Vol. 34. No. 14. Pp. 1436-1440.