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Aquatic therapy versus standard care in 34 patients with chronic low back painCan swimming help chronic back pain? A small study found it might ease pain and fear of movement

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Key Takeaway
Consider aquatic therapy as a potentially comfortable alternative for addressing psychological factors in chronic low back pain.

This randomized controlled trial investigated the effects of aquatic therapy compared to standard care in a population of 34 individuals with chronic low back pain. The study followed participants for a duration of 10 weeks to assess various clinical and psychological outcomes. The primary focus included pain, disability, and quality of life, alongside secondary outcomes such as anxiety, depression, pain catastrophizing, kinesiophobia, and sleep disturbance.

Regarding the main results, both the aquatic therapy and standard care groups demonstrated significant improvements in pain, disability, and quality of life, with p-values less than 0.05 for these measures. No significant group-by-time interactions were found for these primary outcomes, indicating that the trajectory of improvement was similar across both groups. However, specific secondary outcomes favored the aquatic therapy group. Significant reductions in kinesiophobia were observed only in the aquatic therapy group (p = 0.002), and significant reductions in sleep disturbance were also observed only in the aquatic therapy group (p = 0.001).

Safety and tolerability data were not reported in this study, and no adverse events, serious adverse events, or discontinuations were documented. The study limitations include the small sample size of 34 participants, which may affect the precision of the estimates. The practice relevance suggests that aquatic therapy may offer a more comfortable treatment alternative to address psychological factors associated with chronic low back pain.

Living with chronic low back pain is hard enough without the added weight of anxiety, depression, or the fear that moving will make it worse. A recent trial asked if doing exercises in a pool could help people feel better than standard care alone. The study involved 34 individuals struggling with long-term back pain. They spent 10 weeks either doing aquatic therapy or receiving standard care. Both groups saw significant improvements in pain, disability, and quality of life. However, the water-based group showed unique benefits in reducing fear of movement and sleep problems.

There were no serious safety concerns reported, and no one had to stop the treatment early. The researchers found that while both treatments worked well for basic pain relief, the aquatic approach seemed better at tackling the mental and emotional hurdles that often keep people stuck. This is important because many people avoid exercise due to pain or fear, creating a cycle that makes recovery harder.

The study has a small number of participants, which limits how widely we can apply these findings right now. We do not yet know if these results hold true for larger groups or different types of back pain. Still, the results offer a promising, comfortable alternative for those who need to address the psychological factors that accompany chronic pain.

What this means for you:
Aquatic therapy may help reduce fear of movement and sleep issues in chronic low back pain, though the small study size requires caution.

Study Details

Study typeRct
Sample sizen = 34
EvidenceLevel 2
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Anxiety, depression, and pain-related fears are highly prevalent among individuals with chronic low back pain (CLBP). While aquatic therapy is a promising treatment modality for CLBP, its effects on psychological factors remain poorly understood. OBJECTIVE: To compare the effects of aquatic therapy (AT) versus standard care (SC) on psychological outcomes, pain, and disability in CLBP. METHODS: In this two-arm randomized controlled trial, 34 participants with CLBP were assigned to AT ( = 18) or SC ( = 16). Both groups received bi-weekly individual sessions over 10 weeks. Pain, disability, quality of life, anxiety, depression, pain catastrophizing, kinesiophobia, and sleep disturbance were assessed using the following validated questionnaires; Numerical Pain Rating Scale, Modified Oswestry Low Back Pain Disability Index, Short-Form 12 Item Survey Questionnaire, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia and Insomnia Severity Index, respectively. RESULTS: Mixed-design analysis of covariance revealed no significant group*time interactions for any outcomes (all  > 0.05). Both groups improved significantly in pain, disability, quality of life, pain catastrophizing, and anxiety (all  < 0.05). Only AT demonstrated significant reductions in kinesiophobia ( = 0.002) and sleep disturbance ( = 0.001). CONCLUSIONS: Aquatic therapy may offer a more comfortable treatment alternative to address psychological factors associated with CLBP. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov identifier is NCT05823857.
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