Australian research has shown for the first time that a program of swimming can be clinically effective in reducing disability from chronic low back pain.
Published today in the British Journal of Sports Medicine , the EduSwim clinical trial found an eight-week individualised program of swimming and education, guided by a physiotherapist, improved function and pain significantly more than education alone in people with back pain.
"Swimming is commonly recommended as an exercise for people with chronic low back pain, but there was a complete lack of evidence about whether it actually works," said lead researcher Deborah Wareham, a physiotherapist and PhD candidate in the Spinal Pain Research Centre at Macquarie University, Sydney. "We undertook this study because we felt there was an urgent need for research to determine if swimming was effective or not for chronic back pain," said Ms Wareham.
The researchers recruited 76 adults aged 26 to 74 (average 41 years) who were experiencing some disability due to low back pain lasting for at least 12 weeks and allocated them at random to one of two groups. One group received an eight-week individualised program of swimming and education, supported by four telehealth coaching sessions with a physiotherapist. "They weren't regular swimmers, but they were able to swim 25 metres and feel confident in the water," said Ms Wareham.
The swimming programme was based on each participant's current swimming ability and fitness, with a goal of achieving three sessions of 30-45 minutes by the end of the eight weeks. Education covered key concepts and messages including: 'Pain does not always equal harm'; 'The back is made for movement'; 'Flare-ups are likely'; and 'The best management is to keep moving'.
Participants in the other (control) group had one to two sessions with a physiotherapist to learn the same key messages about back pain as the intervention group but otherwise continued their usual treatment and activity.
After eight weeks, disability was significantly lower in the swimming group.
"They improved by about 50 per cent from where they were before starting the program," said Ms Wareham. "Compared to the control group who received education only, swimmers scored on average 2.5 points or 30 per cent lower on a widely used disability scale."
The benefit of swimming persisted at longer-term follow-up (at 26 and 52 weeks), although the difference between the groups reduced over time. Secondary outcomes – including pain intensity, functional limitation, pain self-efficacy and fear of movement – showed a similar pattern, being lower in the swimming group early in the program, but with the difference reducing over time.
Best practice guidelines around the world recommend exercise and education as first-line treatments for chronic low back pain, but only some types of exercise (Pilates, for example) have been clinically evaluated, Ms Wareham noted. "In fact, the improvement we saw in our study compares favourably with effects reported for other exercise such as Pilates in a recent meta-analysis," she said.
"The argument for swimming in back pain is logical, but it was important to test this," said Professor Mark Hancock, Co-Director of the Spinal Pain Research Centre and senior author of the study. "Swimming can improve range of motion, strength and general aerobic capacity and the buoyancy of water can help people engage with movements that might otherwise be painful or limited."
"Importantly, participants told us swimming built their confidence to start exercising and engage with other meaningful physical activities – some continued to swim after the program, while others transitioned to other forms of exercise," said Professor Hancock. "Now we have the evidence to support the recommendation – swimming is a suitable exercise for people with back pain, and it helps."
