The Rehabilitation Effect of Water Exercise for

Chronic Low Back Pain

Yuhong Wen, Xurui Liu and Yiming Zhang

Swimming Section, Beijing Sports University, Beijing, China

Keywords: Chronic Low Back Pain, Water Exercise, Rehabilitation.

Abstract: The main purpose of this paper is to analyze the rehabilitation effect of the water exercise for chronic low

back pain. 10 subjects aged from 20 to 60 are recruited to do water exercise 60 minutes for 3 times a week

through 8 weeks period. 2 tests are executed in the 1st and 8th week. VAS、ODI are filled out by

participants. Motion test are tested by protractor. It is found that by 8 weeks of water exercise training, waist

pain can be relieved dramatically. Water fitness movement such as squat jump, suspending crouching can

effectively extend the muscle and eliminate muscle tension. Waist dysfunction can be relieved effectively.

Exercise such as kicking forward, kicking laterally can improve the balance and coordination ability. Waist

joint mobility and muscle strength can be increased. Exercises such as hip abduction, hip extension and step

walk can enlarge the range of lumbar joints activity. On the other hand the resistance of water can enhance

the waist and back muscle strength furtherly, ease back muscle spasm, correct muscle imbalances, so as to

increase lumbar motion rehabilitation purposes.

1 INTRODUCTION

The Chronic low back pain (CLBP) is a common

chronic orthopaedic disease which occurred in about

80% world's population disease thus become a

common public health problem. It’s difficult to

enhance the muscle strength training on land for

patients with chronic low back pain for fear of

increase of pain degree. However, water exercise

can avoid the negative effect because it can take full

advantage of the natural characteristics of water. In

order to understand the water exercise effect on

prevention and control of chronic low back pain,

experimental analysis of the water exercise is

executed.

2 SUBJECTS AND METHODS

2.1 Subjects

10 subjects with chronic low back pain aging from

20 to 60 are recruited. Clinical exercise testing,

medical examination, special experiment and

questionnaire survey are used to specify the subjects

from symptoms of serious health problems, the

specificity of the waist (spine spondylolysis,

diseases such as scoliosis, birth defects, or specific

low back pain remission patients), pregnant women,

serious cardiovascular, respiratory, digestive, blood,

urinary, endocrine such as rheumatoid immune

system disease history.

2.2 Methods

2.2.1 Experimental Approach to the

Problem

Subjects are instructed to do water exercise for

8weeks, with three times a week for 60 minutes.

Table 1: The phase, load, practice frequency and duration

of water exercise.

Phase Load Frequency Duration

adaptive phase 30%-60% 2/wk 1-2 wks

Improve phase 70%-80% 2/wk 3-5wks

Maintenance phase 80%-90% 2/wk 6-8 wks

Water exercise are conducted according to the

different Phases. Courses are divided into three

parts: activity stage, waist practice stage and

relax(Steve Tarpinian, Brian J. Awbrey, 1997).

Wen Y., Liu X. and Zhang Y..

The Rehabilitation Effect of Water Exercise for Chronic Low Back Pain.

DOI: 10.5220/0005151100530056

In Proceedings of the 2nd International Congress on Sports Sciences Research and Technology Support (icSPORTS-2014), pages 53-56

ISBN: 978-989-758-057-4

 2014 SCITEPRESS (Science and Technology Publications, Lda.)

Table 2: The water exercise training programs.

Practice stage

Exercise Volume

Time

(min

)

Warm-up

land warm up

water walk 50m

Walk back

50m

lunges 50m

water jogging 50m

Waist

practice

stage

hip in 30rep 5

hip out 20 rep 5

crouch 30rep 5

squat 30 rep 5

step walk 2*50m 5

high kicks

20 rep in each

direction

Relax stretch 5

2.2.2 Questionnaire Method

Visual analogue score (VAS) and Questionnaire

Oswestry disability index (ODI) are used during the

experiments.

2.2.3 Test Method

Lumbar flexion and extension angles were measured

by Square plate protractor (Fan Zhenhua, 1999).

3 RESULT AND ANALYSIS

3.1 VAS

The VAS pain score at rest, activity and at night

have all released after the water exercise (P < 0.05).

Table 3: The water exercise training programs (Fan

Zhenhua, 1999).

Pain Degree

Mean Feelings

Mild 2.57±1.04

With mild pain, the subjects

could bear

Moderate 5.18±1.41

Subjects feel pain and that

affect sleep.Though

tolerable, should receive

clinical treatment

Serious 8.41±1.35

Subjects feel more severe

pain, or can't stand the pain

Table 4: The comparison of VAS scores before and after

the experiment (N=10).

Pre-experiment Post-experiment

Rest 2.8±2.0 1.8±1.3*

activity 5.7±2.6 3.8±2.2*

night 2.7±2.1 1.9±1.6*

*: p<0.05

3.2 ODI Dysfunction Index Score

Pre-experiment and Post-experiment in the lab ODI

dysfunction index score declined（p<0.05）which

showed that water training could release the waist

function barrier of people with chronic low back

pain.

Table 5: The comparison of ODI dysfunction index score

before and after the experiment (N=10).

Pre-experiment Post-experiment

ODI 37.9±2.4 32..6±4.3*

*: p<0.05

3.3 Lumbar Spinal Motion Analysis

After experiment, lumbar flexion and extension of

motion increased (P < 0.05) which showed the joint

mobility of the subjects have improved.

Table 6: The comparison of lumbar flexion and extension

before and after the experiment (N=10).

Pre-experiment Post-experiment

Lumbar flexion

40.1±8.1 43.1±9.8*

Lumbar extension

19.6±2.2 21.3±3.5*

*: p<0.05

4 DISCUSSION

4.1 The Characteristics of Water

Exercise for Chronic Low Back Pain

Water exercise training is different from the land

training. Water buoyancy can help patients to

support their own weight, reduce joint muscle

tension (Lynda Huey, Robert Forster, 1993). People

may move to wider range and each part of body can

do exercise for improving balance and coordination.

Those feature help people to achieve the goal of

rehabilitation therapy without adding burden and

pain for body. Submerging body under the water can

relax the muscle, change muscle tension, reduce pain.

The resistance of water can help people improve

muscle strength and endurance, increase the range of

motion and restore the ability of control, balance and

coordination (Martha White, 1995).

4.2 Evaluation Indexes

VAS score, ODI score are recognized as 2 effective

index for reviewing low back pain.VAS score is

icSPORTS2014-InternationalCongressonSportSciencesResearchandTechnologySupport

used for objective feeling of pain level, and ODI

score reflects dysfunction caused by low back pain.

The combination of these two index can reflect the

effect of the treatment of chronic low back pain.

Jiont motion range is one of the most basic

indicators of assessing limb movement function,

pain degree and one of the important indicators of

the degree of disability. Joints, soft tissue and bone

pain and muscle spasm after disease damage and

soft tissue scar and adhesion factors will affect the

joint activity. Patients with low back pain are usually

characterized by decreased muscle endurance and

waist activities range (Fan Zhenhua, 1999).

Therefore, it is also one of the effective indicator of

rehabilitation for chronic low back pain.

4.3 Rehabilitation Effect of Water

Exercise for Chronic Low Back Pain

The etiology of chronic low back pain is so complex

that there are still dispute about it. Research shows

that some factors may aggravating waist and leg

pain, including acute lumbocrural pain, bad posture,

standing or sitting too long, chronic strain and

imbalance of lumbar muscle, and strength decline,

etc(Martha White,2004) . These factors make the

waist and leg muscle, ligaments and tendons over-

pull bones on the attachment points, resulting in

fracture state, local, inflammatory reaction, which

result in the block of local blood supply (Sun

Qilaing, 2007). Patients will experience pain over a

period of time and thus lead to muscle atrophy,

decreased muscle strength, form a vicious circle

(Fan Zhenhua, 1999).

4.3.1 The Effect of Pain Controlling of Water

Exercise for Chronic Low Back Pain

The results showed that VAS scores after water

exercise was lower compared to Pre-experiment,

proving the effect of pain relief. Exercises on land

may be harmful since it may make the waist, knees

and ankle joints suffer more gravity and tension and

may aggravate the damage. However, human body is

almost weightless because of the buoyancy of water.

Thus the weight-bearing joints of lower limbs can

significantly reduce load and prevent hurting.

4.3.2 The Influence of Water Exercise on

ODI Dysfunction Index

ODI is the standardized index recommended to

evaluate low back pain condition. So far, the

questionnaire has been used abroad for more than 20

years as a gold standard, designed basing on the

degree of pain, life care, carrying weight, walking,

sitting, standing, sleeping, family life, social life,

tourism, and other 10 ways to test the subjects, and

lead to comprehensive analysis of the degree of

lumbar dysfunction. Training can effectively

improve the function of the waist in the water and

relieve lumbar dysfunction, because the muscles are

more relax in the water to reduce pain level. At the

same time, water resistance may help muscles to

improve strength and endurance and increase the

range of motion and feel of control, balance and

coordination. All those feature can effectively

improve body flexibility and recovery level.

4.3.3 The Influence of Water Exercise on

Lumbar Motion Range

Lumbar spine is the main joints that hold the body

weight and with small range of motion. Lumbar

spine is very important in maintaining torso stability

and coordination of movement. The motion range of

chronic low back pain patients are limited because

of the weakness of their waist muscle. Water

exercises such as hip flexion, hip rotation and

walking can extend the soft tissue and make the

motion range larger with the help of water buoyancy

(Terry-Ann, Wener Hoeger, 2002). On the other

hand, water exercises are good at enhancing waist

and back muscles strength by reacting against water

resistance and ease back muscle spasm, correct

muscle imbalances, so as to increase lumbar motion

rehabilitation purposes (Marti C Spinkle, 2013).

5 CONCLUSIONS

By 8 weeks of water exercise training, waist pain

can be relieved dramatically. Water fitness exercises

such as squat jump, suspending crouching can

effectively extend the muscle and eliminate muscle

tension.

By 8 weeks of water exercise training, waist

dysfunction can be relieved effectively. Exercise

such as kicking forward, kicking laterally can

improve the balance and coordination ability.

By 8 weeks of water exercise training, waist joint

mobility and muscle strength can be increased.

Exercises such as hip abduction, hip extension and

step walk can enlarge the range of lumbar joints

activity. On the other hand the resistance of water

can enhance the waist and back muscle strength

furtherly, ease back muscle spasm,

correct muscle

TheRehabilitationEffectofWaterExerciseforChronicLowBackPain

imbalances, so as to increase lumbar motion

rehabilitation purposes.

6 SUGGESTIONS

The swimming pools used to do water exercise

should be with comfortable temperature ranging

from 28 to 30 degrees Celsius. Low temperature

may cause muscle tension and restrict movement. T

For the safety of patients, training plan should be

set step by step. Practice time, frequency and

intensity should increase gradually. Trainers should

watch the patients reaction and monitor some useful

index to control exercise.

REFERENCES

Fan Zhenhua, 1999.Medical Science of orthopaedics-

rehabilitation. Shanghai Medical University Press.

Steve Tarpinian, Brian J. Awbrey, 1997. Water Workouts.

The Lyons Press.

Lynda Huey, Robert Forster, 1993, The Complete

Waterpower Workout Book: Programs for Fitness,

Injury Prevention, and Healing. Random House.

Martha White, 1995. Water Exercise for Therapy and

Fitness. Human Kinetics Publishers.

Terry-Ann, Wener Hoeger, 2002. Water Aerobics for

Fitness and Wellness. Wadsworth Publishing Co Inc.

Marti C. Spinkle, 2013. Water Wonder Works: A Guide to

Therapeutic Water Exercises to Manage Arthritis Pain,

Strengthen Muscles and Improve Mobility. CCB

Publishing.

Martha White, 2004. The Aging Spine: Water Exercise &

Treatment Principles. iUniverse.

Sun Qilaing, 2007. Exercises for lower back pain. Chinese

Clinical Rehabilitation. 202 ,6(22) :3310 –3313.

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