For many people with back pain, hydrotherapy -- exercising in water -- offers a way to build muscle strength and flexibility with minimal stress on joints and muscles. This article is written by Kelly Daley, senior physical therapist at Johns Hopkins' Department of Physical Medicine and Rehabilitation.
Strengthening the muscles that support the back helps both to prevent low back pain and injury and to treat existing back problems. But many exercise programs are too strenuous for people who are recovering from a back injury -- such as a herniated disk or vertebral compression fracture -- and for those whose spine is susceptible to injury due to conditions like osteoporosis. For these people, hydrotherapy -- exercising in water -- is an excellent alternative.
Like other forms of exercise, water workouts help to increase flexibility, muscle strength, and cardiovascular fitness. But exercising in water has many additional benefits for people with back problems. Because water is buoyant and helps to support weight, water exercise places minimal stress on joints and muscles, including those in the back. Thus, water may allow a more vigorous exercise program than would be possible on land.
In addition, exercising in warm water can relieve pain, reduce spasm and swelling, and relax back muscles. Water also offers a safe environment for muscle strengthening, which is important for people who are vulnerable to spinal injury.
Because water offers natural resistance to movement, pulling or pushing your body through water can strengthen your muscles. For example, walking while immersed in chest-high water is a gentle and effective way to tone the abdominal muscles, which help support the back. For people with osteoporosis, improved muscle tone can help preserve bone density, and water exercise has the added advantage of reducing the risk of falls while working out.
People who are recovering from a back injury -- such as a herniated disk -- may need to start with personal instruction from a physical therapist, who can devise a safe water program that focuses on warm water stretches to relieve pain and improve range of motion and teach people how to keep the spine properly aligned in the water.
Most water workouts should be done while submerged in chest- to waist-depth water. The deeper you are, the greater the water’s buoyancy and cushioning. People with severe back injury may need to begin exercising while submerged to the neck. This position can reduce pressure on spinal nerves and soft tissues and decrease pain. As the spine grows stronger and is able to tolerate partial weight-bearing exercise, a gradual transition is made to more shallow water.
