The impact of hydrotherapy and water based exercise has always been considered a useful but underutilized treatment option. At Pain Relief Ireland Dr. Hegarty has always considered the use of aquatic exercise an important part of rehabilitation in chronic low back pain. A recent study published in this month’s JAMA Network has highlighted that there is a significant long-term reduction in chronic low back pain (LBP) when compared with physical therapy modalities in a three-month randomized trial with 12-month follow-up (JAMA Network Open 2022;5[1]:e2142069).
The single-blind trial, conducted in China, involved 113 participants (59 women; mean age, 31.0 years) who were randomly assigned to 12 weeks of twice-weekly, one-hour treatment with therapeutic aquatic exercise (n=56) or physical therapy (including transcutaneous nerve stimulation and infrared ray thermal therapy; n=57). Ninety-Eight patients (86.7%) completed the 12-month follow-up phase.
Dr. Hegarty summarised the results and says that at 3 months the level of improvement in level of disability (as measured by score change on the Roland-Morris Disability Questionnaire (RMDQ; range, 0-24 with 24=worst pain) in the therapeutic aquatic exercise group was significantly greater than those in the physical therapy modalities group, with an adjusted mean group difference of −1.77 (95% CI,−3.02 to −0.51; P=0.006).
The gap increased at six months (adjusted mean group difference in favour of aquatic therapy, −2.42; 95% CI, −4.13 to −0.70; P=0.006) and 12 months (−3.61; 95% CI, −5.63 to −1.58; P=0.001).
Minimal clinically important difference (≥2-point improvement on the RMDQ), pain intensity, quality of life and sleep quality were measured as secondary outcomes.
The investigators hoped their findings will “spur pain clinicians to recommend aquatic exercise to their patients with LBP”. Dr. Hegarty could not agree more and he was not surprised with these findings. In fact Pain Relief Ireland in conjunction with the Mardyke Arena Physiotherapy and Hydrotherapy section are presently evaluating the impact of aquatic rehabilitation on a variety of low back pain conditions including those who have received spinal cord stimulation as their treatment.
“In the water the biomechanical load on the lumbar spine and its related structures is reduced."
“In the water” Dr. Hegarty says that “the biomechanical load on the lumbar spine and its related structures is reduced.
This allows the individual to mobilise without repercussion in a controlled environment with professional assistance. This will improve the aerobic capacity as a whole and it will offer individuals important positive physical and psychological feedback to help them progress quickly”.
“for those individuals who attend me with chronic low back pain, aquatic exercise alone is unlikely to resolve the issue so consulting with a pain specialist to ensure a suitable pain management plan is put in place is key to a successful outcome”.
Dr. Hegarty also points out that “for those individuals who attend me with chronic low back pain, aquatic exercise alone is unlikely to resolve the issue so consulting with a pain specialist to ensure a suitable pain management plan is put in place is key to a successful outcome”.
Please Contact Pain Relief Ireland to organise an appointment.
