Understanding and Reducing Low Back Pain with Aquatic Interventions

Marty Biondi, PT, CSCS, ATRIC - Therapeutic & Wellness Specialists

This research based presentation addresses the significance of aquatic intervention in the management of low back pain. The epidemiology of low back pain tells us that:

• One in four adults will lose work time due to back pain
• Leading cause of disability in Americans less than 45 years old
• Third leading cause of disability for all ages
• 70% will have recurrence of low back pain with 40% being chronic
• 85% pathological cases of low back pain cannot be identified.

The review of the Pathophysiology of the spine includes anatomy of the lumbar spine and the biomechanics of movement. It includes the theory of lumbar stability; the anatomical relationships which impact stability; the impact of a specific exercise regime to address instability; and the criteria involved with water therapy. The theory is based on Panjabis Theory of Spinal Stabilization which is a model that incorporates three systems - passive, active, and neural. Decreased function of one system may place increased demands on the other two systems for which they cannot compensate.

Based on current research, land-based evaluation and principles of exercise with desired outcomes will be reviewed. Aquatic based research by the author will be presented with the aquatic program and the indications for choosing aquatic therapy for pain management of the low back patient.

Understanding the appropriate biomechanics and logical progression are presented in applying the goals for an aquatic dynamic stabilization program.

• Facilitate efficient movement patterns from a sound postural base
• Utilizes properties of water to challenge trunk musculature
• Utilize properties of water for more efficient treatment of low back pain.

Specific considerations in choice of aquatic exercise for lumbar stabilization include:

• Movement initiated from a sound base
• Postural education initiated at the onset and become an on-going process
• Increased muscular endurance for proximal musculature to enhance movement
• Setting an accurate neuromuscular program is critical for success.