Hydrotherapy & Aquatic Equipment for Lower Back Pain

Overview of Lower Back Pain

According to Health Direct, at least 1 in 6 Australians has back problems, and a massive 4 out of 5 people experience lower back pain at some point in their lives. Pain in the lower back is one of the most common reasons behind medical visits in Australia. The pain often results from problems with the musculoskeletal system. Lower back pain is more common with age and affects more than 50% of people over 60 years. It is very costly for both sufferers and the medical system in regards to health care claims, disability payments, and missed employment.

The lower back is complex and challenging to heal. The spine consists of backbones (vertebrae) with shock-absorbing discs between each of the vertebrae. The disks have an outer layer of tough fibrocartilage and a soft interior known as the nucleus. Each vertebra has two different joints behind the disks. These are the facet joints. Ligaments and muscles stabilise the facet joints and the spine. The abdominal muscles that run from the bottom of the rib cage to the pelvis also help stabilise the spine by supporting the abdominal contents. The muscles in the buttocks also help to stabilise the spine. All together, these muscles are often termed core muscles. Enclosed inside the spine is the spinal cord. Along the spinal cord, the spinal nerves between the vertebrae connect with the rest of the nerves in the body. The part nearest the spinal cord is called the spinal nerve root. Because of its position, spinal nerve roots can be compressed when the spine is injured, resulting in severe pain and spasms. The lower spine (lumbar spine) is connected to the spine in the upper part of the back (known as the thoracic spine) above and to the pelvis through the Sacrum. The lumbar spine is intended to be flexible to allow turning, twisting, and bending and provides the strength required to stand, walk, and lift. The lower part of the back is involved in all daily activities, and pain can limit many of these activities, having a drastic effect on the quality of life.

The pain that is felt in the lower part of the back can range from:

• A small niggle

• Nerve pain

• A dull ache

• A cramping sensation

• Burning pain

• A pulling pain

• Pain that severely restricts movement.

There is often no rhyme, reason, or explanation for why someone suffers from lower back pain, which can be infinitely frustrating if there is no explanation for the pain experienced. However, there can be many mechanisms of injury that can cause lower back pain, such as:

• Poor posture

• Direct damage to the affected area

• A muscle strain or unusual movement

• Sitting for an extended period

• Immobility or lack of exercise

• Being overweight

These are just a selection of the physical aspects that can be potential causes of lower back pain. There can, of course, be other factors, such as inappropriate manual handling of objects, compression injuries, and diseases.

What is Lower Back Pain?

Lower back pain is a pain felt in the lower part of the spine, in the lumbar region of the spine.

Lower back pain can range widely in severity from a slight ache or pull that may go away over a short period on their own accord, but more often than not, someone who sufferers from lower back pain will have more of a long-term issue or find that the lower back pain is recurrent.

The pain that is felt in this region of the back can affect many other aspects of daily life, including:

• Walking

• Sitting

• Standing

• Driving

• Sleeping

• Concentration

So it is crucial to manage and reduce back pain as effectively as possible to reduce the effect the pain may have on other areas of your life.

Who is more likely to suffer from Lower Back Pain?

Lower back pain does not differentiate between genders, so there is no predisposition to having lower back pain if you are male or female. Pain in the lower part of the back may appear at any time in life, but it is more prevalent in those over 25, which is a sufficiently young age for this type of pain.

Common causes

Common causes of low back pain include: 

• Osteoarthritis

• Vertebral compression fractures

• A ruptured or herniated disk

• Lumbar spinal stenosis

• Spondylolisthesis

• Injuries to muscles and ligaments

• Fibromyalgia

Career Triggers

There are specific careers that can cause or indeed exacerbate lower back pain, and these can include:

Office workers - Those who sit down for extended periods can cause or exacerbate lower back pain by putting prolonged pressure on the spine in an unnatural position, which is why correct workplace ergonomics are crucial.

Manual workers - Those who have manual jobs can find that they are more predisposed to lower back pain, just due to the nature of their career, especially those who do a lot of repetitive movement such as bending, lifting, and twisting.

Those with mobility impairments - Having something that causes someone to be immobile or in the same position for extended periods, such as those who use wheelchairs, can cause and exacerbate lower back pain. The lack of mobility works towards a weakened lower back region which can cause pain and discomfort.

Healthcare workers & therapists - Physiotherapists, Occupational Therapists, and massage therapists whose job involves a lot of leaning movements and unstable actions can affect the lower back, causing pain and discomfort.

Regardless of how lower back pain occurs, most people who suffer from it will say that it causes varying degrees of pain and may also reduce the quality of life for that person by restricting certain areas of life or movement, either through the feeling of discomfort or physically being restricted from the pain.

Symptoms of Lower Back Pain

Lower back pain is often diagnosed through a person's account of how the lower back region feels to them. However, if pain persists, specialists should be engaged to scan and assess the lower back region.

While diagnosis can be difficult, it is often weighted on several factors, such as:

• Severity of pain

• Mechanism of pain

• Any direct injuries

• Any infection markers (such as kidney infections)

• Age

• Career

Many people suffering from Lower Back Pain say that they have at least some, if not all, of these symptoms:

• Deep, achy joint pain

• Muscle spasms

• Reduced range of motion

• Stiffness during rest periods

• Tenderness in the lower back area

• Loss of flexibility

• Grating sensation

• Nerve or shooting pains

• Swelling

• Inability to "get going" straight away

Risk Factors

Risk factors for Lower back pain include:

• Age  

• Overweight 

• Direct trauma  

• Indirect trauma to surrounding areas

• Reduced levels of mobility

• Muscle weakness  

• Repetitive body movements 

• Infection  

• Muscle and tendon damage or atrophy

• Previous lower back pain

• Underlying deformities of the spine

• Bone disorders 

• Surgical interventions such as lumbar punctures or epidurals 

Water Therapy & Lower back pain

People who have lower back pain may find traditional exercise is simply too painful and puts too much exertion on their back. This may cause a person to shy away from activity or avoid it altogether due to the amount of pain and discomfort it brings with it.

Gravity inadvertently puts pressure on the delicate structure of the back, which rest and accumulates at the lower back during most exercises that include weight-bearing on your feet. 

The buoyancy of water and the support it gives during exercise may relieve a lot of this pressure simply by providing a different action to gravity, one that supports the body to reduce some of the pressure points and stress areas of the body when in motion. 

The water can loosen the muscles and relax any tension in the region. This, with gentle movement, can improve flexibility in the lower back and reduce the recurrence of pulling and pain with movement.

Hydrotherapy exercises are recommended for those who suffer from lower back pain. It is a way of performing activities they could not ordinarily achieve on land without feeling varying degrees of pain and discomfort.

Deep and achy joint pain: This is common in lower back pain.

Water helps provide an ideal environment for those with lower back pain to exercise due to the buoyant force that acts as a counteraction to the downward pull of gravity, therefore reducing the overall weight placed on the joints. 

Previous studies around hydrotherapy have shown that around half of the body's weight is supported when in waist-deep water. In contrast, a massive 90% of a person's weight is supported if the submersion is neck-deep. For severe cases, it is recommended the person is deeper in the water.

Patients who suffer from lower back pain can often not perform traditional land-based exercises due to increased pain created by the impact. 

In a wholly supportive medium such as water, patients can perform similar strengthening or endurance exercises with the benefit of gentle resistance and a reduction in pain on exertion. 

Reduced range of movement: This can be both a cause and a symptom of lower back pain.

The water will physically support you and help prevent excess stress on the muscles and the joints in the lower back. This can make exercise easier to achieve without the fear that the pain is too much to bear. 

Hydrotherapy helps to increase the ranges of motion that you can achieve while in the water and improves your overall mobility. 

Stiffness: Stiffness during rest, especially if you have been static for an extended period, can occur in the affected lower back.

Many people who suffer daily from the pain in the lower back will say they feel stiff when they have been static in the same place for too long, which is generally reported to be in the area affected directly and the neighboring areas such as hips and torso. 

Exercising in water is an excellent form of physical therapy as it allows the muscles and stiff joints to relax and release stiffness, therefore potentially easing pain.

Joint pain: The pain of someone who suffers from lower back pain may range from a small ache to a burning or shooting pain. 

The buoyancy that comes as part of working out in water helps support the surrounding muscles while strengthening them for support, making it easier to balance and hold a good posture that otherwise may be too painful to achieve on land. 

Tenderness: Your lower back joints may feel delicate and tender when applying light pressure on or around the affected area, especially when attempting land-based exercise. 

The element of the water physically surrounding and supporting you as you exercise physically prevents stress on the affected area and will help you to mobilize easier than if you were on land, increasing confidence in your movements.

Loss of flexibility: By carrying out a workout when submerged in water, you will have the ability to improve your flexibility and range of movement because of the pressure and support created when the water is surrounding you.

Swelling: Swelling is a symptom of lower back pain likely to be caused by soft tissue inflammation, which is a natural response the body has to protect the damaged area.

To soothe swelling, water therapy can assist in reducing the swelling by adjusting the temperature of the water. 

For instance, hydrotherapists may introduce cold water to help reduce inflammation, while therapists may also use warm water to aid better circulation.

Tender points: These points are areas of tenderness in the affected areas of the body. Preventing excess stress on these tender points as you move in the water will help you be more confident in moving around and may reduce the pain you feel.

Water Therapy Equipment & Lower Back Pain

An Aqua Treadmill is an excellent piece of equipment that can help relieve the symptoms of lower back pain and enables exercise with minimal discomfort as it may : 

• Improve mobility without impact-related pain or compression

• Reduce overall body fatigue

• Increases muscle function for strength

• Relaxes the tense muscles surrounding the back

• Improves posture and spinal positioning

• It soothes tired muscles and tendons and allows more pain-free movement

• Help weight loss and reduce the impact on the region when on land

An Aqua Bike is also and in an excellent piece of water equipment that can allow sufferers to continue to exercise with lower back pain and help alleviate the symptoms as it can:  

• Reduce stiffness in the lower back

• Reduce joint pain when mobilising

• Relieve tenderness in the joints and muscles in the lower back

• Improve the range of mobility

• Help to avoid after workout pain

• Provide physical relief for any continual pain

• Improve back and twisting flexibility

• Help manage weight and reduce impact load when on land

Note: Please seek medical advice before exercising & always train under the advice your medical specialist.