Australian research announced on Jul. 21 has found that a program of swimming can be clinically effective in reducing disability from chronic low back pain. The EduSwim clinical trial, published in the British Journal of Sports Medicine, showed that an eight-week individualized program of swimming and education, guided by a physiotherapist, led to significant improvements in function and pain compared to education alone.
The study involved 76 adults aged between 26 and 74 who had experienced some disability due to low back pain for at least 12 weeks. Participants were randomly assigned to either an intervention group or a control group. The intervention group received an eight-week personalized swimming and education program, supported by four telehealth coaching sessions with a physiotherapist. "They weren't regular swimmers, but they were able to swim 25 meters and feel confident in the water," said Ms Wareham.
The swimming regimen was tailored according to each participant's ability and fitness level, aiming for three sessions of 30-45 minutes per week by the end of the program. Education included key messages such as: 'Pain does not always equal harm'; 'The back is made for movement'; 'Flare-ups are likely'; and 'The best management is to keep moving.' The control group attended one or two sessions with a physiotherapist covering these messages but otherwise continued their usual treatment.
After eight weeks, those in the swimming group reported significantly lower levels of disability than those who only received education. "They improved by about 50 per cent from where they were before starting the program," said Ms Wareham. "Compared to the control group who received education only, swimmers scored on average 2.5 points or 30 per cent lower on a widely used disability scale." The benefit persisted at follow-up after six months and one year, though differences between groups lessened over time.
Secondary outcomes such as pain intensity, functional limitation, self-efficacy regarding pain management, and fear of movement followed similar trends—showing early improvement among swimmers that decreased over time. Ms Wareham said that while exercise and education are recommended worldwide as first-line treatments for chronic low back pain, only some forms like Pilates have been clinically evaluated so far: "In fact, the improvement we saw in our study compares favourably with effects reported for other exercise such as Pilates in a recent meta-analysis," she said.
Professor Mark Hancock commented on why swimming may be beneficial: "Swimming can improve range of motion, strength and general aerobic capacity and the buoyancy of water can help people engage with movements that might otherwise be painful or limited." He added: "Importantly, participants told us swimming built their confidence to start exercising and engage with other meaningful physical activities – some continued to swim after the program while others transitioned to other forms of exercise... Now we have the evidence to support the recommendation – swimming is a suitable exercise for people with back pain, and it helps."
