For many back pain patients, water-based exercises should only be performed under the guidance of a qualified health professional. Water therapy exercise should usually be avoided if a person has any of the following:

  • Fever
  • Severe heart failure
  • Incontinence
  • Infection

The water temperature may be too warm to accommodate some conditions. Water therapy is generally conducted in pools or tanks with water that is between 90 to 94 degrees (Fahrenheit), almost as warm as bath water, so blood circulation is increased. Consequently, patients with any of the conditions listed above should avoid or limit their water therapy exercise, or make sure the pool or tank used is cooler so that their conditions are not exacerbated.


Individuals with severely limited endurance or range of motion may not be able to safely navigate a tiled (and slippery) pool apron to participate in a water therapy exercise program. Rubber mats are often used to increase traction to reduce this risk.

The perception of objects (like the instructor demonstrating exercises) in water is also affected by refraction, leading to difficulty in learning specific motor skills for people with limited eyesight, or impaired sense of body position or balance due to stroke or other injury.

Finally, for patients with low bone density or osteoporosis, the buoyancy provided by the water may not be as beneficial for building bone as weight bearing land-based exercises. The added strength and balance achieved through an aquatic exercise program may facilitate a safe return to land-based exercise, which is more helpful in building bone strength.

Dr. Andrew Cole has 30 years of experience specializing in spine and joint pain management. Dr. Cole has held numerous medical appointments throughout his career, and recently served as the Executive Director of Rehabilitation & Performance Medicine Enterprise for Swedish Health Services and as Medical Director of Ambulatory Musculoskeletal Services for Swedish Medical Group.

Dr. Bruce Becker is a researcher and educator on aquatic therapy with more than 30 years of experience managing spine, muscle, and joint pain.