The techniques used in water therapy exercise for back pain include spa therapy, standing or floating pool exercises, swimming, and conditioning using specialized equipment, such as surgical tubing, flotation devices, and resistive devices for the hands or feet.

Active water therapy exercises for back pain are diverse and should be tailored to the individual and his or her specific condition. Exercises range from simple routines performed in a shallow pool to conditioning using underwater treadmills and other high-tech equipment.

Pool Therapy Exercise Techniques

Some of the basic techniques for pool therapy exercises are as follows (they can be modified for varying degrees of difficulty):

  • Knee-to-chest exercise. This movement is performed while standing on one leg, which is slightly bent, and one leg outstretched in front while one hand holds onto the side of the pool. It strengthens and stretches the muscles in the leg, hip, and lower back.
  • Leg raise exercise. This movement is performed with one leg outstretched and the supporting leg slightly bent while one hand holds onto the side of the pool. It strengthens and stretches the muscles in the leg, hip, and lower back.
  • Wall-facing leg stretch exercise. In this stretching exercise individuals assume a "Superman" position with hands resting on side of pool and the body and legs outstretched into and supported by water. This extends all regions of the back and the joints in the back, as well as stretching shoulder muscles.
  • Pool walking exercise. Walking both forward and backward in chest-high water works the leg muscles while exerting no impact of the knees or hips, which is particularly important for people who have arthritis in those joints. The walking exercise can be made more demanding with the addition of hand floats or light weights, so a stroll in the pool becomes an aquatic version of power walking.

    Also see Exercise Walking for Better Back Health

  • Quadruped activity and exercise. This exercise works legs and arms and is performed while floating on one's back (sometimes achieved with a therapist supporting the trunk or using a flotation jacket). The individual makes paddling motions with his or her arms and legs.

Spa treatments complementing water therapy for back pain typically involve relaxing in warm, agitated water such as that found in whirlpool baths. This form of hydrotherapy relaxes muscles, improves muscle blood flow, and increases general blood circulation, which make the body more flexible and can prepare it for water therapy or land-based exercise.

Combined Water Therapy for Back Exercise with Land-based Methods

Water therapy for back exercise can be a short-term exercise option if back pain or a back injury makes land-based exercise too difficult. Or it can be adopted as part of an ongoing exercise program if land-based methods worsen symptoms or if the person prefers water exercises. If their functional status or competitive goals require it, people may transition to exercise in a dry environment once they are successfully performing exercises in water.

Some people may find mixed use of wet and dry exercise therapy environments most beneficial.

See Exercise and Back Pain


There is a small but growing body of scientific studies demonstrating the benefits of aquatic exercise in the management of spine pain. Although more scientific evidence for the specific benefits of water therapy exercise in treating back pain will be helpful in creating specific programs for particular spine problems, the value of appropriate aquatic exercise programs is well established overall and has been beneficial in many thousands of individuals. The aquatic medium is ideal for patients for whom land-based options for back exercise are limited, and may provide a safe and effective method of managing spine pain while improving function.

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.