A new study from Concordia University suggests that aquatic therapy may offer more than just physical relief for people with chronic low back pain—it can also help ease the mental struggles that often come with the condition.
In a carefully designed trial, researchers found that exercising in water not only strengthened important spinal muscles but also reduced fear of movement, anxiety, and sleep problems among participants.
Chronic low back pain is one of the most common and disabling health conditions worldwide. It can affect every part of life, from physical activity to sleep to mental health.
Many people who live with ongoing back pain also experience what researchers call “pain-related fear,” which includes a fear of movement (kinesiophobia) or a tendency to catastrophize the pain—expecting the worst even from minor physical activity. These psychological patterns can worsen pain and limit recovery, creating a cycle that is hard to break.
To see how aquatic therapy might help, Concordia researchers conducted a randomized controlled trial with 34 adults who had long-term low back pain. Half were assigned to a standard care group, which included land-based exercises.
The other half participated in an aquatic therapy program at Concordia’s SwimEx pool. Both programs lasted 10 weeks, with participants attending two sessions per week. All sessions were supervised by trained athletic therapists.
Before and after the program, participants filled out detailed questionnaires to report on their pain levels, physical function, quality of life, mental health, and sleep quality. They also had their spinal muscle strength tested and underwent MRI scans to measure changes in muscle size.
The results were promising. The aquatic therapy group experienced a notable increase in the size of certain upper spinal muscles—the multifidus and erector spinae—which help support and stabilize the back.
Although these changes were not seen in the lower spine (where muscle loss is more common and harder to reverse), the improvement in upper back muscles could still play a role in better spine function and less pain.
More importantly, the aquatic therapy participants showed improvements in their mental wellbeing. They reported lower levels of pain-related fear, less anxiety, and better sleep after the 10-week program. These improvements were not just minor statistical changes—they were clinically significant, meaning they had a real impact on how participants felt and functioned in daily life.
“Getting into water makes people feel better right away because it takes the pressure off the spine,” said Maryse Fortin, the study’s senior author and a professor at Concordia’s Department of Health, Kinesiology and Applied Physiology. She explained that water provides a safe space for people with chronic pain to move more freely and without fear of hurting themselves.
The study’s lead author, Brent Rosenstein, and a team of co-authors from various health disciplines helped design and carry out the trial. Their work, published in Scientific Reports, adds new evidence that exercise therapy in water may have mental and emotional benefits for people dealing with persistent back pain.
While more research is needed, the study highlights an exciting possibility: that something as simple and accessible as swimming or water-based exercise might help not only strengthen the body but also break the cycle of fear, pain, and poor sleep that many back pain sufferers face.
For patients looking for a more supportive and less intimidating environment to heal, aquatic therapy may offer both relief and renewed confidence.
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The research findings can be found in Scientific Reports.
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