Anyone with almost any kind of chronic pain should consider spending more time in the pool (doing almost anything, but aquajogging is a particularly good choice). This includes many patients who may not normally think of pool therapy.
Aquatic therapy can be great for almost any kind of stubborn pain. Immersion and floatation have curiously potent benefits. The partial relief from gravity, that most relentless of all physical stresses, is valuable both as actual mechanical security and to make movement feel easy, cushioned, and safe — and feeling safer with movement can be a critical stepping stone in all kinds of rehabilitation and pain management. Modern pain science has makes it clear that pain is an expression of perceived danger to the system.1 Pools are one of the few places where we can both be more active while also actually feeling safer. That’s a precious combination. There are some other helpful biological effects of immersion, too: the human nervous system really seems to like it.
But it’s not magic: studies have shown it’s no better than “dry” rehab for most problems.23 It’s not for everyone, and there are some downsides, like getting chilly (a deal-breaker for some chronic pain patients). However, it is well worth taking a shot at it and making the effort to make it work for you.4
The simplest aquatic therapy is to just float. There are two main kinds of floatation therapy:
All of the above is potentially terrific for injury rehabilitation and chronic pain in many ways.
Aquajogging and water aerobics combine the benefits of vertical (deep) immersion with exercise, “the closest thing there is to a miracle cure.”10
The lack of impact, the “cushioning,” and the ease of fine-tuning the intensity make it a fine place for garden variety rehab. But where aquatic therapy may shine brightest is with patients whose primary symptom is unexplained pain, like fibromyalgia.11 I’m not saying that the pool has any special properties that directly treat complex and chronic pain — although that is also possible — just that immersion facilitates exercise in patients that both particularly need it and struggle with it (a difficult benefit to measure).
Aquajogging works a lot better with the help of a simple accessory, a buoyancy belt like the AquaJogger or the WaterGym Water Float Belt (and many others, sometimes called a water aerobics belt). I recently encountered a fellow who was wearing one of these at the pool, and he claimed he’d had his for more than a decade: a good investment!
Oddly enough, I’d never heard of aquajogging until quite recently. Reader Jared Updike introduced me to it in 2016. He’s a persuasive evangelist for it:
I would love for more people to know about aquajogging. It is a weirdly convenient form of swimming where you trade several pieces of equipment (goggles, hair cap, ear plugs, etc.) for a single strange piece of equipment (flotation belt) and in exchange your hair and eyes and ears stay dry and you can wear a hat and sunglasses while you slowly pull yourself across the pool. And it scales up or down for different fitness levels or pain-level fluctuations. It’s the closest thing to a silver bullet I have found for my pain and fatigue.
Or you could just, you know, swim! Swimming itself is, of course, great exercise. If your body will tolerate it, it’s one of the best workouts you can do. But for chronic pain patients, the vertical immersion of aquajogging really is ideal.
The popularity of yoga is almost oppressive. People feel that they “should” try yoga and may even feel guilty for not trying it (or not liking it). For people on the fence, a little water yoga might be more fun and easier to mess around with. 😃
I use a pool regularly for “yoga” rather than for swimming — a casual and unstructured yoga, but yoga nevertheless. Using the buoyancy of water to aid rehabilitation is a well-known and excellent idea, but the potential for your pool to be an excellent place to breathe and stretch is less widely appreciated. Here are five examples of exercises that make good use of the water:
Yoga and stretching are not everything they are cracked up to be, and they probably fail to achieve much of what people are hoping for — such as preventing muscle soreness,17 or curing low back pain.18 But I am not anti-stretching: it feels great, and not only is that sufficient reason in itself, it probably does mean it’s doing something valuable for us biologically, even if it’s surprisingly unclear exactly what. Here’s an interesting clue: a 2011 study showed that a program of static stretching alone — just pulling on muscles — had a clear benefit for heart rate regulation, a common way of measuring fitness.19 Bodies probably need constant sensory feedback for optimum function — use it or lose it — and this evidence is probably a nice demonstration of that principle.
I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.
— Science updated. Added a couple key citations about the efficacy of aquatic therapy, and spelling out the case for it a bit more.
— Added a footnote with some tips about how to cope with getting chilly in pools.
A review of 8 tests of aquatic physical therapy after orthopedic surgeries found that it was safe and at least as effective as land-based therapy. Unfortunately, it showed no superiority for swelling and pain, benefits that might be needed justify the cost and hassle.BACK TO TEXT
A review of 26 tests of aquatic therapy for miscellaneous musculoskeletal conditions. The results are similar to Villalta et al (for rehab after surgical): at least as good as land-based therapy, but no better (alas).BACK TO TEXT
In this simple test of several volleyball players, running in water resulted in a much lower maximum heart rate and recovery heart rate than running on a treadmill: a clear “cardiovascular response mediated by immersion in water.”BACK TO TEXT
In patients with coronary artery disease, short-term head-out water immersion had several significant effects on circulatory function, especially, including a significantly decreased pulse rate, both before and after a rehabilitation program. Patients with chronic heart failure were initially unaffected by immersion, but “restored the usual central responses.” Arterial compliance was the only hemodynamic factor that was not affected by immersion.BACK TO TEXT
Heart rate variability (HRV) refers to the slight wobbles in the rhythm of the heart, tiny variations in the time between beats. Curiously, this is a good indicator of neurological relaxation or arousal, messy and complex but reliable. For this test, HRV was measured in twenty-five scuba divers were tested in head-out immersion and while diving in a pool (27˚C). They found that “all HRV measures showed an increase in the parasympathetic activity” (relaxation) and “immersion under pool conditions is a powerful stimulus for both the sympathetic and parasympathetic nervous system.” Fascinating!BACK TO TEXT
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The big four “proximate” causes of preventable ill-health are: smoking, poor nutrition, lack of physical activity and alcohol excess. Of these, the importance of regular exercise is the least well-known. Relatively low levels of increased activity can make a huge difference. All the evidence suggests small amounts of regular exercise (five times a week for 30 minutes each time for adults) brings dramatic benefits. The exercise should be moderate – enough to get a person slightly out of breath and/or sweaty, and with an increased heart rate. This report is a thorough review of that evidence.
Regular exercise can prevent dementia, type 2 diabetes, some cancers, depression, heart disease and other common serious conditions — reducing the risk of each by at least 30%. This is better than many drugs.
This study of stretching found that
multiple-set flexibility training sessions enhanced the vagal modulation and sympathovagal balance [that’s good] in the acute postexercise recovery, at least in subjects with low flexibility levels. … stretching routines may contribute to a favorable autonomic activity change in untrained subjects.
This seems like a fairly straightforward bit of good-news science about stretching. It’s not a surprising idea that movement would have some systemic regulatory effects (motion is lotion, use it or lose it), but it’s nice to see some corroboration of that common sensical notion, and it’s also nice to know that perhaps just stretching did this (to the extent we can learn anything from a single study). If true, it makes for nice evidence to support a general stretching habit, yoga, mobilizations, really any kind of “massaging with movement,” and probably even massage itself.BACK TO TEXT