Ashoury (2025) Aquatic and Kinetic Chain Exercises for Rehabilitation of Chronic Non-specific Low Back Pain
Aquatic Therapy for Chronic Low Back Pain
Chronic low back pain is one of the leading causes of disability worldwide, affecting mobility, daily activities and quality of life. A 2025 randomized controlled trial demonstrates that aquatic therapy for chronic low back pain significantly reduces pain while improving mobility and balance in just eight weeks.
The study evaluated two different types of aquatic exercise programmes and found that both are highly effective additions to conventional rehabilitation.
What did the study investigate?
Researchers enrolled 60 men with chronic non-specific low back pain and randomly assigned them to one of three groups:
- Open kinetic chain aquatic exercises
- Closed kinetic chain aquatic exercises
- Control group without aquatic therapy
Participants in both aquatic therapy groups completed three supervised sessions per week over an eight-week period.
Key benefits of aquatic therapy for chronic low back pain
Compared with the control group, participants who exercised in water experienced significant improvements in several important rehabilitation outcomes.
Significant pain reduction
Both aquatic exercise programmes resulted in a substantial reduction in chronic low back pain, allowing participants to move more comfortably during daily activities.
Improved spinal mobility
Aquatic therapy significantly increased lumbar range of motion, helping patients regain flexibility and perform everyday movements with greater ease.
Better balance and stability
Dynamic balance improved in all directions following the aquatic exercise programme. Better balance contributes to safer movement, reduced fall risk and improved functional independence.
Enhanced functional recovery
The combination of reduced pain, increased mobility and improved balance allows patients to return more confidently to normal daily activities.
Why is aquatic therapy so effective?
The unique properties of water create an ideal rehabilitation environment for people with chronic low back pain.
Buoyancy reduces spinal loading
Water supports body weight, reducing stress on the spine and joints. Patients can therefore perform movements that may be too painful on land.
Hydrostatic pressure supports recovery
Water pressure improves circulation and muscle activation while helping reduce muscle soreness and discomfort during exercise.
Natural resistance strengthens muscles
Water provides gentle resistance in every direction, strengthening the core and spinal stabilising muscles without placing excessive loads on the lower back.
Safe movement with less pain
The aquatic environment enables patients to move more freely and confidently, encouraging earlier rehabilitation and greater exercise participation.
Open versus closed kinetic chain exercises
The study compared both open and closed kinetic chain exercises performed in water.
Researchers found that both exercise programmes produced comparable improvements in:
- Pain reduction
- Lumbar range of motion
- Dynamic balance
- Functional mobility
This means aquatic therapy programmes can be adapted to the individual patient without compromising clinical outcomes.
Clinical implications
For physiotherapists, rehabilitation specialists and healthcare providers, this study provides further evidence that aquatic therapy for chronic low back pain is an effective complement to traditional rehabilitation.
Hydrotherapy pools offer a safe, low-impact environment where patients can improve mobility, strengthen stabilising muscles and reduce pain while exercising comfortably.
Conclusion
This randomized controlled trial confirms that aquatic therapy for chronic low back pain significantly improves pain, spinal mobility and dynamic balance after an eight-week rehabilitation programme.
The authors conclude that aquatic therapy should be considered an important component of comprehensive rehabilitation programmes for patients with chronic non-specific low back pain.
