Aquatic Therapy for Lumbar Disc Herniation: A Systematic Review

Lumbar disc herniation is one of the leading causes of low back pain and sciatica. Because pain often limits participation in conventional exercise, aquatic therapy has become an increasingly popular conservative rehabilitation option. This systematic review evaluated studies published between 2011 and 2023 investigating the effectiveness of aquatic therapy in patients with lumbar disc herniation.

Why aquatic therapy?

Water creates a therapeutic environment through four important physical properties:

• Buoyancy reduces spinal loading.
• Hydrostatic pressure improves circulation and reduces oedema.
• Water viscosity provides safe multidirectional resistance.
• Warm water promotes muscle relaxation and reduces muscle spasm.

Together these characteristics allow patients to begin rehabilitation earlier and often with less pain than on land.

Pain reduction

Most reviewed studies reported significant reductions in pain following aquatic therapy.

The review attributes these improvements primarily to:

• reduced compression of lumbar discs,
• decreased pressure on irritated nerve roots,
• reduced muscle spasm,
• improved local circulation.

Pain was generally measured using the Visual Analogue Scale (VAS).

Improved physical function

Several studies demonstrated improvements in functional ability and disability scores.

Patients participating in aquatic therapy generally showed larger improvements in:

• Oswestry Disability Index (ODI),
• lumbar flexion,
• lumbar extension,
• confidence during functional movements.

The aquatic environment enables patients to safely practice walking, bending and trunk rotation with less fear of pain.

Core muscle strengthening

Water resistance provides continuous resistance throughout movement without placing excessive stress on the lumbar spine.

Exercises such as:

• walking in water,
• flutter kicks,
• resistance exercises with noodles,
• aquatic dumbbells,

were reported to strengthen the:

• transversus abdominis,
• multifidus,
• abdominal muscles,
• lumbar extensors.

Improved core stability may contribute to reducing recurrence of lumbar disc symptoms.

Quality of life

Chronic lumbar disc herniation affects physical, psychological and social functioning.

The reviewed evidence suggests aquatic therapy improves overall quality of life through:

• pain reduction,
• greater independence,
• improved daily activities,
• increased confidence in movement.

Psychological benefits

Besides physical improvements, aquatic therapy may also reduce:

• fear of movement (kinesiophobia),
• stress,
• anxiety,

which may improve adherence to rehabilitation programmes.

Benefits for older adults

The review discusses evidence suggesting elderly patients with lumbar disc herniation also benefit from aquatic therapy.

Reported improvements include:

• reduced pain,
• better balance,
• lower disability,
• reduced fear of movement.

These findings indicate aquatic therapy may be particularly valuable for older adults who have difficulty tolerating land-based rehabilitation.

Proposed mechanisms

According to the review, immersion may reduce lumbar disc pressure by approximately 70–80% during neck-depth immersion, allowing patients to move more comfortably while decreasing nerve root irritation.

Hydrostatic pressure may further reduce swelling around nerve roots, while warm water (typically 30–34°C) promotes muscle relaxation and increases blood flow to injured tissues.

Clinical recommendations

The authors recommend:

• individualised aquatic therapy programmes,
• supervision by experienced physiotherapists,
• gradual progression of exercise difficulty,
• sessions of 30–45 minutes,
• 2–3 sessions per week.

Limitations

The review notes several important limitations:

• heterogeneous treatment protocols,
• relatively small study populations,
• lack of standardised aquatic exercise programmes,
• need for larger, high-quality clinical trials.

Consequently, although the overall evidence is favourable, stronger randomised controlled trials are still needed to establish optimal treatment protocols.

Conclusion

This systematic review concludes that aquatic therapy is a safe and effective complementary treatment for lumbar disc herniation. It appears to reduce pain, improve functional ability, strengthen core musculature and enhance quality of life while allowing patients to exercise with substantially lower spinal loading. However, further high-quality research is required to determine the most effective treatment protocols.