A Water Exercise Routine for Back Pain

If you struggle with a lot of back pain and medical treatments, including exercise, haven't delivered the relief you seek, water exercise may be for you. It's fun, social, and for many people, it buoys the spirit.

But most important, water exercise can be great for your joints and muscles. In fact, a 2014 meta-analysis found that aquatic exercise can help improve pain, quality of life, and your ability to function in your daily life if you are dealing with a musculoskeletal condition. (Back pain is certainly one of these conditions.)

The study also found that aquatic exercise confers its benefits onto a wide range of musculoskeletal conditions equally and that the results one might get from engaging regularly with exercise in the pool are comparable to those of land-based exercise.


Getting Started

Adults doing exercises in pool

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Interested? If so, you may want to know how to start. 

Perhaps the easiest way is to join a class at your local pool or gym. But if your schedule doesn't permit that, or if such classes are not available to you, giving yourself a water workout is another possibility. It's not a difficult as it may seem.

The first step is to gather the items you'll need. Along with the usual fare: bathing suit, towel, flip flops, etc, you'll likely benefit from the use of flotation devices and other water exercise tools. Many such tools exist, from kickboards to noodles, as well as paddles and tubing. Water tools increase the resistance of the water as a way of helping you build muscle strength; they also can help you stay afloat, which makes moving easier on your joints.

But the floatation belt is likely the most basic of all such devices. As the name suggests, the belt keeps you from sinking while you're in the deep end, and can decrease pressure on joints when you work in the shallow end. If you can only procure one extra item for your aquatic workout, the flotation belt is the one to own.


The Water Warm Up: Walking & Lunges

Water exercise can be good for your back.

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The first activity in your water workout will most likely be walking. The American Physical Therapy Association (APTA) recommends starting your walking forward in waist or chest high water forwards and backward, as well. Start slowly and once you're warmed up a bit, increase your speed. Another way to step up your warm-up is to jog in place, the APTA says. You might also alternate walking and jogging for five minutes.

The APTA suggests following your walking (or jogging) warm up with a few lunges. You can stand near the wall of the pool and hold on for support; if you don't hold onto a wall, you can expect the extra challenge to your core. 

Doing a forward lunge is like walking in that you take a step forward. The difference is that you'll bend that front knee. Don't take the knee too far forward, though. You should always be able to see your toes. Otherwise, you've bent the knee too far. 

Another difference is between walking and lunging is that after you lunge, you come back up to your original start position, and then repeat the move on the other side. That said, walking lunges are a possibility, too. 

As for how many, the APTA suggests doing 3 sets of 10 lunges.


Water Kicks & Sideways Walking

Water exercise - leg kicks and swings

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To get a well-rounded workout, you need to include sideways movement, too. The APTA suggests a sidestepping activity. Here's how:

Face the pool wall (you can hold on if you need) with your feet and toes facing straight ahead. Take 10-20 steps to one side and then 10-20 steps back. Repeat once or twice more.

Okay, it's time for some real hip power in the form of hip kicks/swings. This move can help develop both strength and range of motion at your hip, which is a key joint for a healthy low back.

Stand near the wall—near enough to hold onto it if you have to. Keeping the knee straight, bring one leg forward, and then back behind you. Do 3 sets of 10 on these and then repeat with the other leg. You can also perform this move out to the side, where you bring the leg out and then back in, crossing in front or in back of the standing leg. (I'd suggest alternating between crossing in front and crossing in back.)


Water Work Those Abs

Women using fun noodles in pool

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It's time to work the abdominal muscles and core. If you're in the deep water with a flotation belt, bring both knees up to your chest and down again 10 times. Repeat this for 3 sets. A more advanced version of this exercise is before bringing your legs back down, straighten your knees and extend your body out into one long line—as though you were floating on the water.

To work your oblique muscles and get some spine twisting in, consider doing one or more sets of 10 rotating your knees to the right or left as you bring them up. (And repeat the same on the other side, of course.)

You can challenge your balance while in the shallow water. This, in turn, will likely challenge your core muscles. Try standing on one leg with the other parked high up, propped on the inner thigh of that standing leg. Count to 10 (or longer) while holding the position. Repeat on the other side. Do your best not to hold onto anything while you perform this exercise.

To add even more challenge, bring your arms up over your head.


Water Exercise Session Cool Down

Water exercise for pain

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Return to water walking for your cool down. Cool down should last about 5 to 10 minutes. Include hip stretches, either in the water once you are back on land.

Congratulations! You've completed a basic mini-workout in the water!

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Shi Z, Zhou H, Lu L, et al. Aquatic exercises in the treatment of low back pain: a systematic review of the literature and meta-analysis of eight studies. Am J Phys Med Rehabil. 2018;97(2):116-122. doi: 10.1097/phm.0000000000000801

  2. Barker AL, Talevski J, Morello RT, Brand CA, Rahmann AE, Urquhart DM. Effectiveness of Aquatic Exercise for Musculoskeletal Conditions: A Meta-AnalysisArchives of Physical Medicine and Rehabilitation. 2014;95(9):1776-1786. doi:10.1016/j.apmr.2014.04.005.

  3. American Physical Therapy Association. 10 Exercises to do in the Pool.

  4. American Physical Therapy Association. 10 Exercises to do in the Pool.

  5. American Physical Therapy Association. 10 Exercises to do in the Pool.

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.