Water-based therapies have gained popularity in recent years as a means of treating musculoskeletal conditions, including back pain and spinal issues. However, the effects of water therapy are often short-lived.  Once the patient is out of the water and gravity resumes its impact on the spine, the pain and mobility issues often return.

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Limited Mechanical Impact on the Spine

One of the primary issues with treating the spine in water is the lack of mechanical correction or realignment that can be achieved in a water-based environment. Many spinal conditions, such as herniated discs, scoliosis, or vertebral misalignments, require precise interventions that address the structural mechanics of the spine. These may include target exercises on land, physical manipulation or, in some cases, - surgical procedures that physically alter or stabilize the spine. Water therapy does not offer the resistance or targeted pressure needed to correct these types of mechanical deformities.

Degenerative Disc Disease: In conditions like degenerative disc disease, the discs between the vertebrae wear down over time, leading to pain and restricted movement. The water’s buoyancy can reduce the feeling of gravity’s pull, offering temporary relief. However, this does not address the root cause—degeneration of the disc itself—nor does it halt the progression of the disease.

Herniated Discs: When a disc herniates, part of the disc protrudes and presses against nerves. Water therapy cannot reposition the disc or relieve the pressure on the nerves in any lasting way. More targeted interventions, like target physical therapy on land are often needed to address the core issue.

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No Direct Impact on Nerve Compression

Many spinal issues, such as sciatica, are caused by nerve compression, either by a herniated disc, spinal stenosis (narrowing of the spinal canal), or bone spurs. While water therapy can provide temporary relief by relaxing muscles and reducing inflammation, it does not directly address the underlying nerve impingement.

Spinal Stenosis: In conditions like spinal stenosis, where the spinal canal narrows and compresses the nerves, the lack of gravity in water may temporarily ease pain but cannot widen the canal or relieve the nerve pressure in a lasting way,  -  that is why other mechanical treatments are typically needed to provide long-term relief.

Radiculopathy: In cases where a nerve root is compressed, aquatic therapy may reduce inflammation but cannot physically reduce the compression on the nerve. Treatments such as target exercises, spinal traction, physical adjustments, epidural injections are needed to relieve the impingement.

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‍Lack of Evidence for Long-Term Efficacy

One of the primary benefits of water therapy is pain relief through the relaxation of muscles, reduction of joint stress, and temporary improvement in mobility. This can be useful for patients who are in acute pain or who have difficulty moving on land. However, the effects of water therapy are often short-lived. Once the patient is out of the water and gravity resumes its impact on the spine, the pain and mobility issues often return.

There is a notable lack of robust, long-term scientific evidence supporting the efficacy of water-based therapies as a primary treatment for serious spinal conditions. Aquatic has not been proven to be more effective than land-based therapies in the treatment of spine-related conditions, especially in the long term.

Research comparing aquatic therapy with conventional physical therapy for back pain and spine conditions has shown mixed results. Many studies indicate that while water-based therapy can improve pain and function in the short term, it does not outperform land-based therapy in terms of long-term outcomes for spinal health.

Water therapy, while a valuable tool in the broader spectrum of rehabilitation, is not an effective standalone treatment for serious spinal conditions. It can provide temporary relief of symptoms, especially in terms of pain management and mobility, but it does not address the underlying mechanical, structural, or neurological issues that are often at the root of spine problems. For long-term success, spinal treatment generally requires a comprehensive approach that includes targeted exercises on land, mechanical interventions, and in some cases, surgical treatment. Therefore, while water-based exercises can complement other treatments, they should not be relied upon as the primary means of addressing spinal health issues.

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Referencies

Aquatic Therapy for Spinal Conditions: Becker, B. E. (2009). Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM&R, 1(9), 859-872.
DOI: 10.1016/j.pmrj.2009.05.017

Limitations in Addressing Mechanical Spinal Issues: Anderson, G. B. J. (1999). Epidemiology of spinal disorders. In Frymoyer J. W. (Ed.), The Adult Spine: Principles and Practice (pp. 93–141). Lippincott Williams & Wilkins.

Strength and Stability in Spine Rehabilitation:

Borenstein, D. G., Wiesel, S. W., & Boden, S. D. (1995). Low Back Pain: Medical Diagnosis and Comprehensive Management. W. B. Saunders.

Kisner, C., & Colby, L. A. (2012). Therapeutic Exercise: Foundations and Techniques (6th ed.). F.A. Davis Company.

Impact on Nerve Compression and Spinal Stenosis: Katz, J. N., & Harris, M. B. (2008). Clinical practice. Lumbar spinal stenosis. The New England Journal of Medicine, 358(8), 818–825.
DOI: 10.1056/NEJMcp0708097

Long-Term Outcomes and Efficacy: Foley, B. S., & Halpern, J. L. (2002). How effective is aquatic exercise in improving gait, balance, and fear of falling in older adults? Journal of Aquatic Physical Therapy, 10(3), 4-11.

Simmons, V., & Hansen, P. D. (1996). Effectiveness of water exercise on postural mobility in the well elderly: An experimental study on balance enhancement. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 51(5), 233-238.
DOI: 10.1093/geronb/51B.5.P233

Spinal Pathology and Structural Deformities: Weinstein, J. N., & Rydevik, B. L. (2004). Back pain: Future directions for research. Spine, 29(23), 2707-2713.
DOI: 10.1097/01.brs.0000147589.24825.3e

Comparative Studies in Aquatic vs. Land-Based Therapy:

Waller, B., Lambeck, J., & Daly, D. (2009). Therapeutic aquatic exercise in the treatment of low back pain: A systematic review. Clinical Rehabilitation, 23(1), 3-14.
DOI: 10.1177/0269215508097856

Cuesta-Vargas, A. I., García-Romero, J. C., & Vera-Garcia, E. (2013). The effectiveness of deep water running in comparison with land-based exercise on pain and disability in patients with low back pain: A randomized controlled trial. Clinical Rehabilitation, 27(6), 509-519.
DOI: 10.1177/0269215512469122

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