Is swimming good for back pain?

Yes it can.

The buoyancy effect of water on the body means that when we swim, our joints have much less pressure put on them than when we do other exercises such as running or aerobics. This is why exercising in water is a good way to not only get a workout but also increase your back strength without risking injury or a worsening of back pain.

Exercising in water also provides more resistance on the body than when exercising on land and so helps strengthen your back muscles. It can help increase blood flow to your back - especially if swimming in warm water - which helps with tissue healing if you have had a back injury, and regular swimming can also aid weight loss which is important since being overweight is a risk factor for back pain.

All types of exercise - including swimming - can help with the release of endorphins into the body. These are our ‘feel-good’ hormones that can assist in natural pain reduction and so help to ease back pain.

Which strokes are best for back pain?

If you are using swimming as an exercise to help with back pain, it is obvious that you need to be using a swimming stroke that will not make it worse. The simplest strokes to use - and the ones that are likely to be safest - are freestyle (front crawl) and backstroke. This is because the other strokes of breaststroke and butterfly can cause you to arch your lower back or put excessive strain on parts of your back, which can cause increased discomfort.

Whatever stroke you find most comfortable, if you are not a regular swimmer, you may find doing some sessions of water aerobics helpful and reassuring before you begin to swim on a regular basis.

Tips to remember when swimming with back pain

Although swimming is one of the best exercises you can do if you have back pain, it is not entirely risk-free so follow our tips to make sure you remain as comfortable as possible while exercising in water:

• Try to avoid twisting your hips if possible

• Remember that side and back strokes put less pressure on your back and tend to keep your spine in a neutral position

• Start a swimming programme slowly and gradually increase its frequency, duration and intensity over a number of weeks

• Keep your swimming strokes slow and controlled

• Consider having a refresher lesson with a swimming instructor who can show you the correct form for using different swimming strokes

• If you are feeling tired, rest for a while or finish your session and come back refreshed another day.

As little as an hour and a half of swimming per week can make significant improvements to your health. One reason is that it provides the same aerobic benefits for the heart and lungs as other activities such as jogging, but unlike running, it works all the muscles of the body. Not only that, the buoyancy factor of the water means that it does not put the strain on the joints and musculoskeletal system that aerobics and running can, and so it rarely leads to injury. This also means it is of great benefit to people with joint problems or back pain.

Along with the fitness benefits of swimming comes mental health ones, and these psychological benefits range from increased levels of well-being and libido to reduced levels of stress. 

As little as 30 minutes of swimming three times a week will not only improve the condition of your heart and lungs, it can also lower your blood pressure, help with weight reduction, and decrease total cholesterol levels in the body as part of a balanced exercise and diet programme. If you swim more than that then the results get even better and so if you are able to swim daily or even four to five times a week so much the better.

The treatment of back pain depends on its cause but in general paracetamol is a safe and sensible place to start when reaching for back pain relief, with relatively few risks or side effects, if taken as instructed. It’s well-tolerated and may be sufficient for occasional mild pain that occurs for just a brief time. It’s also safe in pregnancy. It should be avoided by those with a known liver condition who have been told not to use it.

NSAIDs (non-steroidal anti-inflammatory drugs) can help to relieve the swelling and inflammation that causes back pain and loss of function, especially in musculoskeletal injuries. NSAIDs include ibuprofen and aspirin, and stronger versions are available on prescription. Taken regularly for a week or so, NSAIDs can be very effective. They should be taken with food to minimise any irritation to the stomach lining or increasing reflux issues. The anti-inflammatory element of NSAID medications increases throughout the first week, so will continue to give added benefit with regular usage.

NSAIDs should be avoided in pregnancy, and in those with NSAID-sensitive asthma, a long-term kidney condition, on certain medications or those with a stomach ulcer. Aspirin is not suitable for those under 16.

A proton pump inhibitor (PPI) may be recommended by your doctor or pharmacist to protect the stomach lining if recommending regular NSAID medications. These are available on prescription or to buy at the pharmacy, such as Nexium Control (contains esomeprazole) or Pyrocalm tablets (contains omeprazole).

Anti-inflammatory gels can be a good alternative if you would rather not take tablets . You could try creams or gels that contain anti-inflammatory agents, such as Voltarol Back and Muscle Pain Relief 1.16% Gel, containing diclofenac. Be careful to not take anti-inflammatory topical creams alongside anti-inflammatory tablets, as these can lead to increased risk of side effects and problems. You can purchase these from our shop.

Non drug treatments for back pain

For the majority of people with mild back pain, stretching exercises may be all that are needed and even if you need other techniques or medication, moving and stretching is essential throughout your road to recovery. You should avoid complete bed rest with back pain as this stiffens muscles up and can set up new problems in your surrounding joints. Try to move little and often, with gentle stretches for the back, neck, shoulders, waist and legs, to avoid further stiffness, pain and difficulty in recovering.

A cold compress is a good idea in the first few days if you have had a flare-up of back pain or an injury to your back. A bag of frozen peas wrapped in a towel will help to reduce the initial wave of inflammation and swelling that can add to pain. You should only use a cold compress for a maximum of 20 minutes at a time and never apply ice directly to your skin. Deep Freeze can be applied to the injured area to have the same effect, or creams or gels containing menthol.

A warm compress is helpful once inflammation has settled after the first few days, as it helps the muscles relax, prevents stiffness and eases pain. A hot water bottle also does the job well – use a towel to avoid causing any skin damage – or certain creams and gels can cause a local heat, such as Deep Heat patches or capsaicin cream, the substance that gives chilli peppers their heat.

A professional massage or manipulation can help ease aches and pains in the back and improve movement. This is best done by a professional who understands anatomy and injury. A sports therapist, physiotherapist, chiropractor or osteopath are all highly trained, with the latter two working specifically with back problems and alignment. They can also advise on stretches to alleviate pain and rehabilitate, and exercises to prevent future back pain or injury.

A TENS machine (transcutaneous electrical nerve stimulation) can help relieve pain by providing small electrical impulses to the lower back area, giving a mild tingling sensation and reducing pain signals to the brain. It’s a good idea to try if you have long-term back pain.

Acupuncture has evidence to back its role in short-term relief of chronic back pain, and it may allow a little more movement to encourage further rehabilitation and repair. Tiny needles are inserted to the skin and muscles, which is thought to release natural painkillers in the body called endorphins.

CBT and mindfulness may help to treat the brain’s interpretation of pain, if your back pain lasts several weeks or months. Sometimes our bodies malfunction to continue making us think we’re in pain, even after we’ve recovered from the initial injury. So CBT (Cognitive Behavioural Therapy) or mindfulness can be beneficial in reducing your sensitisation to chronic pain and thereby dampening its impact.

Taking care of your mental health is essential with back pain that is slow to recover, as chronic back pain can take its toll on you. Consider what you enjoy and what helps you relax – music, reading, catching up with friends – and work on releasing those natural painkillers, the endorphins. Be aware that low mood, anxiety and depression can sometimes set in with chronic pain. See your doctor if you think your condition is affecting your mental wellbeing.

Core strength and conditioning can help with longer term back pain, and help to prevent future injuries. Pilates, yoga and weight training can all help to build up core muscles, including the paraspinal muscles that hug the spine, and flexibility to keep the spine supple. They also improve posture, which helps if you sit at a desk for long periods or have a physical job requiring lots of lifting.

Most cases of back pain are nothing to worry about and will improve within a few days or weeks. There are certain circumstances when you should seek medical attention, and you may need this urgently:

• if your back pain started after a significant fall or accident

• if you have a history of cancer

• if you have back pain together with unintended weight loss, extreme fatigue or night sweats, a chronic cough, a change in your bowel habit or a lump in your breast, or if you are a long-term smoker

• If you have severe back pain, or intense back pain that wakes you at night

• if you have sciatica affecting both legs, numbness around your bottom or problems with your bowel or bladder control

• if you are aged under 45 and get severe back pain and stiffness first thing in the morning, every morning, lasting for 30 minutes or more, and this has persisted for 3 months or more

• if your back pain has not started to improve after 6 weeks