First trial confirms swimming reduces disability from chronic back pain
· Medical Xpressedited by Sadie Harley, reviewed by Robert Egan
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Australian research has shown for the first time that a swimming program can be clinically effective at reducing disability caused by chronic low back pain. Published in the British Journal of Sports Medicine, the EduSwim clinical trial found that an eight-week individualized program of swimming and education, guided by a physiotherapist, improved function and reduced pain significantly more than education alone in people with back pain.
"Swimming is commonly recommended as an exercise for people with chronic low back pain, but there was a complete lack of evidence about whether it actually works," said lead researcher Deborah Wareham, a physiotherapist and doctoral candidate in the Spinal Pain Research Center at Macquarie University in Sydney.
"We undertook this study because we felt there was an urgent need for research to determine if swimming was effective or not for chronic back pain," Wareham said.
How the trial was structured
The researchers recruited 76 adults ages 26–74 (average age 41) who were experiencing some disability due to low back pain lasting at least 12 weeks. They randomly allocated participants to one of two groups. One group received an eight-week individualized program of swimming and education, supported by four telehealth coaching sessions with a physiotherapist.
"They weren't regular swimmers, but they were able to swim 25 meters (82 feet) and feel confident in the water," Wareham said.
The swimming program was based on each participant's current swimming ability and fitness, with a goal of achieving three sessions of 30–45 minutes by the end of the eight-week program. Education covered key concepts and messages, including "Pain does not always equal harm"; "The back is made for movement"; "Flare-ups are likely"; and "The best management is to keep moving."
Participants in the other (control) group had one to two sessions with a physiotherapist to learn the same key messages about back pain as the intervention group but otherwise continued their usual treatment and activity.
Early gains, then a taper
After eight weeks, disability was significantly lower in the swimming group.
"They improved by about 50% from where they were before starting the program," Wareham said. "Compared to the control group that received education only, swimmers scored, on average, 2.5 points, or 30%, lower on a widely used disability scale."
The benefit of swimming persisted at long-term follow-up (at 26 and 52 weeks), although the difference between the groups decreased over time. Secondary outcomes—including pain intensity, functional limitation, pain self-efficacy and fear of movement—showed a similar pattern, with lower scores in the swimming group early in the program but decreasing differences over time.
Support for a common recommendation
Best-practice guidelines around the world recommend exercise and education as first-line treatments for chronic low back pain, but only some types of exercise (Pilates, for example) have been clinically evaluated, Wareham noted. "In fact, the improvement we saw in our study compares favorably with effects reported for other exercises, such as Pilates, in a recent meta-analysis," she said.
"The argument for swimming in back pain is logical, but it was important to test this," said Professor Mark Hancock, co-director of the Spinal Pain Research Center and senior author of the study. "Swimming can improve range of motion, strength and general aerobic capacity, and the buoyancy of water can help people engage with movements that might otherwise be painful or limited."
"Importantly, participants told us swimming built their confidence to start exercising and engage with other meaningful physical activities—some continued to swim after the program, while others transitioned to other forms of exercise," Hancock said. "Now we have the evidence to support the recommendation—swimming is a suitable exercise for people with back pain, and it helps."
Publication details
Effectiveness of an individualised swimming and education programme for chronic low back pain (EduSwim): a randomised controlled trial, British Journal of Sports Medicine (2026). DOI: 10.1136/bjsports-2026-111730
Journal information: British Journal of Sports Medicine
Key medical concepts
back pain lower back chronicDisability typePain
Clinical categories
Allied healthFitness & Physical activitySports medicineCommon illnesses & Prevention Provided by Macquarie University Who's behind this story?
Sadie Harley
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