An Australian study is the first to show that a swimming program is clinically effective in reducing disability caused by chronic low back pain.
today, British Journal of Sports Medicinethe EduSwim clinical trial found that an eight-week individualized program that combined swimming and education under the guidance of a physical therapist improved function and pain in people with lower back pain to a greater extent than education alone.
Swimming is commonly recommended as an exercise for people with chronic back pain, but there has been a complete lack of evidence as to whether it actually helps. We undertook this study because we felt there was an urgent need for research to determine whether swimming was effective for chronic low back pain. ”
Deborah Wareham, Principal Investigator, Physiotherapist, PhD Candidate, Macquarie University Spine Pain Research Center, Sydney
Researchers recruited 76 adults between the ages of 26 and 74 (mean age 41) who had some form of disability due to low back pain lasting at least 12 weeks and randomly assigned them to one of two groups. One group received an eight-week individual program on swimming and education, supported by four telehealth coaching sessions with a physical therapist. “They weren’t normally good swimmers, but they were able to swim 25 meters and were confident in the water,” Wareham said.
The swimming program was based on each participant’s current swimming ability and fitness, with the goal of completing three 30-45 minute sessions by the end of the 8 weeks. Education covered key concepts and messages such as: “Pain does not necessarily equal harm.” “The back is made for movement.” “There is a high possibility that it will flare up again.” “The best management is to keep moving.”
Participants in the other (control) group received one or two sessions with a physical therapist to learn the same key messages about back pain as the intervention group, but otherwise continued their usual treatment and activities.
After 8 weeks, disability in the swimming group was significantly reduced.
“I’m about 50 percent better than I was before I started the program,” Wareham said. “Compared to a control group who received only education, the swimmers scored an average of 2.5 points, or 30 percent lower, on a widely used disability scale.”
The benefits of swimming persisted at long-term follow-up (26 and 52 weeks), but the differences between groups diminished over time. Secondary outcomes (including pain intensity, functional limitations, pain self-efficacy, and fear of movement) showed a similar pattern, being lower in the swim group early in the program, but the differences diminished over time.
Best practice guidelines around the world recommend exercise and education as first-line treatment for chronic low back pain, but Wareham points out that only some types of exercise (such as Pilates) have been clinically evaluated. “In fact, the improvements seen in our study compare favorably with the effects reported for other exercises, such as Pilates, in recent meta-analyses,” she said.
“The argument for swimming when you have back pain is logical, but it was important to test this,” said Professor Mark Hancock, co-director of the Spine Pain Research Center and lead author of the study. “Swimming can improve your range of motion, strength, and general aerobic capacity, and the buoyancy of the water can help you work on movements that might otherwise be painful or limited.”
“Importantly, participants told us that swimming gave them the confidence to take up exercise or engage in other meaningful physical activity. Some continued swimming after the program ended, while others moved on to other forms of exercise,” Professor Hancock said. “We now have evidence to support this recommendation. Swimming is a good and effective exercise for people with lower back pain.”
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Reference magazines:
Wareham, DM; Others. (2026). Efficacy of an individualized swimming and education program (EduSwim) for chronic low back pain: A randomized controlled trial. British Journal of Sports Medicine. DOI: 10.1136/bjsports-2026-111730. https://bjsm.bmj.com/content/early/2026/07/20/bjsports-2026-111730
