The immediate effect of swimming stroke on pain in people with chronic low back pain: a crossover study

Deborah Wareham; Joel Fuller; Petra Graham; Eoin Doyle; Mark Hancock

doi:10.1016/j.rehab.2025.102030

The immediate effect of swimming stroke on pain in people with chronic low back pain: a crossover study

Deborah Wareham, Joel Fuller, Petra Graham, Eoin Doyle, Mark Hancock

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Abstract

Background: Swimming is anecdotally suggested as a suitable exercise for chronic low back pain. However, swimming involves different strokes that require different movement patterns and, therefore, may impact low back pain symptoms differently. The extent to which different swimming strokes impact chronic low back pain differently is currently unknown.

Objectives: This study compares and describes the intensity of pain experienced during and immediately after different swimming strokes in individuals with chronic low back pain.

Methods: We recruited 30 adults with chronic low back pain. Participants swam 100 m of freestyle, breaststroke, and backstroke in a balanced, randomized sequence. The primary outcome was pain intensity during swimming, measured as average and worst pain (0-10 Numeric Pain Rating). Secondary outcomes included pain after swimming while standing and while completing an aggravating movement. Pain scores were compared between strokes using linear mixed-effects models that included a fixed effect of stroke and period, and a random effect for participant. Carry-over effects were investigated via a stroke-by-period interaction.

Results: There was no evidence of carry-over effects for any outcome measure (P >0.15). Backstroke had lower average pain compared to breaststroke (mean difference, MD -0.63; 95% CI: -1.17 to -0.10) but was not different to freestyle (MD -0.27; 95% CI: -0.80 to 0.27), and lower worst pain compared to breaststroke (MD -1.10; 95% CI: -1.77 to -0.43) but was not different to freestyle (MD -0.60; 95% CI: -1.27 to 0.07). Standing pain had a similar pattern to the primary outcomes, but pain with an aggravating movement showed no statistically significant differences.

Conclusion: Backstroke was the least painful swimming stroke during and immediately after swimming when compared to breaststroke, and to a lesser extent, freestyle. The average differences were typically small but may be important to the long-term effects. Swimming stroke should be considered by health professionals when prescribing an individualized swimming program.

Trial registration: This study was registered in the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12624000263594).

Original language	English
Article number	102030
Pages (from-to)	1-7
Number of pages	7
Journal	Annals of Physical and Rehabilitation Medicine
Volume	69
Issue number	1
Early online date	29 Sept 2025
DOIs	https://doi.org/10.1016/j.rehab.2025.102030
Publication status	Published - Feb 2026

Bibliographical note

Copyright the Author(s) 2025 Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Exercise
Aquatic therapy
Lumbar region
Rehabilitation exercise

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10.1016/j.rehab.2025.102030Licence: CC BY

Publisher version (open access)Final published version, 868 KBLicence: CC BY

Cite this

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title = "The immediate effect of swimming stroke on pain in people with chronic low back pain: a crossover study",

abstract = "Background: Swimming is anecdotally suggested as a suitable exercise for chronic low back pain. However, swimming involves different strokes that require different movement patterns and, therefore, may impact low back pain symptoms differently. The extent to which different swimming strokes impact chronic low back pain differently is currently unknown.Objectives: This study compares and describes the intensity of pain experienced during and immediately after different swimming strokes in individuals with chronic low back pain.Methods: We recruited 30 adults with chronic low back pain. Participants swam 100 m of freestyle, breaststroke, and backstroke in a balanced, randomized sequence. The primary outcome was pain intensity during swimming, measured as average and worst pain (0-10 Numeric Pain Rating). Secondary outcomes included pain after swimming while standing and while completing an aggravating movement. Pain scores were compared between strokes using linear mixed-effects models that included a fixed effect of stroke and period, and a random effect for participant. Carry-over effects were investigated via a stroke-by-period interaction.Results: There was no evidence of carry-over effects for any outcome measure (P >0.15). Backstroke had lower average pain compared to breaststroke (mean difference, MD -0.63; 95\% CI: -1.17 to -0.10) but was not different to freestyle (MD -0.27; 95\% CI: -0.80 to 0.27), and lower worst pain compared to breaststroke (MD -1.10; 95\% CI: -1.77 to -0.43) but was not different to freestyle (MD -0.60; 95\% CI: -1.27 to 0.07). Standing pain had a similar pattern to the primary outcomes, but pain with an aggravating movement showed no statistically significant differences.Conclusion: Backstroke was the least painful swimming stroke during and immediately after swimming when compared to breaststroke, and to a lesser extent, freestyle. The average differences were typically small but may be important to the long-term effects. Swimming stroke should be considered by health professionals when prescribing an individualized swimming program.Trial registration: This study was registered in the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12624000263594).",

keywords = "Exercise, Aquatic therapy, Lumbar region, Rehabilitation exercise",

author = "Deborah Wareham and Joel Fuller and Petra Graham and Eoin Doyle and Mark Hancock",

note = "Copyright the Author(s) 2025 Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2026",

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doi = "10.1016/j.rehab.2025.102030",

language = "English",

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T1 - The immediate effect of swimming stroke on pain in people with chronic low back pain

T2 - a crossover study

AU - Wareham, Deborah

AU - Fuller, Joel

AU - Graham, Petra

AU - Doyle, Eoin

AU - Hancock, Mark

N1 - Copyright the Author(s) 2025 Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2026/2

Y1 - 2026/2

N2 - Background: Swimming is anecdotally suggested as a suitable exercise for chronic low back pain. However, swimming involves different strokes that require different movement patterns and, therefore, may impact low back pain symptoms differently. The extent to which different swimming strokes impact chronic low back pain differently is currently unknown.Objectives: This study compares and describes the intensity of pain experienced during and immediately after different swimming strokes in individuals with chronic low back pain.Methods: We recruited 30 adults with chronic low back pain. Participants swam 100 m of freestyle, breaststroke, and backstroke in a balanced, randomized sequence. The primary outcome was pain intensity during swimming, measured as average and worst pain (0-10 Numeric Pain Rating). Secondary outcomes included pain after swimming while standing and while completing an aggravating movement. Pain scores were compared between strokes using linear mixed-effects models that included a fixed effect of stroke and period, and a random effect for participant. Carry-over effects were investigated via a stroke-by-period interaction.Results: There was no evidence of carry-over effects for any outcome measure (P >0.15). Backstroke had lower average pain compared to breaststroke (mean difference, MD -0.63; 95% CI: -1.17 to -0.10) but was not different to freestyle (MD -0.27; 95% CI: -0.80 to 0.27), and lower worst pain compared to breaststroke (MD -1.10; 95% CI: -1.77 to -0.43) but was not different to freestyle (MD -0.60; 95% CI: -1.27 to 0.07). Standing pain had a similar pattern to the primary outcomes, but pain with an aggravating movement showed no statistically significant differences.Conclusion: Backstroke was the least painful swimming stroke during and immediately after swimming when compared to breaststroke, and to a lesser extent, freestyle. The average differences were typically small but may be important to the long-term effects. Swimming stroke should be considered by health professionals when prescribing an individualized swimming program.Trial registration: This study was registered in the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12624000263594).

AB - Background: Swimming is anecdotally suggested as a suitable exercise for chronic low back pain. However, swimming involves different strokes that require different movement patterns and, therefore, may impact low back pain symptoms differently. The extent to which different swimming strokes impact chronic low back pain differently is currently unknown.Objectives: This study compares and describes the intensity of pain experienced during and immediately after different swimming strokes in individuals with chronic low back pain.Methods: We recruited 30 adults with chronic low back pain. Participants swam 100 m of freestyle, breaststroke, and backstroke in a balanced, randomized sequence. The primary outcome was pain intensity during swimming, measured as average and worst pain (0-10 Numeric Pain Rating). Secondary outcomes included pain after swimming while standing and while completing an aggravating movement. Pain scores were compared between strokes using linear mixed-effects models that included a fixed effect of stroke and period, and a random effect for participant. Carry-over effects were investigated via a stroke-by-period interaction.Results: There was no evidence of carry-over effects for any outcome measure (P >0.15). Backstroke had lower average pain compared to breaststroke (mean difference, MD -0.63; 95% CI: -1.17 to -0.10) but was not different to freestyle (MD -0.27; 95% CI: -0.80 to 0.27), and lower worst pain compared to breaststroke (MD -1.10; 95% CI: -1.77 to -0.43) but was not different to freestyle (MD -0.60; 95% CI: -1.27 to 0.07). Standing pain had a similar pattern to the primary outcomes, but pain with an aggravating movement showed no statistically significant differences.Conclusion: Backstroke was the least painful swimming stroke during and immediately after swimming when compared to breaststroke, and to a lesser extent, freestyle. The average differences were typically small but may be important to the long-term effects. Swimming stroke should be considered by health professionals when prescribing an individualized swimming program.Trial registration: This study was registered in the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12624000263594).

KW - Exercise

KW - Aquatic therapy

KW - Lumbar region

KW - Rehabilitation exercise

UR - https://www.scopus.com/pages/publications/105017319761

U2 - 10.1016/j.rehab.2025.102030

DO - 10.1016/j.rehab.2025.102030

M3 - Article

C2 - 41027336

SN - 1877-0657

VL - 69

SP - 1

EP - 7

JO - Annals of Physical and Rehabilitation Medicine

JF - Annals of Physical and Rehabilitation Medicine

IS - 1

M1 - 102030

ER -

The immediate effect of swimming stroke on pain in people with chronic low back pain: a crossover study

Abstract

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