Skip to main content

Research Repository

Advanced Search

Muscle activity during aquatic and land exercises in people with and without low back pain.

Psycharakis, Stelios G; Coleman, Simon G S; Linton, Linda; Kaliarntas, Konstantinos; Valentin, Stephanie


Stelios G Psycharakis

Simon G S Coleman

Linda Linton

Stephanie Valentin


Chronic low back pain (CLBP) is the most prevalent musculoskeletal disorder. Aquatic exercises are commonly used by physical therapists for CLBP treatment and management; however, there are no data on trunk muscle activation during aquatic exercises in people with CLBP.
We quantified activation of trunk and gluteal muscles, exercise intensity, pain, and perceived exertion in people with and without CLBP when performing water and land exercises.
The study used a cross-sectional design.
Twenty participants with non-specific CLBP and 20 healthy participants performed 15 aquatic exercises and 15 similar land exercises. Mean and peak muscle activation were measured bilaterally from erector spinae, multifidus, gluteus maximus, gluteus medius, rectus abdominis, external oblique, and internal oblique, using waterproof and wireless surface electromyography. Exercise intensity (heart rate), perceived exertion (Borg scale), and for the CLBP group, pain (visual analog scale) were recorded.
There were no significant between-group differences. Significant between-environment differences were found in heart rate (always higher on land), exertion (higher in the water for 3 exercises and on land for 6 exercises) and muscle activation (higher on land in 29% and in the water in 5% of comparisons). Pain levels were low, but pain was reported more than twice as frequently on land than in water (7.7% vs 3.7%, respectively).
People with high levels of disability and CLBP classification were not included.
People with mild-to-moderate CLBP had similar exercise responses to healthy controls. Aquatic exercise produced sufficient muscle activation, intensity, and exertion, and should not be assumed to be less strenuous or less effective in activating trunk and pelvic muscles than exercise on land. These data can be used to inform design and prescription of rehabilitation programs and interventions.

Journal Article Type Article
Acceptance Date Jul 16, 2018
Online Publication Date Jan 23, 2019
Publication Date 2019-03
Deposit Date Feb 4, 2019
Publicly Available Date Feb 4, 2019
Journal Physical Therapy
Print ISSN 0031-9023
Electronic ISSN 1538-6724
Publisher American Physical Therapy Association
Peer Reviewed Peer Reviewed
Volume 99
Issue 3
Pages 297-310
Keywords Electromyography, Physiotherapy, Rehabilitation, Water, Hydrotherapy, Musculoskeletal, Biomechanics,
Public URL
Contract Date Feb 4, 2019


Muscle Activity During Aquatic and Land Exercises in People With and Without Low Back Pain (1.2 Mb)

Publisher Licence URL

Copyright Statement
© 2019 American Physical Therapy Association
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (, which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact

You might also like

Downloadable Citations