The Effect of Hydrotherapy on Pain, Joint Position Sense, and Two-Point Discrimination in Women with Nonspecific Chronic Low Back Pain

Document Type : Original Articles


1 Lecturer, Department of Sport Sciences, School of Humanities, Sari Branch, Islamic Azad University, Sari, Iran

2 Assistant Professor, Department of Corrective Exercise and Sport Biomechanics, School of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran

3 Associate Professor, Department of Corrective Exercise and Sport Biomechanics, School of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran

4 Specialist in Physical Medicine and Rehabilitation, Privete Clinic, Sari, Iran



Introduction: Patients with nonspecific chronic low back pain experience deficit in joint position sense acuity and two-point discrimination, and these deficits are associated with pain in these patients. The aim of present study was to evaluate the effect of hydrotherapy on pain, joint position sensee, and two-point discrimination in patients with nonspecific chronic low back pain and motor control impairment.Material and Methods: 25 women with nonspecific chronic low back pain were selected using Oswestry Disability Questionnaire, and randomly assigned into 2 groups of hydrotherapy (n = 12) and control (n = 13). The experimental group performed an eight weeks of hydrotherapy exercises, and control group did not perform exercise. Before and after complementation of intervention, visual analogue scale, goniometer, and caliper were used to assess pain, joint position sense, and two-point discrimination, respectively. Within and between group comparisons were done using paired t and independent t tests.Results: In hydrotherapy group, there were significant differences between pretest and posttest in pain (P = 0.007), joint positon sense (P = 0.005), and two-point discrimination (P = 0.008); whereas there was not any significant difference in control group.Conclusion: Hydrotherapy exercises result in decreasing pain, improvement in joint position sense, and two-point discrimination of women with nonspecific chronic low back pain and motor control impairment. So, use of these exercises is recommended for treatment of nonspecific chronic low back pain.


  1. Stanton TR, Fritz JM, Hancock MJ, Latimer J, Maher CG, Wand BM, et al. Evaluation of a treatment-based classification algorithm for low back pain: A cross-sectional study. Phys Ther 2011; 91(4): 496-509.
  2. O'Sullivan P. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Man Ther 2005; 10(4): 242-55.
  3. Wand BM, Abbaszadeh S, Smith AJ, Catley MJ, Moseley GL. Acupuncture applied as a sensory discrimination training tool decreases movement-related pain in patients with chronic low back pain more than acupuncture alone: A randomised cross-over experiment. Br J Sports Med 2013; 47(17): 1085-9.
  4. Louw A, Farrell K, Wettach L, Uhl J, Majkowski K, Welding M. Immediate effects of sensory discrimination for chronic low back pain: A case series. New Zealand Journal of Physiotherapy 2015; 43(2): 60-5.
  5. Braga AB, Rodrigues AC, de Lima GV, de Melo LR, de Carvalho AR, Bertolini GR. Comparison of static postural balance between healthy subjects and those with low back pain. Acta Ortop Bras 2012; 20(4): 210-2.
  6. Madigan ML, Davidson BS, Nussbaum MA. Postural sway and joint kinematics during quiet standing are affected by lumbar extensor fatigue. Hum Mov Sci 2006; 25(6): 788-99.
  7. Wand BM, Di PF, George P, O'Connell NE. Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients: a preliminary investigation. Physiotherapy 2010; 96(4): 317-23.
  8. Gutknecht M, Mannig A, Waldvogel A, Wand BM, Luomajoki H. The effect of motor control and tactile acuity training on patients with non-specific low back pain and movement control impairment. J Bodyw Mov Ther 2015; 19(4): 722-31.
  9. Letafatkar A, Nazarzadeh M, Hadadnezhad M, Farivar N. The efficacy of a HUBER exercise system mediated sensorimotor training protocol on proprioceptive system, lumbar movement control and quality of life in patients with chronic non-specific low back pain. J Back Musculoskelet Rehabil 2017; 30(4): 767-78.
  10. Yarahmadi Y. The effect of core stabilization on pain control, Dynamic balance and lumbopelvic proprioception of subjects with non-specific chronic low back pain. J Anesth Pain 2017; 8(1): 54-66. [In Persian].
  11. Nazarzadeh Deh-Bozorgi M, Letafatkar A, Sabounchi R. Efficacy of sensorimotor training on proprioception and neuromuscular coordination in patients with chronic nonspecific low back pain. Sport Medicine Studies 2014; 6(15): 71-88. [In Persian].
  12. Barker KL, Dawes H, Hansford P, Shamley D. Perceived and measured levels of exertion of patients with chronic back pain exercising in a hydrotherapy pool. Arch Phys Med Rehabil 2003; 84(9): 1319-23.
  13. Esbati N, Fallah Mohammadi Z, Sadegh Poor B. The effect of aquatic therapy on pain, function and time movement of women with mechanical low back pain. Applied Sport Physiology Research 2009; 5(9): 7-17. [In Persian].
  14. Resende SM, Rassi CM. Effects of hydrotherapy in balance and prevention of falls among elderly women. Rev Bras Fisioter 2008; 12(1): 57-63.
  15. Mahjur M, Hashemi Javaheri SAA, Soltani H, Khoshraftar Yazdi N. Effects of hydrotherapy on postural control and electromyography. Int J Med Res Health Sci 2016, 5(5): 153-7.
  16. Tavakol A, Daneshjoo A, Sahebozamani M. Effect of six weeks shallow and deep water exercises on static balance and pain of girls with patellofemoral pain. Rehabilitation Medicine 2018; 5(3): 111-8. [In Persian].
  17. Baena-Beato PA, Arroyo-Morales M, Delgado-Fernandez M, Gatto-Cardia MC, Artero EG. Effects of different frequencies (2-3 days/week) of aquatic therapy program in adults with chronic low back pain. A non-randomized comparison trial. Pain Med 2013; 14(1): 145-58.
  18. Shumway-Cook A, Woollacott MH. Motor Control: Translating research into clinical practice. Philadelphia, PA: Lippincott Williams and Wilkins; 2007. p. 141-58.
  19. Flaherty M, Connolly M. A preliminary investigation of lumbar tactile acuity in yoga practitioners. Int J Yoga Therap 2014; 24: 43-50.
  20. Kerr CE, Shaw JR, Wasserman RH, Chen VW, Kanojia A, Bayer T, et al. Tactile acuity in experienced Tai Chi practitioners: evidence for use dependent plasticity as an effect of sensory-attentional training. Exp Brain Res 2008; 188(2): 317-22.
  21. Karimzadeh F, Letafatkar A, Ghasemi G. The effect of 8 weeks core stabilization exercises on pain and functional disability induced by low back pain in the mothers of children with cerebral palsy. Sci J Kurdistan Univ Med Sci 2016; 21(3): 34-44. [In Persian].
  22. Brukner P, Khan K. Clinical sports medicine. Sydney, NSW, Australia: McGraw-Hill Australia; 2012.
  23. Chung JW, Zeng Y, Wong TK. Drug therapy for the treatment of chronic nonspecific low back pain: systematic review and meta-analysis. Pain Physician 2013; 16(6): E685-E704.
  24. Unsgaard-Tondel M, Fladmark AM, Salvesen O, Vasseljen O. Motor control exercises, sling exercises, and general exercises for patients with chronic low back pain: a randomized controlled trial with 1-year follow-up. Phys Ther 2010; 90(10): 1426-40.
  25. Newcomer KL, Laskowski ER, Yu B, Johnson JC, An KN. Differences in repositioning error among patients with low back pain compared with control subjects. Spine (Phila Pa 1976) 2000; 25(19): 2488-93.
  26. Wand BM, Catley MJ, Luomajoki HA, O'Sullivan KJ, Di Pietro F, O'Connell NE, et al. Lumbar tactile acuity is near identical between sides in healthy pain-free participants. Man Ther 2014; 19(5): 504-7.
  27. Waller B, Lambeck J, Daly D. Therapeutic aquatic exercise in the treatment of low back pain: a systematic review. Clin Rehabil 2009; 23(1): 3-14.
  28. Ambrosini AB, Brentano MA, Coertjens M, Kruel LFM. The effects of strength training in hydrogymnastics for middle-age women. Int J Aquatic Re. Educ 2010; 4(2): 153-62.
  29. Sami S, Seyedebrahimi S, Veisi A. The comparison of hydrotherapy, relaxation therapy and Williams exercises in improvement of athletic low back pain. Sport Medicine Studies 2011; 10: 33-44. [In Persian].
  30. Bello AI, Kalu NH, Adegoke BOA, Agyepong-Badu S. Hydrotherapy versus land-based exercises in the management of chronic low back pain: A comparative study. J Musculoskelet Res 2010; 13(04): 159-65.
  31. O'Sullivan PB. Lumbar segmental 'instability': clinical presentation and specific stabilizing exercise management. Man Ther 2000; 5(1): 2-12.
  32. Luomajoki H, Moseley GL. Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls. Br J Sports Med 2011; 45(5): 437-40.
  33. Streicher H, Matzold F, Hamilton C, Wagner P. Comparison of group motor control training versus individual training for people suffering from back pain. J Bodyw Mov Ther 2014; 18(3): 489-96.
  34. Brumagne S, Cordo P, Verschueren S. Proprioceptive weighting changes in persons with low back pain and elderly persons during upright standing. Neurosci Lett 2004; 366(1): 63-6.
  35. Han SK, Kim MC, An CS. Comparison of effects of a proprioceptive exercise program in water and on land the balance of chronic stroke patients. J Phys Ther Sci 2013; 25(10): 1219-22.
  36. Nualona P, Piriyaprasartha P, Yuktanandanab P. The role of 6-week hydrotherapy and land-based therapy plus ankle taping in a preseason rehabilitation program for athletes with chronic ankle instability. Asian Biomed 2013; 7(4): 553-9.
  37. Abbasi A, Sadeghi H, Berenjeian Tabrizi H, Bagheri K, Ghasemizad A. Effects of aquatic balance training and detraining on neuromuscular performance and balance in healthy middle aged male. Koomesh 2012; 13(3): 345-54. [In Persian].
  38. Bystrom MG, Rasmussen-Barr E, Grooten WJ. Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis. Spine (Phila Pa 1976) 2013; 38(6): E350-E358.
  39. Puta C, Schulz B, Schoeler S, Magerl W, Gabriel B, Gabriel HH, et al. Somatosensory abnormalities for painful and innocuous stimuli at the back and at a site distinct from the region of pain in chronic back pain patients. PLoS One 2013; 8(3): e58885.
  40. Moseley GL, Gallagher L, Gallace A. Neglect-like tactile dysfunction in chronic back pain. Neurology 2012; 79(4): 327-32.
  • Receive Date: 21 August 2018
  • Revise Date: 15 April 2024
  • Accept Date: 22 May 2022