Improving chronic back pain in the water polo athlete

“What happens underwater, stays underwater.”


Initial Complaint

Water polo is an incredible sport that requires a lot of strength, especially in the legs and core. The most common injuries in water polo involve the head, the knees and the shoulders. I recently treated a young college student who complained of chronic right sided back pain from playing water polo in high school.  In his health history he reported right knee pain although it wasn’t present at the time. My goal for everyone of my patients is to discover the root cause of their dysfunction, therefore I asked him which came first, the knee pain or the back pain. He said, the knee pain was his initial complaint and then his back pain occurred and was more problematic. He said the back pain calms down when he’s not playing the sport, but has never fully been resolved.

Assessing Movement Patterns

For the water polo athlete, the hips play a major role to keep the body afloat. This hip rotation under water is called the eggbeater. The eggbeater requires a tremendous amount of hip rotation. The hips initiate the movement then the knees follow suit while the ankles are kept in a neutral position (i.e. not pointed).

Since I didn’t have access to a pool for underwater video of his egg beater, I began assessing this movement pattern prone on the treatment table. The first thing I noticed was his pattern of recruiting muscles from his lumbar spine thus causing his pelvic girdle to rise off the table.  I stabilized his pelvis not allowing it to move, and asked him to try again. Interestingly enough, his right side egg beater was primarily driven by rotation at the knee. The rotators of the hip, the prime movers for this motion, did nothing.

The body is pretty amazing in how it compensates for the path of least resistance. Unfortunately, relying on our compensatory patterns leads to further break down of the body. This particular athlete has mobility restrictions in his lumbo-sacral junction on the right side. He had poor recruitment of his posterior pelvic depressors, multifidus, and hip rotators on the right side.  The combination of these led to a significant movement dysfunction causing the body to move the knee out of normal range for this motion and recruit muscles that were not able to endure such an intense load.

Restoring Function

To restore proper function you must address the entire kinetic chain. In the first visit we were able to improve the lumosacral restrictions which would enable a better facilitation of the muscles in the hip and pelvic girdle.  We followed that with PNF techniques to facilitate a stronger muscle recruitment in the multifidus and posterior pelvic depressors.  By the end of the first visit his mobility dysfunction was restored and his deep core stabilizers were engaging. His home program is focused on keeping the mobility in the lumbar spine, strengthening the gluteal muscles and hip rotators, and improving core endurance in the frontal plane.


Home Program

If you or your student athlete are struggling with chronic lower body pain during water polo season, below are 2 mobility exercises you can implement now.  Or you can click here for a free PDF.  

Would you like an personalized assessment? Remedy is a concierge PT clinic specializing in chronic dysfunction. We provide a remedy for people stuck in the pain cycle and are located in Orange County, California. Every student athlete is unique, the best approach is one tailored to your specific needs. 

Contact our office to schedule

Pelvic shift at the wall


While standing next to a wall, place your arm on a wall. Your
other arm should can rest on your hip. Next, glide your pelvis towards the wall. This should
cause a shifting at your pelvis to occur. Keep shoulders upright and do not side bend from the trunk.

Try both sides 5 x.  Notice which side may be more difficult to move into. If you have radiating pain down your leg during this motion, stop and consult your Physical Therapist.

Quadruped Eggbeater



Start in all fours. Raise your leg out to the side and continue into a clockwise direction for 30 seconds. Then repeat on the same leg in a counter clockwise direction for 30 seconds. Maintain a straight upper and mid back. Repeat on the other leg.


 Do you want more specific hip strengthening exercises for water polo? 
 I have a free PDF for you
Click below to receive them 






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