Pilates For Low Back Pain

Pilates is an exercise regimen developed in the early 20th century by Joseph Pilates. It is an exercise program utilizing low-impact exercises to improve postural alignment, core strength, and balance. The data, as with so many things in pain management, is mixed when it comes to the effect of Pilates on low back pain.

A large Cochrane database review of randomized controlled trials (RCTs) examined 264 studies with over 19,000 participants to look at exercise versus no exercise in adults with chronic pain (1). Interventions included aerobic, strength, flexibility, range of motion, and core or balance training programs, as well as yoga, Pilates, and tai chi. The quality of the evidence overall was low, which means there really weren’t that many well-designed studies. In medicine, we like to see large well-designed studies with true “control” groups so that we can detect a real difference between the treatment group and the control group. We also like to look at high-quality end points and studies with long follow-up periods. Only six studies followed people for over a year. Overall, the evidence from this large review indicated physical activity and exercise is an intervention with few adverse events that would likely improve pain and physical function.

I will address yoga and tai chi in separate posts, but for this one, I will focus on Pilates. One study looked at forty females with osteoporosis and assigned them to one of two groups (2). One group received Pilates exercise from a certified instructor three times a week for six weeks while group two had no interventions. They found improvements in pain, functional status, and quality of life in the treatment group at the conclusion of the six weeks. Another study on 54 patients with low back pain had similar results. (3).

A systematic review from 2016 examined eight randomized controlled trials and found that at least twenty hours of Pilates resulted in improvement in pain and functional capacity (4). Another study reported low to moderate quality evidence that Pilates is more effective than minimal intervention for pain and disability (5).

While there is some evidence for the effectiveness of Pilates for low back pain, there is no conclusive evidence that it is superior to other forms of exercises. However, through all the studies reviewed, no adverse events were reported. Therefore, I believe the decision to use Pilates for low back pain should be based on your healthcare provider preferences as well as your diagnosis and functional status.

In conclusion, Pilates-based exercises are superior to no exercise at all for back pain relief. Existing evidence does not establish the superiority of Pilates over other forms of exercise to reduce pain and disability for patients with persistent low back pain. As per the common theme of many of my posts, thirty minutes a day of any exercise will help your pain overall. The key is finding one that works for you.

For those of you in Chicago, there are plenty of opportunities to try out a Pilates class in the city for minimal to low cost. In the summer, there are free outdoor yoga and Pilates classes Tuesdays, Thursdays and Saturdays in Millennium Park. There are also ample videos available online. Please do not start an exercise program without first discussing it with your physician.

References:

  1. Geneen et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017. 14;1.
  2. Oksuz S, Unal E. The effect of the clinical pilates exercises on kinesiophobia and other symptoms related to osteoporosis: Randomised controlled trial. Complement Ther Clin Practice. 2017;26:68-72.
  3. Valenza et al. Results of aPilatesexercise program in patients with chronic non-specific low back pain: a randomized controlled trial. Clin Rehabil. 2017. 31(6): 753-60.
  4. Lin et al. Effects of pilates on patients with chronic non-specific low back pain: a systematic review. J Phys Ther Sci. 2016. 28(10): 2961-2969.
  5. Lim EC, Poh RL, Low AY, Wong WP. Effects of Pilates-based exercises on pain and disability in individuals with persistent nonspecific low back pain: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2011. 41(2): 70-80.

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