The Pilates Method of Exercise: Effectiveness in the Treatment of Chronic Low Back Pain and Intervention Limitations
This first review does not introduce one, but several articles on low back pain, revealing limitations often encountered in Pilates research.
The goal of this article is to assess the effectiveness of the Pilates method in the treatment of chronic low back pain by reviewing scientific studies in which the Pilates Method was used as treatment. A critical look will be taken at the studies’ limitations and the types of exercises used.
The studies were required to meet scholarly standards, be peer reviewed and are randomized and controlled trials.
Study inclusion criteria
A Boolean search for randomized controlled and clinical trials using (Pilates) AND "low back pain" on PubMed (including MEDLINE) returned 24 results.
The effectiveness of Pilates in the treatment of low back pain
Regardless of the limitations of the selected studies described below, the success of Pilates-based exercise in the rehabilitation of low back pain is undeniable:
Due to the different measurements and intervention ranges, there is no statistical data analysis possible. Following a comparative result list:
General limitations in Pilates research
Pilates exercises are being used by physical therapists to support the rehabilitation programs for various musculoskeletal conditions, sports injuries, and neurological disorders, focusing especially on the spine and its stabilization. The increased use of Pilates-based exercises makes it imperative to understand, among other characteristics, its applications, its contraindications, and how to use it appropriately.
As numerous studies about Pilates and low back pain have been authored, the following limitations were observed:
Classical Pilates, contemporary Pilates and therapeutic exercise
(contributor: Heather King Smith)
Following similarities and differences of classical Pilates, contemporary Pilates and therapeutic exercise protocols:
Limitations: Exercise protocol definition and challenges
Most of the exercises taught to physical therapists in the United States for low back pain patients fall into general categories of spinal range of motion and strengthening exercises that may be described as core stability, dynamic stabilization, lumbo-pelvic and spinal stabilization, co-contraction type mat or ball exercises, progressive resistive exercises with weights or elastic bands, and functional activities.
Where is the boundary between such therapeutic exercise protocols and Pilates? A comparison of the 11 selected studies shows that the Pilates protocol used is not always clearly defined and may not even be Pilates.
Surprisingly, 2 studies do not provide any information about the exercises used (Cruz-Díaz et al., 2015 & da Fonseca et al., 2009). Da Fonseca et al. only provide brief information about muscle recruitment concepts, which indicate that the protocol is more closely related to therapeutic exercise than to Pilates.
Rydeard et al. (2006) provide a more detailed description about the exercises used, but the protocol is also about muscle recruitment strategies and doesn’t mention any Pilates exercises, in spite of the title of the study: “Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability”.
Wajswelner et al. (2012) promise “clinical Pilates” in the study title, but they use therapeutic exercises which are performed on the Pilates equipment. It is questionable if the use of equipment makes the exercises Pilates exercises.
Lastly, about a third of the mat exercises that Lee at al. (2014) use are yoga based, such as “seated hip stretch” and “knee over knee twist stretch”, not Pilates.
There is evidence that Pilates-based exercise in the rehabilitation of low back pain is effective. Additional peer-reviewed and randomized, controlled research is needed to produce scientifically reliable meta analyses, preferably utilizing similar measurements, intervention durations, frequencies and equipment.
For further scientific evaluation and in order to achieve reproducible exercise protocols and results, a standardization of contemporary Pilates exercises would be desirable. Classical Pilates has not been scientifically analyzed.
Borges, J., Baptista, A. F., Santana, N., Souza, I., Kruschewsky, R. A., Galvão-Castro, B., & Sá, K. N. (2014). Pilates exercises improve low back pain and quality of life in patients with HTLV-1 virus: A randomized crossover clinical trial. Journal of bodywork and movement therapies, 18(1), 68-74.
Cruz-Díaz, D., Martínez-Amat, A., Manuel, J., Casuso, R. A., de Guevara, N. M. L., & Hita-Contreras, F. (2015). Effects of a six-week Pilates intervention on balance and fear of falling in women aged over 65 with chronic low-back pain: A randomized controlled trial. Maturitas.
Cruz-Díaz, D., Martínez-Amat, A., Osuna-Pérez, M. C., De la Torre-Cruz, M. J., & Hita-Contreras, F. (2015). Short- and long-term effects of a six-week clinical Pilates program in addition to physical therapy on postmenopausal women with chronic low back pain: a randomized controlled trial. Disability and rehabilitation, 1-9.
da Fonseca, J. L., Magini, M., & de Freitas, T. H. (2009). Laboratory gait analysis in patients with low back pain before and after a pilates intervention. Journal of Sport Rehabilitation, 18(2), 269.
Dagenais, S., Caro, J., & Haldeman, S. (2008). A systematic review of low back pain cost of illness studies in the United States and internationally. The spine journal, 8(1), 8-20.
da Luz, M. A., Costa, L. O. P., Fuhro, F. F., Manzoni, A. C. T., Oliveira, N. T. B., & Cabral, C. M. N. (2014). Effectiveness of mat Pilates or equipment-based Pilates exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Physical therapy, 94(5), 623-631.
Gladwell, V., Head, S., Haggar, M.. & Beneke, R. (2006). Does a Program of Pilates Improve Chronic Non-Specific Low Back Pain? J Sport Rehabil. 2006,15, 338-350
La Touche, R., Escalante, K., Linares, M. T. (2008). Treating non-specific chronic low back pain through the Pilates Method. J Bodyw Mov Ther. 2008 Oct;12(4):364-70
Lee, C. W., Hyun, J., & Kim, S. G. (2014). Influence of pilates mat and apparatus exercises on pain and balance of businesswomen with chronic low back pain. Journal of physical therapy science, 26(4), 475.
Lim, E. C., Poh, R. L., Low, A.Y., Wong, W. P. (2011). 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 Feb;41(2):70-80
Van Middelkoop, M., Rubinstein, S. M., Kuijpers, T., Verhagen, A. P., Ostelo, R., Koes, B. W., & van Tulder, M. W. (2011). A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. European Spine Journal, 20(1), 19-39.
Miyamoto, G. C., Pena Costa, L. O., Galvanin, T., Nunes Cabral, C. M. (2013). Efficacy of the Addition of Modified Pilates Exercises to a Minimal Intervention in Patients With Chronic Low Back Pain: A Randomized Controlled Trial. Phys Ther. 2013; 93:310-320
Natour, J., de Araujo Cazotti, L., Ribeiro, L. H., Baptista, A. S., & Jones, A. (2015). Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clinical rehabilitation, 29(1), 59-68.
Pereira, L. M., Obara, K., Dias, J. M., Menacho, M. O., Guariglia, D. A., Schiavoni, D., Pereira, H. M., Cardoso, J. R. (2012). Comparing the Pilates method with no exercise or lumbar stabilization for pain and functionality in patients with chronic low back pain: systematic review and meta-analysis. Clin Rehabil. 2012 Jan;26(1):10-20
Posadzki, P., Lizis, P., Hagner-Derengowska, M. (2011). Pilates for low back pain: a systematic review. Complement Ther Clin Pract. 2011 May;17(2):85-9
Rydeard, R., Leger, A., Smith, D. (2006). Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. J Orthop Sports Phys Ther. 2006 Jul;36(7):472-84
Vibe Fersum, K., O'Sullivan, P., Skouen, J. S., Smith, A., & Kvåle, A. (2013). Efficacy of classification‐based cognitive functional therapy in patients with non‐specific chronic low back pain: A randomized controlled trial. European journal of pain, 17(6), 916-928.
Wajswelner, H., Metcalf, B., & Bennell, K. (2012). Clinical pilates versus general exercise for chronic low back pain: randomized trial. Medicine and science in sports and exercise, 44(7), 1197-1205.