I'm convinced that #Pilates is a powerful tool for treating and preventing #Chroniclowerbackpain (CLBP) because clients who come to my Pilates for Lower Back Pain sessions (on Monday nights at 7pm, on Zoom), tell me they find it really helpful and their pain has been reduced. I also know from my own experience of CLBP: I went to see an Osteopath during an episode of CLBP and he recommended I take up Pilates. Over the next few weeks my lumbar spine loosened up, my posture improved and I was able to move freely again, without pain. I now practice Pilates regularly and it has prevented any further recurrences. But what does the research evidence tell us?
A research review by Lim at al, published in the Journal of Orthopaedic Sports Physiotherapy in 2011, concluded that "Pilates-based exercise is superior to minimal intervention for pain relief" but evidence existing at the time did not establish the "superiority of Pilates-based exercise to other forms of exercise to reduce pain and disability for patients with persistent, non-specific low back pain", though the group warned that the "relatively low quality of existing studies and heterogeneity of pooled studies....suggest results should be treated with caution." In 2014, Wells et al, published a review of fourteen Randomised Control Trials (RCTs) in an online article (The Effectiveness of Pilates Exercise In People with Chronic Lower Back Pain: A Systematic Review; 10.1371/journal.pone.0100402, July 2014), finding that "Pilates exercise offers greater improvements in pain and functional ability compared to usual care and physical activity in the short term. Pilates exercise offers equivalent improvements to massage therapy and other forms of exercise."
Both these studies were limited by the lack of consistency across studies of Pilates session design (i.e. different exercises within the Pilates repertoire were used in each study), so Wells et al recommend that future studies should explore optimal Pilates exercise design, to identify whether there is particular combination of exercises which have the biggest impact.
More recently, De Freitas et al (Journal of Body Work Movement Therapy, 2020 (3): 300-306: Effects of the Pilates Method on Kinesiophobia Associated with Chronic, non-specific low back pain: A Systematic Review and Meta-Analysis), found there is "...a favourable effect of the Pilates method compared to minimal intervention or no treatment in reducing kinesiophobia associated with chronic, non-specific low back pain, with a moderate quality of evidence." Kinesiophobia is the fear of movement. Many people living with CLBP report being anxious about moving too much as they worry with will make the pain worse. Current advice is that on the contrary, moving more relieves pain and strengthens the back. Pilates is a wonderful way to begin exercising again if you are worried movement could make the pain worse because of the layering approach: every movement in a routine is broken down into different layers, depending on how much your are able or willing to move. You practice at the layer you are comfortable with, moving on to the next layer when you feel ready.
In 2023, Zheng et al published a meta-analysis of nineteen studies, with 1108 participants in the International Journal of Environmental Research & Public Health, concluding that "Pilates may have positive efficacy for pain relief and functional improvement for chronic lower back pain patients."
What does all this mean? Researchers are rightly keen to avoid making any claims about a treatment which the evidence does not support, hence the cautious terms of the conclusions in these studies but what does seem to be emerging is that Pilates is a better treatment for CLBP than treatment-as-usual or not not exercising and may be more effective than other forms of exercise. Why is this? Well, naturally, further research needs to be done on this question, but my own view is that the focus in Pilates on strengthening the core, so your deep core, stabiliser muscles have the endurance to hold your spine in optimal posture and on the flexibility of strength-in-movement of the spine are essential elements. Pilates also impacts on the psychological elements of CLBP, which I will explore in a future Blog.
The best way to discover whether Pilates could help you with your CLBP though, is to come along to a class!