Can Pilates help with low back pain?

In short - YES it can. It is a question I get asked a lot...let's look at the evidence.

It is predicted that a whopping 60% of us will experience low back pain at some point in our lifetime (Campbell & Colvin, 2013). Therefore, finding solutions & things that can help relieve the pain has never been so important.

Non-specific lower back pain is when it isn’t possible to identify a specific disease or structural reason to explain the pain. Non-specific cases make up 90% of those who suffer from lower back pain (WHO, 2023).

Pilates is a method of exercise, which works on progressing through a series of exercises with the focus on the control, precision, and the quality of movement. It balances working on mobility and flexibility with strength and control. It utilises breathing to activate deep stabilising core muscles (transverse abdominis, multifidus) before working through the controlled range of movements.

We know that when we are in pain those deep abdominal spinal stabiliser muscles weaken and don’t switch on (activate) as quickly (Kloubec J, 2011). These muscles act as a corset for our spine. A Pilates programme can be helpful in retraining these muscles, building back strength and prevent recurrence of lower back pain.

As Pilates has risen in popularity, more research comes out all the time demonstrating that it can be an effective treatment modality in managing non-specific lower back pain.

What does the evidence say?

• Pilates can improve pain, function and aspects related to quality of life. (Natour et al, 2015)

• Pilates in patients with chronic- non specific low back pain is effective in the management of disability, pain and kinesiophobia (fear of movement)   (Cruz-Diaz et al 2018)

• Treatment of low back pain using Pilates was more effective than the usual back care treatments in those with chronic, unresolved low back pain (Rydeard et al. 2006).

• An 8-week supervised Pilates-based core exercise program is an effective therapeutic modality for improving self-perceived health status in patients with chronic low back pain (Yang et al, 2021)

• Pilates was found to be more effective compared to aerobic exercises in the treatment of older adults with chronic non-specific low back pain. Potentially since the exercises are more targeted to the trunk stabilisation muscles. (Bastos de Oliveria et al 2017)

The NICE Guidelines (National Institute of Clinical Guidelines) are evidence based guidelines provided for doctors and health care professionals regarding a wide range of medical conditions, providing evidence based recommendations.

The NICE Guidelines for LBP (2016) recommend the consideration of group exercise programme's in the management of LBP, with Pilates interventions reviewed, found effective and considered a biomechanical exercise based intervention.

How often should you practice and how?

A recent systematic evidence review (Eilks et al, 2019) recommended that a Pilates session should last about 60 minutes, ideally with a frequency of two to three times a week and should be supervised by a qualified instructor. The exercises should be tailored to the people in the class.

How long should it take?

This does vary. Most of the evidence studies looked at for this article found positive outcomes, reduction in pain after 3 months of consistent Pilates practice.

NOTE: Whilst the evidence is suggestive that Pilates exercises can be helpful in the management of non-specific low back pain, it is essential that a proper assessment is provided by a doctor or health professional before partaking in Pilates classes to ensure it is the correct method of treatment for your specific low back pain.