Pilates Effective in Alleviating Chronic Low Back Pain

Women performing pilates.
Women performing pilates.
Pilates may represent an effective therapy for the management of chronic lower back pain.

Pilates may represent an effective therapy for the management of chronic lower back pain (LBP), as it was shown to be associated with improvements in pain intensity, disability and function, deep trunk muscle activation, and kinesiophobia in a study recently published in Complementary Therapies in Medicine.1

In recent years, Pilates — an exercise program focused on controlled movements — has become a highly recommended activity for patients with chronic LBP as it activates and strengthens the transversus abdominis (TrA) muscle, which plays a significant role in chronic LBP management.2 In order to assess the efficacy of Pilates on chronic LBP, researchers in the Department of Health Sciences at the University of Jaén, Spain, selected 98 patients with chronic LBP and baseline pain levels between 3 and 7 on a 10-cm visual analog scale (VAS) to participate in a randomized controlled trial.

Participants were randomly assigned to a Pilates mat group (n=34), a Pilates with apparatus group (n=34), or a control group (n=30). Both Pilates groups followed the same structure; however, the Pilates with apparatus group was given access to a multipulley-based machine that aids in intensity regulation. Study participants attended Pilates sessions monitored by a Pilates expert physiotherapist twice a week (50 minutes per session for 12 weeks) and were assessed at baseline, 6 weeks, and 12 weeks.

Patient-reported pain intensity assessed with the VAS was the trial’s main outcome, and functional impairment assessed with the Roland-Morris Disability Questionnaire [RMDQ] and TrA activation ratio ([TrAR] using real-time ultrasound scanning were secondary outcomes.

Results showed improvements in both Pilates groups compared with the control group in all studied assessments (P <.001), except for TrA thickness at rest. In the Pilates mat group, VAS mean scores decreased by the 12-week follow-up (4.64 ± 1.22 to 2.10 ± 1.36; 95% CI; P <.05). The Pilates with apparatus group also saw a decrease in VAS mean scores by the 12-week follow-up (4.95 ± 1.12 to 1.70 ± 1.41; 95% CI; P <.05). The control group saw little change in VAS scores (4.84 ± 1.04 to 4.96 ± 1.31).

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RMDQ scores decreased for both Pilates groups from baseline to 12-week follow-up assessment (Pilates mat group, 11.38 to 6.35; Pilates with apparatus group, 11.23 to 4.76; control group, 10.50 to 10.41). There was no statistically significant change in Tampa Scale of Kinesiophobia mean scores (Pilates mat group, 34.52 to 31.73; Pilates with apparatus group, 36.50 to 32.00; control group, 33.90 to 34.10).

“Equipment-based Pilates seems to provide faster and better results in comparison with mat Pilates, especially in the short term,” concluded the researchers. “These findings suggest that use of apparatus provides larger stimuli to sensory system which provides information about the status of lumbo-pelvic stability and contributes to elaborate a coordinated internal response in relation with environment interaction.”

The study may have been limited due to various variables such as study population, performance of the instructor, patient motivation during sessions, accuracy of the instructions during TrA activation, and individual intensity of kinesiophobia.

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  1. Cruz-Díaz D, Bergamin M, Gobbo S, Martínez-Amat A, Hita-Contreras F. Comparative effects of 12 weeks of equipment based and mat Pilates in patients with chronic low back pain on pain, function, and transversus abdominis activation. A randomized controlled trial. Complement Ther Med. 2017;33:72-77.
  2. Yamato TP, Maher CG, Saragiotto BT, et al. Pilates for low back pain: complete republication of a Cochrane review. Spine. 2016;41(12):1013-1021.