Can Pilates help with lower back pain?

Pilates for Lower Back Pain Management

Pilates shows small or no clear effects on pain and no clear effects on function for lower back pain compared with usual care plus physical activity, based on low-quality evidence. 1

Efficacy of Pilates for Lower Back Pain

• Low-quality evidence indicates that Pilates results in small or no clear effects on pain and no clear effects on function compared with usual care plus physical activity 1
• Low-quality evidence shows no clear differences between Pilates and other types of exercise for pain or function 1
• When compared to other exercise interventions, Pilates is not superior for improving lower back pain outcomes 1

Comparative Effectiveness of Exercise Interventions

• Moderate-quality evidence shows that exercise in general results in small improvements in pain relief and function compared with no exercise for chronic low back pain 1
• Moderate-quality evidence indicates no clear differences between different exercise regimens in more than 20 head-to-head RCTs in patients with chronic low back pain 1
• Exercise programs that incorporate individual tailoring, supervision, stretching, and strengthening are associated with the best outcomes for chronic low back pain 1, 2

Recent Research on Pilates

• Some recent systematic reviews suggest Pilates may provide short-term pain relief and functional progression for chronic low back pain 3
• Emerging evidence indicates Pilates may positively impact core muscle strength in people with chronic low back pain 4
• A 2023 meta-analysis found Pilates may have positive efficacy for pain relief and improvement of functional disorders in chronic low back pain patients, though improvement in quality of life was less obvious 5

More Effective Alternatives for Lower Back Pain

• Moderate-quality evidence shows that tai chi moderately decreases pain intensity at 3 and 6 months compared with backward walking or jogging 1
• Low-quality evidence shows that yoga results in moderately lower pain scores and improved function compared with usual care at 24 weeks 1
• Moderate-quality evidence shows that mindfulness-based stress reduction is effective for chronic low back pain 1
• Moderate-quality evidence shows that multidisciplinary rehabilitation moderately reduces short-term pain intensity and disability compared with usual care 1, 2

Clinical Application and Pitfalls

• Patient preference and adherence may be more important than specific exercise type for lower back pain management 2
• A common pitfall is overreliance on a single intervention rather than considering a comprehensive approach to lower back pain management 2
• Short-term improvements in postural control have been observed immediately after Pilates sessions in young adults with non-specific low back pain, but long-term benefits remain unclear 6
• The methodological quality of many Pilates studies for lower back pain is relatively low, making definitive conclusions difficult 7

Treatment Algorithm for Lower Back Pain

• First-line treatment should include general exercise therapy, which has moderate-quality evidence for small improvements in pain and function 1, 2
• Consider motor control exercises which moderately decrease pain scores and slightly improve function in short to long-term follow-up 1
• For patients interested in mind-body approaches, consider tai chi or yoga which have better evidence for pain reduction than Pilates 1
• Multidisciplinary rehabilitation should be considered for patients with persistent symptoms, as it moderately reduces short-term pain intensity and disability 1, 2