Can Pilates help alleviate low back pain?

“If your spine is stiff at 30,” he once said, “you are old. If it’s flexible at 60, you are young.” (Joe Pilates)

Low back pain has been consistently ranked among the top 10 health concerns in primary care, as evidenced by data from 1999(1) and 2016(2). Interestingly, one of the earliest recorded descriptions of acute lower back strain can be traced back to 1500 BC in the Edwin Smith papyrus. Documentation on this issue also survives in texts from ancient civilizations such as Egyptian, Greek, Roman, and Arabic sources(3). Given this historical perspective, one might assume that in the presence of modern medicine, low back pain would have become a thing of the past. Unfortunately, the opposite is true.

Let’s explore the latest research on the treatment of low back pain through Pilates and other exercises.

*Before we delve into this, it’s important to acknowledge that the human body is an incredibly complex system, and there can be various underlying causes of low back pain, necessitating an individualized approach to its treatment. In the following text, I will summarize several specific research findings. If you happen to identify with any of these scenarios or if you are experiencing any form of low back pain, please consult a medical professional for guidance. These insights should not be interpreted as medical advice, as we are all unique individuals.*

First, let’s look at the Meta-analysis of 2022(4), which collected and analyzed data from 118 trials focused on identifying the Best Exercise Options for Reducing chronic low back pain (lasting 12 weeks or longer with or without pathologies). The study involved a total of 9,710 participants aged 18 to 65 from 35 different countries. These trials encompassed various exercise categories, divided into 8 groups: aerobic, strength, combined (or multi-modal), core-based, McKenzie, Pilates, stretching, and mind-body. The analysis considered factors such as age, sex, sample size, exercise frequency, volume, duration, and the underlying causes of chronic LBP.
So, what emerged as the most effective exercise option?
I understand it might seem like I have a preference for Pilates, but indeed, IT WAS PILATES! Although all the exercises (except for stretching) contributed to reducing low back pain, Pilates (with at least one to two 60 min. sessions per week lasting 3 to 9 weeks) proved to be the most effective. Following Pilates, in terms of pain reduction, were mind-body, core-based, and strength exercises. In conclusion, the authors recommended minimizing prolonged bed rest and instead staying active to alleviate low back pain and to go back to regular activities as soon as possible.

Another meta-analysis(5), conducted based on the evidence that exercise does provide relief for non-specific low back pain (with no pathologies), aimed to examine which exercises are more efficient for achieving this relief. This study involved an even larger number of participants (20,969 from 217 trials) and found evidence indicating that Pilates, McKenzie therapy, and functional restoration were more effective than other types of exercises in alleviating low back pain. Exercises were performed one to three times per week, for 4–15 weeks, and the duration of each session was 30–60 min.

So the answer to my question in the title is YES!

Now, let’s explore how the application of Pilates in the treatment of chronic non-specific low back pain looks, based on a 2019 study(6). 

In order to alleviate low back pain the study recommended that Pilates exercises for individuals with CNLBP (chronic non-specific low back pain) should be conducted during supervised sessions lasting 30–60 minutes, with a frequency of two sessions per week. However, this intervention should be sustained for a duration of 3 to 6 months and should be overseen by qualified instructors. So to do Pilates and to do Pilates properly – it’s not the same league!

Pilates Mat vs. Equipment-Based Exercises

Several research studies have compared the effectiveness of mat-based Pilates exercises to equipment-based Pilates exercises.

In one study(7), both groups showed a significant improvement in balance and pain reduction. However, a more substantial improvement was observed in favor of Pilates mat exercises. According to the authors, this outcome suggests that exercises using body weight to strengthen stabilizing muscles may be more suitable for this group of patients compared to exercises using apparatuses.

On the contrary, different findings emerged in another study(8). In the short term (6-week program) both groups showed significant improvement. However, after 6 months, there was a significant difference favoring equipment-based Pilates exercises in terms of disability and kinesiophobia (fear of exercise because they believe that it will trigger pain or re-injure them).

Yet another study(9) revealed significant improvements in both groups for all outcome measures after 6 and 12 weeks. However, when comparing the two groups, equipment-based Pilates was found to be superior.
Researchers in this study have suggested that this finding might be due to the apparatus-based exercises providing stronger sensory stimuli, leading to increased feedback and improved stability during exercises. Additionally, authors proposed that this result could be influenced by a placebo effect associated with the use of equipment.

Conclusion

Based on the research used for the purpose of this article, Pilates is a type of exercise that can help alleviate both specified and non-specified low back pain. However, it needs to be performed regularly, at least once a week, for a duration of 60 minutes, for more than 4 weeks. Of course, it should be supervised by a qualified instructor. So, the exercises need to be worthwhile, and you need to be patient to feel the difference.