Pilates helps in the treatment of chronic lower back pain to improve functional ability and symptoms
Date First Published:
January 22, 2007
Last Updated:
January 23, 2007
Report by:
Mr Kumar Kunasingam & Miss Vivien Shuen, Clinical Fellow in Orthopaedics (Dartford and Gravesham NHS trust)
Search checked by:
Dr Charlotte E Evans, Dartford and Gravesham NHS trust
Three-Part Question:
In [patients with chronic lower back pain] does [pilates] help to [improve functional outcome and symptoms?]
Clinical Scenario:
A 35 year old fit female presents with several years history of lower back ache/pain. She is otherwise well. Her work requires her to be mobile, flexible and strong enough to assist in the movement of heavy objects while also having a minor desk role. She also enjoys an active sporting/social life. She wishes to know if pilates can help her back pain and prevent any further recurrence.
Search Strategy:
An advanced medline search from 1950 to Jan 2007. Using lower back pain with a thesaurus search and pilates without. Also, the Allied and Complementry medicine (AMED) database 1985 to Jan 2007. Also, the CINAHL database 1982 to Dec 2006 using both pilates and lower-back-pain as thesaurus searched terms.
Search Details:
Medline {(pilates) AND (lower back pain OR intervertebral disk displacement OR spinal disease OR pain OR lumbar vertebrae)}
AMED {(pilates) AND (lower back pain OR pain OR back pain OR lumbar vertebrae OR chronic pain)}
CINAHL {(pilates) AND (lower back pain OR pain OR back pain OR lumbar vertebrae OR chronic pain)}
AMED {(pilates) AND (lower back pain OR pain OR back pain OR lumbar vertebrae OR chronic pain)}
CINAHL {(pilates) AND (lower back pain OR pain OR back pain OR lumbar vertebrae OR chronic pain)}
Outcome:
Medline found 5 papers which 1 was relevant. AMED found 8 papers of which 3 shown some relevance. CINAHL found 17 papers of which 3 were relevant. After removing the duplicates of the relevant papers from the three database, a total of 4 relevant papers were found.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The influence of Pilates training on the ability to contract the transverse abdominis muscles in asymptomatic individuals Herrington L. Davies R. Jan-05 UK | 36 asymptomatic females divided equally into a pilates group, a abdominal curl group and a non training group | Transverse abdominis isolation test | 83% pass from pilates group, 33% pass from the abdominal curl group and 25% pass from the non training group | Small group size. Could have performed a true RCT if the patients were symptomatic. Not specifically answering the question but related. | |
| Lumbo-pelvic stability | 42% pass from the pilates group with all others failing | ||||
| Does a Program of Pilates Improve Chronic Non-Specific Low Back Pain? Gladwell V, Head S, Haggar M and Beneke R Nov-06 | 49 participants with chronic low back pain were randomly allocated to control (n=24) or Pilates group (n=25). 34 subjects completed the study (14 and 20 individuals for control and Pilates group, respectively). Pilates group underwent a 6-week program of pilates. Both groups continued with normal activities throughout the study. | A blinded assessor conducted functional and questionnaire-based assessments pre- and post intervention. | Pilates group | Significant improvement in general health, sports functioning, flexibility, proprioception and a decrease in pain. | Small sample size used and not a double blinded RCT. |
| Control group | No significant differences seen in general health, sports functioning, flexibility, proprioception and a decrease in pain. | ||||
| Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. Rydeard R, Leger A and Smith D Jul-06 Canada | Thirty-nine physically active subjects between 20 and 55 years old with chronic LBP were randomly assigned to 1 of 2 groups. The specific-exercise-training group participated in a 4-week program consisting of training on specialized (Pilates) exercise equipment, while the control group received the usual care, defined as consultation with a physician and other specialists and healthcare professionals, as necessary. | A randomized controlled trial, pretest-posttest design, with a 3-, 6-, and 12-month follow-up. Objectives of the study is to investigate the efficacy of a therapeutic exercise approach in a population with chronic low back pain (LBP) by measuring Functional disability outcomes with The Roland Morris Disability Questionnaire (RMQ/RMDQ-HK) and average pain intensity using a 101-point numerical rating scale pre and post exercise program. |
Pilates group | significantly lower level of functional disability (P = .023) and average pain intensity (P = .002). Improved disability scores in the specific exercise-training group were maintained for up to 12 months following treatment intervention. | Small sample size, single blinded RCT. |
| Control group | No significant decrease seen in level of functional disability and average pain intensity | ||||
| Efficacy of Pilates exercises as therapeutic intervention in treating patients with low back pain Gagnon LH 2005 USA | Twelve subjects who presented for physical therapy with low back pain (LBP), were randomly assigned to either the traditional lumbar stabilization exercise group (A, n = 6) or the Pilates exercise group (B, n = 6) and completed participation in the study. | The purpose of this research was to investigate the efficacy of Pilates exercises as a therapeutic intervention in treatment of low back pain (LBP). Pilates exercises have been integrated into many rehabilitation programs for those with LBP; however, no clinical research was found that supports its efficacy. Outcome measures used were the Visual Analogue Scale (VAS), the Revised Oswestry Disability Index (ODI), lumbar spine active range of motion (AROM), and measures of core stability on the Stability Platform (LaFayette Instrument Co), taken at pre-treatment, every fourth visit and at discharge from physical therapy. | There were no significant differences in any of the outcome measures between the groups over time. | Extremely small sample size to demonstrate anything significant, if significant findings were found, relevance of such findings would be questionned. |
Author Commentary:
There is little published evidence to support pilates and improving symptoms of chronic lower back pain. Most studies used very small sample sizes hence despite having significant results, the relevant findings are questionnable. Emerging evidence are showing that pilates is able to improve range of movement in the lower back and increased strength in the core muscles.
Bottom Line:
There is some evidence using small sample sizes to suggest that pilates is more useful than conventional care in treatment of chronic low back pain, possibly due to the increase range of movement and increased strength in core stability muscles.
Further larger and double blinded randomised controlled trials are required to fully determine the extent of pilates has on chronic low back pain.
Further larger and double blinded randomised controlled trials are required to fully determine the extent of pilates has on chronic low back pain.
References:
- Herrington L. Davies R.. The influence of Pilates training on the ability to contract the transverse abdominis muscles in asymptomatic individuals
- Gladwell V, Head S, Haggar M and Beneke R. Does a Program of Pilates Improve Chronic Non-Specific Low Back Pain?
- Rydeard R, Leger A and Smith D. Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial.
- Gagnon LH. Efficacy of Pilates exercises as therapeutic intervention in treating patients with low back pain