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Pilates to help with low back pain

This is an excerpt from Pilates for Rehabilitation-2nd Edition by Samantha Wood.

PILATES FOR NONSPECIFIC CHRONIC LOW BACK PAIN

So far the studies reviewed have shown that Pilates exercises are effective in recruiting the deep spinal stabilizers in asymptomatic individuals. But do Pilates exercises have the same effect on people with low back pain?

Pilates Research Review: Pilates for Chronic Low Back Pain

Pilates for Treating Chronic Low Back Pain

Rydeard, Leger, and Smith conducted a randomized controlled trial in 2006 to investigate the effectiveness of Pilates-based therapeutic exercise on pain and functional disability in a population with nonspecific chronic lower back pain.

In this study, 39 physically active subjects between 20 and 55 years of age were randomly assigned to an exercise-training group and a control group. The exercise-training group did a four-week treatment protocol consisting of specific Pilates exercises on a mat and reformer three days per week in the clinic and a 15-minute home exercise program six days per week. The control group received no specific exercise training and continued with usual care, defined as consultation with a physician and other specialists as necessary. They were instructed to continue with their previous physical activities.

Results showed a significantly lower level of functional disability and average pain intensity in the Pilates group than in the control group following the four-week treatment intervention period. The disability scores in the Pilates group were maintained over the 12-month follow-up period. The main finding of this study was that a program of specific exercise directed at retraining neuromuscular control based on the Pilates method was more efficacious in reducing pain intensity and functional disability levels compared to usual care or no intervention. It is interesting to note, however, that all subjects participating in this study had received treatment for their low back pain in the past. Most of them (90 percent) had tried physiotherapy, 74 percent of which included exercise therapy of some type. So although not specifically investigated or proven in this study, it stands to reason that for this typical active population of people who have nonspecific low back pain, the Pilates-based exercises were more effective than other types of exercise and treatment in decreasing their pain and functional disability.

Rydeard, R., A. Leger, and D. Smith. 2006. “Pilates-Based Therapeutic Exercise: Effect on Subjects with Nonspecific Chronic Low Back Pain and Functional Disability: A Randomized Controlled Trial.” Journal of Orthopaedic and Sports Physical Therapy 36 (7): 472-484.

Pilates and Quality of Life for Chronic Low Back Pain Patients

Another study published in 2015 in Clinical Rehabilitation aimed to assess the effectiveness of the Pilates method on pain, function, and quality of life among patients with chronic nonspecific low back pain. The researchers selected 60 patients from a physical therapy waiting list and randomly assigned them to either the experimental group or the control group. Both groups maintained medication treatment with use of nonsteroidal anti-inflammatory drugs (NSAIDs). The experimental group took classes in a Pilates studio twice per week for 90 days.

At four intervals during the study (baseline, 45 days, 90 days, and 180 days) the following parameters were blindly assessed: pain, function, quality of life, satisfaction of treatment, flexibility, and NSAID intake. Comparison between the two groups over time showed a significant difference favoring the Pilates group regarding pain, function, and some quality-of-life domains. The patients in the Pilates group used less medication and gradually reduced their intake, whereas the control group patients took the same amount of NSAIDs through the end of the study.

From these results, Natour and colleagues concluded that the Pilates method was effective in reducing pain and improving function and quality of life in patients with chronic, nonspecific low back pain. Further, they pointed out that the Pilates exercises did not worsen pain in the experimental group, demonstrating that use of this method had no harmful effects, and adding support to the belief that Pilates is a safe exercise option for low back pain patients.

Natour, J., L. Araujo Cazotti, L.H. Ribeiro, A.S. Baptista, and A. Jones. 2015. “Pilates Improves Pain, Function, and Quality of Life in Patients With Chronic Low Back Pain: A Randomized Controlled Trial.” Clinical Rehabilitation 29 (1): 59-68.

Pilates Versus Conventional Exercises for Low Back Pain

Most studies on the efficacy of Pilates for low back pain compare Pilates exercises to a control group (no exercises). It is exciting to see a study with a large sample size that compares Pilates to another type of exercise.

In 2021, a group of researchers in India compared Pilates to conventional exercises as a treatment program for people with nonspecific chronic low back pain. At four intervals during the study (baseline, 4 weeks, 8 weeks, and 12 weeks), pain, function, and disability were assessed via subjective testing. In this study, 100 subjects between 25 and 40 years old were randomly assigned to either a Pilates group or a conventional exercise group. The conventional exercise group did cat and camel, straight-leg raise, pelvic tilt, lumbar rotation, prop-up on elbows, piriformis stretches, and a hip flexor exercise. The Pilates group did a set of six basic mat exercises. Each exercise session was 45 minutes in duration and was performed three days per week for 12 weeks.

Although both groups showed improvement in pain reduction and disability at the end of the 12 weeks, the Pilates group’s improvement was much more significant. Thus, the researchers concluded that Pilates is an effective nonpharmacological, noninvasive therapy that helps with pain reduction and functional ability without any side effects or hazards. These results imply that Pilates is more beneficial than conventional exercises in decreasing pain and functional disability in patients with chronic, nonspecific low back pain.

Manikandan, P.G., V. Mohan Kumar, C. Rajalaxm, G. Priya, G. Yuvarani, K. Tharani, K. Kamatchi, Vaishnavi, and G. Muthu Raj. 2021. “Effectiveness of Pilates Exercises on Non-Specific Low Back Pain to Determine Pain and Disability.” Biomedicine 41 (4): 825-829.

Pilates Versus the Back School for the Treatment of Chronic Low Back Pain

Although this study is not yet peer-reviewed, it holds promise as further evidence of the benefits of Pilates for low back pain. A group of rehabilitation professionals in Spain hypothesized that Pilates is more effective in the treatment of low back pain and functional disability than the conventional Back School. They chose 48 patients from the waiting list at the Hospital del Henares in Madrid who were over 18 years old and had been experiencing low back pain for more than three months. The subjects were randomly assigned to either a Pilates group or a Back School group but were not informed as to which group they were in. The interventions were done at different times so that the participants did not have contact with each other. This is therefore considered a single-blind randomized controlled trial.

Each group did two sessions per week for 12 weeks, with each session lasting between 60 and 90 minutes (20 minutes manual therapy and 40 minutes small-group exercise). The Pilates group followed the recommendations and performed a selection of mat exercises from Rael Isacowitz and Karen Clippinger’s book, Pilates Anatomy, Second Edition: single-leg lift, leg circles, roll-up, hundred, side kick, twist, single-leg stretch, spine stretch, swimming, and double-leg stretch. The control group did the Back School exercises recommended by the Spanish Society of Rehabilitation and Medicine: stretching exercises for the back, lumbar pelvic area, and back of the lower limbs; vertebral flexion exercises; strengthening exercises of the abdominal musculature; strengthening exercises for the paravertebral musculature; back extension exercises; gluteal musculature strengthening exercises; and standing and supine pelvic scale exercises.

At the end of the 12 weeks, the Pilates group showed more significant improvements in both functional disability and pain as compared to the Back School group. For functional disability (measured by the Roland-Morris Questionnaire), the Back School group reported a 6.96 percent improvement, whereas the Pilates group had an 8.69 percent improvement. Comparing the results of the visual analog scale of pain reported by the two groups, the Back School group’s pain decreased by 14.2 percent and the Pilates group by 18.2 percent.

The authors concluded that treatment of nonspecific low back pain with therapeutic Pilates is more effective than the therapeutic treatment of the Back School, both in terms of functional disability and intensity of pain. Therefore, the results obtained in this research indicate that the Pilates method can be considered as an alternative treatment to the Back School.

López-Mesa, M.M., J.J. Cabrerizo-Fernández, A. López-Román, and E.M. Rodríguez-Fernández. 2019. “Effectiveness of the Back School and the Pilates Method in Disability and Pain of Patients With Chronic Non-Specific Low Back Pain. Randomized Controlled Clinical Trial.” Trial registration: This trial is registered in 5nk2tr/, with the ID number of www.ensaiosclinicos.gov.br/rg/RBR- RBR-5nk2tr, date of trial registration 4/11/2019.

More Excerpts From Pilates for Rehabilitation-2nd Edition

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