Effects of pilates exercise programmes for chronic low back pain


Pilates has been around since 1920, and now people finally seem to be catching on to it! It might have taken almost 100 years to happen, but it seems a lot more patients and physiotherapists are talking about it.

So, the burning question – does it help one of our most commonly seen conditions: chronic, non-specific low back pain (CLBP)? This new systematic review examined the literature to determine the effectiveness of Pilates exercises on pain and disability on CLBP.

Here’s what they did

They looked for randomized controlled trials, reviews and meta-analyses, in English language, published in the: MEDLINE-NLM; MEDLINE-EBSCO; Scopus Elsevier; Cochrane; SciELO and PLOSONE databases, using a comprehensive search strategy.

The methodological quality of the studies were rated (PRISMA) by two independent investigators, with a third reviewer available to provide consensus in areas of disagreement.

Here’s what they found

Nine review papers were included within this systematic review. Four reached no firm conclusion while five reported Pilates exercise was effective in reducing pain. None reported the Pilates method to be inferior to any other exercise regime and results from individual studies show some promise:

  • When comparing Pilates exercises with a minimal intervention approach all studies (n=9) showed a reduction in pain, with six reaching statistical significance (p<0.05; 0.0001; 0.001 for pain reduction).
  • In one trial, all participants received flexibility exercises plus either Pilates exercises or therapeutic exercises. Both groups improved on pain, function, general health and flexibility (VAS/Oswestry), with greater gains reported in the Pilates group.
  • Comparing NSAID’s with or without a Pilates programme of exercise, the Pilates group improved with regards not only to pain and function but also reduced medication (p<0.010).
  • Six studies compared Pilates exercises with other exercise programmes and found pain was significantly reduced across the board, regardless of exercise regime (p<0.05). One trial showed improvement in favour of Pilates exercises. This trial was conducted on postmenopausal osteoporotic women who were either exercising at home, or attending a Pilates class twice weekly for one year. Both groups showed significant improvements in pain, functional status and quality of life, but this was greater in the Pilates group.
  • The authors analysed five studies to assess the therapeutic effect of Pilates exercises alone on those with chronic low back pain. All but one reported statistically significant reductions in pain.

The authors concluded

The consensus in the field suggests that Pilates method is more effective than minimal physical exercise intervention in reducing pain.


The Pilates method is more effective than minimal physical exercise intervention in reducing pain but further studies are needed to understand the short and long term effects .


However, due to variance in methodology, populations, interventions and outcome measures, further studies are needed to better understand the short and long term effects of Pilates exercise in CLBP.

The Musculoskeletal Elf’s view

The Musculoskeletal Elf
The authors conducted a comprehensive search of the literature, but CINAHL was not included in their search. Only studies published in English were included, and whilst practical, may have introduced bias. In the majority of the studies, population demographics or specifics of interventions were not reported, which unfortunately affects the extent to which the results can be applied clinically, unless the reader locates the original articles themselves.

While evidence shows Pilates exercises are clinically useful in significantly reducing CLBP pain, we cannot say that Pilates exercises are any better, nor any worse, than any other exercise intervention.

What do you think?

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Do you know that there is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses? This is called the Preferred Reporting Items for Systematic Reviews and Meta-Analyses or PRISMA statement and can be accessed through the website of the EQUATOR Network. The Elves use the PRISMA statement for critical appraisal of systematic reviews, although it is not a quality assessment instrument to gauge the quality of a systematic review.


Patti, A., Bianco, A., Paoli, A., Messina, G., Montalto, M. A., Bellafiore, M., … & Palma, A. 2015, ‘Effects of Pilates Exercise Programs in People With Chronic Low Back Pain: A Systematic Review’, Medicine, Vol.94, no.4, e383 [Full text]

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