Pilates for Low Back Pain

Three systematic reviews now demonstrate that  Pilates is one of the supervised exercise pro grams effective in the treatment of chronic, non -specific low back pain (LBP).1-3 This category  of low back pain is characterised by pain or  discomfort in the region between the costal  margins and the inferior gluteal fold, with or  without referred pain to the legs, lasting three  or more months, but without serious spinal  pathology or nerve root compromise.4 As with  most therapeutic exercise approaches, the next  question becomes how to maximise the effec tiveness, and how to inform patients about the  potential effectiveness of different interven tions. To that end, researchers in Brazil recently  completed an analysis of the dose-response  relationship between Pilates training and LBP.5 

Pilates is a method of exercise focusing on  controlled movement, stretching, and breath ing. Practitioners describe Pilates as having six  major components: centering, concentration,  control, precision, flow, and breathing.6 Joseph  Pilates developed the exercise system bearing  his name to be a low-impact fitness routine  that would be suitable for anyone and that  could also enhance mindfulness and mood.  

In the current study, Maria Liliane da Silva and  colleagues recruited 222 patients with LBP.  Most had received previous treatment, felt  depressed in the last month, and presented  with a moderate level of pain and disability at  baseline. Researchers randomised patients into  four groups. One received a back pain infor mation book explained by a physiotherapist.  The others received six weeks of Pilates at 1 x  week, 2 x week, or 3 x week.  

Pilates proved superior to patient education.  After the first week of Pilates, patients  achieved complete pain improvement at these  rates: 

• Three times weekly: 44.6% 

• Twice weekly: 37.8% 

• Once weekly: 29.7% 

However, when measured as the average  number of weeks to 100% pain resolution, the  differences did not achieve statistical signifi cance. Furthermore, at the end of six weeks,  the Pilates treatment achieved 100% pain  relief in 78.4%, 77%, and 71.6% of the  patients (ordered from most frequent sessions  to least).  

The results trend toward earlier resolution and  improved outcomes with higher frequency.  Theoretically, this could contribute to greater  patient satisfaction and adherence in clinical  practice. But the good news is that even those  patients who can only schedule one supervised  session per week have a strong likelihood of  clinically significant improvement if they can  adhere to the treatment plan for six weeks.

References 

1. Yamato TP, Maher CG, Saragiotto BT, Hancock MJ, Ostelo RW, Cabral CM, Costa LC, Costa LO. Pilates  for low back pain. Cochrane Database of Systematic Reviews. 2015(7).  

2. Lin HT, Hung WC, Hung JL, Wu PS, Liaw LJ, Chang JH. Effects of Pilates on patients with chronic non specific low back pain: a systematic review. Journal of Physical Therapy Science. 2016;28(10):2961-9.  

3. Byrnes K, Wu PJ, Whillier S. Is Pilates an effective rehabilitation tool? A systematic review. Journal of  Bodywork and Movement Therapies. 2018 Jan 1;22(1):192-202.  

4. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal  JB, Ursin H, Zanoli G. European guidelines for the management of chronic nonspecific low back pain. Eu ropean Spine Journal. 2006 Mar;15(Suppl 2):s192.  

5. da Silva ML, Miyamoto GC, Franco KF, dos Santos Franco YR, Cabral CM. Different weekly frequencies  of Pilates did not accelerate pain improvement in patients with chronic low back pain. Brazilian Journal of  Physical Therapy. 2020 May 1;24(3):287-92.  

6. Wells C, Kolt GS, Bialocerkowski A. Defining Pilates exercise: a systematic review. Complementary Thera pies in Medicine. 2012 Aug 1; 20(4):253-62.