Pilates for Low back pain- what the evidence says

Research has shown that low back pain affects an estimated 80% of people at some stage during their lives. It is also one of the most common conditions that clients present to us in the clinic with.

Low back pain is defined as pain originating anywhere in the region between the lower ribs to above the inferior gluteal folds, with or without sciatica. Structures that can contribute to low back pain include the intervertebral discs, myofascial trigger points, sensitive spinal joints and ligaments, spinal canal stenosis/narrowing and direct trauma.

Follow this link to read about what Pilates is

A summary of what Iā€™m going to talk about below:

  • The Evidence concludes that ALL exercise INCLUDING  Pilates, once performed consistently and regularly will significantly improve your back pain and associated levels of disability in both the short and long term

  • Evidence suggests that people with low back pain have reduced movement through their spines, and have increased trunk stiffness. To positively affect this- we need to move!

  • Evidence suggests that increased trunk stiffness may be related to fear of movement. To increase our spinal flexibility and improve affect pain levels- we need to take the fear out of movement!

  • A Physiotherapist led Pilates class may help to reduce fears associated with certain movements and facilitate you moving more freely and with confidence, resulting in a positive effect on your low back pain

  • Improved confidence in our own movement with associated reduced pain levels opens up the options of trying different types of exercise

What the evidence says about Pilates for lower back pain

The best evidence available to us that looks at the effect of Pilates on low back pain is this systematic review published in 2015. This review appraised 10 studies looking at the effects of Pilates in those with low back pain.

Some studies looked at the effect of a Pilates program compared to the effects of minimal intervention such as medication, education or no intervention at all. The results showed that at 4-8 week follow up, levels of pain intensity, disability, recovery and function were significantly improved in the groups that completed the Pilates program compared to those who partook in minimal intervention. Pilates was also found to be significantly more effective at reducing levels of pain and disability at 3-6 month follow up. This is a very important landmark at assessing the effects of Pilates in those with chronic low back pain.

The other studies in the review looked at the effects of a Pilates program compared to the effects of other exercise interventions in those with low back pain. The results showed that there is weak evidence supporting better outcomes in pain intensity after 4-8 week follow up for the group that completed the Pilates program compared to other exercise interventions. However, at 3-6 month follow up, both Pilates and other forms of exercise were found to both be significantly effective in reducing pain and disability.

This means that Pilates is scientifically proven to be effective at reducing pain and dysfunction caused by lower back pain when practiced consistently with a frequency of once or twice per week. It also shows that exercise in general will positively affect levels of pain and dysfunction- so when in doubt, get moving!

So why then choose a Pilates class?

Findings re movement characteristics that may relate to low back pain

A lot of people that we see in the clinic have had ongoing issues with their back for years and over time, have naturally developed different coping strategies and learned beliefs around their pain. This can result in movement patterns that are not serving them optimally and are likely contributing to their pain.

Such movement patterns that we commonly come across include reluctance amongst patients to bend or flex their spine or move it very much at all in any direction. This can cause the muscles around the spine to become tight and thus limit flexibility of the spine. A systematic review investigating lumbopelvic joint movements among those with and without low back pain, showed the group with low back pain to have significantly reduced lumbopelvic movement compared to their pain free counterparts. This means that people who are pain-free tend to move more freely through their lumbar spine. Another study related trunk stiffness to fear of movement in those with low back pain. The findings of this study make sense if we think of muscle spasm or tightness as a natural response to pain post acute injury- spasm helps to limit painful movement at the injured tissue or joint. This is not a helpful response however, when we consider it in relation to chronic issues where the injured tissue has since healed but the muscle tightness has remained and is limiting the restoration of normal movement through the back. This sustained muscle tightness effects normal joint movement and is likely to be a factor in their ongoing pain. Such movement limitations that develop may be explained as possible measures taken to protect the back or indeed a tissue response to the perceived threat of pain.

Take the fear out of movement

From the evidence we have seen above, a valuable step we can take to increase the movement through our back (and hopefully reduce pain), is to take the fear out of movement and reduced some of the natural worries that go hand in hand with starting a new type of exercise when you suffer with back pain. If you are at a stage where you are perhaps still very cautious of exercise in general and would like reassurance and advice, then a physiotherapist led pilates class could be of great benefit to you by increasing your activity levels in a safe, supported environment and facilitating you finding a long term means of positively affecting your low back pain. Specifically during the class we perform exercises that encourage lumbopelvic movement with gentle low load exercises that are very safe to perform. Gradually as you progress through each term you will be exposed to more challenging exercises and will explore the capability that your body has to adapt, at your own pace, under closely supervised classes.

Eamon Wilson