Can Pilates Reduce Chronic Low Back Pain?
Low back pain is a major problem worldwide, affecting 80% of people at some point in their lives (Yamato et al 2015). Approximately 16% of Australians have chronic or reoccurring low back problems and it is the third largest cause of disease in Australia (Australian Institute of Health and Welfare, 2017).
Exercise, and in particular Pilates is a commonly used treatment method for low back pain. But is it effective?
– Both Pilates and general exercise are effective at reducing chronic low back pain. So get active!
– Pilates may be more effective than general exercise in the first 4-8 weeks after commencing an exercise program.
– Improvements were noted for both Pilates and general exercise after exercising only once or twice a week.
– Do what you enjoy! If you enjoy a certain type of exercise you are more likely to stick to it long term.
What is low back pain?
Low back pain is defined as pain or discomfort localised below the ribs and above the gluteal crease (where the upper leg meets the buttock), with or without referred leg pain. Low back pain is considered chronic when it occurs for at least three months (Yamato et al 2015).
What causes lower back pain?
There are many causes of low back pain, some examples include:
- Intervertebral disc – degeneration or rupture
- Soft tissues – muscles and ligaments
- Spondylolisthesis – slipping of the vertebrae
- A traumatic injury
- Spinal canal stenosis or narrowing
What is Pilates?
The Pilates method was developed in the 1920s by Joseph Hubertus Pilates, originally for dance training and rehabilitation. The Pilates Method aims to train mind-body awareness control of movement and posture. Exercises mainly involve contracting the core muscles without moving the spine (isometric contraction) to improve stabilisation of the body. Exercises become more dynamic as the individual progresses.
Joseph Pilates first developed mat Pilates, where exercises are performed on the ground. He then developed apparatus that created added resistance through springs and pulleys. Both forms of Pilates are easily adapted to the individual and are can be made progressively more difficult (Rydeard et al 2006).
Pilates with apparatus – the springs provide resistance or assistance with movements.
In general, Pilates is believed to improve strength, flexibility, balance, co-ordination, awareness of posture and general health.
It is hypothesised that the activity of deep muscles that stabilise the spine is delayed in people who have low back pain. In turn, their more superficial muscles compensate which increases the stiffness of the spine. Therefore, Pilates is believed to improve low back pain as it aims to stabilise the deep muscles whilst improving posture and awareness (Yamato et al 2015).
What does the evidence say?
A systematic review (review of all of the literature on a particular topic) published in 2015 (Yamato et al. 2015) analysed ten randomised controlled trials that looked at Pilates and chronic low back pain.
Six studies compared Pilates to minimal interventions such as education and pain relief medications, or to no intervention. It was found that Pilates is more effective for improvement of pain intensity, disability, function and recovery in the first 4-8 weeks. Pilates is also more effective for pain intensity and disability after 3-6 months.
Four studies compared Pilates to other exercise interventions such as cycling or a Physio monitored strength programme. There is some evidence that in the first 4-8 weeks Pilates is more effective at reducing pain than other exercise interventions. However, in general both Pilates and other exercises interventions were found to be similarly effective both at 4-8 weeks and 3-6 months. Both Pilates and general exercise was effective for reducing pain and disability.
So what does this mean?
Both Pilates and exercise in general are effective at improving chronic low back pain! In most studies, participants completed Pilates or exercise only once or twice a week, which is very achievable for most people!
When would you choose Pilates over other exercise?
There is some evidence that Pilates is more effective than other exercise in the first 4-8 weeks. Pilates focuses on building an understanding of your body and movements, usually under the watch of a Physiotherapist or someone trained to administer Pilates. As people who suffer from chronic low back pain are often understandably worried that exercise may aggravate their pain, having a Physio present to give advice and alter the exercise specifically for the individual allows the individual to be confident that they are not worsening their low back condition. As mentioned previously, The Pilates Method focuses on activation of deep core muscles rather than over using more superficial muscles. A Physiotherapist can assess whether this may be affecting your lower back and develop a Pilates based exercise program accordingly.
However, it is important to emphasise that all exercise was found to be more beneficial than rest, pain relief medications and continuing ‘normal activities’. So the key here is to keep moving! Another recent randomised controlled trial (Shnayderman & Katz-Leurer, 2012) compared a walking program to core strengthening exercises and found that both groups improved at a similar rate. However, all participants were sedentary prior to the study so perhaps doing any exercise was the important factor in this sedentary population, rather than the specifics of the activity. Therefore, if you have chronic low back pain and you aren’t currently exercising, get active! Try walking short distances and gradually increase the distance. And if your low back pain persists, a more specific intervention that focuses on core muscles, such as Pilates may be more effective for you.
After analysing the evidence it is clear that any exercise will improve low back pain – the key is consistency. Most studies involved exercise programs completed only once or twice a week, but they were consistently completed, with the greatest improvements found after 6 months. And as such, it is important to choose an exercise method that you will enjoy! At Kinetic Balance we understand that this will differ for each individual and can therefore tailor a program to suit you. This may include Pilates, aerobic exercise, strength training or a combination of all three.
Australian Institute of Health and Welfare 2017. What are back problems? Australian Government, viewed 2 August 2017, < http://www.aihw.gov.au/back-problems/what-are-back-problems/>
Rydeard R, Leger A, & Smith D 2006. Pilates-Based Therapeutic Exercise: Effect on Subjects With Nonspecific Chronic Low Back Pain and Functional Disability: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2006;36(7):472-484. doi:10.2519/jospt. 2006.2144
Shnayderman, I & Katz-Leurer, M 2012. An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial. Clinical Rehabilitation Vol 27, no. 3, pp. 207-214.
Yamato TP, Maher CG, Saragiotto BT, Hancock MJ, Ostelo RWJG, Cabral CMN, Menezes Costa LC, Costa LOP 2015, Pilates for low back pain. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD010265. DOI: 10.1002/14651858.CD010265.pub2.
We run Pilates mat classes every Wednesday at 11.00-11.45am.
To find out more give us a call on 8326 3681 or make a booking with Courtney our Physiotherapist at our Noarlunga Centre Physio clinic.