Pilates helps back pain, but no better than other exercise

Low back pain without a specific identifiable cause is one of the most common reasons people seek treatment, and exercise sits at the centre of managing it. Pilates has become one of the most popular exercise approaches offered for back pain, in studios, gyms and physiotherapy clinics alike. Despite that popularity, its effectiveness had not been well established, and the practical question for anyone choosing a class is really two questions: does Pilates work at all, and does it work better than other kinds of exercise? This review set out to answer both.

The reviewers searched six databases up to March 2014 for randomised controlled trials of Pilates in people with acute, subacute or chronic nonspecific low back pain. The outcomes evaluated were pain, disability, function and global impression of recovery. Two reviewers independently screened studies, assessed risk of bias and extracted the data, and the overall quality of evidence was formally graded. From 126 trials retrieved, 10 were included, covering 510 participants; seven were judged at low risk of bias and three at high risk.

Compared with minimal intervention, Pilates reduced pain in both the short and intermediate term, with medium effects and low to moderate quality evidence. Disability also improved in Pilates' favour, with a small effect in the short term and a medium effect at intermediate term. Against other forms of exercise the picture was murkier: it is unclear whether Pilates is better for short-term pain, there is low quality evidence of an intermediate-term pain advantage, and moderate quality evidence of no difference in disability at either time point. Overall, the review found no conclusive evidence that Pilates is superior to other exercise.

This lands where much of the back pain literature has been converging: structured exercise helps, and the specific brand of exercise appears to matter less than doing something. The review firmly establishes Pilates as better than minimal intervention, which is worth having on record given how widely it is recommended. What it deliberately does not do is crown a winner among exercise types, and because much of the evidence was rated low to moderate quality, the effect estimates could shift as larger and better trials arrive. Whether particular groups of people respond better to Pilates specifically remains an open question.

If Pilates is the exercise you actually turn up to, this is evidence it earns its keep for nonspecific low back pain, with mostly medium-sized benefits over doing very little. If you prefer swimming, lifting or walking, nothing here suggests you are missing out by skipping the mat: no conclusive advantage over other exercise was found. The evidence gives no reason to think the choice between exercise types matters nearly as much as choosing one at all.