I was recently asked by a patient whether pilates would be beneficial for their back pain. They had experienced back pain on a number of occasions over a period of years and at times was feeling bombarded by information from different sources.
After thinking about the question, I said to them that the principles behind pilates were simple. It is low resistance, low velocity strength training for the abdominals and trunk muscles. In essence it has benefit, particularly for the short term, if the patient has problems with low force, low speed movements. But as time moved on and they would require higher force producing capability (lifting boxes, gardening, running etc) and this type of exercise would have less transfer and therefore the patient would require a progression in the intensity of the rehabilitation.
I went looking for some research that may explain these thoughts that I was having and came across an interesting article by Marshall et al 2013, it showed that comparing pilates (or specific trunk and abdominal exercises to be more precise) to stationary cycling exercise for the treatment of back pain. Interestingly it showed that at the 8 week follow up specific strength for the trunk did lower pain measures more than cycling alone. However at 6 month follow up there was little to no difference between the groups in pain and function tasks.
This highlights the idea mentioned above. Completing low velocity, low force trunk strength (whether it is pilates or general strength training exercises) is likely to benefit in the short term to reduce pain. However over time it is important to move on and increase the patient’s ability to participate in higher intensity exercises.