How Does Clinical Pilates Help Low Back Pain?

How Does Clinical Pilates Help Low Back Pain?

Learn about Clinical Pilates and how it can be used as treatment for low pain pain.

Lower back pain is a serious health problem across the world. The most common treatments for lower back pain are exercise-based interventions.


Over the last years, Clinical Pilates has become a popular form of exercise to treat people with lower back pain. Research has also shown that Pilates have numerous potential benefits for LBP.


Lets Get Into It!



Clinical Pilates can either be completed on the mat (Mat Pilates) or specific equipment (i.e. Reformer Pilates).


There are many philosophies around how to practice Pilates, but they all revolve around the intention to incorporate exercise that improve strength, balance, posture, muscle tone, and flexibility.


These exercises are all aimed at creating better body awareness in different positions under different loads!


Pilates entails the use of back and abdominal muscles in a properly coordinated manner. These exercises are aimed at training the muscles in the lower back, pelvis, abdomen, and hips to ensure that they work harmoniously.


This enhances coordination, balance and stability whether while performing daily activities or playing sports. Most physical activities and sports depend on the good coordination between these muscles.


Research on Clinical Pilates has shown that these exercises have numerous benefits for individuals that need core stability for performance and health.


Incorporating these exercises in a rehabilitation program can facilitate a new approach in teaching exercises!


“These exercises are all aimed at creating

better body awareness in different positions under different loads!”


Back Pain Can Be Quite Confusing



Lower back pain is a musculoskeletal condition which is characterised by discomfort and pain which are experienced above the buttocks and below ribs. No specific disease is attributed to this pain.


However, people with lower back pain have significantly limited mobility of the hips and spine. The pain has also been associated with low flexibility of the back and hamstrings tightness.


Several factors contribute to LBP including:

  • Erector spine muscles force and incorrect activation (i.e. too much tension!)
  • Decreased trunk and gluteal muscle strength 
  • Strength imbalance in the trunk and gluteal muscles 
  • Poor behavioural habits such as prolonged postures, spikes in activity loads 
  • Other psychosocial factors such as increased life stresses, work stresses, beliefs and understanding of pain (this topic is complex and will be covered in it’s own post in the future) 


Major Benefits of Clinical Pilates



Enhanced Muscle Strength

Research has shown that Pilates provides an effective method of reducing disability and pain among LBP patients. That’s because Clinical Pilates utilises an approach to strengthen the entire body with a focus on maintaining good control during various movements.


When a person has lower back pain, their muscle strength is reduced due to immobility and pain. With supervision, a patient can engage in Pilates which target specific muscles while enhancing their strength safely while reducing pain along the way.


Reduced Fear of Movement

When a person has lower back pain, they move abnormally because they anticipate or feel pain. This leads to poor mobility and movement patterns which leads to further physical deconditioning.


Abdominal bracing increases while segmental spine movement is reduced due to the poor patterns. This makes the spine stiff while causing more pain.


So, it becomes a terrible cycle!


Clinical Pilates helps by reassuring the patient that they can perform movements safely without pain. Reassurance that movement can be performed without causing injury is vital in the progression for someone with back pain.


“Reassurance that movement can be performed without causing injury is vital in the progression for someone with back pain”


Improved Movement Patterns

People with lower back pain have poor habitual movement patterns due to their pain. Unfortunately, these patterns can lead to further pain due to inefficient and restrictive muscle use.


Clinical Pilates makes it possible for physiotherapists to observe these poor patterns and correct them by offering alternative ways to complete the same movement. Poor movement patterns take time to change because the brain needs time to ensure that the new pattern is not a threat and safe to perform.


The whole rehab process is based on upon this concept…learn new movement > brain assesses whether the movement is safe > brain confirms safety > less pain with that movement > make movement harder.


Improved Flexibility

A component to Clinical Pilates involves stretching and mobility which improves flexibility and available joint range of motion over time.


Reduction in stiffness, primarily in the hamstrings, hip flexors and erector spinae (back muscles) will decrease pain.


Improved Mental Outlook

For individuals who suffer from low back pain on a regular basis, it can take a toll on other aspects such as thoughts and emotions.


An individual may become anxious, depressed and feel isolated due to the inability to do regular daily activities or complete things that bring joy to their life.


With the engagement of a Pilates exercise program, there can be a mindset shift from “I can’t move without pain” to “I can now exercise for a full exercise class”. This has a huge positive flow on effect in other areas of life.


What Can We Take From The Research?



Clinical Pilates offers greater improvements in functional ability and pain among people with lower back pain.


The improvements provided by these exercises are equivalent to those of the other types/forms of exercise!


Tara Clifford

Physiotherapist & Clinical Pilates Instructor



Wells, C, Kolt, GS, Marshall, P, Hill, B and Bialocerkowski, A, 2014, Indications, benefits, and risks of Pilates exercise for people with chronic low back pain: a Delphi survey of Pilates-trained physical therapists. Phys Ther. 94(6):806-17.


Barna, S, Patti, A, Bianco, A, Paoli, A, Messina, G, MontaltoMA, Bellafiore, M, et al., 2015, Effects of Pilates Exercise Programs in People With Chronic Low Back Pain: A Systematic Review, Medicine, 94(4), p e383.


Wells, C, Kolt, GS, Marshall, P, Hill, B and Bialocerkowski, A, 2014, The Effectiveness of Pilates Exercise in People with Chronic Low Back Pain: A Systematic Review, PLoS One, 9(7): e100402.

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