Pilates for low back pain: Is it a futile exercise?

Every Physiotherapist in Sydney seems to either have a Pilates studio attached to the clinic or is recommending one for back pain . So it would be fair to conclude that this modality must work for the 20% of the population in Australia that suffer from back pain? Well not necessarily!


I became a Pilate’s instructor in 2012 and worked at a Private Physio clinic in Sydney with all the fancy equipment and technology. We would scan peoples Transverse Abdominus muscle with an ultrasound machine to see if it would “switch on”. This is the muscle that every Pilate’s instructor tells you to either zip up or draw your belly to the floor. Most people are clueless about this and that attitude may well be a good thing. This type of thinking is a little dated. Lederman et al, wrote an excellent research paper condemning this type of approach. The effect was shown to increase intra-abdominal pressure and potentially put forces down onto the pelvic floor, an unwanted side effect (especially in pre/post natal women).  When Pilates was compared to general exercise they both helped but the general exercise group had better longer-term results. More information can be found here.


My main issue with physio-led Pilates is that physio’s charge in excess of $40 a class. That’s $4k a year if you go twice a week! An expensive habit (especially if you can get the same benefit from taking a walk!) if you still have your back pain. Your money may well be better spent in the gym or on your real passion (like a Gibson 1960s les paul guitar!!).


However, we cannot through the baby out with the bath water. There does seem to be a sub group of individuals that benefit from Pilates. For example people with joint hypermobility and general muscular weakness around the pelvis. I suppose the big question is would these people benefit equally from general strength and conditioning.  Research does show that low impact exercise can help with lower back pain; we just don’t really know the specifics. For example the duration, type and frequency of the low impact exercise. The key here is that movement seems to help. Everyone is different and the focus should be on individualised care.


I still like Pilates but probably not for my clients with chronic low back pain.