Pilates can decrease chronic low back pain and related functional disability

Abstract

Background Recently, the popularity of Pilates has increased with both the general public and clinicians utilising therapeutic approaches developed from the Pilates method. The claimed benefits of Pilates include strengthening the ‘core’ musculature, decreasing low back pain, improving flexibility, and improved posture. To date there have been few studies undertaken to investigate the merit of these claims. Objectives The objective of this study was to evaluate changes in pain, functional disability and flexibility in adults with chronic low back pain following a 6-week Pilates exercise programme. Methods and Measures A pretest-post test single group study design was used. Data from 47 participants (n=31 females, n=16 males), between 25 – 65 years of age (mean age 41.25 years) was analysed. Participants attended a total of 12 Pilates sessions over a 6 week period arranged as two reformer and one mat sessions per week. Primary outcome measures were the 11-point numeric pain scale (NPRS, 0-10) to measure low back pain (LBP) intensity and any associated leg pain. The Patient Specific Functional Scale (PSFS, 0-10), and the Oswestry Disability Questionnaire (ODQ, 0-100) were used to assess levels of functional disability. Secondary outcome measures were the Troublesomeness Scale; and Schober’s Index, and Fingertip to Floor Test as an objective measure of flexibility of the lumbar spine, hips and hamstrings. Results After the intervention there was a significantly lower level of functional disability as measured by both PSFS and ODI (p≤0.001), and a decrease in average pain intensity (NPRS). PSFS (0-10) score mean was 3.57±1.28 pre-intervention and 6.38±1.87 post-intervention (mean difference 2.81, p≤0.001, d=0.81). 63% of participants (n=30) experienced an improvement in PSFS scores of at least the minimum clinically important difference (MCID ≥ 2 points). The mean LBP intensity (0-10) was 4.73±1.75 at pre-intervention and decreased to 3.11±1.19 post-intervention (z=3.85, p≤0.001, d=0.55). Over half the participants (n=26) achieved a clinically meaningful outcome (achieved the MCID) for low back pain intensity. Results also showed significant decrease in LBP troublesomeness (0-5), pre-intervention mean of 3.21±0.81, improving to a post intervention mean of 2.28±0.90, with a mean difference of 0.96 (95% CI: 0.64 to 1.23, p≤0.001). Conclusion These findings indicate that Pilates exercise is an effective treatment option in improving functional disability and decreasing pain and troublesomeness in adults with chronic non-specific low back pain. Further research should include comparing Pilates exercise with other interventions; and also compare the efficacy of group classes to more individualised one-on-one sessions with a instructor. The ideal frequency of classes and duration of trial period has yet to be determined, future research should also include an intervention over longer duration and longer term follow up periods.