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Pilates & Back Pain Rehab (Part 3 of 3): How Much Is Enough?

Pilates & Back Pain Rehab (Part 3 of 3): How Much Is Enough?

by | Apr 30, 2025 | Reformer Pilates

In the final part of our three-part blog series, we dive into one of the most common questions we’re asked at Praxis Physiotherapy: “How often should I do Pilates for my back pain?”

The short answer? It depends — but more isn’t always better.

What Does the Research Say?

Several studies have explored the ideal frequency of Pilates for managing chronic low back pain and improving quality of life:

  • A high-quality randomised trial found that two supervised sessions per week resulted in better pain and disability outcomes compared to one session, but three sessions per week didn’t add significant extra benefit (Miyamoto et al., 2018).

  • A more recent scoping review suggested that the most effective dose was 2–3 Pilates sessions per week, over at least 8–12 weeks, with each session lasting 50–60 minutes (Sivrika et al., 2024).

  • Other research found that while Pilates is more effective than minimal intervention, its long-term effects are similar to other forms of exercise when it comes to disability reduction (Lim et al., 2011).

Interestingly, even in postmenopausal women with osteoporosis, clinical Pilates performed twice weekly over 12 weeks improved physical performance, bone health, and quality of life (Angın et al., 2015).

In short: Twice a week for 8–12 weeks seems to be the sweet spot — balancing benefit with adherence.

Does That Mean Daily Pilates Is Too Much?

Not necessarily — but more frequent Pilates isn’t always better, especially in early rehab stages. Muscles and tendons need time to adapt, and overtraining can aggravate sensitive tissues.
In most cases, it’s smarter to focus on progressive challenge and good technique, rather than pushing volume too early.

The Praxis Approach

At Praxis, we use Pilates as a physiotherapy-led rehab tool, not just a workout. That means:

  • Exercises are tailored to your injury, goals, and stage of recovery

  • We combine matwork and reformer-based Pilates, adapting for pain or functional limitation

  • Programs scale over time — from pain relief to performance and everything in between

Many of our clients begin with once-weekly sessions, progressing to twice per week as tolerated. We also provide home-based exercises to support consistency without overloading the system.

So, How Often Should You Do Pilates?

Here’s our evidence-informed summary:

  • Start with 1–2 supervised sessions per week

  • Add 1–2 home sessions with guidance

  • Continue for 8–12 weeks, then reassess progress and goals

The most important part? Consistency, not perfection. And making sure every movement has a purpose.

Ready to get started?
Chat to our team at Praxis Physiotherapy — we’ll help tailor a Pilates plan that’s safe, effective, and backed by the latest research.

Until next time,  Praxis What You Preach!

References

Angın, E., Erden, Z., & Can, F. (2015). The effects of clinical Pilates exercises on bone mineral density, physical performance and quality of life of women with postmenopausal osteoporosis. Journal of Back and Musculoskeletal Rehabilitation, 28(4), 849–858. https://doi.org/10.3233/BMR-150604

Lim, E. C. W., Poh, R. L. C., Low, A. Y. H., & Wong, W. P. (2011). Effects of Pilates-based exercises on pain and disability in individuals with persistent nonspecific low back pain: a systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 41(2), 70–80. https://doi.org/10.2519/jospt.2011.3307

Miyamoto, G. C., Costa, L. O. P., Cabral, C. M. N., & Costa, L. C. M. (2018). Efficacy of two Pilates exercise programs for patients with chronic low back pain: A randomized controlled trial. Brazilian Journal of Physical Therapy, 22(2), 137–143. https://doi.org/10.1016/j.bjpt.2017.09.004

Sivrika, M., et al. (2024). Different doses of Pilates-based exercise therapy for chronic low back pain: a scoping review. Applied Physiology, Nutrition, and Metabolism, [Ahead of print]. https://doi.org/10.1139/apnm-2021-0462

Navigating Knee Osteoarthritis: A Physio-Centric Pathway to Strength and Mobility Before Surgery

Navigating Knee Osteoarthritis: A Physio-Centric Pathway to Strength and Mobility Before Surgery

by | Apr 22, 2025 | Knee, Reformer Pilates

Knee osteoarthritis (OA) is one of the most common causes of chronic pain and mobility restriction in Australians over 45. Whether you’re a weekend warrior, an active grandparent, or someone just trying to keep up with the daily demands of life, OA can slowly erode your confidence in movement — long before X-rays show the full extent of joint degeneration.

At Praxis Physiotherapy, we take a forward-thinking, collaborative approach to managing knee OA. Working closely with renowned orthopaedic knee surgeon Dr. Kelly Macgroarty and drawing from our extensive experience with high-performance athletes and everyday patients alike, we believe the journey toward better knees starts well before surgery — and, for many, might even avoid or delay it altogether.

What is Knee Osteoarthritis?

Knee OA is a progressive condition involving the breakdown of joint cartilage and underlying bone, typically leading to:

  • Pain during or after activity

  • Morning stiffness or stiffness after rest

  • Swelling and inflammation

  • Loss of flexibility and range of motion

  • Difficulty with stairs, kneeling, or prolonged standing

Radiographic OA becomes more common with age, but symptoms often precede visible changes on X-ray. Up to 30% of people over 65 show radiographic OA, yet many remain functionally capable — highlighting the importance of early, movement-based interventions (Naja et al., 2021).

Why a Physio-Led Model Before Knee Replacement?

Surgery is not the first or only option. A large systematic review of 19 randomized controlled trials found that non-surgical interventions such as physiotherapy, platelet-rich plasma (PRP), and structured exercise were associated with meaningful improvements in pain and function over 12 months (Naja et al., 2021). Physiotherapy, in particular, is consistently supported by international guidelines as a first-line treatment (Fransen et al., 2015; Bennell et al., 2014).

Traditionally, knee OA rehab has emphasised quadriceps strengthening — and for good reason, as quadriceps weakness is strongly linked to OA-related pain and disability. However, more recent research suggests that focusing exclusively on the quadriceps may be too narrow. Programs that include hip (gluteal), hamstring, and calf muscle strengthening are now shown to be superior in improving functional outcomes, especially for activities like walking, stair climbing, and maintaining balance (Bennell et al., 2014). This broader approach addresses the full kinetic chain around the knee, optimises joint load distribution, and better supports long-term movement efficiency.

At Praxis, our physios:

  • Assess gait, strength, joint mobility, and function

  • Design individualised exercise programs targeting quadriceps, glutes, and calf strength

  • Implement manual therapy techniques to restore joint mobility

  • Provide pain education, load management advice, and real-world strategies

  • Monitor progress and adjust programs over time

This proactive approach not only builds resilience in the knee but also prepares the joint and surrounding muscles should surgery eventually be required.

Booster Sessions: Keeping Gains, Lowering Costs

An often-overlooked strategy is the use of booster physiotherapy sessions — structured follow-ups after an initial rehab program. Research by Bove et al. (2018) showed that exercise programs with booster sessions at 3, 6, and 12 months were not only more clinically effective but also more cost-effective over a two-year period compared to standard physiotherapy care.

At Praxis, we now embed these booster sessions into long-term OA management. They help patients:

  • Maintain strength and conditioning gains

  • Stay accountable with home programs

  • Troubleshoot new symptoms early

  • Reduce future health care costs and medication reliance

What About Injections and Other Adjuncts?

We often collaborate with GPs and orthopaedic specialists to incorporate adjunct treatments where the evidence supports it:

  • Platelet-rich plasma (PRP) injections showed significant long-term benefit for pain and function, with improvements of ~20 points on the WOMAC index. PRP ranked just behind stem cells as the most effective non-surgical treatment in a large 2021 network meta-analysis (Naja et al., 2021).

  • Hyaluronic acid (HA) injections have shown mixed results. A review of overlapping meta-analyses concluded that HA is likely safe and modestly effective, especially in early-stage OA, although guideline recommendations remain inconsistent (Xing et al., 2016).

Ultimately, our philosophy is to build strong knees first, and complement physiotherapy with interventions like PRP or HA only when clinically indicated and appropriately timed.

Surgical Collaboration 

In more advanced cases, where conservative management fails, we work closely with Dr. Kelly Macgroarty, one of Queensland’s leading knee surgeons. Our relationship allows:

  • Streamlined triage for surgical consultation

  • Shared prehabilitation planning to improve surgical outcomes

  • Integrated post-operative rehab, using in-clinic gym equipment and reformer Pilates to accelerate return to function

This continuity ensures you’re never left navigating knee OA alone — whether your journey stays entirely within physio care or progresses to surgical management.

Why Praxis Physiotherapy?

At Praxis, we’ve built our care model around best-practice guidelines, decades of elite sport and private practice experience, and a shared goal of keeping our patients active, independent, and thriving.

Our Teneriffe, Carseldine and Buranda clinics offer:

  • In-clinic rehab gyms

  • Reformer Pilates for joint-friendly loading

  • Real-time strength testing technology

  • Physios with elite sports and post-surgical rehab experience

Take the First Step

If you or someone you love has been told you’re “heading for a knee replacement,” don’t wait. There is so much we can do to reduce pain, improve function, and build confidence in your knees — surgery or not.

Book an appointment today at one of our Brisbane clinics and start your journey to stronger, more resilient knees.

Interested in ACL specific rehab? Check our guide on return to sport after ACL injury

Until next time, Praxis What You Preach!

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

References

  • Bove, A. M., Smith, K. J., Bise, C. G., et al. (2018). Exercise, manual therapy, and booster sessions in knee osteoarthritis: cost-effectiveness analysis from a multicenter randomized controlled trial. Physical Therapy, 98(1), 16–27.

  • Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee: a Cochrane systematic review. British Journal of Sports Medicine, 49(24), 1554–1557.

  • Bennell, K. L., Dobson, F., & Hinman, R. S. (2014). Exercise in osteoarthritis: moving from prescription to adherence. Best Practice & Research Clinical Rheumatology, 28(1), 93–117.

  • Naja, M., Fernandez De Grado, G., Favreau, H., et al. (2021). Comparative effectiveness of non-surgical interventions in the treatment of patients with knee osteoarthritis: a PRISMA-compliant systematic review and network meta-analysis. Medicine, 100(49), 

  • Xing, D., Wang, B., Liu, Q., et al. (2016). Intra-articular hyaluronic acid in treating knee osteoarthritis: a PRISMA-compliant systematic review of overlapping meta-analyses. Scientific Reports, 6, 32790.

Blood Flow Restriction – more than just a gimmick?

Blood Flow Restriction – more than just a gimmick?

by | Oct 11, 2022 | ACL, Gym and Strength, Knee, Reformer Pilates, Return to Sport

Summary:

  • Restriction of blood flow purportedly creates an internal environment of greater stress, thus greater adaptation
  • Importantly, the greater adaptation can occur with less absolute load to damaged or painful tissues
  • Started in healthy population to build muscles but the principles are transferable to rehabilitation
  • Best suited persons who are unable to tolerate normal load
  • Post surgery, tendinopathies and people needing to arrest atrophy or build muscle fast are best candidates

Blood flow restriction (BFR) training is becoming increasingly popular in rehabilitation and conditioning settings. As the name suggests, BFR training incorporates a restriction of blood to an area paired with low resistance training (20-50% of 1 rep maximum). The principle is to achieve greater muscle strength and hypertrophy gains for healthy and load-compromised populations with the same or less load than without a cuff. Essentially – more bang for your buck in the early phases of rehabilitation!

Benefits of BFR include; prevention of muscle mass in early post-operative periods, similar benefits of muscle mass and strength as heavier resistance training in achilles tendinopathies (>70% 1RM) (Centner et al, 2019), and improvement in maximum voluntary torque.

 

Whilst research is still being developed, multiple studies have been conducted recently showing the benefits of BFR training in post-operative populations ie. ACLR, patella / achilles tendinopathies, as well as knee osteoarthritis and patellofemoral pain syndrome.

Here at Praxis Physiotherapy, we have used a BFR cuff paired with low-resistance training on the reformer pilates and in the gym to optimise the distal quadriceps strength post ACL surgery. As you can see we are putting to the distal quadriceps to fatigue under a small amount of load, thus preventing muscle loss (Prue, et al. 2022) which can be common postoperatively.

General prescription guidelines according to the Australian Institute of Sport recommend that “the application of BFR should be limited to less than 20 minutes for lower limb, and 15 minutes for upper limb, before allowing adequate time for reperfusion of tissues (3 min).” (AIS, 2022).

In summary, this is an exciting new area of research that we are investigating clinically. Anecdotally, we hear from patients that they fatigue earlier in the desired muscle groups. We as a Praxis Team are embarking on some in clinic research in the area and hoping to provide feedback on our experiences so keep your eyes peeled. In the meantime, if you are pre or post your operation and are looking to maximise your recovery, come and have a chat with us about whether BFR is suitable for you!

Until next time,

Prevent | Prepare | Perform

Team Praxis

Peri-Menopause and injury – your guide to the most common issues

Peri-Menopause and injury – your guide to the most common issues

by | Mar 17, 2022 | Gym and Strength, Reformer Pilates

  • Menopause alters hormones and results in physical changes
  • These changes typically result in increased injury risk or activity reduction
  • The most common injuries affect structures such as the plantar fascia, tendons of the hip and shoulder
  • Appropriate exercise and judicious hands on therapy should be cornerstones of management
Betty Friedan said it best when she said “Aging is not lost youth but a new stage of opportunity and strength.” If only our bodies would play the game and come along for the ride as Betty wishfully thought. Age related transitions such as menopause often results in physiological changes (as outlined in other blogs) is an increase in weight, a loss of muscle and bone mass and a drop in physical activity. Not something anyone would wait in line for. A spiral of further activity loss, deconditioning and ultimately, injury can easily occur as a result. As a physiotherapist who looks after everyone from elite athletes, to weekend warriors to desk jockeys, I see the frustration injuries cause my patients (and myself!). So, in the interests of helping you enter the chapter of “opportunity and strength”, these are the most common injuries I see on a daily basis in perimenopausal women and what to do about them.

Heel pain – Plantar fasciopathy (the injury formerly known as plantar fasciitis)

Heel pain can be a number of things. The heel pain that I tend to see the most of is the one that feels like you are walking on glass the first thing in the morning or after you have been sitting down for a while. It makes you walk like your Grandma used to for those first few steps and the thought of doing a long walk, or heaven forbid wearing heels, gives you the sweats.

This pain is usually characterized by a condition called plantar fasciopathy. The plantar fascia is designed to help to absorb, store and transfer force during walking, running and jumping activities. Collagen (the main protein based building blocks of the body) is a non contractile tissue that sits on the underside of your foot. The attachment point for this tissue, is you guessed it, on the bottom of your heel where that “burning glass” feeling .

Plantar fasciopathy loves the status quo. It likes loading the same way, at the same intensity, at the same volume day in day out. Pain and dysfunction is brought about typically in a sudden increase in dynamic loading, whether that is walking, running or jumping. This often happens with women hell bent on a health kick to lose those extra kilos. With the shoelaces tied, lycra on and the world your oyster, some women start at where they remember they left their exercise behind, often several years (and children) ago. The resultant spike in load, particularly dynamic loading coupled with musculoskeletal detraining, is what kicks off the pain as the plantar fascia gets overloaded more easily and grizzles about it.

Key tip – Start slow with walks – not running – if it has been a while since you last exercised. Progress to jogging with some walk intervals in there (e.g 30s jog, 90s walk). Do calf raises (eg. 3 sets to a feeling of semi-fatigue) to get more calf strength as this can help deload the plantar fascia.

Outside / Lateral hip pain (Gluteus medius tendinopathy)

The muscles on the outside of your hips are designed to help keep your pelvis level when you are walking or running. This area is a particular passion of mine given my masters thesis was based on the single leg squat. Similar to the plantar fasciopathy, gluteal tendinopathies tend to be an injury that I see when people go too hard, too quickly. This results in outside hip pain that hurts rising from a chair, walking up stairs or even lying on that side at night.

The human instinct is to rest, but tendinopathies don’t work that way, in fact it is the opposite. The only way to adequately address issues such as gluteal tendinopathy is getting on top of your workload. Ensure you are graduating whatever activity you are re-engaging in appropriately, and you have the strength to do so. I typically use a hand held dynamometer in my clinic to assess someone’s strength to give me accurate numbers to work with. However, a rough guide is that if you can do a side plank for 30 seconds, you need some more hip strength.

Key tip – Workload management and pain management are paramount. If in pain, reduce loading and focus on strength. Lying hip lifts (e.g. 10 x 10 sec holds) are good when pain is acute. If not sore (just weak), side plank with top leg lifts are a good option to start. 3 x semi-fatigue each side. We employ reformer pilates often in this space but gym based activities are also appropriate.

Shoulder Pain – “Rotator Cuff” tears / tendinopathy

Do you have a ‘good’ and ‘bad’ shoulder? Have you been putting up with that grumbly shoulder for weeks, months or even years? Shoulder pain can put a real dampener on activities where repetitive overhead dynamic loading is common (e.g weights, tennis, golf or boxing).

The “rotator cuff” is a group of four muscles that help provide stability and control of the shoulder joint through range, particularly overhead. Rotator cuff tears are common in individuals over the age of 40 with linear increase in incidence as we get older. The most common reason for rotator cuff tears are due to overactivity of the shoulder joint coupled with deconditioning of the shoulder complex. Pain with movement and function is one of the biggest symptoms of a rotator cuff pathology.

Key Tip – Look at how much overhead activity you are doing and adequately prepare for it. This is best achieved in my experience with something like a banded Y Press hold (10x10s holds daily for a month) then progressing to more dynamic activities.

All in all, changes associated with menopause can leave you open to more injuries. However, if you can appropriately navigate, and most importantly graduate, your return to physical activity, then your body will certainly pay you dividends down the line. The evidence is overwhelming for the positive influences physical has on the human body. So do yourself (and your future self) a favour and ensure you aren’t retreating from your physical activity goals due to injury. It’s not what Betty would want.

If you have some of the above aches and pains, feel free to reach out or book in with one of our expert therapists.

Until next time, Praxis what you Preach.

Stephen Timms

All information is general in nature and it is always best to see your local physiotherapist, who uses exercise as the cornerstone of your rehabilitation.

Pilates: Mat vs Reformer Pilates (Part 2 of 3)

Pilates: Mat vs Reformer Pilates (Part 2 of 3)

by | Jun 21, 2019 | Reformer Pilates

In part one, we unearthed that pilates has a role to play in reducing the severity of chronic lower back pain. In part two, we tackle a common question from our patients and delve further into the research to see if there is a difference between mat and reformer pilates.

SUMMARY:

  • A reformer is a large piece of pilates equipment that utilises a spring mechanism to apply load in various positions and degrees of loading from gravity.
  • Both forms of exercise are better than the ‘wait and see’ or pharmacological approach with respect to chronic lower back pain
  • The use of reformers may provide a larger stimuli to the sensory system which facilitates proper performance due to better stabilisation
  • Pilates promotes the restoration of the function of muscles involved in lumbopelvic stabilisation, that is, transversus abdominis, multifidus, diaphragm and pelvic floor muscles (the “core”)
  • Reformer pilates provides more options for strengthening, ideal for those recovering from injury, pregnancy or surgery

 

As a general rule, the aim of pilates is to restore or sustain the motor control of the lumbar spine and proper body posture. Joseph Pilates (the founder of pilates) believed beginning exercise in the horizontal plane was important to relieve the stress and strain on the joints, and to align the body before adding additional gravitational forces while standing, sitting or kneeling.

Both mat and reformer are popular types of pilates which both focus on strengthening. Mat pilates, as its names suggests is a floor based method that tends to use bodyweight as the chief form of resistance.

Reformer, is the most popular equipment of Pilates. The design of Reformer utilises a spring mechanism that the person works to control while moving in various planes (Bulguroglu et al 2017). Reformer pilates allows more exercises compared to a mat and it provides the option of performing exercises numerous body positions – from your back, side, stomach and being seated — and also on your feet or knees.

COMPARE THE PAIR

Not a great deal of research has been conducted on differentiating the two forms of pilates. What studies do exist tend poorly define what equipment was used or whether individual tailoring of the sessions occurred.

Luz et al compared the effectiveness of Pilates mat and equipment-based Pilates exercises (with the use of Reformer) in a group of 86 individuals with chronic lower back pain. The 6-week routine included individual, 1-hour sessions performed twice a week and supervised by a Pilates-experienced physical therapist. The outcome measures were: pain intensity, disability, global perceived effect, patient’s specific disability and fear of movement, known as kinesiophobia (Luz et al 2014). The assessment was recorded after 6-week intervention and 6 months. A significant difference was noted in both groups after a 6-week programme in all of the areas evaluated. After 6 months however, a significant difference was found in disability, specific disability and kinesiophobia in favour of equipment-based Pilates exercises (Luz et al 2014; Eilks et al 2019).

 

In the study by Cruz-Diaz et al, the influence of Pilates mat exercises and equipment-based Pilates exercises (with reformer) on pain, disability, kinesiophobia and activation of transversus abdominis (expressed as a change in muscle thickness and assessed by real-time ultrasound examination) was assessed. The trial involved 98 patients with chronic lower back pan (CLBP) allocated to three groups: Pilates mat exercises, Pilates apparatus or the control group. The programme was conducted in groups of four participants during 12 weeks with 50 min sessions (twice a week). The evaluation was carried out during intervention (6 weeks after baseline) and after 12 weeks. As with Luz et al, significant improvement were shown in both groups for all outcome measures after 6 and 12 weeks. However, in the comparison between groups, the superiority of equipment-based Pilates was noted (Cruz-Diaz et al 2017). In both studies, it was suggested that the finding may be an effect of the use of apparatus in exercises that provides larger stimuli to the sensory system, resulting in larger feedback, which facilitates proper performance due to better stabilisation (Eilks et al 2019). According to da Luz et al, this result may also be caused by a placebo effect inherent for the application of equipment. As noted earlier however, reformer pilates offers a larger scope of exercises to draw upon for those who are limited by pain, weakness or fear of movement. So there you have it. What little research there is suggests that any pilates is good for your rehabilitation or as a part of your ongoing strength program. However, it appears that reformer pilates is more effective, and allows a greater degree of variability of training. For more about what makes Praxis Pilates special, check out our website here. Join us for part 3 next week where we look at what the research suggests regarding the frequency of pilates. Is more actually better? Till next time – Praxis what you preach Prevent. Prepare. Perform

References:

  1. Eliks, M., Zgorzalewicz-Stachowiak, M., & Zeńczak-Praga, K. (2019). Application of Pilates-based exercises in the treatment of chronic non-specific low back pain: state of the art. Postgraduate medical journal, 95(1119), 41-45.
  2. da Luz Jr, M. A., Costa, L. O. P., Fuhro, F. F., Manzoni, A. C. T., Oliveira, N. T. B., & Cabral, C. M. N. (2014). Effectiveness of mat Pilates or equipment-based Pilates exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Physical therapy, 94(5), 623-631.
  3. Bulguroglu, I., Guclu-Gunduz, A., Yazici, G., Ozkul, C., Irkec, C., Nazliel, B., & Batur-Caglayan, H. Z. (2017). The effects of Mat Pilates and Reformer Pilates in patients with Multiple Sclerosis: A randomized controlled study. NeuroRehabilitation, 41(2), 413-422.
  4. Cruz-Díaz, D., Bergamin, M., Gobbo, S., Martínez-Amat, A., & Hita-Contreras, F. (2017). Comparative effects of 12 weeks of equipment based and mat Pilates in patients with Chronic Low Back Pain on pain, function and transversus abdominis activation. A randomized controlled trial. Complementary therapies in medicine, 33, 72-77.
Pilates: Reforming our back pain rehabilitation (Part 1 of 3)

Pilates: Reforming our back pain rehabilitation (Part 1 of 3)

by | Jun 3, 2019 | Lower Back, Pain, Reformer Pilates

With our 30 day pilates challenge starting today, we thought we would take a look at why we love pilates so much for our patients, and what some of the benefits are. Part 1 looks at how pilates affect those with chronic lower back pain. Part 2 looks at the difference between mat and reformer pilates and part 3 looks at how often is required to see the benefit of pilates.

SUMMARY:

  • Back pain is extremely common, multifactorial, and often reoccurs
  • Strengthening interventions appear better for long term suffers of lower back pain
  • Pilates has been shown to improve muscular strength and endurance of key pelvic and postural musculature associated with lower back pain
  • Specifically, pilates promotes the restoration of the function of muscles involved in lumbopelvic stabilisation, that is, transversus abdominis, multifidus, diaphragm and pelvic floor muscles
  • As little as 2 sessions per week for 6 weeks has been shown to see improvements in pain and function for those with longstanding lower back pain, even after stopping pilates

Chronic low back pain (CLBP) is one of the commonest musculoskeletal problems in modern society (Anderson 1999) and is a highly prevalent in both the sporting and general public. CLBP is experienced by 70%–80% of adults at some time in their lives (Crombez et al 1999) and as such, the costs associated with LBP and related disability are enormous, causing a major economic burden for patients, governments and health insurance companies (Dagenais 2008).

Lower back pain has been one of the most extensively studied musculoskeletal conditions as a result of the prevalence and debilitation nature. Its management comprises a range of different intervention strategies including surgery, drug therapy and non-medical intervention like rehabilitation (Paolucci et al 2018). Within Physiotherapy, exercise therapy is probably the most commonly used intervention for the treatment of patients with chronic non-specific LBP due to its plausible biological rationale and low cost.

Whilst general conditioning programs to train strength and endurance of the spine musculature have been shown to reduce pain intensity and disability (Rainville et al 2004), the popularity of pilates (both mat and reformer) has helped provide an accessible and supervised form of therapeutic exercise.

EVIDENCE FOR PILATES

The Pilates method, using functional exercises aims to improve muscular strength and endurance. Specifically, the pilates method have promotes the restoration of the function of muscles involved in lumbopelvic stabilisation, that is, transversus abdominis, multifidus, diaphragm and pelvic floor muscles. Using the principles of progressive overload, your body adapts to the incremental loading week after week and consequently results important postural control improvement. In 2009, Curnow and colleagues showed that the Pilates method improves load transfer through the pelvis, something that intuitively helps those with CLBP.

However, a systematic review (Patti et al 2015) reported evidence that Pilates method-based exercises are more effective than no treatment or minimal physical exercise interventions in the management of chronic nonspecific LBP. Further, they pointed out that the effects of the Pilates method are only proven for patients with chronic nonspecific LBP in the short term.

A recent study by Natour and colleagues (2015) showed that the group of participants that were practicing Pilates method resulted statistically better compared with the a non exercising group who only used inflammatory medication. Those who were in the pilates group used less pain medication at 45, 90 (conclusion of the Pilates method), and 180 days, 90 days after the conclusion of the exercise program.

In conclusion, Pilates as an exercise choice is more effective than minimal physical exercise or drug based interventions in reducing pain and disability in the short-term period. There is agreement that exercise “helps” in the treatment of chronic pain, but it is still not clear exactly which factors or particular kind of exercises may be responsible of such improvements (Natour et al 2015; Patti et al 2015). Praxis Physiotherapy has always been a strong proponent of movement and loading early in rehabilitation (more on this in later blogs!).

In the next instalment, we discuss the difference between mat and reformer pilates and perhaps find some more answers regarding which exercise regime reigns supreme!

Check out all our other reformer pilates services on our website

Until next time,

Prevent. Prepare. Perform.

References:

  1. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354(91789178):581–585.
  2. Crombez G, Vlaeyen JW, Heuts PH, Lysens R, Crombez G. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80(1-2):329–339.
  3. Dagenais DC, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. The Spine Journal 2008;8(1):8‐20.
  4. Paolucci, T., Attanasi, C., Cecchini, W., Marazzi, A., Capobianco, S. V., & Santilli, V. (2019). Chronic low back pain and postural rehabilitation exercise: a literature review. Journal of pain research, 12, 95.
  5. Rainville J, Hartigan C, Martinez E, Limke J, Jouve C, Finno M. Exercise as a treatment for chronic low back pain. Spine J. 2004;4:106-115
  6. Patti, A., Bianco, A., Paoli, A., Messina, G., Montalto, M. A., Bellafiore, M., … & Palma, A. (2015). Effects of Pilates exercise programs in people with chronic low back pain: a systematic review. Medicine, 94(4).
  7. Curnow, D., Cobbin, D., Wyndham, J., & Choy, S. B. (2009). Altered motor control, posture and the Pilates method of exercise prescription. Journal of bodywork and movement therapies, 13(1), 104-111.
  8. Natour, J., Cazotti, L. D. A., Ribeiro, L. H., Baptista, A. S., & Jones, A. (2015). Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clinical rehabilitation, 29(1), 59-68.