BACKGROUND: The Pilates method has been used to improve function and reduce pain in patients with chronic nonspecific low back pain, although there is little scientific evidence that describes its efficacy.
OBJECTIVE: The purpose of this study was to investigate the effectiveness of the addition of modified Pilates exercises to minimal intervention in patients with chronic low back pain.
DESIGN: A randomized controlled trial was conducted.
SETTING: The study was done in an outpatient physical therapy department in Brazil.
PATIENTS: Eighty-six patients with chronic nonspecific low back pain participated in the study.
INTERVENTION: All participants received an education booklet containing information about low back pain and were randomly allocated to receive 12 sessions, over 6 weeks, of exercises based upon Pilates principles (n=43) or of education alone (n=43).
MEASUREMENTS: Primary outcomes were pain intensity and disability measured at 6 weeks and 6 months. Secondary outcomes were patient-specific functional disability, global impression of recovery, and kinesiophobia measured at 6 weeks and 6 months. All outcomes were measured by a blinded assessor in all time points.
RESULTS: There was no loss to follow-up at any of the time points. Improvements were observed in pain (mean difference=2.2 points, 95% confidence interval [CI]=1.1 to 3.2), disability (mean difference=2.7 points, 95% CI=1.0 to 4.4), and global impression of recovery (mean difference=-1.5 points, 95% CI=-2.6 to -0.4) in favor of the Pilates group after intervention, but these differences were no longer statistically significant at 6 months.
LIMITATIONS: Treatment provider and participants could not be blinded to the interventions.
CONCLUSIONS: The addition of modified Pilates exercises to an educational booklet provides small benefits compared with education alone in patients with chronic nonspecific low back pain; however, these effects were not sustained over time.
STUDY DESIGN: Randomized controlled trial.
OBJECTIVE: This is the companion study to a previous publication that presented 8-week pain, disability, and trunk muscle motor control results. The objective of this study was to compare the effect of 8 weeks of specific trunk exercises and stationary cycling on outcomes measures of catastrophizing and fear-avoidance beliefs (FAB) in patients with chronic nonspecific low back pain, and provide 6-month outcome data for all self-report measures.
SUMMARY OF BACKGROUND DATA: It is thought that any form of moderate-to-vigorous physical activity is sufficient to address catastrophizing and FAB, and concomitant levels of pain and disability.
METHODS: Sixty-four patients with low back pain were randomly assigned to 8 weeks of specific trunk exercise group (SEG), or stationary cycling group (CEG). Self-rated pain, disability, catastrophizing and FAB scores were collected before, immediately after (8 wk), and 6 months after the training program. Clinically meaningful improvements were defined as greater than a 30% reduction from baseline in pain and disability scores. "Intention-to-treat" principles were used for missing data. Per-protocol analysis was performed on participants who attended at least two-thirds of the exercise sessions.
RESULTS: At 8 weeks, disability was significantly lower in the SEG compared with the CEG (d = 0.62, P = 0.018). Pain was reduced from baseline in both the groups after training (P < 0.05), but was lower for the SEG (P < 0.05). FAB scores were reduced in the SEG at 8 weeks, and in the CEG at 6 months. No between-group differences in FAB scores were observed. Similar reductions in catastrophizing in each group were observed at each time point. At 6 months, the overall data pattern suggested no long-term difference between groups. Per-protocol analysis of clinically meaningful improvements suggests no between-group differences for how many patients are likely to report improvement.
CONCLUSION: Inferential statistics suggest greater improvements at 8 weeks, but not 6 months, for the SEG. Inspection of clinically meaningful changes based on a minimum level of adherence suggests no between-group differences. If a patient with low back pain adheres to either specific trunk exercises or stationary cycling, it is reasonable to think that similar improvements will be achieved.
LEVEL OF EVIDENCE: 2.
PURPOSE: This single-assessor-blinded randomized controlled trial aimed to compare the efficacy of physiotherapy-delivered clinical Pilates and general exercise for chronic low back pain.
METHODS: Eighty-seven community volunteers with low back pain for ≥3 months and age 18-70 were randomized to either the Pilates (n = 44) or general exercise (n = 43) group. The primary outcome was pain/disability measured with the Quebec scale. Secondary outcomes included pain on a numeric rating scale, Patient-Specific Functional Scale, Pain Self-efficacy Questionnaire, quality of life, and global perceived effect of treatment. All participants attended 60-min exercise sessions twice weekly for 6 wk supervised by a physiotherapist and performed daily home exercises that were continued during the follow-up. Participants from the clinical Pilates group received an individualized direction-specific exercise program prescribed by the physiotherapist after a clinical examination. The general exercise group received a generic set of exercises that were multidirectional and nonspecific. Outcomes were assessed after 6 wk (primary time point) and at 12 and 24 wk. Differences in mean change were compared between groups using ANCOVA adjusted for baseline values of the outcome.
RESULTS: Eighty-three participants (96%) completed the 6-wk intervention and 60 (69%) completed the 24-wk follow-up. At 6 wk, no difference was found between groups for change in the Quebec scale (3.5, 95% confidence interval = -7.3 to 0.3, P = 0.07); both groups showed significant improvements. Similar results were found at the 12- and 24-wk follow-up and for the secondary outcome measures.
CONCLUSIONS: An individualized clinical Pilates program produced similar beneficial effects on self-reported disability, pain, function and health-related quality of life as a general exercise program in community volunteers with chronic low back pain.
BACKGROUND: Pilates has been advocated to be of benefit for patients with low back pain (LBP). The aim of this study was to investigate the possible benefits of attending Pilates classes for patients who had completed standard physiotherapy treatment but still had some symptoms. METHODS: Ethical approval was obtained. All LBP patient charts (n=181) who had completed physiotherapy treatment in the participating hospital during a 6 month period were screened for study inclusion. 29 women (16%) were recruited into the study. Subjects were randomly allocated either to attendance at a one hour Pilates mat class consisting of modified Pilates exercises for 8 weeks (n=15) or no further intervention (n=14). Outcome measures were evaluated by a blinded assessor using Visual Analogue Scale (VAS) for pain, Roland Morris Disability Questionnaire for disability and Sahrmann Abdominal Test for lumbopelvic control before and after the 8 week intervention period. RESULTS: Statistical Package for the Social Sciences (SPSS) version 15.0 was used to analyse data. The Mann-Whitley U test was used to identify any significant changes between the groups. There was a statistical (p=0.047) but not clinically significant improvement in pain in the Pilates group (9.5mm mean change on VAS) compared to the control group (−4.7mm). No significant difference in disability was noted between the groups at follow up (p=0.301). A trend towards improvement in lumbopelvic control was observed in the Pilates group. CONCLUSION: Despite the small sample size this study provides some evidence to support the use an 8 week Pilates class to improve pain in women with ongoing LBP who have completed conventional physiotherapy treatment.
PURPOSE: The popularity of the Pilates method created by Joseph H. Pilates in the early 1920s has increased worldwide in the last decade, confirming the fact that Pilates is much more than a fitness fad. According to a survey conducted by American Sports Data Inc, more than 10.5 million Americans participated in a Pilate's class in 2004. The aim of this study was to determine effectiveness of Pilate's protocol in decreasing of low back pain and urine catecholamine levels. METHODS: Twenty athletes. Recruited for the study were between the ages of 22 and 25 years old, with a mean age of 24 years. Divided into two groups, experimental group consisted of (10) athletes. Control group consisted of (10) athletes. All two groups had chronic low back pain. Pilate's exercises were eight-week period for experimental group.4 days weekly. RESULTS: The experimental group showed improvement increase in lumbar spine flexion and extension but not significant between the pre and Post measurement. Significant differences between two groups in the urine catecholamine levels. CONCLUSIONS: Urine catecholamine can be used an indicator to sports injury.
OBJECTIVE: To evaluate the effect of a program of modified Pilates for active individuals with chronic non-specific low back pain. DESIGN: A single blind randomized controlled trial. Participants: 49 individuals with chronic low back pain were randomly allocated to control (n = 24) or Pilates group (n = 25). Thirty-four individuals completed the study (14 and 20 individuals for control and Pilates group, respectively). INTERVENTION: The Pilates group undertook a six week program of Pilates. Both groups continued with normal activity. MAIN OUTCOME MEASURES: An assessor blinded to group allocation conducted functional and questionnaire-based assessments pre- and post- intervention. RESULTS: Improvements were seen in the Pilates group post- intervention period with increases (P < 0.05) in general health, sports functioning, flexibility, proprioception, and a decrease in pain. The control group showed no significant differences in the same measures post- intervention. CONCLUSIONS: These data suggest that Pilates used as a specific core stability exercise incorporating functional movements can improve non-specific chronic low back pain in an active population compared to no intervention. Additionally, Pilates can improve general health, pain level, sports functioning, flexibility, and proprioception in individuals with chronic low back pain.
The Pilates exercise method applies many of the principles of lumbar stabilisation that have been found to be effective in the treatment of chronic low back pain. Pilates has recently found its way into the physiotherapy setting, where it is being integrated into the rehabilitation of patients with low back pain. This study consisted of a randomised control trial using an intervention group that underwent a twelve-week Pilates programme, and control group that continued with standardised physiotherapy treatment as necessary. Baseline, three-week, and twelve-week scores for a Visual Analogue Scale for pain and the Roland Morris Disability Questionnaire were recorded and compared. The Pilates group showed significantly greater improvements in pain and functional disability mean scores when compared to the control group (p=0.059 and p=0.026 respectively). It therefore appears that Pilates can be recommended as an effective treatment modality for the reduction of pain and the improvement of functional disability for chronic low back pain sufferers.
