Principles of the Pilates method and its effect on low back pain, pelvic floor function and posture: A systematic review of the literature

Naama Mizrachi, Dr. Rachel Kafri


Introduction: Pilates method is a form of physical exercise that was developed by Joseph Hubertus Pilates. The popularity of the Pilates method as a physical activity for healthy individuals as for those engaged in rehabilitation has grown rapidly over the past years, and an increasing number of healthcare practitioners are using the Pilates-based approach for rehabilitation. The fans of the Pilates method claim that it leads to increased trunk and core-muscle strength, and improves range of motion, proprioception, balance, and coordination. If so, it can theoretically be used to treat different musculoskeletal problems, e.g., low back pain, posture deficit, etc.

The objective of this study was to assess the influence of the Pilates method on low back pain, posture, and pelvic floor function.

Methods: Using the Pubmed and Google scholar databases, a structured search was conducted for relevant articles published in the last 5 years. 

Results: Forty-four articles were found, 19 of them were included in the review, and 25 were excluded for the following reasons: 1. No intervention was executed. 2. No outcome measures (i.e pain scale, disability, pelvic floor muscles strength, pelvic floor function and / or posture measures) were demonstrated.

Discussion and conclusions: Pilates-based exercise may decrease the intensity of low back pain and disability compared to minimal intervention; however, it is not more effective than general exercise or other forms of exercise. The majority of articles reviewed concluded that Pilates method had a positive effect on pelvic floor dysfunction, but this effect did not differ from the effect gained from conventional physical therapy. Pilates-based exercise was found to have a positive effect on posture, in comparison to no treatment. As physical activity is recommended for low back pain, posture deficit, and pelvic floor dysfunction, yet no method has been shown to offer a clear advantage over the others, the choice to use the Pilates method should be based on the patient’s and/or care provider’s preferences.

The paucity of comparative clinical studies, as well as the methodological limitations of existing studies, indicates the need for additional high-quality studies, in order to substantiate the benefits of the Pilates method for treating various musculoskeletal problems, such as low back pain, posture deficit and pelvic floor dysfunction.

Key words: Pilates, Pilates-based exercise, Pelvic floor, Low back pain, Posture

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