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Pilates method on pain in patients with low back pain: systematic review

ABSTRACT

BACKGROUND AND OBJECTIVES:

The weakness of the trunk extensors is one of the main causes in the development of low back pain in a large part of the population. Low back pain is a disabling condition and due to the pain many people have difficulty performing activities of daily life. Thus, Pilates becomes one of the methods of choice in the treatment of low back pain because it brings muscle strengthening exercises that positively impact the stabilization of the spine. The objective of this study was to review the impact of the Pilates method on pain in patients with low back pain.

METHODS:

This is a systematic review, with search for data in the Scielo, OVID, Lilacs, Pubmed and PEDro databases, which included randomized clinical trials that addressed the Pilates method in patients with low back pain. The following search descriptors were used: low back pain, Pilates method, exercise movement techniques. The Boolean operators were: “and” and “or”.

RESULTS:

Of the 8 selected studies, all obtained positive results in the reduction of low back pain, each using a different protocol associated with physical therapy treatment. Of the eight studies considered eligible, only seven were included. For the study of this comparison, a random model was used (I2=92%, df=6, p=0.01), in which there was a statistically significant diference between the Pilates and control groups (95% CI -1.79, -0.19).

CONCLUSION:

It was possible to conclude that the Pilates method he was effective in the treatment of low back pain.

HIGHLIGHTS

  • The study reinforces the importance of the Pilates method for patients with low back pain, focusing on pain reduction, but with an impact on functionality and quality of life.

  • The role of Pilates as an integral part of a care protocol is also reinforced, not as the only tool for physical therapy care.

  • The application of Pilates method should begin with exercises of mild to moderate difficulty and, with functional gain, progress to high complexity.

INTRODUCTION

It is estimated that at least once in life, 80% of the population will have an episode of low back pain (LBP), and in 40% of these, the pain will become chronic11 Miyamoto GC, Costa LO, Cabral CM. Eficacy of the Pilates method for pain and disability in patients with chronic nonspecific low back pain: a systematic review with meta-analysis. Braz J Phys Ter. 2013;17(6):517-32.. Chronic LBP is a health problem that affects much of the population, reaching a prevalence of 11.9% of inhabitants worldwide. It is noteworthy that chronic LBP is a disabling condition, generating high absenteeism from life activities22 Oliveira JK, Oliveira FB, Silva DH, Silva PH. The effect of the Pilates method on the treatment of chronic low back pain: a clinical, randomized, controlled study. BrJP. 2018;1(1):21-8..

LBP has a multifactorial etiology, such as: age, gender, smoking, alcoholism, body weight, social class, and work activities33 Almeida ICGB, Sá KN, Silva M, Baptista A, Matos MA, Lessa I. Prevalência de dor lombar crônica na população da cidade de Salvador. Rev Bras Ortop. 2008;43(3):96-102.. The literature believes that the imbalance between the function of the trunk flexor and extensor muscles increases the probability of developing disorders that affect and impair the stability of the lumbar spine44 Ferreira TN, Martins PCML, Cavalcanti DSP. O método Pilates em pacientes com lombalgia. Saúde e Ciência em Ação. 2016;2(1):55-65.. Study55 Amorim MBJ, Bittencuort S W, Salício AM, Salício MAV. O método Pilates no tratamento da lombalgia crônica não-específica. Conect Line. 2012;7:101-9. proves that the work of strengthening the trunk extensors (lumbar square, multifdus, semispinatus, spine erector and interspinal) is the main responsible for reducing the symptoms of LBP, since there is considerable improvement in the stabilization of the lumbar spine.

The Pilates method is an exercise program often prescribed for these individuals, as it is used to activate and strengthen the stabilizing muscles of the trunk44 Ferreira TN, Martins PCML, Cavalcanti DSP. O método Pilates em pacientes com lombalgia. Saúde e Ciência em Ação. 2016;2(1):55-65.. This method is divided into two principles: the basic, which includes an exercise program that strengthens the abdominal and paravertebral muscles, such as the spine flexors; and the intermediate/advanced principle. Trunk extension exercises are gradually introduced and both include exercises for the whole body55 Amorim MBJ, Bittencuort S W, Salício AM, Salício MAV. O método Pilates no tratamento da lombalgia crônica não-específica. Conect Line. 2012;7:101-9..

Pilates can stimulate circulation, improve physical conditioning, increase flexibility and muscle range, improve postural alignment, increase levels of body awareness and improve motor coordination. Such benefts help prevent injuries and provide relief from chronic pain11 Miyamoto GC, Costa LO, Cabral CM. Eficacy of the Pilates method for pain and disability in patients with chronic nonspecific low back pain: a systematic review with meta-analysis. Braz J Phys Ter. 2013;17(6):517-32..

It was recently discovered by physiotherapists and orthopedists that this method can be used as a rehabilitation exercise, bringing quick and effective results66 Hasanpour-Dehkord A, Dehghani A, Solati K. A comparison of the effects of Pilates and McKenzie training on pain and general health in men with chronic low back pain: a randomized trial. Indian J Palliat Care. 2017;23(1):36-40.. It incorporates movement principles that include physical and cognitive elements: full-body movement, attention to breathing, balanced muscle development, concentration, control, centering, precision and rhythm77 Stolse RL, Allison CS, Childs DJ. Derivation of a preliminary clinical prediction rule for identifying a subgroup of patients with low back pain likely to beneft from Pilates-based exercise. J Orthop Sports Phys Ter. 2012;42(5):425-36.. Therefore, this method can be effective to improve general health, such as athletic performance, proprioception and pain reduction in patients with LBP55 Amorim MBJ, Bittencuort S W, Salício AM, Salício MAV. O método Pilates no tratamento da lombalgia crônica não-específica. Conect Line. 2012;7:101-9..

Pilates may be indicated for the treatment of non-specific LBP88 Alves MC, de Souza Neto RJ, Barbosa RI, Marcolino AM, Kuriki HU. Efects of a Pilates protocol in individuals with non-specific low back pain compared with healthy individuals: clinical and electromyographic analysis. Clin Biomech (Bristol, Avon). 2020;72:172-8.. Pilates training also shows effective evolution in static and dynamic balance, in addition to strengthening the lower and upper limbs, center control, breathing work, hip and lumbar flexibility and cardiovascular endurance99 Carrasco Poyatos M, Ramos-Campo DJ, Rubio-Arias JA. Pilates versus resistance training on trunk strength and balance adaptations in older women: a randomized controlled trial. Peer J.2019;14;7:e7948..

Recently, the literature brought evidence of the Pilates method on pain in patients with chronic musculoskeletal conditions, especially the seniors. The present review seeks to bring evidence related to Pilates in patients with LBP, without age restriction. Others authors1010 Yamato T P, Maher CG, Saragiotto BT, Hancock MJ, Ostelo RWJG, Cabral CMN, Costa LCM, Costa LOP. Pilates for Low Back Pain: Complete Republication of a Cochrane Review. Spine (Phila Pa 1976). 2016;41(12):1013-1021.,1111 Patti A, Bianco A, Paoli A, Messina G, Montalto MA, Bellafore M, Battaglia G, Iovane A, Palma A. Efects of Pilates exercise programs in people with chronic low back pain: a systematic review. Medicine (Baltimore). 2015;94(4):e383. have already published about Pilates on LBP, however, nine years after this publication, there is a need for an update on the subject. Given the above, the aim of the study is to review the impact of the Pilates method on pain in the treatment of patients with LBP.

METHODS

This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the study’s guiding question was: “What are the effects of the Pilates method on pain for low back pain”? The survey was structured based on the PICO tool (Table 1)1212 da Costa Santos CM, de Mattos Pimenta CA, Nobre MR. The PICO strategy for the research question construction and evidence search. Rev Lat Am Enfermagem. 2007;15(3);508-11.. The study was registered with the International prospective register of systematic reviews (PROSPERO) under number CRD42021228049.

Table 1
PICO’s research strategy.

The following databases were systematically searched: PubMed, Scielo, PEDro (Physiotherapy Evidence Database), OVID and LILACS (Latin American and Caribbean Health Sciences). MeSH terms used were: “low back pain” and “exercise movement techniques”, in these already related words, and the keyword “Pilates method” was also used. Boolean operators “AND” and “OR” were added, according to the Medical Subject Headings (MeSH) (Table 2). The study was conducted from March to April 2020.

Table 2
Search strategy in Pubmed data library.

Inclusion and exclusion criteria

The selected studies were randomized clinical trials that addressed the Pilates method when applied to patients with chronic nonspecific LBP, without restriction of language or year of publication. Studies that addressed other diseases, that related LBP to pregnancy and that used surgical treatment for LBP were excluded.

Methodological quality assessment

Methodological quality of the studies was assessed according to the criteria of PEDro scale, which scores 11 items, namely: 1-Eligibility criteria, 2 - Random allocation, 3 - Hidden allocation, 4 - Baseline comparison, 5 - Blinded individuals, 6 - Blind therapists, 7 - Blind evaluators, 8 - Adequate follow-up, 9 - Intention to treat the analysis, 10 - Comparisons between groups, 11 - Point estimates and variability. Items are scored as present (1) or absent (0), generating a maximum sum of 10 points, with the first item not counting. PEDro is a specific database for studies investigating the effectiveness of interventions in physical therapy and can be accessed free of charge through the website <www.pedro.org.au>1313 PEDro is the Physiotherapy Evidence Database. Escala de PEDro. Acesso em: 16/07/2020. Disponível em: https://www.pedro.org.au/portuguese/downloads/pe-dro-scale/
https://www.pedro.org.au/portuguese/down...
.

Data extraction

Searches performed in the databases followed three steps, which included: search of titles, abstracts and complete reading of the articles in order to extract data, carefully analyzing each part that composes them, such as: author, title, abstract, journal, year and conclusions, thus making it possible to flter the most relevant information for final research.

Selection and data extraction of the articles were performed by two independent reviewers. When there was disagreement between them, both reread the article for re-examination. If disagreement remained, a third independent reviewer would analyze and decide. The research followed the PRISMA 20201414 Moher D, Liberati A, Tetzlaf J, Altman DG. The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta- Analyses: The PRISMA Statement. PLoS Med. 2009;6(7):e1000097. protocol items for systematic reviews.

RESULTS

A total of 190 articles were found, 37 in Scielo, 80 in LILACS, 74 in Pubmed and 13 in PEDro. Only 14 scientific articles were selected after reading the titles and abstracts. The other six articles were excluded for the following reasons: one did not include LBP as the focus, one did not address Pilates as the main form of treatment, one literature review, one non-randomized study, one case report and one study that had no control group. The figure 1 demonstrates all the criteria and databases used to select the articles.

Figure 1
Flowchart for obtaining randomized clinical trials

In the assessment of methodological quality with PEDro scale, the scores of five articles were already available in PEDro database1515 Silva PH, Silva D F, Oliveira JK, Oliveira FB. The effect of the Pilates method on the treatment of chronic low back pain: a clinical, randomized, controlled study. BrJP. 2018;1(1):21-8.,1616 Rydeard R, Leger A, Smith D. Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. J Orthop Sports Phys Ter. 2006;36(7):472-84.,1919 Valenza MC, Rodrigues-Torres J, Cabrera-Martos I, Díaz-Pelegrina A, Agular-Ferrándiz ME, Castellote-Caballero Y. Results of a Pilates exercise program in patients with chronic non-specific low back pain: a randomized controlled trial. Clin Rehabil. 2017;31(6):753-60., 2020 Miyamoto GC, Costa LO, Galvanin T, Cabral CM. Eficacy of the addition of modified pilates exercises to a minimal intervention in patients with chronic low back pain: a randomized controlled trial. Phys Ter. 2013;93(3):310-20., 2121 Bhadauria EA, Gurudut P. Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: randomized clinical trial. J Exerc Rehabil. 2017;13(4):477-85., 2222 Natour J, Cazotti LA, Ribeiro L, Baptista AS, Jones A. Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clin Rehabil. 2015;29(1):59-68. and the two articles1717 Cruz-Díaz D, Martínez-Amat A, De la Torre-Cruz MJ, Casuso RA, de Guevara NM, Hita-Contreras F. Efects of a six-week Pilates intervention on balance and fear of falling in women aged over 65 with chronic low-back pain: a randomized controlled trial. Maturitas. 2015;82(4):371-6.,1818 Cruz-Díaz D, Martinez-Amat A, Osuna-Pérez MC, De la Torre-Cruz MJ, Hita-Contreras F. Short- and long-term effects of a six-week clinical Pilates program in addition to physical therapy on postmenopausal women with chronic low back pain: a randomized controlled trial. Disabil Rehabil. 2016;38(13):1300-8. were evaluated by two independent reviewers as the scores were not yet available. Scores ranged from 6 to 7 points on a scale of zero to 10 points (Table 3). All studies lost points in items related to blinding the patient and therapist, and only two studies1717 Cruz-Díaz D, Martínez-Amat A, De la Torre-Cruz MJ, Casuso RA, de Guevara NM, Hita-Contreras F. Efects of a six-week Pilates intervention on balance and fear of falling in women aged over 65 with chronic low-back pain: a randomized controlled trial. Maturitas. 2015;82(4):371-6.,2121 Bhadauria EA, Gurudut P. Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: randomized clinical trial. J Exerc Rehabil. 2017;13(4):477-85. blinded the evaluator.

Table 3
Assessment of the methodological quality of the studies included in this review using the PEDro Database scale

Eight studies1515 Silva PH, Silva D F, Oliveira JK, Oliveira FB. The effect of the Pilates method on the treatment of chronic low back pain: a clinical, randomized, controlled study. BrJP. 2018;1(1):21-8., 1616 Rydeard R, Leger A, Smith D. Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. J Orthop Sports Phys Ter. 2006;36(7):472-84., 1717 Cruz-Díaz D, Martínez-Amat A, De la Torre-Cruz MJ, Casuso RA, de Guevara NM, Hita-Contreras F. Efects of a six-week Pilates intervention on balance and fear of falling in women aged over 65 with chronic low-back pain: a randomized controlled trial. Maturitas. 2015;82(4):371-6., 1818 Cruz-Díaz D, Martinez-Amat A, Osuna-Pérez MC, De la Torre-Cruz MJ, Hita-Contreras F. Short- and long-term effects of a six-week clinical Pilates program in addition to physical therapy on postmenopausal women with chronic low back pain: a randomized controlled trial. Disabil Rehabil. 2016;38(13):1300-8., 1919 Valenza MC, Rodrigues-Torres J, Cabrera-Martos I, Díaz-Pelegrina A, Agular-Ferrándiz ME, Castellote-Caballero Y. Results of a Pilates exercise program in patients with chronic non-specific low back pain: a randomized controlled trial. Clin Rehabil. 2017;31(6):753-60., 2020 Miyamoto GC, Costa LO, Galvanin T, Cabral CM. Eficacy of the addition of modified pilates exercises to a minimal intervention in patients with chronic low back pain: a randomized controlled trial. Phys Ter. 2013;93(3):310-20., 2121 Bhadauria EA, Gurudut P. Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: randomized clinical trial. J Exerc Rehabil. 2017;13(4):477-85., 2222 Natour J, Cazotti LA, Ribeiro L, Baptista AS, Jones A. Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clin Rehabil. 2015;29(1):59-68. were considered eligible for this review. Table 4 shows the details of the studies and interventions.

Table 4
Characteristics of the studies.

Comparison of the Pilates method with other interventions for the outcome of pain

Eight studies1515 Silva PH, Silva D F, Oliveira JK, Oliveira FB. The effect of the Pilates method on the treatment of chronic low back pain: a clinical, randomized, controlled study. BrJP. 2018;1(1):21-8., 1616 Rydeard R, Leger A, Smith D. Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. J Orthop Sports Phys Ter. 2006;36(7):472-84., 1717 Cruz-Díaz D, Martínez-Amat A, De la Torre-Cruz MJ, Casuso RA, de Guevara NM, Hita-Contreras F. Efects of a six-week Pilates intervention on balance and fear of falling in women aged over 65 with chronic low-back pain: a randomized controlled trial. Maturitas. 2015;82(4):371-6., 1818 Cruz-Díaz D, Martinez-Amat A, Osuna-Pérez MC, De la Torre-Cruz MJ, Hita-Contreras F. Short- and long-term effects of a six-week clinical Pilates program in addition to physical therapy on postmenopausal women with chronic low back pain: a randomized controlled trial. Disabil Rehabil. 2016;38(13):1300-8., 1919 Valenza MC, Rodrigues-Torres J, Cabrera-Martos I, Díaz-Pelegrina A, Agular-Ferrándiz ME, Castellote-Caballero Y. Results of a Pilates exercise program in patients with chronic non-specific low back pain: a randomized controlled trial. Clin Rehabil. 2017;31(6):753-60., 2020 Miyamoto GC, Costa LO, Galvanin T, Cabral CM. Eficacy of the addition of modified pilates exercises to a minimal intervention in patients with chronic low back pain: a randomized controlled trial. Phys Ter. 2013;93(3):310-20., 2121 Bhadauria EA, Gurudut P. Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: randomized clinical trial. J Exerc Rehabil. 2017;13(4):477-85., 2222 Natour J, Cazotti LA, Ribeiro L, Baptista AS, Jones A. Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clin Rehabil. 2015;29(1):59-68. evaluated pain before and after the intervention (n=497) and the study1717 Cruz-Díaz D, Martínez-Amat A, De la Torre-Cruz MJ, Casuso RA, de Guevara NM, Hita-Contreras F. Efects of a six-week Pilates intervention on balance and fear of falling in women aged over 65 with chronic low-back pain: a randomized controlled trial. Maturitas. 2015;82(4):371-6. did not have pain as an outcome. One study33 Almeida ICGB, Sá KN, Silva M, Baptista A, Matos MA, Lessa I. Prevalência de dor lombar crônica na população da cidade de Salvador. Rev Bras Ortop. 2008;43(3):96-102. compared the Pilates method with conventional kinesiotherapeutic exercises, such as conventional stretching and strengthening of the lumbar spine and lower limbs (n=16); the following exercises of the Pilates method were performed: breathing with transverse abdomen activation, in addition to the following postures: spine stretch, the spine twist, the hundred, the one leg circle, the plank, leg pull front, swimming, rocking and swan. In total, 12 sessions were held, twice a week, lasting 40 minutes and performed individually.

The study1616 Rydeard R, Leger A, Smith D. Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. J Orthop Sports Phys Ter. 2006;36(7):472-84. compared the Pilates method with defined usual care, such as consulting a physician and other specialists and health professionals as needed (n=39). The Pilates group received a treatment protocol consisting of training in specialized apparatus (Pilates) in the clinic for three sessions of 1 hour per week and training in a 15-minute home program, performed 6 days a week for 4 weeks. The apparatus used in the clinic consisted of a foor mat and a Pilates Reformer with a standing platform and accessories for jumping boards.

The study1717 Cruz-Díaz D, Martínez-Amat A, De la Torre-Cruz MJ, Casuso RA, de Guevara NM, Hita-Contreras F. Efects of a six-week Pilates intervention on balance and fear of falling in women aged over 65 with chronic low-back pain: a randomized controlled trial. Maturitas. 2015;82(4):371-6. compared the conventional physical therapy intervention of the control group with Pilates exercises (n=97). The Pilates group received the control group treatment plus two sessions per week of Pilates exercise. The control group performed Transcutaneous Electrical Stimulation, massage and stretching of the lumbar region.

The study1818 Cruz-Díaz D, Martinez-Amat A, Osuna-Pérez MC, De la Torre-Cruz MJ, Hita-Contreras F. Short- and long-term effects of a six-week clinical Pilates program in addition to physical therapy on postmenopausal women with chronic low back pain: a randomized controlled trial. Disabil Rehabil. 2016;38(13):1300-8. compared the Pilates method with physical agents such as electrical stimulation or manual therapy (n=101). Pilates exercises were performed aiming at strengthening with the use of implements such as ft balls, magic rings and TeraBands; flexibility and joint mobility exercises; breathing exercises; posture control and correction tasks for 6 weeks or conventional physical therapy using analgesics, electrotherapy and joint mobilization. The study1919 Valenza MC, Rodrigues-Torres J, Cabrera-Martos I, Díaz-Pelegrina A, Agular-Ferrándiz ME, Castellote-Caballero Y. Results of a Pilates exercise program in patients with chronic non-specific low back pain: a randomized controlled trial. Clin Rehabil. 2017;31(6):753-60. compared the results of Pilates exercises with usual activities and guidance through leafets (n=54). In the Pilates method, foor exercises were performed using a 55 cm ball on a rubber mat, including the following exercises: saw, mermaid, unilateral stretch, leg stretch, cross, swan dive, spine twist, unilateral kick, leg kick double, one leg circle, side kick and 3-5 minutes of relaxation progressing at basic, intermediate, and advanced levels. Control group patients continued their usual activities and received advice in the form of a leaflet.

The study2020 Miyamoto GC, Costa LO, Galvanin T, Cabral CM. Eficacy of the addition of modified pilates exercises to a minimal intervention in patients with chronic low back pain: a randomized controlled trial. Phys Ter. 2013;93(3):310-20. compared results between the Pilates method applied in practice with theoretical guidelines in the form of a study for postural reeducation (n=86). In the Pilates method group, exercises were applied working on lower back muscle flexibility and strengthening exercises encompassing progression with load and isometry. The control group received guidance and study materials and only worked with theory.

The study2121 Bhadauria EA, Gurudut P. Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: randomized clinical trial. J Exerc Rehabil. 2017;13(4):477-85. compared the results between groups using the Pilates method and joint mobilization. Joint mobilization was accomplished by activating the powerhouse, which represents isometric contraction. This included finding the neutral spine, breathing practice, engaging pelvic foor and transverse traction. In the Pilates group, both solo Pilates and Pilates with the aid of equipments were applied, working on the patient’s pain with strengthening exercises that improve muscle flexibility, giving more conditions to muscle fibers and improving the stabilization of the pelvic foor. In patients who were in more acute pain, electrostimulation as analgesia was applied. In the control group, patients were submitted to a protocol of muscle strengthening and relaxation exercises.

Another author2222 Natour J, Cazotti LA, Ribeiro L, Baptista AS, Jones A. Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clin Rehabil. 2015;29(1):59-68. compared the Pilates method with the use of antisteroids without exercise intervention. The Pilates group had a protocol applied with stretching, improving muscle flexibility and strengthening, thus improving the capacity of muscle fibers. Strengthening exercises were worked with isometrics and Pilates classes were done twice a week, lasting 50 minutes each. Control group was followed only with the use of antisteroids and postural recommendation. General data for each study are shown in Table 5.

Table 5
Details of study data, in means and standard deviations.

DISCUSSION

Based on the results obtained in this systematic review in all studies, it can be observed that Pilates associated with physical therapy treatment generated a significant reduction in pain. It is important to emphasize the high heterogeneity of the study and the non-use of the assessment of the level of evidence, which may have influenced the results of this review.

The study1515 Silva PH, Silva D F, Oliveira JK, Oliveira FB. The effect of the Pilates method on the treatment of chronic low back pain: a clinical, randomized, controlled study. BrJP. 2018;1(1):21-8. showed that the Pilates Method is an alternative to conventional methods because it verifed that, like Physiotherapy, Pilates is also effective for the treatment of patients with chronic LBP. Study1616 Rydeard R, Leger A, Smith D. Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. J Orthop Sports Phys Ter. 2006;36(7):472-84. proved that exercise produces a great reduction in pain in these individuals, as it is a resource that plays an important role in the treatment of LBP. Improved posture is a consequence of increased flexibility along with strengthening the core, which is extremely important to maintain the correct spine position2323 Borges CS, Fernandes LFR, Bertoncello D. Correlação entre alterações lombares e modificações no arco plantar em mulheres com dor lombar. Acta Ortop Bras. 2013;21(3):135-8..

The addition of the Pilates method to the protocol by the authors1717 Cruz-Díaz D, Martínez-Amat A, De la Torre-Cruz MJ, Casuso RA, de Guevara NM, Hita-Contreras F. Efects of a six-week Pilates intervention on balance and fear of falling in women aged over 65 with chronic low-back pain: a randomized controlled trial. Maturitas. 2015;82(4):371-6.,1818 Cruz-Díaz D, Martinez-Amat A, Osuna-Pérez MC, De la Torre-Cruz MJ, Hita-Contreras F. Short- and long-term effects of a six-week clinical Pilates program in addition to physical therapy on postmenopausal women with chronic low back pain: a randomized controlled trial. Disabil Rehabil. 2016;38(13):1300-8. provided good results in terms of reducing LBP in patients. It was also possible to verify the long-term effectiveness, where it was concluded that benefts remained after one year of treatment. This is justifed by the strengthening of the diaphragm, hip flexors, buttocks, perineum musculature and deep erectors of the spine, generating continuous improvement in lumbar stabilization2424 Pereira NT, Ferreira LAB, Pereira WM. Efetividade de exercícios de estabilização segmentar sobre a dor lombar crônica mecânico-postural. Fisioter Mov. 2010;23(4):605-14..

Approaching the treatment in a different way, involving basic Pilates body exercises and breathing control, authors1919 Valenza MC, Rodrigues-Torres J, Cabrera-Martos I, Díaz-Pelegrina A, Agular-Ferrándiz ME, Castellote-Caballero Y. Results of a Pilates exercise program in patients with chronic non-specific low back pain: a randomized controlled trial. Clin Rehabil. 2017;31(6):753-60. obtained positive diferences regarding chronic nonspecific LBP in patients. In addition to an improvement in pain, it was also possible to develop a better postural awareness acquired through exercises that encourage bilateral muscle development and flexibility.

The distinction between the results obtained in the treatments for LBP can be justifed by the diference between the treatment programs in terms of duration and protocol used for each group. The authors2020 Miyamoto GC, Costa LO, Galvanin T, Cabral CM. Eficacy of the addition of modified pilates exercises to a minimal intervention in patients with chronic low back pain: a randomized controlled trial. Phys Ter. 2013;93(3):310-20. observed a great advantage in short-term treatment with Pilates interventions compared to a posture education treatment without the Pilates Method intervention.

Unlike authors2121 Bhadauria EA, Gurudut P. Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: randomized clinical trial. J Exerc Rehabil. 2017;13(4):477-85., who state that the Pilates Method is only effective when the dynamic stabilization of the lower back is performed, study2222 Natour J, Cazotti LA, Ribeiro L, Baptista AS, Jones A. Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clin Rehabil. 2015;29(1):59-68. believe that it is better for patients to perform Pilates than not to practice any type of physical activity. In this method, the stabilization of the lower back is worked through the activation of abdominal muscles, in addition to the guidelines to keep the spine and pelvis neutral.

The present results may have been influenced by the variation in mean age. The Pilates modality was not the same in all articles, alternating between mat Pilates and Pilates with the aid of equipments. There was also heterogeneity in relation to the application time between the articles’ protocols. In addition, the absence of GRADE assessment and the high heterogeneity are limitations of this study. From a social perspective, this work signals to the population the benefts and the need to popularize the Pilates method for individuals with LBP. For science, it becomes a propagator of the method, in addition to serving as a basis for further studies on the subject.

This review brings the perspective of the production of new studies with more adequate protocols for this population, presenting homogeneity and allowing the exact understanding of the role of the Pilates method in patients with chronic nonspecific LBP in the short, medium, and long term.

CONCLUSION

With the results obtained in this study, it is possible to conclude that the Pilates method has significantly positive effects in the treatment of lower back pain. The clinician must be careful and prescribe the Pilates method individually.

  • Sponsoring sources: none.

REFERENCES

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Publication Dates

  • Publication in this collection
    21 Nov 2022
  • Date of issue
    Jul-Sep 2022

History

  • Received
    20 Dec 2021
  • Accepted
    27 Aug 2022
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