Pilates for Low Back Pain?

Group of women doing Pilates exercises.
This week we are going to talk about a research article: Effectiveness of Mat Pilates or Equipment-Based Pilates Exercises in Patients with Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial published by Mauricio Antonio da Luz Jr, Leonardo Oliviera Pena Costa, Fernanda Ferreira Fuhro, Ana Carolina Taccolini Manzoni, Naiane Teixeira Bastos Oliveira, Cristina Maria Nunes Cabral.
Chronic low back pain, which is classified as persistent low back pain that lasts for a minimum of 3 months, is a significant public health problem due to three main reasons. First of all, 39% of adults report having at least one episode of low back pain per year, making low back pain one of the most common conditions. Second of all, low back pain affects all age groups, all nations and leaves many people living with disabilities.  Third reason is the high cost to our society due to overall cost of treatment added with cost of loss of time from work/ productivity.
Modified pilates has been used in treatment of low back pain for patients of all ages. The pilates method is based on 6 basic principles: centering, concentration, precision, fluidity and diaphragmatic breathing. Pilates primarily focuses on activating deep core stabilizors during diaphragmatic breathing which is known as “Powerhouse”. Once our core is stable then we can move our limbs more effectively. Pilates can be performed on a mat without any apparatus or using equipment based Pilates that is consistent of springs and pulleys such as Cadillac, Ladder Barrel, Step chair and Reformer.
In this article, the researchers compare the effectiveness of mat pilates versus equipment based pilates in treatment of nonspecific low back pain. In this 2- arm controlled randomized trial with a blind assesor, they had 86 participants. The subjects ages from 18-60, including both sexes and all had been experiencing low back pain for the past at least 3 months. The mat pilates group performed exercises on mat using elastic bands and swiss ball. Equipment based pilates group performed exercises on Cadillac, step chair, reformer and Ladder Barrel. Both groups performed prescribed exercises by a pilates certified physical therapist  for an hour twice a week for 6 weeks. Each group performed 15-20 exercises per session with each exercises being performed no more than 10 reputations. The level of difficulty for each exercise was modified according to individual need, each patient was supervised by the physical therapist to ensure each exercise was performed without spinal compensation.
Pain numeric scale and Roland-Morris Disability Questionnaire were the tools used for assessment.What does that mean? The researchers primarily measured how much low back pain the participants experienced, as well as how disabled they felt during everyday activities of the course of this study. Assessments were performed at baseline, at 6 weeks and at 6 months. At 6 weeks mark, both groups exhibited improvements in pain and disability. There was no significant difference between groups for any of the assessed outcomes. At 6 months, there was a significant improvement in disability score for equipment based group, possibly due to the exercises on machines and resistance controlled by respires and weights facilitate learning and performance due to better stabilization.
Take home message…
We need to be stable proximally in order to be able to move distally. Proximal meaning towards the center of our body and distal means away from the center of our body. For example. if you want to throw a ball overhead, your upper back muscles need to stabilize for your arm muscles to throw. Weakened abdominals is one of the common denominators in people who suffer from low back pain. Even though Pilates is an effective way of fitness training when it comes to dealing with chronic low back pain, equipment based pilates found to be more effective than mat pilates in long term. To learn more about pilates, check out two pilates links below:
Image retrieved from: http://studiouonline.com/wp-content/uploads/2012/09/pilates-clothing.jpg

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