You’ve started Pilates to help with your back pain, attending classes regularly, and putting in the effort. But you’re not seeing the improvement you’d hoped for. So why isn’t it working?
Pilates for back pain is commonly recommended, and research suggests it can improve pain and function in people with chronic low back pain (Lim et al., 2011). However, Pilates isn’t necessarily more effective than other forms of exercise when compared directly (Wong et al., 2023). Exercise therapy more broadly is also supported as a treatment option for chronic low back pain (Hayden et al., 2021).
The effectiveness of Pilates depends partly on how it’s used, the individual participating and what they’re hoping to achieve.
Why can Pilates help with back pain?
Pilates combines controlled movement, strength, coordination and body awareness. Depending on the exercises and equipment used, it can challenge the muscles around the trunk, hips and pelvis while encouraging movement through different ranges and positions.
For someone who has become less active because of back pain, Pilates can provide a structured way to start moving again. Exercises can begin at a manageable level and gradually become more demanding as strength, confidence and physical capacity improve.
Pilates can also be useful for people who have become cautious about bending, twisting or loading their back. Practising these movements in a controlled environment may help them become more comfortable with movement and build confidence in what their body can do.
Although Pilates is often associated with improving posture and strengthening the core, these aren’t necessarily the reasons it helps with back pain. Poor posture and weak abdominal muscles aren’t established causes of all back pain, and there isn’t one correct way to position or move the spine that prevents symptoms. The benefits of Pilates can come from becoming stronger, increasing activity levels and developing greater confidence in movement, rather than correcting a particular physical fault.
So why isn’t Pilates helping my back?
There are several reasons why someone might not notice much improvement in their back pain, even when they’re attending Pilates regularly.
One possibility is that the exercises aren’t well suited to their current symptoms or physical capacity. Pilates classes can include a wide range of movements, from relatively gentle exercises to more demanding strength and resistance work. An exercise that feels comfortable for one person may be difficult or aggravate symptoms for another, particularly when their back pain is more irritable.
Someone may feel stronger and more comfortable during class but still experience pain when lifting at work or spending long periods on their feet. Their Pilates program may not yet provide enough of the physical challenge needed for those activities.
How frequently someone exercises and whether their program progresses over time can also influence the results. Attending one class a week may be a useful starting point, but depending on someone’s goals and activity levels, it may not provide enough exercise on its own to achieve the improvements they’re hoping for.
Back pain can also fluctuate independently of someone’s progress with exercise. As O’Sullivan (2012) discusses, persistent back pain is influenced by more than physical strength or movement alone. Changes in activity levels, work demands, sleep and stress, as well as previous experiences of pain, can all influence symptoms.
This means someone can be making genuine improvements through Pilates while still experiencing occasional back pain. A return of symptoms doesn’t automatically mean that the exercises have stopped helping or that something has been damaged.
What should you do if Pilates isn’t helping?
If you’re enjoying Pilates but aren’t noticing much improvement in your back pain, it doesn’t necessarily mean you need to stop. It may be worth reviewing your current program to see whether the exercises are appropriate for your symptoms, physical capacity and goals.
Start by discussing your experience with your Pilates instructor. Are there particular exercises that consistently aggravate your symptoms? Have you been performing the same routine for several months? Are the exercises becoming easier, or are you finding certain movements particularly difficult? These details can help guide changes to your program.
Adjustments might include modifying the range of movement, changing the resistance, using additional support or gradually introducing more challenging exercises. Depending on your goals, you may also benefit from incorporating other forms of exercise, such as resistance training or aerobic activity.
If your back pain persists, worsens or continues to interfere with everyday activities, a physiotherapy assessment may be useful. Rather than focusing solely on which Pilates exercises you’re performing, a physiotherapist can consider your symptoms, physical capacity, activity levels and the particular tasks you’re finding difficult.
At Hawker Place Physio, clinical Pilates incorporates Pilates-based exercises into an individual physiotherapy assessment and rehabilitation plan. Exercises can be selected, modified and progressed according to your needs, with other rehabilitation strategies included where appropriate.
This doesn’t mean clinical Pilates is automatically more effective than a general Pilates class. Many people benefit from group Pilates, particularly when the exercises suit their abilities and goals. Clinical Pilates offers an opportunity to use Pilates within a broader physiotherapy approach when additional assessment or more individualised rehabilitation may be helpful.
References
Hayden, J. A., Ellis, J., Ogilvie, R., Malmivaara, A., & van Tulder, M. W. (2021). Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, (9), CD009790. https://doi.org/10.1002/14651858.CD009790.pub2
Lim, E. C., Poh, R. L., Low, A. Y., & 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.2011.3393
O’Sullivan, P. (2012). It’s time for change with the management of non-specific chronic low back pain. British Journal of Sports Medicine, 46(4), 224–227. https://doi.org/10.1136/bjsports-2010-081638
Wong, C. M., Rugg, B., & Geere, J. (2023). The effects of Pilates exercise in comparison to other forms of exercise on pain and disability in individuals with chronic non-specific low back pain: A systematic review with meta-analysis. Musculoskeletal Care, 21(1), 78–96. https://doi.org/10.1002/msc.1667
