Pilates for Back Pain 

In a world where the idea of pain relief often involves complicated gadgets and elaborate contraptions, an exercise like Pilates can seem overly simplified  – and at the same time, cliche.  Let’s dive into whether – and how – Pilates can help you bid farewell to your persistent back pain.  (And if you prefer to get right to it and want to jump right in and find a class, check out more information about our Pilates classes here.)

A Little Background 

Pilates is a method developed by Joseph Pilates back in the early 20th century to help injured individuals and athletes alike to heal injuries and optimize their movement potential. Since then, it has become an internationally recognized exercise regimen.

Pilates is a challenging workout that will keep your body and mind engaged. From the infamous “Hundred” (where you pump your arms like a maniac while trying to keep your legs at a 45-degree angle) to its many rolling exercises, Pilates can be both playful and serious.

A little known fact about Pilates is that its original name was Contrology: the Art of Control, and only later was changed to memorialize its founder. While it is anything but sexy, this original name speaks to the discipline’s primary goal: to help individuals better control movements through stabilization. This means that it by necessity helps to strengthen core muscles, improves flexibility, and enhances body awareness. The 6 principles of Pilates (concentration, control, centering, breath, flow, and precision), all contribute to effective performance of the movements – by which we mean stable and controlled. . 

If you are wondering  “What does this have to do with my back pain?” – we’re glad you asked! It turns out that a stronger core helps support your spine and distribute work more evenly, taking the strain off any one body part, including the often over-taxed back muscles. Greater flexibility of hamstrings, back, and neck muscles frequently improve back pain, and better body awareness helps to address the habitual patterns that may have caused the problem in the first place. 

The Evidence

The internet is flooded with anecdotal evidence about Pilates helping people bounce back from back injuries or and heal chronic back issues. But have the claims been backed up by scientific research? 

The most recent meta-analysis of Pilates-based exercises and functional disability shows a positive effect for Pilates for pain relief and functional disorders in patients with chronic low back pain, and maybe more importantly, that the effects of the treatment could be maintained over time.  And a  2013 meta-analysis of randomized controlled trials (RCT’s) involving Pilates-based exercise for persistent, non-specific low back pain showed superior ability to reduce disability of Pilates exercises over other physiotherapeutic interventions. 

In the area of clinical Pilates, or using Pilates to augment physical therapy, a  2015 study compared outcomes for post-menopausal women with low back pain undergoing a 6 week PT program compared to those who did PT plus Pilates for the same duration, and those in the latter group healed significantly faster. 

Does Pilates help more than other exercises? A 2018  randomized clinical trial and  randomized controlled trial in 2006 both found that Pilates-based exercises are more effective in reducing pain and improving function in individuals with chronic low back pain compared to general exercise, though all exercise was beneficial. Other randomized trials (1, 2, 3) have found that Pilates has significant benefits on study participants’ pain, function, and vitality. 

Additionally, several of these studies show that Pilates can be particularly helpful in preventing recurrent lower back pain; so the benefit of the workouts may accrue over time.

There are a wide variety of exercises in the Pilates method, and an even greater application of these exercises in the research setting. This creates a challenge to validate a method that can look many different ways.  Additionally, many PT techniques that are compared to Pilates in trials use Pilates-based theories and techniques (e.g. “spine stabilizing exercise,” “core exercise,” “direction specific exercise”), so results comparing the modalities may therefore not adequately distinguish between Pilates and non-Pilates based exercises.  This being said, there is evidence that Pilates is an effective rehabilitation tool for many different types of injuries. 

But How? 

Why is it that Pilates helps more than other forms of exercise to improve measures of low back pain?

  • Pilates improves lumbo-pelvic and scapular-humeral rhythm, or “bone rhythms.”  These are fancy terms for the way that the pelvis moves relative to the lumbar spine, and the shoulder blade to the arm, respectively. In other words, it improves efficiency of movement by addressing the alignment and coordination of movements involving the pelvis with the spine, and the arm with the shoulder blade. Both can alleviate tension/pain in the back. 

  • Pilates strengthens and improves endurance of the intrinsic, or deeper core muscles by ensuring that they initiate and sustain the movements, so that the back muscles are relieved of doing so much work. This also reduces joint compression and improves alignment, all of which may directly affect back pain. 

  • The focus on Pilates on “lengthening the spine,” through articulation and oppositional lengthening helps to achieve isometric contraction of the core muscles.  It also stretches out the intervertebral spaces, which can produce relief for compression related types of back pain. 

  • Pilates stretches the hamstrings, which is a common cause of tight lower back. 

  • Pilates reduces reliance on the dominant, or more commonly used muscles. With respect to the low back, these might be the lower back muscles themselves, and often also include a pattern of relying on the quadriceps at the expense of the hamstrings and glutes. 

  • By increasing awareness of alignment and head posture, Pilates often positively impacts the tension held in the neck, and as a result, the lower back. 



In short, Pilates seems to improve lumbar dysfunction by improving sensorimotor ability, or the process of receiving sensory information (sensory input) and producing a response (a sensory output). 

Pilates is a unique combination of bodywork (via hands-on stretching) and exercise, and that is sometimes where the magic is for people who are in pain. They simply don’t know that their body could be in a different position or move in a different way, until they are set up to do it differently. While it is possible to feel that in an online class, it is much less likely, and having 1:1 support or a hands-on class teacher is often the best way. 

If you’re tired of your achy back and want a solution that’s long lasting, empowering, and simple, Pilates is worth considering. Pilates is about creating a strong, resilient body; as you work  your way to a healthier back, you may find your mood improving as well.. 

We focus on small group and individual classes at Lemon Tree because we believe that personalized attention is the best way to help people make lasting changes in their movement and health. Interested in giving Pilates a try? 

Check out our schedule for privates here, and our beginner and mixed level group equipment classes. Pilates may just be the exercise regimen you never knew you needed, lightening both the load on your back and your spirit! 

For a review of  types of back pain and acupuncture for back pain , see our article on acupuncture and back pain.