Cochrane for Clinicians

Putting Evidence into Practice

Pilates for the Treatment of Low Back Pain


Am Fam Physician. 2016 Apr 1;93(7):556-557.

Author disclosure: No relevant financial affiliations.

Clinical Question

Are Pilates exercises effective for patients with low back pain?

Evidence-Based Answer

There is low- to moderate-quality evidence that Pilates exercises taught by certified instructors improve pain and reduce disability in patients with chronic low back pain. It is unclear whether a Pilates regimen is superior to other exercise plans for the treatment of low back pain. Adverse effects are uncommon. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Up to 40% of patients with acute low back pain will not have resolution of pain in the first three months, and more than one-half of these patients will have residual pain after one year.1 No systematic review has concluded which, if any, of the commonly suggested exercise regimens—including yoga, tai chi, and McKenzie method regimens—is best for treating patients with chronic low back pain. Once known as “centrology,” the Pilates method was originally developed in the 1920s by Joseph Pilates. It is based on the principles of centering (i.e., toning the core trunk muscles), concentration (i.e., being attentive to movements), control (i.e., maintaining posture), precision (i.e., being accurate in techniques),

Author disclosure: No relevant financial affiliations.

The practice recommendations in this activity are available at


Yamato TP, Maher CG, Saragiotto BT, et al. Pilates for low back pain. Cochrane Database Syst Rev. 2015;(7):CD010265.


show all references

1. Menezes Costa LC, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012;184(11):e613–e624....

2. Wells C, Kolt GS, Marshall P, Hill B, Bialocerkowski A. The effectiveness of Pilates exercise in people with chronic low back pain: a systematic review. PloS One. 2014;9(7):e100402.

3. Lim EC, Poh RL, Low AY, Wong WP. Effects of Pilates-based exercises on pain and disability in individuals with persistent nonspecific low back pain: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2011;41(2):70–80.

4. Hooten WM, Timming R, Belgrade M, et al. Assessment and management of chronic pain. Bloomington, Minn.: Institute for Clinical Systems Improvement (ICSI); 2013.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at


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