Treating non-specific chronic low back pain through the Pilates Method

Summary

The goal of this study is to review and analyze scientific articles where the Pilates Method was used as treatment for non-specific chronic low back pain (CLBP). Articles were searched using the Medline, EMBASE, PEDro, CINAHL, and SPORTDICUS databases. The criteria used for inclusion were randomized controlled trials (RCT) and clinical controlled trials (CCT) published in English where therapeutic treatment was based on the Pilates Method. The analysis was carried out by two independent reviewers using the PEDro and Jadad Scales. Two RCTs and one CCT were selected for a retrospective analysis. The results of the studies analyzed all demonstrate positive effects, such as improved general function and reduction in pain when applying the Pilates Method in treating non-specific CLBP in adults. However, further research is required to determine which specific parameters are to be applied when prescribing exercises based on the Pilates Method with patients suffering from non-specific CLBP. Finally, we believe that more studies must be carried out where the samples are more widespread so as to give a larger representation and more reliable results.

Introduction

Chronic low back pain (CLBP) is the most common cause for frequent absenteeism at work in the less than 45-year-old (Carr and Moffett, 2005; Cunningham and Kelsey, 1984) adult population. It has been estimated that low back pain (LBP) can be found in between 8% and 56% of the population in the United States (Manchikanti, 2000) and amounts to a billion dollars per year in medical expenses and other expenses indirectly related to LBP (Luo et al., 2004).

Philips and Grant have described that between 30% and 40% of patients suffering from LBP never completely recover and, on the contrary, later develop permanent chronic LBP (Philips and Grant, 1991) symptoms. Although causes for LBP are multi-faceted, they are directly related to etiological factors such as social demographic characteristics, habits, as well as physical and psychosocial factors (Manchikanti, 2000). In a prospective study, Lee et al. (1999) demonstrated that an imbalance between flexor and extensor muscles of the trunk is a risk factor that can cause LBP to appear. Other authors have found that dysfunctions and weaknesses that exist in the deep abdominal muscles (transverse muscle of the abdomen, pelvic floor, diaphragm and the multifidus muscles) can be associated to LBP (Hodges and Richarson, 1996; O’Sullivan et al., 1997a). In reference to this, Hodges and Richardson (1999) have added that the function and coordination of the stabilization of low back muscles (mainly the extensors) are reduced in LBP patients.

Several studies mention that LBP is the main reason for physiotherapy consultations (Boissonnault, 1999; Di Fabio and Boissonnault, 1998; Jette and Davis, 1991). Jette and Jette (1996) note that the physiotherapeutic treatment most frequently applied is focused on strengthening and stretching exercises, thermo-therapy, and manual therapy. However, therapeutic exercise seems to be the most effective in treating LBP, according to scientific research described by several reviews (Philadelphia Panel, 2001; van Tulder et al., 1997, van Tulder et al., 2002).

The Pilates Method started to be developed by Joseph H. Pilates during World War I (Latey, 2001). It was originally referred to as Contrology and was only later called the Pilates Method during Joseph Pilates lifetime (Anderson and Spector, 2000). This method was introduced in the United States in 1923 and spread in the 1930s and 1940s among choreographers and dance instructors (Anderson and Spector, 2000). These professionals were the first to describe the method as a rehabilitation technique that led to recovery from their sports-related injuries (Anderson, 2001; Anderson and Spector, 2000).

Currently, the Pilates Method is popular in all areas of fitness and rehabilitation, although there is little scientific evidence that describes its benefits. An observational prospective study carried out by Segal et al. (2004) demonstrated significant improvement in flexibility after doing 3 months of Pilates; however, the body's composition values were not modified. In reference to this, Jago et al. (2006) carried out a controlled randomized study on girls practicing Pilates 5 days a week, 1 h per session, for a 4-week period. They obtained positive results in terms of modifying their body composition. As a result, the authors concluded that Pilates could be a useful preventive measure against obesity.

In terms of aspects related to rehabilitation, Pilates has been shown to improve the dynamic balance in healthy adults (Jonson et al., 2007) and postural stability in senior citizens (Kaesler et al., 2007). There is also good tolerance to the Pilates Method when combined with counter-resistance exercises in hospitalized senior citizens (Mallery et al., 2003). However, the authors concluded that it would be valuable to study the benefits of these exercises with other groups of people. Moreover, Smith and Smith (2004) touch on the theory that the Pilates Method can improve physical features such as flexibility, propioception, balance, and coordination. They also suggest that these benefits can be integrated into rehabilitation programs, as well as training for improving muscular resistance and balance in senior citizens.

In terms of treating low back and pelvic muscles, García et al. (2004) found significant statistical gains in the strength of low back extensor muscles after 25 Pilates sessions applied to 20 healthy subjects. Moreover, Herrington and Davies (2005) demonstrated that Pilates is more effective than regular abdominal curls in triggering the transversus abdominis contractions in healthy subjects.

In 2004, an article by Maher (2004) focusing on treating CLBP did not recommend Pilates for this type of ailment, as there is no scientific evidence that justifies its effectiveness. However, it is important to mention that randomized clinical studies on this subject began to be published as of 2006.

The goal of this study is to review and analyze scientific articles where the Pilates Method was used as treatment for non-specific CLBP.