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Three Part Question

In [adults with chronic back pain], is [equipment-based pilates better than mat pilates] at [reducing pain and increasing mobility]?

Clinical Scenario

A 39 year old man is experiencing acute on chronic non specific lower back pain, this is the second such episode he has had despite being active and a regular attendee at the gymnasium. His current employment requires a reasonable level of fitness and he is struggling without constant topical analgesia. A colleague suggests pilates, upon research he wonders if a certain style/type is more effective at reducing symptoms and preventing future episodes.

Search Strategy

English language only
Results within the last 10 years
Random controlled trial comparison required
Medical terms considered/thesaurus used for back pain/injuries/diseases etc
Research into types of equipment used in pilates
Google Scholar used to gain full access to trial paper


Pubmed {(back pain) AND pilates (magic circle OR trapeze OR reformer OR Cadillac OR resistance bands OR apparatus OR mat OR roller OR yoga ball)}

CINAHL - {(back pain) AND pilates (equipment OR apparatus)}

Cochrane - (("back pain") AND (mat pilates)) AND (equipment based pilates)

PEDro – (Equipment based pilates and mat based pilates)


Google Scholar - {(back pain) AND pilates (magic circle OR trapeze OR reformer OR Cadillac OR resistance bands OR apparatus OR mat OR roller OR yoga ball)}

Search Outcome

Pubmed 6x articles found
CINAHL 13x articles found
Cochrane 7x articles found
PEDro 5x articles found
Google Scohlar 7x articles found


4x articles of note were found containing the comparison element relevant to question

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Da Luz , M.A. et al 2014 Brazil	86 patients with lower back pain greater than 12 weeks, both sexes aged between 18-60 years. Primary and secondary assessments made between mat pilates and equipment-based pilates after 6 weeks treatment. Further tests carried out after 6 months post treatment	2-arm randomised controlled trial	Pain	No difference between groups at 6 weeks or 6 months	Outcomes are all subjective to patient opinion scoring only The duration of treatment Equipment/space required to undertake Impossible task of blinding therapist and participants
			Disability	Equipment based showed improvement in scoring after 6 months only 4.1 (4.9) compared to 7.8 (6.1)
			Patient-specific disability	Slight improvement for equipment based after 6 months
			Global impression of recovery	Significant improvement after 6 months again for equipment based 0.7 (3.2) compared to 2.5 (2.4)
			Kinesiophobia	Improvement seen with equipment based after 6 months
Cruz-Díaz, D. et al. 2017 Spain	98 volunteers with chronic back pain, both sexes aged between 18-50 spilt into three groups of pilates mat; equipment based pilates and control group. Outcomes will be measured initially, at 6 weeks and finally at 12 weeks	Randomised control trial	Pain	Clear reduction in pain scores for both pilates groups compared to control group	Recruited from health & sports centre Ultrasound scanning and interpretation available 12% dropout rate in control group demograph of trial may exclude many with back pain
			Disability	Improvement again with pilates groups
			Transversus abdominis activation	Growth can be found clearly in pilates groups, non in control group
			Kinesiophobia	Slight reduction in fear in both pilates groups, non found in control group
Lee, C.-W., Hyun, J. and Kim, S.G. 2014 Republic of Korea	40 businesswomen with chronic back pain under the age of 45 years are allocated to either pilates mat based exercises (PME) or pilates apparatus based group (PAE).	Randomly allocated into two groups. Each pilates exercise group was taught 3 times each week for 8 weeks	Pain	clear reduction in pain with pilates mat exercises slightly more effective	Validity of trial due to lack of data included in article Evidence only refers to females of a certain profession and age No post training to monitor long term effects
			Static balance ability	decrease in both sway length & velocity, again Pilates matt exercises shown to be more effective than apparatus group
Castro, J.B. et al. 2022 Brazil	22 postmenopausel females with chronic back pain were allocated into one of either two groups, a pilates group with accessories (PAG) or another without (PG) performing pilates twice a week over a period of 8 weeks	Randomised controlled trial	Biochemical markers	training showed increase in IGF-1/IGFBP-3 ratio and reduction in creatine kinase compared with the other group.	Laboratory fasted blood samples required Basic pilates equipment used only
			Pain intensity	Both groups showed reduction in pain PG - (7.12 vs 3.48 -51.12%) & PAG (6.75 vs 3.68 -45.48%) (p<0.05)
			Functional disability	Reduction in scores in both groups PG (-50.3%, p=0.001, d=1.16) & PAG (-38.13% p=0.005, d =0.76)
			Muscle strength (abs & lumbar)	Abs – significant increase in equipment pilates 25.08%, p = 0.034, d = 0.64 Lumber- both groups showed increased lumber strength & strong effect size.

Comment(s)

There is clear evidence that equipment based pilates is more effective than ‘traditional’ mat pilates at reducing back pain. Three of these papers contain high quality randomised trials with direct comparisons made over many time intervals underlying this argument. These studies further enhance the believe that pilates should be considered as part of an individual treatment package for difficult to treat non-specific lower back pain.

Clinical Bottom Line

Equipment based pilates is shown to be better than mat pilates for treatment of lower back pain in reducing pain and improving movement.

References

1. Maurício Antônio da Luz, Jr, Leonardo Oliveira Pena Costa, Fernanda Ferreira Fuhro, Ana Carolina Taccolini Manzoni, Naiane Teixeira Bastos Oliveira, Cristina Maria Nunes Cabral Effectiveness of Mat Pilates or Equipment-Based Pilates Exercises in Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial Physical Therapy 01 May 2014,94(5), pp. 623–631
2. David Cruz-Díaz a, M. Bergamin b, S. Gobbo b, Antonio Martínez-Amat a, Fidel Hita-Contreras a Comparative effects of 12 weeks of equipment based and mat Pilates in patients with Chronic Low Back Pain on pain, function and transversus abdominis activation. A randomized controlled trial Complementary Therapies in Medicine, Volume 33, August 2017, Pages 72-77
3. Lee, C.-W., Hyun, J. and Kim, S.G. Influence of Pilates Mat and Apparatus Exercises on Pain and Balance of Businesswomen with Chronic Low Back Pain Journal of Physical Therapy Science 2014 Apr; 26(4): 475–477.
4. Juliana BP de Castro, Vicente P Lima, Danielli B de Mello, Gustavo C Lopes, Jacqueline C Peixoto, Andressa OB dos Santos, Rodolfo AM de Nunes & Rodrigo G de Souza Vale Effects of pilates with and without elastic resistance on health variables in postmenopausal women with low back pain Pain Management Feb 2022, 12(4), pp. 509–520