Introduction

Physiotherapy aims to find methods that are meaningful to the client. Pilates is a gentle form of exercise that has found its place as an exercise that calms both the body and the mind. One of the studied methods for treating lower back pain is Pilates training, as it strengthens the muscles of the core, improves posture, and increases mobility. (Finnish Pilates Association 2022.) Lower back pain is a very common musculoskeletal disorder, and in most cases the pain is non-specific. Although the prognosis for lower back pain is usually good, patients often need guidance from a physiotherapist on how to stay active despite the pain. (Low back pain: Current care guidelines, 2025.)

This article is part of a series produced within the course of Professional in Physiotherapy, which is included in the physiotherapy degree program. The article was created as part of the evidence-based physiotherapy section of the course. In small groups, students practice elements of a systematic literature review, including systematic information retrieval, critical appraisal using the PEDro Scale tool, and writing up the results in the form of a scientific article.

The aim of this article is to describe the importance of Pilates training in physiotherapy as one method among others. The aim is to specifically examine how Pilates is suitable for the rehabilitation of adults suffering from lower back problems and what role it could play in the client’s rehabilitation process.

Methods

The article is based on a small literature review conducted by third-year physiotherapy students at Savonia University of Applied Sciences, which selected four randomized controlled trials that are less than a year old. The aim was to evaluate the effectiveness and methodological quality of the studies.

In this article we go through the following articles: Preventing chronic low back pain: investigating the role of Pilates in subacute management, High-intensity and low-intensity Pilates have similar effects on pain and disability in people with chronic non-specific low back pain, Effects of reformer Pilates on pain, psychological factors, and sleep in chronic musculoskeletal pain and Effectiveness of Pilates compared with home-based exercises in individuals with chronic non-specific low back pain.

This article presents a summary and comparison of four randomized controlled trials focused on Pilates as a therapeutic intervention.

The methodological quality of the studies included in this article was assessed using the PEDro scale. The Physiotherapy Evidence Database (PEDro) scale consists of 11 criteria, of which 10 evaluate internal validity and statistical reporting. The scale was used to systematically rate the quality of randomized controlled trials. A higher PEDro score indicates better methodological quality, making the study more reliable and valid for evidence-based conclusions. (Physiotherapy Evidence Database, 2020)

Results

Pilates interventions varied between studies, including supervised mat Pilates, reformer Pilates and high- versus low-intensity formats. Control groups included home exercise programs or no intervention. The study subjects were adults aged 18-60 years with subacute (6-12 weeks) or chronic low back pain (more than 3 months). Measurements were administered before and after the intervention. Pain was measured using a variety of pain questionnaires, including numerical pain and visual analogue scales. In addition, some studies used a variety of other measures, such as the Tampa Kinesiophobia Scale, the Quality of Life Scale, and the Functional Limitations Questionnaire.

Pilates-based interventions have shown promising results in adult patients with both chronic and subacute low back pain. Şahan et al. (2025) found that reformer Pilates significantly improved pain, psychological well-being, and sleep quality with chronic musculoskeletal pain. But when assessing the reliability of the study, all participants were women and in addition to those with low back pain, those with neck pain were also selected for the study (PEDro score 7/10). Asik & Sahbaz (2025) demonstrated that Pilates was more effective than home exercise in preventing chronic low back pain during the subacute phase. While the study was a reliable RCT with validated measures, its small sample size and short follow-up limit the generalizability of the results. (PEDro score 7/10). Tottoli et al. (2024) concluded that while Pilates led to statistically better outcomes than home-based exercises in pain and disability (PEDro score 7/10).

Coelho et al. (2025) found that both high- and low-intensity Pilates were found to similarly reduce pain and disability, indicating that either approach can be effective in clinical practice. However, low-intensity Pilates was associated with fewer adverse effects, highlighting the importance of safety and patient comfort in exercise prescription. The study received a PEDro score of 8 out of 10. The findings suggest the physiotherapists can confidently recommend low-intensity Pilates as a viable option, as it offers comparable benefits to higher-intensity exercise while minimizing potential risks. Additionally, the benefits of pain and function were maintained over a 6- to 12-month follow-up, supporting Pilates as a sustainable and effective component of long-term rehabilitation for chronic low back pain.

All four studies were assessed using the PEDro scale to evaluate their methodological quality. In each study, eligibility criteria were specified, and participants were randomly allocated to groups. Allocation was concealed in three of the four studies. Blinding of subjects and therapists was not performed in any of the studies, but assessors were blinded in all four. Three studies conducted an intention-to-treat analysis, and all four reported between-group statistical comparisons, as well as point estimates and measures of variability for at least one key outcome.

Summary and Further Development

Pilates can be effectively integrated into physiotherapy sessions. However, education and training in Pilates-based techniques are needed to ensure safety and optimal training sessions. New research topics could reveal whether Pilates training alone has an effect on pain or whether other complementary exercises performed in addition to Pilates also have a similar effect on pain.

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Authors:

Tuuli Honkonen Bachelor’s degree student, Physiotherapy degree programme, Savonia University of Applied Sciences

Riitta Huotari, Nurse, Bachelor’s degree student, Physiotherapy degree programme, Savonia University of Applied Sciences

Maria Suomela, Bachelor’s degree student, Physiotherapy degree programme, Savonia University of Applied Sciences

Tero Tikkanen, Engineer (Master’s level), Bachelor’s degree student, Physiotherapy degree programme, Savonia University of Applied Sciences

Marja Äijö, TtT, ft, Senior Lecturer in Gerontology and Rehabilitation, Savonia University of Applied Sciences.

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References:

Asik, H. K., & Sahbaz, T. (2025). Preventing chronic low back pain: investigating the role of Pilates in subacute management—a randomized controlled trial. Irish Journal of Medical Science (1971-), 1-8. https://doi.org/10.1007/s11845-025-03939-y. Accessed 26.9.2025.

Coelho, A. C. S., Dourado, J. F., & de Paula Lima, P. O. (2025). High-intensity and low-intensity Pilates have similar effects on pain and disability in people with chronic non-specific low back pain: A randomized controlled trial. Journal of Physiotherapy, 71(2), 123–130. https://doi.org/10.1016/j.jphys.2025.03.002 . Accessed 27.9.2025.

Finnish Pilates Association 2022. What is Pilates? Online publication. https://suomenpilatesyhdistys.fi/mita-on-pilates/. Accessed 1.10.2025.

Low back pain. Current care guidelines. Working group appointed by the Finnish Medical Society Duodecim and the Finnish Physiatry Association. Helsinki: Finnish Medical Society Duodecim, 2025. https://www.kaypahoito.fi/hoi20001. Accessed 1.10.2025.

Pilates picture. Microsoft Corporation. (n.d.). Stock image of a business meeting. Microsoft 365. Accessed 1.10.2025

Physiotherapy Evidence Database 2020. PEDro scale. Online publication. Updated 1.9.2025. https://pedro.org.au/english/resources/pedro-scale/. Accessed 26.9.2025.

Şahan, N., Uluğ, N., & Özeren, A. (2025). Effects of reformer Pilates on pain, psychological factors, and sleep in chronic musculoskeletal pain: a randomized controlled trial. BMC psychology, 13(1), 836. https://doi.org/10.1177/02692155241277041 Accessed 25.9.2025.

Tottoli, C. R., Ben, Â. J., da Silva, E. N., Bosmans, J. E., van Tulder, M., & Carregaro, R. L. (2024). Effectiveness of Pilates compared with home-based exercises in individuals with chronic non-specific low back pain: Randomised controlled trial. Clinical Rehabilitation, 38(11), 1495-1505. https://doi.org/10.1177/02692155241277041 Accessed 2.10.2025.