# Exercise as it relates to Disease/The effects of Pilates on chronic low back pain

This Wikibooks page is an analysis of an article examining Pilates exercise and how it relates to chronic low back pain.
The article: Natour, J., de Araujo Cazotti, L., Ribeiro, L. H., Baptista, A. S., & Jones, A. (2015). Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clinical rehabilitation, 29(1), 59-68.

## What is the background to this research?
### What is Chronic Low Back Pain?

Chronic Low Back Pain (CLBP) is defined as pain persisting for more than three months presenting in the area between the lowest rib and the gluteal folds (sitting bones) of the lower back. CLBP has a large socio-economic cost to society due to the prevalence and significant levels of disability linked with the condition. Commonly people presenting with CLBP will not fit a specific clinical presentation, often referred to as non-specific low back pain and often have associated psychological, social or work-related issues coinciding with the presentation, that may be contributing to the chronic nature of the pain.

### Common treatment options

Treatment options for CLBP regularly include exercise, physical therapy (usually prescribed by a Physiotherapist or GP), pharmacology, surgery and/ or behavioural therapy. Pilates is regularly prescribed to CLBP patients. Current Pilates exercise was developed from the method created by Joseph Pilates in the 1920s which focused on core stability, movement and postural control, breathing, flexibility and strength.

### What the article examines

This article looks at the role of Pilates exercise at improving pain, function and quality of life in CLBP patients.

### Real-world importance of the research

The majority of recent systematic reviews of the literature on the implementation of Pilates exercise for the treatment of CLBP have been of low methodological quality, small sample sizes, heterogeneous population samples and short treatment periods. In addition, these reviews did not follow Pilates protocol or progressions of exercise. Conclusions from current evidence have prompted for further research to investigate longer term effects of Pilates for CLBP population, which this study aims to achieve.

## Where is the research from?

This study was conducted by researchers from The Federal University of Sao Paulo, Brazil. The study was approved by the Ethics Committee of the University. No conflict of interest was declared.

## What kind of research was this?

This study was a randomised control trial. Randomised control trials are an experiment where participants are placed into two different groups randomly, with each group receiving different interventions. Measurements of the different intervention effects are collected at the end of the trial. Evaluations were completed by a blinded examiner who was independent to the study, minimising the effect bias in the results of the study.

## What did the research involve?

The research involved 60 patients with CLBP, randomly allocated into one of two groups:
* Experimental Group: maintained medication treatment using Non-Steroidal Anti Inflammatory Drugs (NSAIDs) plus Pilates exercise
* Control group: maintained medication treatment (NSAIDs) with no additional treatment or exercise
Pilates exercise was completed in classes lasting 50 minutes twice a week for 90 days, following a pre-established Pilates protocol.
Outcome measurements of pain (Visual Analogue Scale), function (Roland-Morries Questionnaire) and quality of life (SF-36) were collected immediately prior to study randomisation (baseline), 45 days after baseline, 90 days after baseline and 90 days after the conclusion of the Pilates exercise program.
Statistical analysis was completed using The Kolmogorov-Smirnov test.

## What were the basic results?

* 96% of patients completed all Pilates sessions
* Differences between the experimental group and control group regarding quality of life outcomes, pain and function were statistically significant
* Less NSAIDs were taken by the experimental group compared to control group, also statistically significant

### The level of the evidence study provides

The study provides a quality level of evidence, as a randomised control trial it is ranked as level 1b evidence in evidence based practice.

### Supporting evidence of authors claims

The authors' claims of the effectiveness of Pilates exercise at improving pain, function and quality of life in CLBP population has been supported in similar research investigating the effects of Pilates on CLBP versus general exercise. Similarly, other research involving Pilates exercise in CLBP populations using randomised control trials have found comparable outcomes.

## What conclusions can we take from this research?

* Pilates exercise is a safe intervention for CLBP population
* Pilates exercise is an effective treatment to aid the reduction of pain levels, improving function and improving quality of life in CLBP population
* Pilates is superior to no exercise when comparing outcomes related to quality of life, pain and function in CLBP population
* There are no harmful effects from Pilates in this population

## Practical advice

* Individuals suspected of suffering from CLBP should be assessed by an appropriate health care professional (Physiotherapist, GP etc.) before commencing Pilates exercise
* Pilates exercise can be commenced under the supervision of a trained professional (e.g. Physiotherapist) who can assist in the progression and monitoring of the condition
* Equipment and Mat Pilates options available and may be modified to any level of function, assisting a patient from early stage rehabilitation to end stage activities and function
* Pilates can be an expensive treatment option and may be completed in conjunction with other exercise options

## Further information/ resources

For further information on CLBP and the benefits of Pilates exercise see below. Alternatively, contact your Pilates trained Physiotherapist or GP who will be able to provide additional education, information and exercise options.
* Pilates Exercise and Back Pain: http://www.spine-health.com/wellness/yoga-pilates-tai-chi/pilates-exercise-and-back-pain
* Lower back pain Factsheet: http://www.health.vic.gov.au/edfactsheets/downloads/lower-back-pain.pdf
* Understanding chronic pain: http://www.bodyinmind.org/who-are-we/
* Find an Australian Accredited Physiotherapist: http://www.physiotherapy.asn.au/APAWCM/Physio_and_You/Find_a_Physio/APAWCM/Controls/FindaPhysio.aspx?hkey=44f0e9c4-a964-4300-8d21-341bf315f4fc

## References

* ↑ Wells, C., Kolt, G. S., Marshall, P., Hill, B., & Bialocerkowski, A. (2014). The effectiveness of pilates exercise in people with chronic low back pain: a systematic review. Plos one, 9(7), e100402.
* ↑ Hoy, D., Brooks, P., Blyth, F., & Buchbinder, R. (2010). The epidemiology of low back pain. Best practice & research Clinical rheumatology, 24(6), 769-781.
* ↑ Dagenais, S., Caro, J., & Haldeman, S. (2008). A systematic review of low back pain cost of illness studies in the United States and internationally. The spine journal, 8(1), 8-20.
* ↑ Krismer, M., & Van Tulder, M. (2007). Low back pain (non-specific). Best Practice & Research Clinical Rheumatology, 21(1), 77-91.
* ↑ Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., & Owens, D. K. (2007). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of internal medicine, 147(7), 478-491.
* ↑ Brennan, S., & French, H. (2008). A questionnaire survey of the knowledge and use of Pilates based exercise for chronic low back pain amongst Irish physical therapists. Phys Ther Rev, 13, 212-213.
* ↑ Aladro-Gonzalvo, A. R., Araya-Vargas, G. A., Machado-Díaz, M., & Salazar-Rojas, W. (2013). Pilates-based exercise for persistent, non-specific low back pain and associated functional disability: a meta-analysis with meta-regression. Journal of bodywork and movement therapies, 17(1), 125-136.
* ↑ Latey, P. (2001). The Pilates method: history and philosophy. Journal of Bodywork and Movement Therapies, 5(4), 275-282.
* ↑ Natour, J., de Araujo Cazotti, L., Ribeiro, L. H., Baptista, A. S., & Jones, A. (2015). Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clinical rehabilitation, 29(1), 59-68.
* ↑ Hoffmann, T., Bennett, S., & Del Mar, C. (2013). Evidence-based practice across the health professions. Elsevier Health Sciences.
* ↑ Burns, P. B., Rohrich, R. J., & Chung, K. C. (2011). The levels of evidence and their role in evidence-based medicine. Plastic and reconstructive surgery, 128(1), 305.
* ↑ Wajswelner, H., Metcalf, B., & Bennell, K. (2012). Clinical Pilates versus general exercise for chronic low back pain: randomized trial. Med Sci Sports Exerc, 44(7), 1197-205.
* ↑ Anand, U. A., Caroline, P. M., Arun, B., & Gomathi, G. L. (2014). A STUDY TO ANALYSE THE EFFICACY OF MODIFIED PILATES BASED EXERCISES AND THERAPEUTIC EXERCISES IN INDIVIDUALS WITH CHRONIC NON SPECIFIC LOW BACK PAIN: A RANDOMIZED CONTROLLED TRAIL. Int J Physiother Res, 2(3), 525-29.
* ↑ da Luz, M. A., Costa, L. O. P., Fuhro, F. F., Manzoni, A. C. T., Oliveira, N. T. B., & Cabral, C. M. N. (2014). Effectiveness of mat Pilates or equipment-based Pilates exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Physical therapy, 94(5), 623-631.
* ↑ Miyamoto, G. C., Costa, L. O. P., Galvanin, T., & Cabral, C. M. N. (2013). Efficacy of the addition of modified Pilates exercises to a minimal intervention in patients with chronic low back pain: a randomized controlled trial. Physical therapy, 93(3), 310-320.