Curr Rev Musculoskelet Med (2008) 1:39–47 (range of 20–65 years). Regarding outcome measures, there were signiﬁcant reductions in both disability and pain intensity in both groups. In the Pilates group, average OLBPDQ scores showed a sharper but nonsigniﬁcant fall in the ﬁrst month versus baseline values compared to the Back School group. The mean improvement, however, between baseline values and those obtained at the ﬁnal 6- month visit was similar in both groups. In addition, the participants in the Pilates method reported a better sub- jective response to treatment as compared to those in the Back School method at all follow-up time points. For adherence to home practice, only 26% of the total partic- ipants performed any home-based exercises with just 7% performing them on a regular basis. Regarding level of satisfaction, 62% of participants in the Pilates Method stated they were ‘‘very satisﬁed’’ compared to 4.5% of those in the Back School; for beneﬁt perceived, participants in both groups showed similar results. The authors concluded that the equally good results obtained with the Pilates CovaTech method demonstrated it was as efﬁcacious as the Back School method in terms of both short- and long-term (6 month) outcomes. They also stated the Pilates intervention had better compliance because of subjective responses such as improvement of symptoms and satisfaction with treatment. In conclusion, the authors proposed the Pilates CovaTech method was a valid alternative in the management of patients with non- speciﬁc CLBP. Lastly, Rydeard et al. published a randomized con- trolled study in 2006 on the effects of a Pilates-based therapeutic exercise protocol on patients with CLBP as compared to a control group receiving usual care [9]. Thirty-nine subjects with nonspeciﬁc CLBP were enrolled in this study. Participants were required to have had per- sistent LBP for greater than 6 weeks or recurring LBP with at least two painful episodes per year ‘‘of sufﬁcient inten- sity to restrict functional activity.’’ They were also required to be physically active, deﬁned by the authors as partici- pating in a minimum of three moderately intense 30 min sessions of activity per week. Finally, subjects had to exhibit strength of 4/5 or less on manual muscle testing of the gluteus maximus as well as altered recruitment of this muscle as determined by visual and manual inspection during a prone leg extension test. These individuals were then randomized to one of the two groups including 21 to the Pilates group and 18 to the control group. The Pilates protocol consisted of exercises performed on the mat and the Reformer that were designed to train the activation of speciﬁc muscles thought to stabilize the lumbar-pelvic region. Subjects recruited the pelvic ﬂoor and lumbar multiﬁdus and then activated the gluteus maximus during a variety of movement patterns involving hip extension. Movements were initially performed in supine with the 45 lumbar spine in neutral and then progressed to more upright postures with movement out of neutral postures. One of the two physical therapists trained in this protocol taught the 1 h session 3 times weekly for 4 weeks. In addition, the Pilates participants were asked to complete a 15-min home program 6 days per week which involved similar exercises performed on the ﬂoor. The control group received usual care as deﬁned by the authors as ‘‘consul- tation with physicians and other health care professionals as necessary.’’ The control group was also instructed to continue participating in their usual physical activity. Outcome measures included functional disability asses- sed with the 24-point Roland Morris Disability Questionnaire (RMQ) and average pain intensity measured with a 101-point numerical rating scale. Outcomes were evaluated at baseline and end of treatment in both groups; in addition, retention of treatment effect for disability was tested at 3, 6, and 12 months post-treatment in the Pilates group. Both groups were matched regarding baseline char- acteristics. In the entire group, subjects were aged 20– 55 years and had a median duration of symptoms of 8.2 years; 20% reported recurring LBP while 80% reported persistent LBP. Of note, 90% of all participants reported having received previous physical therapy intervention and 74% of those interventions had included exercise-based therapy. There were signiﬁcantly lower levels of disability and pain following intervention in the Pilates group com- pared to the control group. For functional disability, the mean RMQ score in the Pilates group was 2.0 compared to 3.2 in the control group at end of treatment. For average pain intensity, the mean number in the Pilates group was 18.3 compared to 33.9 in the control group at end of treatment. In addition, improved disability scores were maintained in the Pilates group for up to 12 months post-treatment. The authors concluded that treatment with a modiﬁed Pilates-based approach was more efﬁcacious in reducing functional disability and pain intensity than usual care in a population with CLBP. They noted a major limitation of their study was the results were potentially not generaliz- able to other CLBP patients who had more disabling pain precluding them from being as physically active or did not have altered performance of the gluteus maximus. On the other hand, they stated their particular group of patients likely represented individuals who sought ongoing treat- ment from healthcare providers for CLBP after they returned to normal daily activities with still some restric- tions and limitations. Making sense of the Pilates literature Since the literature review on the subject of Pilates and LBP yielded only two randomized controlled studies, it is