Reducing back pain with the Pilates reformer

Recommended for rehab


Back pain is not lethal but it can make your life a misery. Reducing back pain is a major health issue with non specific chronic low back pain affecting up to to eighty percent of the population at some point in their lives. In the UK back pain costs the NHS £1.3m daily and it accounts for 12.5% of all work absences. In 85% of those suffering back pain the cause of the pain is unknown. When the cause is unknown, prescribing effective therapy is a complex problem and much more research will be required. Most current research advises that it is better to remain physically active as recovery is negatively affected by inactivity.

Core strength is fundamental to Pilates although Joseph Pilates was referring to this almost 100 years ago as 'the powerhouse' . A review of chronic low back pain in 2015 by Rebecca Gordon and Saul Bloxham found that core stabilisation exercises significantly reduced chronic low back pain (by 76.8%) and highlighted the importance of core stability. Since Pilates exercises stress the importance of a strong core this may explain why Pilates has so many followers who claim positive and lasting results in finding relief for back pain.

Causes of back pain

The possible causes of back pain are endless; arthritis, kidney stones or kidney infections, obesity, poor posture, accidents or sports injuries, ruptured intervertebral discs, blood clots and irritated joints to name but a few. But these are the least likely causes. More commonly the cause of the pain will be found hidden in the intricate structure of the back that includes bones, muscles, ligaments, joints and tendons. It is often something here which will be responsible for the pain but even then an exact diagnosis may not be possible and the pain is then referred to as being non specific. Many studies have concluded that strengthening the muscles that are referred to as the core can result in reductions in pain levels. Because Pilates focusses on improving this core strength it is often the exercise of choice for anyone suffering with non specific back pain. However there are alternative ways to practice Pilates and for back pain sufferers not all of these may be suitable.

Mat Pilates classes and back pain

These are a one size fits all type class where generally a group of up to 12 participants all perform the same exercise simultaneously albeit with some variations for the differing health conditions of the participants. Mats are placed on the floor and you perform exercises whilst kneeling, standing, sitting, or lying on your back, front or side. If because of back pain you are unable to freely move between these different positions or if you would struggle to maintain the pace of the group then mat classes would probably not be suitable for you.

Over time, some participants will drop out of the class and they are in turn replaced by others who are usually unfamiliar with the Pilates exercises. These beginners will then lag behind the established and more experienced class members and will need more attention, help and correction. It is not uncommon to find a mat class of several years standing having some members that have been in class for only a few weeks. Within that class you could also have for example someone with a knee problem, another with a shoulder issue, a twenty something fitness fanatic and a retiree. If you have any kind of back problem it may be unwise for you to join a mat class which has differing levels of ability, mixed health conditions and where you are required to constantly be changing positions. Whilst it is probable that you can perform some of the mat exercises, others may actually make your back problem worse.

Group reformer pilates classes

This is a fairly recent innovation which is very popular in the USA. It works well for anyone who is fit, but not if you have a health condition that affects your ability to exercise. This teaching style has more to do with income generation than rehabilitation. Commonly up to 8 reformers are placed in a line and an instructor works up and down the line cueing and making corrections. As in a mat class all of the group perform each exercise together. The group reformer class will have similar negative issues to the group mat classes.

Group reformer sessions

The critical difference is between the words 'classes' and 'sessions'. In a class everyone does the same exercise at the same time but in a small group reformer session you would be working to an individual programme of exercises that specifically addresses your own health condition. A small group reformer session could therefore be suitable for a cardio athlete and for a back pain sufferer working in the studio together. Typical teacher client ratios would normally be about 1 to 5. A bespoke programme of exercises that is tailored to the condition of a back pain sufferer is far more likely to achieve positive long term results.


Back pain of 12 weeks or longer is classed as chronic back pain. Non specific back pain is where the pain cannot for instance be attributed to something like a fracture or an infection. Pilates has had considerable success with reducing pain levels in non specific chronic low back pain, and sometimes significantly. In most adults almost all back pain is forward flexion intolerant which means that forward bending can cause pain. Appropriate exercises must be chosen very carefully. Back pain is a complex health condition with 85% of cases having no known cause. It is important to make an informed choice and if your choice is Pilates then following an exercise programme which allows you to work independently and at your own pace would seem to be the most sensible option.

Back pain studies

There have been numerous studies on the effectiveness of Pilates in relation to back pain. Many were carried out as research studies at various universities worldwide. The diverse geographical nature of the studies is welcome and adds to the increasing acceptance of Pilates as a genuine and effective option to back pain compared to previous medical advice which suggested drugs, bed rest and a firm mattress.

A recent study at Queens University, Ontario, Canada, decided to test whether Pilates exercises were effective in improving the condition of a group of adult patients. All of the adults were suffering with chronic low back pain and they were divided into two groups. One an experimental group and the other a usual care group. The experimental group exercised on Pilates equipment while the second group received the usual care provided to individuals seeking medical help for low back pain through their GP. Post-testing revealed that the Pilates participants had significantly lower levels of pain intensity and functional disability than the usual care group. But perhaps most important of all, the study found that one year later, the Pilates participants had maintained their physical improvements.

Journal of orthopaedic and sports physical therapy

Queens University, Kingston, Ontario

Griffith University, Australia.

University of British Columbia

Dayton Children's hospital, Dayton, Ohio.

A systematic review of the effects of exercise on non-specific chronic low back pain. Rebecca Gordon and Saul Bloxham.
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