The No-Pill Treatment for Low Back Pain

pilates, mat work, low back pain

CEU Article Title: Chronic Low Back Pain Sufferers can Benefit from Pilates Mat Exercises

Chronic, non-specific back pain can be annoying and debilitating, especially for athletes and avid exercisers. Exercise therapy to help this type of pain can be helpful, including the many Pilates alternatives. Traditional mat exercises are only one aspect of Pilates; exercisers can also use specialized equipment such as a Reformer, Cadillac, Stability Chair, Barrels, or other props.

A recent study published in the Journal of Physical Therapy Science (Lee, Hyun, & Kim, 2014) examined the impact that Pilates mat exercises and Pilates apparatus exercises could have and how they could help lower back pain. In one particular study, 40 businesswomen with chronic back pain were chosen as test subjects. The participants were given mat exercises (PME) or apparatus exercises (PAE) and performed the exercises assigned three days per week, for a total of eight weeks. Each session was 50 minutes in length, which included a warm-up, main exercises, and a cool-down period. The balance of each of the study participants was tested by measuring sway length and sway velocity before exercising began and then after. The test subjects stood on a balance performance monitor for 30 seconds to measure this (Lee et al., 2014).

The results showed that sway length and sway velocity decreased after the test, and the group that performed mat work (PME) outperformed the group that did equipment work (PAE). Pilates has been used to help treat the painful symptoms of back pain by improving spinal stabilization.

Causes of Low Back Pain

According to the article, “LBP (low-back pain) occurs when coordination and stabilization of the trunk muscles are weak. LBP negatively affects the trunk, including its strength and endurance; it brings about abnormal changes in the neuromuscular mechanism that influences trunk stabilization and efficiency when exercising” (Lee et al., 2014).

Lack of trunk stabilization has been shown to influence balance and core stabilization. During the study, Pilates mat exercises were found to help decrease swaying and help improve balance, which helped build trunk stabilization and enhance stability in the core.

Mat Exercises Prove Beneficial

According to the study, “PME showed greater improvement in pain level and balance compared with PAE in this research. Since the subjects of this study were patients with low back pain, PME is assumed to have been more suitable and effective because it uses body weight to strengthen core muscles rather than heavier apparatuses as in PAE” (Lee et al., 2014).

The Workout Formula

For the mat (PME) portion, participants performed breathing work, imprint and release, supine spinal work, arm circles, swimming, side lying variations, roll over, child’s pose, and more. Breathing was also initiated at the end of the session. For the equipment portion (PAE), breathing was also done, as well as hamstring stretches, footwork, sit-ups, glute and trunk raises, mermaid stretches, and more (Lee et al., 2014).

Weak Core, Pelvic Muscles, and Spinal Stabilization Factors

Since low back pain can stem from weak core muscles (Lee et al., 2014), Pilates exercises that strengthen muscles such as the transversus abdominis and multifidus can be helpful for helping prevent chronic lower back pain. Pelvic muscles also play a role, as does spinal stabilization (Lee et al., 2014).

Other studies have shown that Pilates does activate the transversus abdominis (TA). A 2008 study in the Archives of Physical Medicine and Rehabilitation found that, when performed correctly, classical Pilates exercises activated the TA, as well as the obliquus internus abdominis (OI) muscles (Endleman & Critchley, 2008). The study also found that using Pilates reformer equipment could create greater activation of the transversus abdominis muscles during select exercises. However, if the exercises were performed incorrectly or without imprint, then they did not help.

The Lee, Hyun, and Kim (2014) study stated that, “of all the various exercise methods, Pilates therapy is the most popular because it has the least degree of possible injury and can easily be practiced by anyone.”

Pilates at Your Gym

Pilates instructors today have many options of what to do for lower back pain. They can work in a variety of roles and teach diversified sessions at your gym. Group classes and one-on-one sessions can be performed in your gym to provide clients with exercises that might help them with low back pain.

Pilates programming is in high demand, because the classes and sessions can be used by many groups of people, from strong athletes to elderly clients looking to maintain muscle and balance. Several different companies sell Pilates equipment and accessories, including Balanced Body, Gratz, Peak Body Systems, PowerHouse Pilates, and STOTT Pilates.

Classes and sessions can include equipment or they can simply use a padded mat and small props, depending on which type of class is most appealing to clients.

In 2010, 8.6 million people were practicing Pilates, making it one of the most popular mind-body exercise programs at facilities across the world. And, just as Pilates mat work exercises have been shown to help with low back pain, the regimen is also being used in physical therapy and medical offices. As doctors continue to prescribe Pilates as the thing to do for lower back pain, the demand for classes in gyms will continue to grow.



Endleman, I., & Critchley, D. (2008). Transversus abdominis and obliquus internus activity during pilates exercises: Measurement with ultrasound scanning. Physical Medicine and Rehabilitation, 89(11), 2205-2212.

Lee, C., Hyun, J., & Kim, S. (2014). Influence of Pilates mat and apparatus exercises on pain and balance of businesswomen with chronic low back pain. Journal of Physical Therapy Science, 26(4), 475-477.

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. doi:10.1371/journal.pone.0100402