Pilates for Low Back Pain

Pilates can be a great exercise choice for the management of low back pain. It promotes back health through the prescription of specific core exercises for our deep postural muscles, as well as our more global muscle groups.

Before commencing Pilates it is important you have an understanding of low back pain and its causes. Low back pain affects the lumbo-sacral area of the back, the area between your lower ribcage and the top of your legs. It affects around one third of the adult population each month (1). In most cases, low back pain is non-specific and serious causes for back pain are rare. It is important that you seek advice from a Chartered Physiotherapist to determine the nature and source of your low back pain before commencing exercise.

If Pilates is deemed appropriate for you, then an experienced physiotherapist who is trained in Pilates can uniquely blend their expert knowledge of back pain with Pilates exercise and can tailor it to your needs. You may benefit from a one to one assessment prior to commencing a class in order to develop an understanding of your body and how to perform the exercises correctly. You can then practice the exercises at home between your scheduled Pilates class. Matwork Pilates consists of 34 exercises that have been created to improve and promote flexibility, endurance, core stability, postural awareness and correction of muscle imbalances. The APPI (Australian Physiotherapy and Pilates Institute) method has been designed by Physiotherapists for specific use in a rehabilitation setting. The exercises have been broken down and modified to be suitable for a clinical population using our clinical reasoning skills.

The National Institute for Health and Care Excellence (NICE) recently published guidelines on the management of low back pain (1). Their recommendation on exercise is based on expert opinion by the University Of Michigan Health System 2010 (2). They suggest exercise which involves back core strengthening exercises and aerobic exercises which minimally stress the back. This encompasses everything Pilates is based on.

So, what is our deep core?
The deep core muscles consist of your transversus abdominus, multifidus, pelvic floor and diaphragm.


How does this relate to back pain?
Dysfunction in our deep core muscles has been shown to relate to low back pain. Pain affects our normal movement patterns and inhibits the function of our deep core muscles (3). This can lead to muscle guarding and altered movement patterns. Recovery from pain and dysfunction is not automatic and requires movement re-learning and muscle re-training.

So, how can Pilates help?
The APPI Pilates method focuses on dynamic stabilisation retraining that reconditions the body from the central core. They have based their Pilates teaching on segmental spinal stabilisation research and lumbo-pelvic stabilisation theory. Each exercise focuses on control of neutral alignment before increasing range of motion and skill.

The first step is achieving the 5 key elements;
1. Breathing. The APPI Pilates method encourages the natural mechanics of the ribcage when breathing to increase awareness of your natural breath patterns. The aim is to breathe in wide and full into the sides and back of the ribcage. Breathing correctly can help your pain by avoiding any unnecessary muscular tension.
2. Centring. Also known as, your neutral spine position. It encourages the deep core muscles to work together in maintaining a neutral position of the spine. It is important that you are instructed on the correct position for this as it can differ for everyone. Transversus abdominus muscles have been shown to work optimally in a neutral spine position.

Neutral spine

3. Ribcage Placement. During Pilates, we encourage optimal spinal alignment which includes alignment of the ribcage. When lying on your back your ribcage should rest naturally on the mat.
4. Shoulder Blade Placement. The importance of this is as great as ensuring your neutral pelvic position. Imagine your shoulder blades gliding down towards your back pockets.
5. Head and Neck Position. The head and neck are held in position by the deep stabilising muscles of your neck. Correct positioning ensures there is no excess stress being placed on your neck during exercise.

Watch the video below to see the 5 key elements in action:

In summary, low back pain can have many sources but most cases are non-specific. If you are suffering with low back pain then seek advice from a Chartered Physiotherapist to determine the nature and cause of your pain. Pilates is a great exercise option for those recovering from low back pain if deemed suitable for you.

All classes at Centre Focused Pilates are Physiotherapy led. If you are interested in a 1:1 Pilates assessment or signing up to a class then please contact me at centrefocusedpilates@gmail.com








1. National Institute of Health and Care Excellence (2017) Back pain- low (without radiculopathy). NICE
2. University of Michigan Health System (2010) Acute low back pain. University of Michigan Health System.
3. Hodges and Richardson (1996) Inefficient muscular stabilisation of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominus. Spine 21: 2640-2650