Is Pilates good for Low Back Pain?


Is Pilates good for Low Back Pain?

When people ask if Pilates is good for low back pain my answer is a resounding YES.
However, there are many important variables to consider. To clarify, not ALL Pilates exercises are great for all back pain sufferers because not all low back pain originates from the same structures. Therefore, your choice of Pilates exercises will depend on specific individual variants. Find our more…

How much do you know about your injury?

In order to understand whether you’re doing the right thing for your back you need to think about the following.

  • The onset of the injury is important.There will be inflammation on a very recent injury immediately that will tail off gradually. in contrast a chronic injury will not necessarily have it.
  • The extent of your injury is important. For example, a large acute disc herniation may press on the nerve roots and may take longer to heal. A small annular tear will not press and will take less time to heal. Likewise, a facet irritation could resolve sooner.
  • Your health status is important. Generally, people who have healing problems, like diabetics, will heal slower. Similarly, people who are cardiovascularly fit might heal sooner, as the tissues get more oxygen in the blood.

While the answers to these questions are important to your exercise regime, the  approach will greatly influence your prognosis. For instance, a 65 year-old client with lumbar facet OA might react differently to loaded lumbar flexion than a 38 year-old client with an acute disc herniation.

Consider the following factors.

The origin of your low back pain

The nature of your low back pain is paramount to the suitability of exercises.
Various structures in the low back may cause pain. For instance, the muscles, ligaments, discs, facet joints, facet capsule and articular cartilage are all sources of pain. In fact, some of the structures in the spine are extremely pain sensitive, like the outside potion of your disc. So determining the source of the pain is important, as they all behave differently and require different treatment.

Healing in also Important

Some spinal structures heal more rapidly than others. For instance, muscles are metabolically more active compared to ligaments or tendon. As a result, muscles take significantly less time to heal, so for a muscle strain injury most Pilates exercises can be done soon after the client is pain free. On the other hand, structures such as a disc or nerve injury require longer healing periods as blood supply to them is meagre.

Who gets the Low Back Pain

Anyone can get low back pain, however, there are notably differences between age groups, body composition and level of activity. For example, an active healthy 21 year-old who pulled a back muscle playing tennis won’t heal like a 48 year-old sedentary, overweigh individual with a disc herniation. Although the source of the pain differs among the two, the healing time and the exercise programming will too.
Wheras the 21 year-old with a pulled muscle will be fine with loaded lumbar flexion, the client with a disc herniation will not be. Thus, the second individual is more likely to have a diagnosis of wear and tear, his recovery time will be longer. After all, tissue healing time varies significantly with age. In short, the health of the person also plays a major role on how the tissues will heal, including high stress levels.

One Size Does Not Fit All

Although Pilates exercises would be beneficial for both cases above, not all injuries in the above examples are equal, and not all Pilates exercises are “One size fits all”. In the example above, different exercises would be suitable for each individual.
While there are specific recommendations to non specific low back pain, some lumbar spine pathologies carry contraindications. For example, spinal flexion is not ideal for lumbar disc herniations because it further comprises the disc material. Spinal extension is a contraindicated movement for people with spondylolisthesis because it may worsen the fractured pars interarticularis.

Herniated Discs

Lumbar spinal flexion is contraindicated when during episodes lumbar herniations . In this case, loaded flexion further compresses the disc material and may tear the fibres during the healing process. Indeed, lumbar flexion is discouraged when referred pain and neurological symptoms are present in herniations. This is because the load pushes the disc further outwards. So, sit-ups are definitely not appropriate during this period.

Flexion-free workouts are widely recommended in rehabilitation settings. The deep spinal stabilisers become inhibited during episodes of low back pain.  These muscles need retraining as they do not activate automatically. Retraining exercises are therefore introduced as soon as the individual is relatively pain free. In addition, exercises in a flexion-free range are aimed to retrain the deep local spinal stabilisers.

There is a plethora of Pilates exercises consisting of fantastic movement alternatives to spinal flexion.
During the subacute phase of the injury it’s best to work in a flexion free range. However, in our daily lives we require spinal flexion, so spinal flexion should be gradually introduced. Firstly, non-loaded flexion as in a cat stretch, and later in the remodelling phase, loaded flexion as in a half roll back.

The General Rule

As a general rule, if it’s painful stop. In other words, exercise under pain free and discomfort free conditions. However, in chronic pain, 3 months or more, it is possible to exercise under slight discomfort. This is because scarring tissue will likely cause discomfort, but it will be necessary to remodel the fibres in the scar.
Pilates exercise is widely recommended for people who suffer with mechanical low back pain. However, in certain types of low back pain, it is necessary to make modifications to avoid further injury. If in doubt, seek advise from a qualified  medical professional.

Pilates for Injury Prevention and Maintenance

Pilates for core stability

“Improving the ability of muscles to respond to perturbations that potentially disrupt spinal stability is important in protecting the motion segments against repetitive microtrauma (1), (2) that potentially leads to low back disorders”

In the field of sport rehabilitation achieving abdominal muscle strength and proper order of activation of the abdominal muscles are major considerations. Especially, for improving performance and functional movement, as well as for preventing musculoskeletal lower back pain (3).

Pilates exercises help people improve spinal stability and abdominal strength. Most importantly, prevention is always the key. In particular for those who have had previous spinal injuries or chronic problems and wish to prevent recurrences.

Accordingly, the best recommendation is to find knowledgable instruction, so search for someone who knows their anatomy and physiology. For this reason, we recommend that you choose a scientifically based Pilates method.

In conclusion, the body forms scars during tissue injury. The scar is weaker than the original architecture of the tissue. This will need time to heal and then remodel. Exercise is crucial to the remodelling phase of tissue healing.

Core Kensington offers knowledgable and highly qualified instruction in Pilates and spinal rehabilitation.

National Guidelines

The National Institute for care and Health Excellence guidelines recommend:
*Consider a group exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica

Book now an assessment now and find out how Pilates exercise can be good for you.


  1. McGill, S.M. Stability (from biomechanical concept to chiropractic practice) . J Can Chirop Assoc. 1999;43:71–86
  2. Richardson, C., Jull, G., Hodges, P., and Hides, J. Therapeutic exercises for spinal segmental stabilization in low back pain. Churchill Livingstone, Toronto; 1999
  3. Cho KH, Beom JW, Lee TS, Lim JH, Lee TH, Yuk JH. Trunk muscles strength as a risk factor for nonspecific low back pain: a pilot study. Ann Rehabil Med. 2014;38:234–240.