Osteopathic Journals and Research by Darren Chandler


Pilates for pain

Posted on



  • Introduction
  • Pilates for low back pain
  • What is the core?
  • Key concepts in Pilates – power is nothing without control!
  • How osteopathy can help core muscle strength


Pilates was created by Joseph Pilates in the 1920s. It blends Western yoga, Greek and Roman gymnastics, karate, and Zen, among others, and has developed into a series of physical and mental conditioning exercises(1).

Joseph Pilates was self-educated in anatomy, bodybuilding, boxing, wrestling, yoga, gymnastics, and martial arts. At the outbreak of World War One he became a nurse-physiotherapist. He took bedsprings and rigged them to posts, headboards, and footboards of the bed frames, transforming them into resistance-type equipment for disabled patients(2).

He was essentially a therapeutic personal trainer of his day!

Pilates for low back pain

Low back pain is a common disorder seen in practice and is a serious problem. Nearly 75–85% of people have experienced low back pain, which has large economic and social costs(3).

The definitions of chronic low back pain include pain for more than 7 to 12 weeks. The prevalence and high relapse rates of nonspecific chronic low back pain often cause disability, and severely affect the quality of life(3).

Your core muscles maintain the posture in your pelvis and spine so the muscles that move you when, for example, bending forwards don’t pull on your spine. The analogy is that if you had no core muscles supporting and maintaining your posture when you moved, other muscles, could almost drag your spine and pelvis into a position where they can get strained.

A recent systematic review of evidence on pilates found patients with chronic low back pain showed significant improvement in pain relief and their ability to perform day to day activities. However other exercises showed effects similar to those of Pilates, if waist or torso movement was included and the exercises were performed for 20 cumulative hours(3).

What is the core?(2)

Joseph Pilates is credited for labelling the core, or center, “the powerhouse.” For those with an interest in anatomy the most common core muscles include: Quadratus Lumborum, Internal and External Obliques, Transverse Abdominis, Multifidus and the Rotator Cuff muscles. However there are other muscles that also offer core stability. Research indicates that there is no single element of the core that is inherently more important than another.

Jospeph Pilates conceptualised these muscles by drawing  a “box” in the body. The two horizontal lines ran from shoulder to shoulder and hip joint to hip joint. The vertical lines ran between the left shoulder and left hip and right shoulder and right hip. By actively retraining and conditioning the muscles in this ‘box’ he maintained you could keep a good posture giving your body a ‘powerhouse’ on which to operate from.

Whilst this analogy of a box acting as a core or powerhouse to stabilize and integrate all the movements in the body has use and originates a lot of modern day core exercises we now know there are core stabilizing muscles outside this ‘box’ from the foot to the jaw (TMJ).

Key concepts in pilates(2) – power is nothing without control!

Mind over matter is a central element in Pilates. This entails fusing the mind and body so that without thinking, the body utilises the greatest mechanical advantage to achieve the best possible balance, strength, and health.

This is why Pilates movements are performed to master precision and flow and, ultimately, are transferred to day to day activities so that, for example, the simple act of bending forwards engages all your core muscles correctly minimising strain on your back and pelvis. This is why pilates emphases rhythmic breathing, mental focus and motor learning (muscles learning a skill), tailoring the practice to individual needs and total core control.

As an example one of the key Pilates techniques to align, lengthen, and protect the spine is to draw the navel to the spine. Abdominal hollowing, or the abdominal drawing-in manoeuver engages your core muscles with the aim of stabilizing your pelvis (sacroiliac joints) more so than just tensing your abdominal muscles. 

However you don’t get full value by initiating this manoeuvre during the movement it must be before. Research has shown to stabilize the spine for movement core muscles must activate no later than 100 milliseconds prior to the movement.

How osteopathy can help core strength

Many patients present to us feeling misaligned. This may be because of an injury or how they’ve been compensating for an injury. Sometimes because of this the correct execution of a core stability exercise is impossible or at the very least so difficult to perform patients don't get the full benefit. By correcting these areas of injury core exercises are more easy and effective to perform and can even be prescribed by your osteopath.


(1) Effects of pilates on patients with chronic non-specific low back pain: a systematic review (2016). Lin HT, Hung WC, Hung JL, Wu PS, Liaw LJ, Chang JH.

(2) Pilates (2011). What Is It? Should It Be Used in Rehabilitation? Christine E. Di Lorenzo

(3) Effects of pilates on patients with chronic non-specific low back pain: a systematic review (2016). Lin HTHung WCHung JL, Wu PSLiaw LJChang JH.



Add a comment:

Leave a comment:


Add a comment