Effects of a Pilates protocol in individuals with non-specific low back pain compared with healthy individuals: Clinical and electromyographic analysis

The relationships between spinal amplitude of movement, pain and disability in low back pain: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

The role of spinal movement alterations in low back pain (LBP) remains unclear. This systematic review and meta-analyses examined the relationships between spinal amplitude of movement, disability and pain intensity in patients with LBP.

DATABASES AND DATA TREATMENT

We searched PubMed, CINAHL, Embase, Pedro and Web of Science for relevant articles until 14th March 2023. Risk of bias was assessed with the Quality in Prognostic Studies Tool. We analysed the relationships between amplitude of movement, disability and pain intensity with standard correlational meta-analyses and meta-analytic structural equation modelling (MASEM) in cross-sectional and longitudinal data.

RESULTS

A total of 106 studies (9001 participants) were included. In cross-sectional data, larger amplitude of movement was associated with lower disability (pooled coefficient: -0.25, 95% confidence interval: [-0.29 to -0.21]; 69/5899 studies/participants) and pain intensity (-0.13, [-0.17 to -0.09]; 74/5806). An increase in amplitude of movement was associated with a decrease in disability (-0.23, [-0.31 to -0.15]; 33/2437) and pain intensity (-0.25, [-0.33 to -0.17]; 38/2172) in longitudinal data. MASEM revealed similar results and, in addition, showed that amplitude of movement had a very small influence on the pain intensity-disability relationship.

CONCLUSIONS

These results showed a significant but small association between amplitude of movement and disability or pain intensity. Moreover, they demonstrated a direct association between an increase in amplitude of movement and a decrease in pain intensity or disability, supporting interventions aiming to reduce protective spinal movements in patients with LBP.

SIGNIFICANCE

The large meta-analyses performed in this work revealed an association between reductions in spinal amplitude of movement and increased levels of disability and pain intensity in people with LBP. Moreover, it highlighted that LBP recovery is associated with a reduction in protective motor behaviour (increased amplitude of movement), supporting the inclusion of spinal movement in the biopsychosocial understanding and management of LBP.

Effectiveness of Pilates exercise on low back pain: a systematic review with meta-analysis

PURPOSE

Low back pain is the most frequently reported musculoskeletal disorder and represents one of the highest patient burdens in healthcare. This systematic review and meta-analysis aimed to investigate the effectiveness of Pilates exercise on pain intensity and functional disability caused by low back pain (LBP).

MATERIALS AND METHODS

A Systematic review with meta-analysis was conducted. Data sources: MEDLINE-NLM and MEDLINE-EBSCO. We also searched on Scopus Elsevier, Cochrane, DOAJ, SciELO, PEDro, and PLOS ONE databases. Eligibility criteria: randomized controlled trials (RCTs) evaluating LBP in which the primary treatment was based on Pilates exercise compared with no exercise, or non-specific exercise.

RESULTS

The search returned 1566 records of which 36 articles were included in the systematic review and 19 in the meta-analysis. Twenty-two studies compared the effects of Pilates exercise vs no exercise and 13 studies examined the effects of Pilates exercise vs non-specific exercise. Analysis showed that Pilates had a positive effect on the perception of LBP vs no exercise. A similar trend occurred with non-specific exercise.

CONCLUSIONS

Pilates exercise can decrease LBP compared to no exercise and non-specific exercise. General practitioners should consider Pilates exercise as an effective strategy to manage LBP and counteract the growing health.

TRIAL REGISTRATION

PROSPERO registration number: CRD42022308387.IMPLICATIONS FOR REHABILITATIONPilates is a good strategy for improving low back pain and is more effective than other exercise programs or no exercise.Pilates is a safe tool to apply to most of the population with low back pain.Pilates is a non-pharmacological strategy useful for counteracting low back pain.

Pilates to Improve Core Muscle Activation in Chronic Low Back Pain: A Systematic Review

Low back pain is prevalent in the community and associated with deficits in core muscle strength and activation. Pilates is argued to improve movement and reduce pain, yet there is a limited understanding of the specific effects of Pilates training on core muscle strength or activity. A systematic search of databases (CINAHL, Embase, Ovid MEDLINE) used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methods to evaluate randomised controlled trials (RCTs) on the effects of Pilates to improve core muscle activation. Methodological quality was assessed using the Physiotherapy Evidence Database scale (PEDro). The certainty of findings was determined using the Grading of Recommendations Assessment, Development and Evaluation tool. Of the initial yield of 563 articles, eight RCTs met the inclusion criteria. A diverse range of Pilates interventions and outcome measures were utilised to assess effects on core muscle activation and strength. The main finding was that Pilates is not inferior to equivalently dosed exercises, and can be superior to non-equivalent or no exercise, for improving core muscle strength as indicated by muscle thickness. There was emerging evidence that Pilates positively impacts core muscle strength and can be an effective intervention for people living with chronic low back pain.

Motion Analysis of Core Stabilization Exercise in Women: Kinematics and Electromyographic Analysis

As core stabilization exercise is essential for maintaining a stable spine and improving functional performance, understanding the activation of core muscles and the stabilization of the trunk and pelvis during such exercise is crucial. The purpose of this study was to investigate the muscle activation and stabilization of the lumbar–pelvic region during core stabilization exercise, with a specific focus on analyzing EMG and 3D motion kinematic data. The study aimed to understand how different tension settings on the reformer affect muscle activation and hip motion, as well as how these factors impact pelvic and trunk stability during the exercise. The reformer consists of a carriage that slides back and forth on rails, with springs providing resistance. The springs can be adjusted to vary the resistance level. Twenty-eight healthy women participating in this study were asked to perform ‘side splits’, a hip abduction exercise, on the reformer in both heavy and light tension settings. Activation of the internal oblique (IO), rectus abdominis (RA), multifidus (MU), costal lumbosacral (IL), gluteus medius (GM), and adductor muscles (AL) were measured using electromyography (EMG) and 3D motion. Kinematic data using an assay were also measured during exercise. GM, IO, and MU muscles were more active when heavy springs were used, and AL muscles were more active when light springs were used. Hip motion was more symmetrical when lighter springs were used with a greater range of hip motion. There was less pelvis and torso weight transfer and more torso and pelvis stability when the heavier springs were used. In this study, we confirmed that core stabilization exercise on an unstable surface activates the deep muscles of the abdomen and back and is effective for pelvic and trunk stabilization training.

THE EFFECT OF PILATES EXERCISES ON MUSCLE ELECTRICAL ACTIVATION IN ADULTS WITH CHRONIC LOW BACK PAIN: A SYSTEMATIC REVIEW

ABSTRACT Low back pain is one of the most prevalent orthopedic conditions, affecting around 70% to 80% of the world’s population at least once during their life times. Surface electromyography is an important tool for assessing the muscle function of the lumbar stabilizers. One of the best treatment options for patients with chronic low back pain (CLBP) is physical exercise, particular lyaerobic exercise and Pilates, as these can reduce short-term pain and disability, and improve balance. This review aims to identify the state of art regarding the benefits of pilates on the population with CLBP, evaluating changes in the muscular activation of the muscles of the lumbar region. Searches were conducted on the following databases: PubMed (Medline), Science Direct, Scopus, Web of Science, Cochrane, Ebsco and Scielo; including gray literature: Google Scholar, Grey Literature, Pro Quest Dissertations & Theses. The inclusion criteria were adults with low back pain for three months or more, with or without referred pain in the lower limbs; studies that used electromyographic variables; studies with a pain assessment measure at two different times; studies with physical exercise performed only using the Pilates method. Applying these criteria, the searches retrieved 439 abstracts. Of these, 44 articles were evaluated for eligibility, and three fulfilled the qualitative and quantitative synthesis criteria. The average methodological quality score on the Downs and Black checklist was 15 out of 28. It was therefore concluded that Pilates is an excellent option for the treatment of non-specific low back pain, promoting health and helping prevent low back pain among asymptomatic individuals. Level of evidence II; Systematic Review of Level II or Level I Studies with Discrepant Results.