Effects of Pilates exercise programs in people with chronic low back pain: a systematic review

Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis

Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability.

Pilates versus Zumba training effects on postural control under conflicting sensory conditions in postmenopausal women

The current study aimed to compare the effects of Pilates versus Zumba training on postural performance in middle-aged postmenopausal women. Fifty-seven eligible women, aged between 50 and 60 years, were randomized into three groups: Zumba (ZG) group, Pilates (PG) group or control (CG) group. Postural control was assessed using a force platform under 4 sensory manipulation conditions: on firm and foam surfaces with eyes opened (EO) and closed (EC). Our results showed more marked adaptations in favor of ZG concerning postural performance compared to PG. For the PG, postural control was significantly improved only in simple postural conditions on the firm surface with EO (p < 0.1) and EC (p < 0.05) conditions. However, postural control of the ZG significantly improved in both the simple and complex postural conditions, even under conflicting sensory situations (firm surface/EO (p < 0.001; 95 % CI: [1.34, 4.46]), EC (p < 0.001; 95 % CI: [2.13, 5.24])); foam surface/EO (p < 0.01; 95 % CI: [0.70, 8.57]), EC (p < 0.01; 95 % CI: [0.65, 8.52])). In conclusion, Zumba training seems to be more effective and a better strategy to promote postural control in daily living activities and autonomy in postmenopausal women than Pilates training. These findings are useful for public health practitioners in designing physical interventions for balance disorders.

The effect of corrective exercises on musculoskeletal disorders among the older adults residing in a nursing home in Rasht, Guilan, Iran

BACKGROUND

Ageing causes changes in the function of musculoskeletal systems and disability, and injury among older adults. This study aimed to determine the effect of corrective exercises on musculoskeletal disorders among older adults residing in a nursing home in Iran.

METHOD

This controlled clinical trial study was conducted on 58 older adults (29 samples in each group). The intervention group performed corrective exercises for 8 weeks and three sessions per week and each session lasted for one hour. The pre-test was performed one week before intervention and the post-test one week after the 8-week intervention. The research instruments included Nordic Musculoskeletal Questionnaire (NMQ), and the pain visual analog scale (VAS). Descriptive and inferential (Chi-square, Mann-Whitney, Wilcoxon, and McNemar test) statistics were used to analyze the data using SPSS software version 19.

RESULTS

the majority of the participants were males (67.2%) and in the age range of 60-74 years (82.8%). The mean age of samples in intervention and control groups was 68.45 (SD = 5.38) and 69.17 (SD = 5.86), respectively. The results showed that the prevalence of musculoskeletal disorders (MSDs) was decreased in the intervention group after the intervention (%Δ = -34.68, p < .05). The results also showed a statistically significant decrease in pain intensity of musculoskeletal in the intervention group, after the intervention (%Δ = -68.34, p < .001).

CONCLUSIONS

Corrective exercises reduce the prevalence of MSDs and the pain intensity among older adults. It is recommended to pay attention to these exercises to improve physical health and reduce the prevalence of MSDs among older adults.

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.

Effectiveness of Different Training Modalities on Static Balance in Older Adults: A Systematic Review and Meta-Analysis

(1) Background: aging is associated with functional changes such as balance, which plays a critical role in older adults. Physical exercise has been established as a factor capable of modulating these age-related alterations. (2) Methods: a meta-analysis of randomized clinical trials (RCTs) was conducted. The systematic search was performed in the PubMed/MEDLINE, Web of Science, the SPORTDiscus and Cochrane Library databases. Articles were included if participants were 65 years or older, healthy and performing resistance training, aerobic training, balance training or multicomponent training. Studies were excluded if there was a combination of training with other types of intervention. The protocol of this systematic review was published in the International Prospective Register of Systematic Reviews (PROSPERO) with the code CRD42021233252 (3) Results: the search strategy found a total of 1103 studies. After removing duplicates and the inclusion and exclusion criteria, eight articles were included in the meta-analysis, with a total of 335 healthy older adults analyzed. The results showed no significant differences between the intervention groups and the control groups after the exercise programs. (4) Conclusions: interventions based on different types of exercise improved static balance in elderly population, but without statistically significant difference in comparison with the control groups.

The effects of Pilates exercise in comparison to other forms of exercise on pain and disability in individuals with chronic non-specific low back pain: A systematic review with meta-analysis

OBJECTIVE

To compare the effects of Pilates exercise (PE) with other forms of exercise on pain and disability in individuals with chronic non-specific low back pain (CNSLBP) and to inform clinical practice and future research.

STUDY DESIGN

Systematic review with meta-analysis conducted and reported in line the Preferred Reporting Items for Systematic review and Meta-analysis.

LITERATURE SEARCH

Six electronic databases were searched from inception to April 2021.

STUDY SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing the effect of PE with other forms of exercise for adults with CNSLBP on pain and disability.

DATA SYNTHESIS

Two reviewers assessed the risk of bias of the trials, guided by the Cochrane RoB2 tool. Available data were extracted for meta-analysis with subgroup analysis. Pilates exercise was compared to general exercise (GE), direction-specific exercise (DSE) and spinal stabilisation exercise (SSE). Certainty of evidence was interpreted following the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

Eleven RCTs were included. A low certainty of evidence supported PE was more effective than GE in pain reduction [Effect size (ES) 0.44]. Moreover, very low levels of certainty were revealed for effectiveness of PE compared with DSE for pain reduction (ES 0.65) and equivalence of PE and SSE for pain and disability.

CONCLUSIONS

This review found no strong evidence for using one type of exercise intervention over another when managing patients with CNSLBP. Existing evidence does not allow this review to draw definitive recommendations. In the absence of a superior exercise form clinicians should work collaboratively with the patient, using the individual's goals and preferences to guide exercise selection. Further appropriately designed research is warranted to explore this topic further.

The Effect of a Non-Pharmacological Multicomponent Pain Management Program on Pain Intensity and Quality of Life in Community-Dwelling Elderly Men With Chronic Musculoskeletal Pain

BACKGROUND AND AIM

Improving the level of care for the elderly with musculoskeletal pain requires pharmacological and non-pharmacological pain control methods. This study aimed to investigate the effect of a non-pharmacological pain management intervention on pain intensity and quality of life in community-dwelling older men with musculoskeletal pain who were referred to comprehensive healthcare centers in the city of Ilam, Iran.

MATERIALS AND METHODS

A quasi-experimental study with pre and post-test design was performed on 65 older men with chronic musculoskeletal pain. The samples were selected regarding inclusion criteria as available and randomly assigned to either the control (usual care) or the experimental group (educational intervention plus physical exercises). Baseline characteristics of participants, the Visual Analogue Scale, and the CASP-19 Quality of Life were used to collect data. Data were analyzed by SPSS software using the ANCOVA, independent and paired t-test, and chi-square test at the statistically significant level of 5 %.

RESULTS

According to the findings, there was a significant difference between the experimental and control groups in terms of quality of life (p < .05) and pain intensity (p < .05) after the intervention. No relevant differences were found between groups regarding demographic characteristics at baseline.

CONCLUSIONS

A six-week physical activity and education program for community-dwelling older men with chronic musculoskeletal pain could improve quality of life and decrease pain intensity after a one-month follow-up compared with usual care. Therefore, it seems necessary to consider pain management programs in the elderly care program and familiarize health care professionals with these pain control methods.

The effects of Pilates on pain, functionality, quality of life, flexibility and endurance in lumbar disc herniation

Aim: To assess the effects of clinical Pilates exercises (CPE) on the level of pain, functional status, flexibility, static and dynamic endurance of the trunk muscles and quality of life (QoL) in patients with lumbar disc herniation. Materials & methods: Individuals were divided into two groups: the CPE (6 weeks, three-times a week) group (n = 27) and the control group (n = 27). The clinical outcome measures were the visual analog scale for the evaluation of the pain intensity, Oswestry disability index for functional disability, short form-36 for health related QoL, sit and reach and hand finger floor distance test for the flexibility, side-bridge and sit-ups test for the static and dynamic endurance. Results: At the end of the 6 weeks the amount of decrease in the level of pain and Oswestry disability index, amount of increase in sit-reach test and hand-finger-to-floor distance, duration of the lateral bridge and sits-ups test and most of the short form-36 sub parameters was significantly higher (p < 0.05) in the CPE group. Conclusion: CPE was an effective and safe method for symptomatic patients with lumbar disc herniation in reducing the pain level and functional disability and improving flexibility, static and dynamic endurance and partially their QoL. Clinical Trial Registration: NCT03198273 (ClinicalTrials.gov).

The Effect of Pilates Exercise Nursing Combined with Communication Standard-Reaching Theory Nursing and Pelvic Floor Muscle Training on Bladder Function and Family Function of Patients after Cervical Cancer Surgery

Objective

To explore the effect of Pilates exercise nursing combined with nursing based on the theory of communication compliance and pelvic floor muscle training on bladder function and family function of patients after cervical cancer surgery.

Methods

The medical records of 96 postoperative cervical cancer patients treated in our hospital from November 2019 to May 2021 were selected as retrospective research objects and were divided into observation group and control group with 48 cases each according to the digital table method. The control group received nursing care based on the theory of communication compliance and pelvic floor muscle training, and the observation group received Pilates exercise therapy nursing on the basis of the control group. The differences in urinary retention, family intimacy and adaptability, bladder function, and family function evaluation scores were compared between the two groups.

Results

After nursing, the residual urine volume, urination time, and urination interval of the observation group were lower than those of the control group, while the self-resolving urination rate and urination volume of the observation group were higher than those of the control group, which was statistically significant (P < 0.05). Before nursing, the family intimacy and adaptability scores of the two groups of patients were not statistically significant (P > 0.05). After nursing, the family intimacy score, family adaptability score, and sexual function score of the observation group were significantly higher than the control group; the comparison was statistically significant (P < 0.05). After nursing, the bladder function recovery of the observation group was significantly better than that of the control group, which was statistically significant (P < 0.05). Before nursing, the comparison of family function evaluation between the two groups of patients was not statistically significant (P > 0.05). After nursing, the observation group's problem solving, communication, role, emotional response, emotional intervention, behavior control, and total functional scores were lower than those of the control group, which were statistically significant (P < 0.05).

Conclusion

Carrying out nursing care based on the theory of communication compliance with Pilates exercise therapy for patients after cervical cancer surgery has a good nursing effect improves the patient's family intimacy and adaptability and patient's urinary retention and bladder function. Moreover, Pilates exercise nursing is a postoperative treatment for cervical cancer which provides a certain reference for clinical care of patients.

The Effectiveness of Group-Based Core Stability Exercise and Educational Booklet for Hospital Workers in Taiwan with Nonspecific Low Back Pain: A Preliminary Study

To investigate the effectiveness of health promotion strategies for nonspecific low back pain in hospital workers, we compared the therapeutic effects of group-based core stability exercises and an educational booklet. Subjects participated in a 60-min core stability exercise on a weekly basis for 8 weeks (N = 24) or consulted an educational booklet for advice (N = 22). The numerical rating scale (NRS), Oswestry Disability Index (ODI), and the brief version of the World Health Organization’s Quality of Life (WHOQOL-BREF) were used as outcome measures. The ODI, as well as the total score and domains of overall, physical, and psychological health in the WHOQOL-BREF were significantly improved in the exercise group (p < 0.05). The NRS score significantly improved in the booklet group (p < 0.05). The total score, psychological domain, and environmental domain of the WHOQOL-BREF improved significantly in the exercise group compared with the booklet group (p < 0.05). Group-based core stability exercises and educational booklets are helpful to hospital workers in different ways for nonspecific low back pain. In contrast to the pain reduction by the educational booklet, more active participation in group-based core stability exercise can provide a better outcome in the overall quality of life, especially in the psychological and environmental domains of hospital workers.

The Effect of Exercise Programs on Pain Management and Motor Control in Patients with Nonspecific Chronic Low Back Pain: A Randomized Matched Subjects Trial

Backgroud:

Many exercise approaches have been suggested for the treatment of nonspecific chronic low back pain. However, the best exercise approach is still unknown. The purpose of this study was to compare the effect of three exercise approaches based on the Postural Restoration Institute (PRI) and National Academy of Sports Medicine (NASM) on the pain management and motor control of men with nonspecific chronic low back pain.

Methods:

The study was designed with matched subjects. Thirty-three participants were randomly assigned to three training groups: NASM (n = 11), PRI (n = 11), and NASM-PRI integration (n = 11). Interventions: The participants in each group performed the exercise for eight weeks, three sessions per week and about one hour each session. Pain was measured using a visual analog scale (VAS) scale and functional disability using the Roland–Morris questionnaire. Also, the movement control impairment was measured by the movement control impairment test set.

Results:

Repeated measures ANOVA showed no significant interaction effect between pain perception, functional disability, and movement control impairment of the groups (P >.05).

Conclusions:

The findings suggest that different types of exercise rehabilitation were not significantly different on pain reduction, functional disability, and movement control impairment. It is suggested that the participant's preference for an approach should also be considered for encouraging them to adhere to exercise.

The Pain at Work Toolkit for Employees with Chronic or Persistent Pain: A Collaborative-Participatory Study

Self-management tools for people with chronic or persistent pain tend to focus on symptom reporting, treatment programmes or exercise and do not address barriers to work, facilitators of work ability, or workplace pain self-management strategies. We developed the Pain at Work (PAW) toolkit, an evidence-based digital toolkit to provide advice on how employees can self-manage their pain at work. In a collaborative-participatory design, 4-step Agile methodology (N = 452) was used to co-create the toolkit with healthcare professionals, employers and people with chronic or persistent pain. Step 1: stakeholder consultation event (n = 27) established content and format; Step 2: online survey with employees who have persistent pain (n = 274) showed employees fear disclosing their condition, and commonly report discrimination and lack of line manager support. Step 3: online employer survey (n = 107) showed employers rarely provide self-management materials or education around managing pain at work, occupational health recommendations for reasonable adjustments are not always actioned, and pain-related stigma is common. Step 4: Toolkit development integrated findings and recommendations from Steps 1–3, and iterative expert peer review was conducted (n = 40). The PAW toolkit provides (a) evidence-based guidelines and signposting around work-capacity advice and support; (b) self-management strategies around working with chronic or persistent pain, (c) promotion of healthy lifestyles, and quality of life at work; (d) advice on adjustments to working environments and workplace solutions to facilitate work participation.

A Comprehensive Update of the Treatment and Management of Bertolotti's Syndrome: A Best Practices Review

Bertolotti's Syndrome is defined as chronic back pain caused by transitional lumbosacral vertebra. The transitional vertebra may present with numerous clinical manifestations leading to a myriad of associated pain types. The most common is pain in the sacroiliac joint, groin, and hip region and may or may not be associated with radiculopathy. Diagnosis is made through a combination of clinical presentations and imaging studies and falls into one of four types. The incidence of transitional vertebra has a reported incidence between 4 and 36%; however, Bertolotti's Syndrome is only diagnosed when the cause of pain is attributed to this transitional anatomy. Therefore, the actual incidence is difficult to determine. Initial management with conservative treatment includes medical management and physical therapy. Injection therapy has been established as an effective second line. Epidural steroid injection at the level of the transitional articulation is effective, with either local anesthetics alone or in combination with steroids. Surgery carries higher risks and is reserved for patients failing previous lines of treatment. Options include surgical removal of the transitional segment, decompression of stenosed foramina, and spinal fusion. Recent evidence suggests that radiofrequency ablation (RFA) around the transitional segment may also provide relief. This manuscript is a comprehensive review of the literature related to Bertolotti's Syndrome. It describes the background, including epidemiology, pathophysiology, and etiology of the Syndrome, and presents the best evidence available regarding management options. Bertolotti's Syndrome is considered an uncommon cause of chronic back pain, though the actual incidence is unclear. Most evidence supporting these therapies is of lower-level evidence with small cohorts, and more extensive studies are required to provide strong evidence supporting best practices.

Effect of Pilates mat exercise and home exercise programs on pain, functional level, and core muscle thickness in women with chronic low back pain

BACKGROUND

To investigate the effects of Pilates exercise in patients with chronic non-specific low back pain (CNLBP) by training core stabilization muscles in aspects such as: pain, functional level, depression, quality of life, and muscle thickness measured by Ultrasound Imaging (UI) and to compare it with home based exercise.

METHODS

A prospective, randomized-single blinded study included 60 female patients with CNLBP. Patients were randomized into Pilates (group 1) or home exercise group (group 2) three times/week for eight weeks. The evaluations were made at the beginning and end of the treatment. Outcome parameters were VAS, Oswestry Disability Index, Qubec Disability Scale, Short Form-36, Beck Depression Questionnaire, sit and reach, Modified Schöber and sit up tests. Multifidus and abdominal muscle thickness were measured by UI.

RESULTS

Significant improvement has been observed in all parameters in both groups. It was found that Group 1 was more effective in terms of all parameters (p < 0.05).

CONCLUSIONS

Both Pilates and home exercises are effective in treating patients with chronic low back pain. UI can be useful for evaluating the core muscle thickness progression of chronic low back pain patients who are undergoing exercise therapy.

Effects of clinical Pilates exercises in individuals with fibromyalgia: A randomized controlled trial

OBJECTIVE

This study aimed to investigate the effects of clinical Pilates exercises in patients with fibromyalgia (FM) and to compare the effects of one-to-one and group-based exercise methods.

METHODS

A total of 42 women (mean age, 50.90±7.78 years) with FM were included. The participants were randomly divided into 2 groups (one-to-one exercise, n=16; group-based exercise, n=26). Disease impact was evaluated with the FM Impact Questionnaire, functional status with the Health Assessment Questionnaire, anxiety with the Beck Anxiety Inventory, quality of life with short form-36, and biopsychosocial status with the Bilişsel Egzersiz Terapi Yaklaşımı-biopsychosocial questionnaire. All the evaluations were performed pre- and post-treatment. Clinical Pilates exercises were carried out 2 days a week for 6 weeks.

RESULTS

When the pre- and post-treatment data were compared, significant improvement was seen in all parameters in the group-based exercise group; in the one-to-one exercise group, improvement was noted in disease impact, quality of life, and biopsychosocial status. When post-treatment data were compared, only disease impact was significant for the one-to-one exercise group. Effect size results were found to be moderate and high for both methods.

CONCLUSION

For clinical Pilates exercise in FM, one-to-one method was suggested to have high disease impact and low quality of life, whereas group-based exercise method showed high anxiety.

The effects of clinical pilates exercises on functional disability, pain, quality of life and lumbopelvic stabilization in pregnant women with low back pain: A randomized controlled study

BACKGROUND

Although the Pilates method has been reported to be effective in women with low back pain (LBP), the efficacy of Pilates exercises in pregnant women with LBP has not been evaluated widely.

OBJECTIVE

The purpose of this study was to determine the effects of clinical Pilates exercises on lumbopelvic stabilization, pain, disability and quality of life in pregnant women with LBP.

METHODS

Fourty pregnant women were randomized into either a Pilates exercise group (n= 20) or control group (n= 20). Subjects in the Pilates exercise group performed the exercises two times a week for eight weeks. Subjects in the control group followed regular prenatal care. Lumbopelvic stabilization was assessed with a pressure biofeedback unit, pain with the Visual Analog Scale, disability with the Oswestry Low Back Pain Questionnaire and quality of life with the Nottingham Health Profile (NHP).

RESULTS

Pain and disability were significantly improved in the Pilates exercise group after intervention (p= 0.03, p< 0.001, respectively). There were also significant improvements in sleep, physical mobility sub-parameters of NHP and lumbopelvic stabilization after Pilates exercises (p= 0.048, p= 0.007, respectively). However, there were no statistically significant changes in all outcome measures in the control group (p> 0.05).

CONCLUSIONS

Pilates exercises can be recommended as an effective and safe method for increasing lumbopelvic stabilization, reducing pain and disability, improving physical mobility and sleep problems in pregnant women with LBP.

A systematic review of the effectiveness of Pilates on pain, disability, physical function, and quality of life in older adults with chronic musculoskeletal conditions

OBJECTIVES

This systematic review aims to evaluate the effectiveness and delivery of Pilates to reduce pain and disability and to improve physical function and quality of life in middle-aged to older adults with a range of chronic musculoskeletal conditions.

METHODS

Searches were conducted using CENTRAL, CINAHL, SCOPUS, Pubmed, PsycInfo, Web of Science Core Collection and Google Scholar. Inclusion criteria were controlled trials and observational studies, population mean age 50 years and over with chronic musculoskeletal conditions, using mat-based Pilates exercise. Outcomes included pain, disability, physical function and quality of life.

RESULTS

Seven studies were included, with a combined total sample of 397 participants (73% female). Pilates was significantly effective (p ≤ 0.05) for reducing back pain, neck pain and pain associated with knee osteoarthritis and osteoporosis. Additional significant disability, physical functioning and quality of life effects were found for back pain, osteoporosis, and knee OA. Overall Pilates was as effective as other exercise. Adherence to group exercise was good, but poor for home exercise. No significant adverse effects were reported.

CONCLUSION

Pilates is a safe and effective exercise intervention for adults over 50 with a diverse range of musculoskeletal conditions which may otherwise put them at risk of becoming sedentary. Although no overall significant superiority was found over other exercise, participants reported psychosocial benefits particular to the Pilates group exercise, with enjoyment a possible positive factor in adherence. Further research on Pilates exercises for various pathologies could inform teaching and improve engagement with older adults, including those with chronic conditions.

Physical exercise and prevention of falls. Effects of a Pilates training method compared with a general physical activity program: A randomized controlled trial

INTRODUCTION

Falls are the leading cause of injury-related mortality and morbidity in the elderly. Physical activity plays a key role in the prevention of falls and stimulates postural control. The aim of this study was to compare a general physical activity program for the elderly with a Pilates program to evaluate the effects on balance and on reducing the risk of falling.

MATERIALS AND METHODS

Forty-six subjects were enrolled in this study, but only 41 were included in the study. The subjects were divided into 2 groups: Pilates group (P-G) and a group following a nonspecific program of physical activity (Pa-G). Each subject underwent the hand grip test, Berg balance scale test, and posturographic analysis.

RESULTS

Spearman correlation coefficient showed correlations between the following parameters: BBS versus hand grip test (r = 0.68); BBS versus ellipse surface area (r = -0.75). There were significant differences between groups after the exercise program: both groups showed an improvement in performance but the P-G recorded significantly better results than the Pa-G.

DISCUSSION AND CONCLUSIONS

This study confirmed that physical activity improves both balance and strength. However, our data show that Pilates has a greater effect on these physical abilities than a general physical activity program.

Pilates-based core exercise improves health-related quality of life in people living with chronic low back pain: A pilot study

PURPOSE

To investigate the effects of Pilates exercise on improving health-related quality of life in people living with chronic low back pain.

METHODS

This was a single-blind, randomised clinical trial. Thirty-nine physically active subjects aged between 30 and 70 years with nonspecific chronic low back pain for more than three months were recruited. The study employed a pretest-posttest design, with a 4 -, 8 -, and 26-week follow-up. For eight weeks, the intervention group participated in a group-supervised, mat-based Pilates program, while the control group received the usual pharmacologic and rehabilitation standard of care, including patient education on chronic low back pain. The primary outcome was self-perceived health status measured using the EQ-5D questionnaire in a structured form and a visual analogue scale. Secondary outcomes included intensity of pain and degree of disability.

RESULTS

By the end of the 8-week Pilates program, the intervention group achieved a better health-related quality of life on the EQ-5D visual analogue score than the control group. In assessing the trends in each individual group regarding pain, the intervention group demonstrated an earlier pain reduction than the control group that lasted until the end of the trial.

CONCLUSIONS

An 8-week supervised Pilates-based core exercise program is an effective therapeutic modality for improving self-perceived health status in patients with chronic low back pain. This finding could inform clinicians of better alternatives when they suggest exercise interventions for chronic low back pain.

Effects of applied swan pilates motions on upper body muscle activities

BACKGROUND

There have been very few studies involving swan motion during pilates exercises, and there is also insufficient scientific evidence to support the fact that Pilates swan motion strengthens specific muscles.

OBJECTIVES

Firstly, the purpose of this study was to evaluate the effect of 5 types Pilates swan motion (swan basic (SB), swan push-up (SP), swan holding posture (SH), form roller-based swan (SF), and circle-based swan (SC)) on muscle activity of deltoideus p. acromialis (DA), infraspinatus (IP), trapezius (TP), latissimus dorsi (LD), and erector spinae (ES). Secondly, the purpose of this study was to suggest an effective Pilates swan motion for strengthening muscle strength of each targeted muscle.

METHODS

Twenty-four healthy men in their 20s participated and all participants were measured muscle activity in DA, IP, TP, LD, and ES muscles by electromyography (EMG) during 5 Pilates swan motions (SB, SP, SH, SF, & SC). The measured values were expressed as relative voluntary contraction (%RVC) values based on the SB.

RESULTS

The %RVC values representing the muscle activity of DA and TP were significantly higher in SH and SP than in SC, SF, and SB (p < .001). The %RVC values of IP and LD were significantly higher in SH and SC than in SF, SP, and SB (p < .001). The %RVC value of ES was were significantly higher in SH than in SP, SC, SF, and SB (p < .001).

CONCLUSION

The application of SP, SC, and SH Pilates swan motion is an effective method to activate the back muscles of the trunk.

Effectiveness of workplace intervention strategies in lower back pain prevention: a review

The aim of this study was to identify effective work place intervention strategies for the prevention of low back pain (LBP). The study focused on interventions to two major groups: personal interventions and technical interventions. Data basis were searched for with inclusion criteria: study design based on randomised controlled trial; outcome measures including non-specific LBP occurrence expressed by prevalence or intensity; intervention met the definition of the technical and/or personal (physical exercises, behavioural training, educational) intervention programme. Eighteen papers were selected for full analysis. The diversification of quantitative indicators of differences between control and intervention groups were carried out using Cohen's d index. The results of analysis showed strong differences in effects among intervention strategies, as well as among different cases within similar intervention strategies. LBP severity before intervention and the length of intervention were discussed as potentially influencing factors. The results of the analysis suggest that the most effective strategies for LBP prevention include technical modifications of the workstand and education based on practical training. Behavioural and physical training seems to be of lesser importance. LBP severity before intervention and the time when the measurements of outcome measures take place play an important role in the effectiveness of intervention.

Core muscle activation during Pilates exercises on the Wunda chair

OBJETIVES

The Pilates method, developed by Joseph Pilates (1886-1967), has been widely used to improve trunk stability, muscle flexibility and strength, physical fitness, and body awareness. To measure the electromyography of four trunk muscles during three Pilates exercises carried out of the wunda chair. DESING: cross-section study.

METHODS

Sixteen women participated in this study with a height and body weight of 1.64 ± 0.04 m and 58.7 ± 7.4 kg, respectively, and a mean age of 27.6 ± 3.7 years. Rectus abdominis (RA), internal oblique (IO), longissimus (LO), and multifidus (MU) muscles was evaluated by electromyographic (EMG) tests activity during three Pilates exercises: going up front (GF), mountain climb (MC), and swan (SW). EMG was normalized and expressed in the time domain, by the RMS.

RESULTS

The highest EMG values concerning the four muscles were observed for the MC exercise, followed by GF and SW (ANOVA: p = 0.0001, p = 0.04, p = 0.0002, and p = 0.0013, respectively). Our results show that the three Pilates exercises could recruit all the muscles, with a moderate activity intensity. The ANOVA; p < 0.05 showed significant difference between the muscles, concerning SW (p = 0.0002).

CONCLUSION

Our results show that the three Pilates exercises could recruit all the muscles, with a moderate activity intensity.

Rehabilitation for Low Back Pain: A Narrative Review for Managing Pain and Improving Function in Acute and Chronic Conditions

Low back pain (LBP) is prevalent and may transition into chronic LBP (cLBP) with associated reduced quality of life, pain, and disability. Because cLBP affects a heterogenous population, rehabilitation efforts must be individualized to meet the needs of various patient populations as well as individuals. This narrative review evaluated the many approaches to LBP rehabilitation including treatment-based classifications and specific types of rehabilitation efforts from exercise and physical therapy to spinal manipulation and bracing. Clinicians caring for patients with LBP or cLBP must be aware of the various options to find the right treatment course for each patient. In many cases, with proper patient expectations and care, nonpharmacological options may suffice to manage cLBP. While there is a rightful role for analgesics in the management of LBP, nonpharmacological options should be seriously considered, as they can play an important and health-sustaining role in patient management.

Effects of the pilates method on kinesiophobia associated with chronic non-specific low back pain: Systematic review and meta-analysis

BACKGROUND

Patients with chronic low back pain with higher levels of kinesiophobia have a 41% greater risk of developing a physical disability. The kinesiophobia model suggests that patients fear movements because of pain, associating movement with worsening of their state. Studies that apply the Pilates method for chronic low back pain achieve positive results in reducing pain and disability, and moderate results regarding kinesiophobia.

OBJECTIVE

The purpose of this review is to evaluate the effects of the Pilates method on kinesiophobia associated with chronic non-specific low back pain.

SEARCH METHODS

The following databases were searched from August to October 2018: MEDLINE, PEDro, SciELO, LILACS and the Cochrane Database of Systematic Reviews (CENTRAL), without restriction of language and year of publication.

SELECTION CRITERIA

Randomized clinical trials assessing the effectiveness of the Pilates method in the treatment of kinesiophobia in patients with chronic non-specific low back pain.

DATA COLLECTION AND ANALYSIS

Two authors independently selected the studies, assessed the risk of bias and extracted data. A third author was consulted in case of disagreements. The primary outcome was kinesiophobia as evaluated by the Tampa scale.

RESULTS

Our electronic searches resulted in 314 studies; 288 studies were excluded and 27 were selected for reading in full-text. Five articles were included in this review and four in the meta-analysis.

CONCLUSION

There is a favorable effect of the Pilates method compared to minimal intervention or no treatment in reducing kinesiophobia associated with chronic non-specific low back pain, with a moderate quality of evidence.

DESCRIPTORS

Low Back Pain, Exercise Movement Techniques, Exercises, Pilates-Based.

Acute effects of Pilates on mood states among young adult males

BACKGROUND

Evidence supports positive effects of acute exercise on mood states. Non-traditional exercise modalities, including Pilates, remain understudied, particularly among males. This study examined mood state responses to a single Pilates bout among young adult males, and explored if responses differed according to analogue Generalized Anxiety Disorder (AGAD) or depression status, or physical activity level.

METHODS

Eighty-seven young adult males completed 30-min of mat-based Pilates. Outcomes included state anxiety, worry, feelings of tension, depressed mood, anger, energy and fatigue, and total mood disturbance (TMD). Paired samples t-tests compared pre- and post-session means within the group; magnitude of change was quantified with standardized mean differences. Two condition X two time repeated measures ANOVA examined outcome differences according to AGAD and depression status, and physical activity level.

RESULTS

Acute Pilates significantly reduced state anxiety, feelings of fatigue, and TMD, and significantly increased feelings of energy (allp ≤ 0.007). Small-to-moderate effect sizes were found for state anxiety, feelings of energy and fatigue, and TMD (all d = 0.22-0.51). Pilates resulted in significant improvements in state anxiety, feelings of fatigue and energy, and TMD among participants with AGAD (n = 28) (all d = 0.10-0.32, p < 0.007) and depressed (n=41) participants (all d = 0.01-0.19, p < 0.008).

CONCLUSIONS

Notwithstanding potential limitations, including the absence of a control group and a lack of follow-up beyond immediate effects, this is the first report to support potential positive mood state responses to an acute bout of Pilates among young adult males. Findings varied based on analogue GAD and depression statuses, and physical activity level.

Pilates method in the treatment of patients with Chikungunya fever: a randomized controlled trial

Objective:

The aim of this study was to evaluate the effects of the Pilates method on the reduction of pain, improvement of joint function, and quality of life of patients with chronic Chikungunya fever.

Design:

This is a randomized, controlled, blind trial for the evaluators.

Setting:

The study was conducted at the Advanced Laboratory in Physical Education and Health at Federal University of Pernambuco, Brazil.

Subjects:

A total of 51 patients were allocated randomly and divided into 2 groups: a Pilates group (26 patients) and a control group (25 patients). After 12 weeks, 4 patients in the Pilates group and 5 in the control group were lost to follow-up.

Intervention:

The Pilates group performed 24 Pilates method intervention sessions; the control group continued to receive standard clinical treatment at the outpatient clinic.

Main measures:

The main measures were as follows: visual analogue scale (VAS) for pain, functional capacity evaluated by Health Assessment Questionaire (HAQ), quality of life measured by the 12-Item Short-Form Health Survey (SF-12), and range of joint motion by goniometry.

Results:

After 12 weeks, patients in the Pilates group presented lower VAS ( P < 0.001), lower HAQ scores ( P < 0.001), and higher quality-of-life scores ( P < 0.001) compared with the control group. We found statistically significant results for the Pilates group in the range of movement for shoulder, knee, ankle, and lumbar spine ( P < 0.001). In the intragroup analysis, there was a significant improvement in all outcomes evaluated.

Conclusion:

In this study, patients undertaking Pilates method for 12 weeks had less pain, better function and quality of life, and increased range of joint movement.

Effectiveness of the Pilates method versus aerobic exercises in the treatment of older adults with chronic low back pain: a randomized controlled trial protocol

BACKGROUND

Chronic low back pain is potentially disabling for older adults, and exercise is considered the best treatment. The Pilates method and aerobic exercises have been proven to be effective in pain and function improvement in patients with low back pain, but evidence in the treatment of older adults with low back pain is scarce. Therefore, the objective of this study is to investigate the effectiveness of the Pilates method compared to aerobic exercises in the treatment of older adults with chronic nonspecific low back pain.

METHODS

This is a randomized controlled trial with blinded assessor, to be held in a physical therapy clinic in Sao Paulo, Brazil. Seventy four patients aged 65 to 85 years with chronic nonspecific pain will be randomized into Pilates Group (n = 37) with exercises based on the Pilates method and Aerobic Group (n = 37) with treadmill aerobic exercise. The primary outcomes will be pain intensity and general disability, assessed eight weeks after randomization. The secondary outcomes will be: pain intensity and general disability, assessed six months after randomization; and global perceived improvement, specific disability, dynamic balance, muscle strength (gluteus maximus, gluteus medius, and lateral hip rotators), and pressure pain threshold, assessed eight weeks and six months after randomization. Therapists and patients will not be blinded.

DISCUSSION

This study has the potential to reduce pain and, consequently, improve balance and function of older adults with chronic low back pain with both therapies. However, Pilates may be more effective because the exercises are more targeted to the trunk stabilization muscles. The results of this study may provide valuable information on the effects of Pilates and aerobic exercise in older adults with chronic low back pain and contribute to a better selection of the treatment program according to the patient preference.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02729779 , April 6, 2016.

Overall confidence in the results of systematic reviews on exercise therapy for chronic low back pain: a cross-sectional analysis using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) 2 tool

OBJECTIVE

To evaluate the overall confidence in the results of systematic reviews of exercise therapy for chronic non-specific low back pain using the AMSTAR 2 tool.

METHODS

PubMed, Embase, Cochrane Database of Systematic Reviews, PEDro and CINAHL was searched up to February 2017. Two independent reviewers selected systematic reviews of randomized controlled trials that investigated exercise therapy in patients with low back pain. AMSTAR 2 assessment was performed by pairs of reviewers, and the overall confidence in the results of the systematic reviews were rated as 'High', 'Moderate', 'Low' and 'Critically low'. Descriptive analysis was used to summarize the characteristics of included systematic reviews. The percentage of systematic reviews achieving each item from the AMSTAR 2 and the overall confidence in the results were tabulated.

RESULTS

The search identified 38 systematic reviews. Most of the reviews included a median of 10 clinical trials and total sample size of 813 participants per review. Five of 38 (13%) reviews were Cochrane reviews, and 8 (21%) systematic reviews had a protocol published or registered prospectively. The overall confidence in the results of 28 reviews (74%) was rated as 'Critically low', 6 (16%) as 'Low', 1 (2%) as Moderate, while 3 of 38 reviews (8%) were rated as 'High'.

CONCLUSION

The results demonstrate very low confidence in the results of most systematic reviews of exercise in chronic non-specific low back pain. Clinicians are more likely to deliver the most efficacious interventions to patients by critically appraising systematic reviews using AMSTAR 2 before making their decisions.

Predictors of functional improvement in people with chronic low back pain following a graded Pilates-based exercise programme

BACKGROUND

Several studies have investigated subgroups of patients with low back pain (LBP) most likely to benefit from Pilates or movement control exercises, but none have determined prognostic factors specifically for chronic LBP. This prospective cohort study aimed to determine predictors of change in disability in people with chronic LBP following a Pilates-based exercise programme and reports summarised integrated prediction statistics to aid clinical utility for determination of subgroups likely to benefit or not benefit from treatment.

METHODS

Healthy adults (n = 55) with non-specific chronic LBP undertook a graded 6-week programme involving two 1-hour Pilates sessions/week (1 mat and 1 equipment-based) led in small groups by a trained Pilates instructor. Predictors of change in Patient-Specific Functional Scale (PSFS) were identified through regression analysis and used to develop clinical prediction statistics.

RESULTS

Clinically important improvement (n = 14 of 48 analysed) was predicted by four variables: gradual rather than sudden onset of LBP, PSFS <3.7 points, absence of aberrant motions on forward bending, and body mass index >24.5 kg/m². Presence of ≥3 improved probability of success from 29% to 73%. Failure to improve (n = 18) was predicted by three variables: sudden onset of low back pain, patient-specific functional score ≥3.7, and difference between left and right active straight leg raise >7°. Presence of all three increased probability of failure from 38% to 80%.

CONCLUSIONS

A combination of five, easily measured variables were able to predict disability outcome following a graded programme of Pilates-based exercises in people with chronic LBP. Two common movement deficits were inversely related to positive changes in function which may call into question the structural mechanism of improvements observed.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12616001588482.

Core Training in Low Back Disorders: Role of the Pilates Method

The Pilates method is a system of exercises developed by Joseph Pilates, which emphasizes recruitment and strengthening of the core muscles, flexibility, and breathing, to promote stability and control of movement. Its focus bears similarity to current evidence-based exercise programs for low back disorders. Spinal stability is a function of three interdependent systems, osseoligamentous, muscular, and neural control; exercise addresses both the muscular and neural function. The "core" typically refers to the muscular control required to maintain functional stability. Prior research has highlighted the importance of muscular strength and recruitment, with debate over the importance of individual muscles in the wider context of core control. Though developed long before the current evidence, the Pilates method is relevant in this setting and clearly relates to current evidence-based exercise interventions. Current literature supports the Pilates method as a treatment for low back disorders, but its benefit when compared with other exercise is less clear.

Non-Specific Low Back Pain

BACKGROUND

For many years, low back pain has been both the leading cause of days lost from work and the leading indication for medical rehabilitation. The goal of the German Disease Management Guideline (NDMG) on nonspecific low back pain is to improve the treatment of patients with this condition.

METHODS

The current update of the NDMG on non-specific low back pain is based on articles retrieved by a systematic search of the literature for systematic reviews. Its recommendations for diagnosis and treatment were developed by a collaborative effort of 29 scientific medical societies and organizations and approved in a formal consensus process.

RESULTS

If the history and physical examination do not arouse any suspicion of a dangerous underlying cause, no further diagnostic evaluation is indicated for the time being. Passive, reactive measures should be taken only in combination with activating measures, or not at all. When drugs are used for symptomatic treatment, patients should be treated with the most suitable drug in the lowest possible dose and for as short a time as possible.

CONCLUSION

A physician should be in charge of the overall care process. The patient should be kept well informed over the entire course of his or her illness and should be encouraged to adopt a healthful lifestyle, including regular physical exercise.

Immediate effects of Pilates based therapeutic exercise on postural control of young individuals with non-specific low back pain: A randomized controlled trial

OBJECTIVES

Low back pain affects the person's ability to keep balance, especially in challenging conditions. The purpose of this study was to determine the immediate effects of Pilates exercises on postural sway and dynamic balance of young individuals with non-specific low back pain.

DESIGN

Controlled laboratory design.

SETTINGS AND MAIN OUTCOME MEASURES

Forty-six participants with non-specific low back pain were randomized to a Pilates (n=23, 10 males; age: 21.8±3.2years) and a control group (n=23, 9 males; age: 22.8±3.6years). Postural sway was assessed with a force platform and dynamic balance with the Star Excursion Balance Test, before and after the intervention or rest period. To assess postural sway, participants stood still on an unstable surface set on the force plate for 90s, with eyes closed.

INTERVENTION

The intervention lasted 20min and consisted on four Pilates exercises: single leg stretch (level 1), pelvic press (level 1), swimming (level 1) and kneeling opposite arm and leg reach.

RESULTS

At baseline, no differences were found between groups. The Pilates group improved in all the postural sway values (area of CoP: 11.5±3.4 to 9.7±2.7cm², p=0.002 and CoP velocity: 2.8±0.6 to 2.3±0.5cm/s, p<0.001) and in the Star Excursion Balance Test. Control group only improved in CoP velocity, however, this improvement was significantly inferior compared to the Pilates group.

CONCLUSIONS

Pilates exercises immediately improved postural sway and dynamic balance in young adults with non-specific low back pain.

The effectiveness of Pilates for partial anterior cruciate ligament injury

PURPOSE

This study explored the effects of Pilates on the muscle strength, function, and instability of patients with partial anterior cruciate ligament (ACL) injuries in situations in which a non-surgical treatment option is preferred.

METHODS

Fifty participants 20-45 years of age who were diagnosed with isolated ACL injuries were included in the study. The participants were randomly assigned to either the Pilates exercise group (n = 24) or the control group (n = 26). The subjects in the Pilates exercise group performed basic mat exercises that focused on the muscle strength and flexibility of the lower limbs and core muscles during each class session, which met three times per week for 12 weeks. The control group did not receive any treatment or home exercise programme. All patients were evaluated using the Lysholm Knee Scale, the Cincinnati Knee Rating System, and isokinetic quadriceps and hamstring strength. Patient satisfaction regarding improvement in knee stability was assessed using the Global Rating of Change scale.

RESULTS

The Pilates group experienced significant improvement over the control group as measured by the difference in quadriceps strength at 12 weeks (p = 0.03). Both groups showed some clinical change over time, but the Pilates group improved for all outcome measurements at the 12-week follow-up, and the control group only improved for functional outcomes. Patient satisfaction with the level of knee stability based on the Global Rating of Change scale was higher in the Pilates group than in the control group.

CONCLUSION

Although both groups exhibited improvements in knee strength and functional outcomes, the results suggest that Pilates is a superior management approach over a control treatment for increasing quadriceps strength in participants with partial ACL injury. Pilates may provide clinicians a novel option when choosing a treatment for a partial ACL injury. Further study is needed to determine whether certain subgroups of individuals might achieve an added benefit with this approach.

LEVEL OF EVIDENCE

II.

Innovative exercise device for the abdominal trunk muscles: An early validation study

BACKGROUND

Exercise is one of the few treatments that provide significant improvements in chronic low back pain (CLBP). We developed an innovative exercise device for abdominal trunk muscles. This device can be used in a sitting or standing position and contains a built-in system to measure abdominal trunk muscle strength. We examined whether subjects can adequately use the device to perform the exercises and measure their abdominal trunk muscle strength.

METHODS

We collected data on the body height, body weight, body mass index, and girth of 30 healthy male volunteers, and measured their grip power and trunk extensor muscle strength using a dynamometer. The volunteers performed a sit-up test as an indicator of trunk flexor muscle strength, and we measured their abdominal muscle strength using the device. We then evaluated the correlations between abdominal trunk muscle strength and anthropometric parameters as well as the strength of other muscles. In subsequent tests, 5 of the 30 subjects participated in two positron emission tomography (PET) series consisting of examinations after a resting period (control study) and during exercise (exercise study). For the exercise study, the subjects performed 2 sets of exercises for 20 minutes using the device before and after an injection of 18F-fluorodeoxyglucose (FDG). PET-computed tomography images were obtained 60 minutes after FDG injection in each study. We compared the skeletal muscle metabolism of the participants in both studies using the standardized uptake value.

RESULTS

The muscle strength measured by the device and the 30-second sit-up frequency were correlated. FDG accumulation within the diaphragm and abdominal rectus muscles was significantly higher in the exercise study.

CONCLUSION

Our innovative exercise device facilitates a coordinated contraction of the abdominal trunk muscles at the anterior aspect and the roof of the core, and enables subjects to measure the strength of these muscles.

The effects of physical training without equipment on pain perception and balance in the elderly: A randomized controlled trial

BACKGROUND

Research supports a link between exercise and falls prevention in the older population.

OBJECTIVES

Our aims were to evaluate pain perception and balance skills in a group of elderly subjects and to examine the consequences of a standardized equipment-free exercise program intervention on these variables. The study utilized a randomized controlled trial method.

METHODS

92 subjects were recruited from a rural Sicilian village (Resuttano, Sicily, Italy). Subjects were randomly split into two groups, an experimental group (EG; n = 49) and a control group (CG; n = 43). Qualified fitness instructors delivered the standardized physical exercise program for the EG whilst the CG did not receive this exercise intervention. The Berg Balance Scale and the Oswestry Disability Index were administered in both groups before (T0) and after the intervention (T1).

RESULTS

At T1, the EG group significantly improvement in balance (p < 0.0001) and pain perception (p < 0.0001). No significant differences were found within the CG both in BBS and ODI, respectively.

CONCLUSIONS

Our findings suggest that a 13-weeks standardized exercise equipment-free program is effective in improving balance and perception of pain in the elderly. This type of intervention can consequently provide a low cost strategy to counteract the rate of disability in elderly.

Pain Perception and Stabilometric Parameters in People With Chronic Low Back Pain After a Pilates Exercise Program: A Randomized Controlled Trial

Various exercise interventions, such as Pilates exercises and traditional physical therapy methods, are employed to decrease low back pain (LBP). Nonspecific low back pain (NSLBP) is distinct from LBP, however, as the distribution of pain is restricted to the region between the costal margin and the inferior gluteal. The aim of our randomized controlled trial was to evaluate the effects of a program of Pilates exercises on pain perception and stabilometric parameters in patients with NSLBP.Thirty-eight participants were randomly allocated, using a 1:1 scheme, to either the experimental group (EG) or control group (CG). The EG completed a 14-week program of Pilates exercises, performed thrice per week under the supervision of an exercise specialist, while the CG was managed with a social program only. Measures of posturography and Oswestry Disability Index (ODI) for pain perception were obtained at baseline (T0) and after the 14 weeks of intervention (T)1.Posturography measures improved for patients in the EG, with both eyes open and eyes closed (P < 0.05). There were no statistical differences in posturography in the CG. ODI decreased significantly in both groups over the 14 weeks of the study protocol: EG, T0, 13.7 ± 5.0 compared with T1, 6.5 ± 4.0 (P < 0.001); and CG, T0, 10.7 ± 7.8 compared with T1, 8.4 ± 7.8 (P < 0.01). A greater extent of reduction in pain was achieved in the EG.The Pilates exercise program yielded improvements in pain and posturography outcomes. Our study also confirms the applicability of posturography in evaluating postural instability in patients with NSLBP. Due to our relatively small study group, future studies would be necessary to confirm our findings.

Effects of a Pilates exercise program on muscle strength, postural control and body composition: results from a pilot study in a group of post-menopausal women

Participation in exercise programs is heartily recommended for older adults since the level of physical fitness directly influences functional independence. The aim of this present study was to investigate the effects of supervised Pilates exercise training on the physical function, hypothesizing that a period of Pilates exercise training (PET) can increase overall muscle strength, body composition, and balance, during single and dual-task conditions, in a group of post-menopausal women. Twenty-five subjects, aged 59 to 66 years old, were recruited. Eligible participants were assessed prior and after 3 months of PET performed twice per week. Muscular strength was evaluated with handgrip strength (HGS) test, 30-s chair sit-to-stand test (30CST), and abdominal strength (AST) test. Postural control and dual-task performance were measured through a stabilometric platform while dynamic balance with 8 ft up and go test. Finally, body composition was assessed by means of dual-energy X-ray absorptiometry. Statistically significant improvements were detected on HGS (+8.22%), 30CST (+23.41%), 8 ft up and go test (-5.95%), AST (+30.81%), medio-lateral oscillations in open eyes and dual-task condition (-22.03% and -10.37%). Pilates was effective in increasing upper body, lower body, and abdominal muscle strength. No changes on body composition were detected. Results on this investigation indicated also that 12-week of mat Pilates is not sufficient to determine a clinical meaningful improvement on static balance in single and dual-task conditions.

A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome

BACKGROUND

Lumbosacral transitional vertebrae (LSTV) are increasingly recognized as a common anatomical variant associated with altered patterns of degenerative spine changes. This review will focus on the clinical significance of LSTV, disruptions in normal spine biomechanics, imaging techniques, diagnosis, and treatment.

METHODS

A Pubmed search using the specific key words "LSTV," "lumbosacral transitional vertebrae," and "Bertolotti's Syndrome" was performed. The resulting group of manuscripts from our search was evaluated.

RESULTS

LSTV are associated with alterations in biomechanics and anatomy of spinal and paraspinal structures, which have important implications on surgical approaches and techniques. LSTV are often inaccurately detected and classified on standard AP radiographs and MRI. The use of whole-spine images as well as geometric relationships between the sacrum and lumbar vertebra increase accuracy. Uncertainty regarding the cause, clinical significance, and treatment of LSTV persists. Some authors suggest an association between LSTV types II and IV and low back pain. Pseudoarticulation between the transverse process and the sacrum creates a "false joint" susceptible to arthritic changes and osteophyte formation potentially leading to nerve root entrapment. The diagnosis of symptomatic LSTV is considered with appropriate patient history, imaging studies, and diagnostic injections. A positive radionuclide study along with a positive effect from a local injection helps distinguish the transitional vertebra as a significant pain source. Surgical resection is reserved for a subgroup of LSTV patients who fail conservative treatment and whose pain is definitively attributed to the anomalous pseudoarticulation.

CONCLUSIONS

Due to the common finding of low back pain and the wide prevalence of LSTV in the general population, it is essential to differentiate between symptoms originating from an anomalous psuedoarticulation from other potential sources of low back pain. Further studies with larger sample sizes and longer follow-up time would better demonstrate the effectiveness of surgical resection and help guide treatment.