Adding Pilates for Chronic Low Back Pain, Injury Prevention, and You

Pilates has come up a lot lately in the medical literature with studies suggesting benefits for those suffering from chronic low back pain. My general understanding of the exercises seemed to mesh well with how we try to help patients to activate and use their deep core stabilizing muscles to prevent the recurrence of certain kinds of back pain, but the fancy equipment and movements still sounded a bit abstract to me. I wanted to learn more and reached out to a local leader in the Pilates method, Dan Walton of Studio Blue, who offered to meet with me for a first-hand experience.



Pilates exercise is a mind-body intervention that focuses on core stability, posture, flexibility, strength, breathing, and movement control.1

Joseph Pilates, a German national stuck in England at the outbreak of WWI, began developing exercise programs for sick/injured people by rigging springs and pulleys to hospital beds. His designs allowed people to experience the health benefits of gentle resistance exercises while they were bed-ridden. He moved to New York to continue working as a physical trainer, and, with the help of his wife (a nurse), developed the Pilates exercise method and equipment.

Pilates continues to grow and evolve, but the focus on spinal stabilization and emphasis on “quality” over “quantity” remains. Trained instructors guide clients through movements on either specially designed spring-resistant apparatuses (most commonly the Reformer) or simply the floor (mat work).

Why it works well with Physical Therapy

Pilates is a low impact total body workout that can be tailored to fit a wide range of physical abilities. In some cases of chronic low back pain, the home exercises prescribed by your doctor of PT may be the most strength training they’ve done in years, and the idea of getting thrown back into the fitness world when PT ends is overwhelming. Taking classes at a Pilates studio is a nice progression to your core strengthening where you’ll continue to receive individual attention and feedback for safe, correct form.

The Evidence

In healthy people:

– Pilates can improve flexibility, dynamic balance, and muscular endurance.2

For those with chronic low back pain…

– Pilates can improve functional ability, movement confidence, body awareness, posture, and movement control.3

– Pilates-based exercise + PT provides greater improvements in pain and disability than traditional care (physician or specialist consultation, medication, or anything else the person was already doing for treatment).4

– Pilates on the Reformer was more successful than mat Pilates at decreasing disability and fear of movement.5

Benefits for Runners and Athletes

The importance of including lower extremity and core strengthening exercises into your training regimen cannot be overstated- it is crucial for both improving performance or for simply maintaining a strong stride that lowers your risk of injury. One major benefit of Pilates exercises is developing multisegmental stability similar to how plank variations might, but where I believe the Pilates method adds a unique layer to a well-rounded program is body awareness and precise control. For example, during my session with Dan I followed subtle, but clear cues such as “roll your thighs in to stabilize” during certain positions/movements. I remember the movement becoming 10 times harder to perform, but this minor correction dramatically improved my posture and made me aware of a weakness (hip internal rotators) that I had been overlooking in my regular cross-training routine. In a private session, this weakness could then be addressed by incorporating more tasks requiring activation of the internal rotators. Or in a mat class, a vigilant runner might make a mental note to practice the move on their own for the next couple weeks.

Load your Gun

From low back pain to plantar fasciitis to the common cold, our current healthcare system and the people in it often act as though there are (or eventually will be) perfect treatments to quickly fix problems when they eventually get bad enough to address. In reality, magic bullets rarely exist. Injury prevention is about keeping a gun loaded with strength, adequate mobility, balance and wellbeing. For those seeking to take an active role in staying healthy, Pilates is a fantastic option to fill a few of those chambers.

By: Dr. Nicholas Chamley DPT


1. Wells, C., Kolt, G. S., & Bialocerkowski, A. (2012). Defining Pilates exercise: A systematic

review. Complementary therapies in medicine, 20(4), 253-262.

2. Cruz-Ferreira, A., Fernandes, J., Laranjo, L., Bernardo, L. M., & Silva, A. (2011). A systematic

review of the effects of pilates method of exercise in healthy people. Archives of physical

medicine and rehabilitation, 92(12), 2071-2081.

3. Wells, C., Kolt, G. S., Marshall, P., & Bialocerkowski, A. (2014). Indications, Benefits, and

Risks of Pilates Exercise for People With Chronic Low Back Pain: A Delphi Survey of Pilates-
Trained Physical Therapists. Physical therapy, 94(6), 806-817.

4. Rydeard, R., Leger, A., & Smith, D. (2006). Pilates-based therapeutic exercise: effect on

subjects with nonspecific chronic low back pain and functional disability: a randomized

controlled trial. Journal of Orthopaedic & Sports Physical Therapy, 36(7), 472-484.

5. da Luz, M. A., Costa, L. O. P., Fuhro, F. F., Manzoni, A. C. T., Oliveira, N. T. B., & Cabral,

C. M. N. (2014). Effectiveness of Mat Pilates or Equipment-Based Pilates Exercises in

Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial. Physical

therapy, 94(5), 623-631.

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Alice Holland, DPT

Doctor of Physical Therapy, Director at Stride Strong Physical Therapy
Alice earned her Doctorate of Physical Therapy from USC in 2007, and have practiced Physical Therapy for 12+ years in the Outpatient Orthopedic Setting. Certified in ASTYM, she also has been a featured expert on Physical Therapy on numerous publications including health.com, healthline.com and yahoo.com.
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02:18 20 Oct 17
This place is amazing. I am so happy I found Stride Strong PT. Alice pays attention to all of the details, she watches every single move I make, my posture, and the way I move through every exercise. She is very knowledgeable, she was able to pin-point the problems in my back and she has a plan to help me become stronger where I need. The place is brand new, huge, and has nice exercise machines. I tried a few physical therapists in the area, and Alice is TOP, second to none, and I feel super lucky to have found her. Highly recommended!!
Prashant Gupta
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Dr. Alice at Stride Strong is one of the best PTs I have come across. Her attention to detail and assessment of the root cause of injury is very good. She is excellent in evaluating pain patterns and giving a training schedule for a rehab & injury prevention, she is extremely knowledgeable. I would strongly recommend Stride Strong to anyone looking for PT. It is easily the best PT clinics in Hillsboro area.
steven zollin
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Highly recommend Stride Strong Physical Therapy , Alice showed me proper form to assist in recovery with my shoulder and is very knowledgeable.
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I recently had a massage from Joel at the Hillsboro location. He was able to work on an ongoing issue I have been experiencing with my back after a sports injury, and I left feeling so much better. The whole facility looked incredible, and everyone I met was friendly and welcoming. I would highly recommend Stride Strong for massage and physical therapy.
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Dr. Sydney is by far the absolute best physical therapist I've worked with ever! Her expertise in designing highly effective and efficient exercise plans is beyond compare. I feel so much better as my strength and function increases. She comes up with the most brilliant and fun ideas to motivate. To my delight she even offered to come to my home in Vancouver and work with me on my own equipment including a Stott Pilates Reformer. Talk about going above and beyond! Couldn't be more grateful I found her!!!
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A full hour of a dedicated PT professional's time without aides or techs? That's just one of the things that sets this clinic apart from others. Competent, professional, and amiable, Dr. Alice Holland and her team are the best in the area. While I generally see them at the Cedar Mill Clinic on Cornell, situational constraints took me to their new Hillsboro clinic today near Intel Jones Farm. Beautifully furnished, spacious with easy parking and access. May you continue to grow and thrive, Stride Strong!
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After foot surgery I went to Stride Strong for therapy with Alice Holland. She helped me reach my full mobility again by continuously introducing new and challenging exercises. The entire staff is friendly and professional. They are always on time and do not rush. I look forward to doing 1/2 marathons again and riding my recumbent trike. Thank you Stride Strong for your care and high level of expertise.
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The best physical therapy ever. Both JP and Sydney were a great PT, they helped me understand how I can help treat my injury and how it may have caused. And also they informed about so many techniques that I can use to help my injuries or any other injuries I get in the near future. They are both friendly and nice to talk too, and verbunformative. And there is also Krystal, she is the best front desk receptionist ever, she is nice and friendly and can easily manage your schedule based on the patients comfort if they want to schedule or not. She can help and she replies fast to any patients email. And she is easy to talk to. Thank you Stride Strong Physical Therapy.
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In just a month I've seen great progress! I've been incorporating the exercises taught to me into my daily workout routine. Im very happy with my continued results.
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Awesome place for PT. Hillsboro location has plenty of parking and very spacious. I had the pleasure to work mostly with Dr. Alice Holland and JP. I came in with a shoulder injury and thank goodness they understood what I was going through. They are the best of what they do, I would recommend Stride Strong to anyone who needs PT.
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