Pilates is often recommended for people with lower back pain. But what does the research actually show, and how might it help us move more comfortably?
Back pain can change how we approach ordinary movements, from getting out of a chair to carrying groceries. Research suggests that Pilates can help reduce pain and improve daily function, offering a structured way to build strength and become more comfortable with movement. Its emphasis on controlled exercise, trunk endurance, and body awareness makes it a useful option to explore (Patti A et al. 2015, Nageswari C et al. 2025).
What the research tells us:
A systematic review by Patti and colleagues examined Pilates for chronic nonspecific low back pain: persistent pain without an identified specific underlying condition. The authors found that Pilates generally offered greater short-term improvements in pain and disability than minimal intervention. Here, disability means the extent to which pain interferes with daily activities. Pilates was not consistently better than other exercise programs, but it could be a helpful way to exercise. (Patti A et al. 2015,)
A 2025 study brought attention to postmenopausal women, a population particularly relevant to movement teachers. Among 128 participants, both Pilates and conventional exercise improved outcomes. The Pilates group reported larger improvements in pain, core endurance, back-related disability, and menopause-related quality of life. Average pain scores decreased from 7.2 to 4.7 out of 10 with Pilates, compared with 6.97 to 5.85 with conventional exercise. (Nageswari C et al. 2025)
These findings are encouraging because they connect exercise with changes people can recognize: less discomfort and fewer limitations in everyday life. The postmenopausal study did contain reporting inconsistencies, so it is best treated as promising evidence rather than a definitive comparison. (Nageswari C et al. 2025)
Build strength and learn muscle coordination
Pilates asks us to coordinate the trunk with movement of the arms and legs. In teaching, this can mean practicing how to steady the pelvis during a leg movement or how to move the spine with control. The aim is to develop usable strength and coordination that can support a wider range of activities.
A randomized trial involving 98 people with chronic low back pain measured changes in the transversus abdominis, a deep abdominal muscle, using ultrasound. After 12 weeks, both mat and equipment-based Pilates groups showed improved activation alongside improvements in pain, function, and fear of movement. These results support the value of studying muscle coordination as part of Pilates practice, although they do not prove that improved activation alone caused the pain relief. (Cruz-Díaz D et al. 2017)
Importantly, coordination does not mean holding the abdomen tightly throughout every exercise. In a 2026 trial, participants instructed to move with a relaxed abdomen had slightly greater improvement in disability than those instructed to contract their core; however, a difference in pain was not established. (Lunkes LC et al. 2026)
Use alignment as a guide for movement
Alignment describes how body segments are positioned in relation to one another. In Pilates, attention to the ribs, pelvis, and spine can provide a practical reference for exploring an exercise. An instructor might adjust a starting position or reduce the range of movement to help someone perform the exercise with greater control.
A study examining exercise and the positioning of the lower spine and pelvis found no significant overall alignment changes after treatment. However, some subgroups did show changes: participants with less lumbar curvature initially showed an increase in that curvature, while those with a higher sacral angle—the angle of the bone at the base of the spine—showed a decrease. These findings suggest that alignment may change with exercise in some people, although the study did not establish that these changes caused pain relief. The exercise programs studied involved lifting and motor control exercises, rather than Pilates specifically (Berglund L et al. 2018).
In my teaching, alignment is a tool for exploring movement and responding to the person in front of me. The goal is to help clients develop strength and discover positions that make an exercise more manageable, while gradually expanding what they can do.
What about scoliosis?
A 2021 review of 10 studies involving 359 participants reported potential benefits of Pilates for pain, trunk mobility, and quality of life in people with scoliosis. The combined results also favored Pilates-containing programs for reducing Cobb angle, a measurement of spinal curvature on an X-ray, and the angle of trunk rotation, a measurement of rotational asymmetry (Gou Y et al. 2021).
These findings are encouraging because they suggest potential improvements in both symptoms and measurements of spinal shape. However, results for spinal curvature varied substantially between studies, and some programs combined Pilates with scoliosis-specific exercises. Pilates was not shown to be superior to Schroth exercises for reducing Cobb angle (Gou Y et al. 2021).
The review supports cautious optimism about symptom relief, movement capacity, and possible changes in curvature. Because the evidence was generally limited in quality and long-term effects remain uncertain, it does not establish that Pilates will reliably straighten the spine or prevent curve progression (Gou Y et al. 2021).
Make progress meaningful
Looking at these studies together, they support Pilates as one useful approach to easing back pain and improving function. They also give us a reason to look beyond a single muscle or posture when thinking about progress.
As a Pilates instructor, I want movement to help people understand their bodies and build lasting confidence. In practice, meaningful progress might be an easier transition from sitting to standing, greater comfort carrying a bag, or feeling more capable during a favorite activity. Strength, movement awareness, and thoughtful progression provide a constructive focus for that work.
References
Berglund, Lars, et al. “Sagittal Lumbopelvic Alignment in Patients with Low Back Pain and the Effects of a High-Load Lifting Exercise and Individualized Low-Load Motor Control Exercises—A Randomized Controlled Trial.” The Spine Journal, vol. 18, no. 3, 2018, pp. 399–406. https://doi.org/10.1016/j.spinee.2017.07.178.
Cruz-Díaz, David, et al. “Comparative Effects of 12 Weeks of Equipment Based and Mat Pilates in Patients with Chronic Low Back Pain on Pain, Function and Transversus Abdominis Activation. A Randomized Controlled Trial.” Complementary Therapies in Medicine, vol. 33, 2017, pp. 72–77. https://doi.org/10.1016/j.ctim.2017.06.004.
Gou, Yanyun, et al. “The Effect of Pilates Exercise Training for Scoliosis on Improving Spinal Deformity and Quality of Life: Meta-analysis of Randomized Controlled Trials.” Medicine, vol. 100, no. 39, 2021, article e27254. https://doi.org/10.1097/MD.0000000000027254.
Lunkes, Luciana Crepaldi, et al. “Keeping the Abdomen Relaxed versus Contracted during Pilates Improves Disability Slightly and May Improve Other Outcomes in Chronic Non-specific Low Back Pain: A Randomised Trial.” Journal of Physiotherapy, vol. 72, no. 2, 2026, pp. 116–21. https://doi.org/10.1016/j.jphys.2026.03.007.
Nageswari, C., et al. “Effect of Pilates Exercises on Pain, Endurance, Quality-of-Life, and Disability in Postmenopausal Women with Low Back Pain.” Musculoskeletal Care, vol. 23, 2025, article e70071. https://doi.org/10.1002/msc.70071.
Patti, Antonino, et al. “Effects of Pilates Exercise Programs in People with Chronic Low Back Pain: A Systematic Review.” Medicine, vol. 94, no. 4, 2015, article e383. https://doi.org/10.1097/MD.0000000000000383.
