Abstract
Purpose: To examine changes in pain, disability, function and muscle thickness (a proxy of muscle activity) in transversus abdominis (TrA)
and obliquus internus (OI) in people with chronic low back pain (cLBP) following Pilates training. In addition, to evaluate associations
between changes in pain and disability, and changes in TrA muscle thickness.
Relevance: Physiotherapists prescribe Pilates exercises for cLBP as they are claimed to increase deep abdominal muscle activity
and consequently reduce pain and disability. There is limited evidence to support these claims and no evidence that changes in pain and
disability are associated with changes in deep abdominal muscle activity.
Participants: Participants with non-specific LBP of >12 months duration were recruited from University staff and students via circular email.
Methods: A cohort of participants attended six once-a-week, one-hour duration, maximum ten participants, Pilates mat exercise classes.
They were encouraged to exercise at home twice weekly. Mat exercises loading trunk muscles with leg and arm movements were
taught, individually modified, and progressed, incorporating Pilates' principles of drawing-in the abdomen and maintaining a mid-range and
pain-free spine. The sole instructor was a physiotherapist and Pilates instructor. Data were collected in the week before and after classes
started and finished. Disability, pain, and function were assessed with Roland-Morris Disability Questionnaire (RMDQ), numerical pain rating
scale (NPRS) and patient specific functional scale (PSFS). Thickness of left and right transversus abdominis (TrA) and obliquus
internus abdominis (OI) was measured using real-time ultrasound imaging in functional postures supine resting, standing and standing lifting
one leg and Pilates exercises 'imprint' (drawing-in abdomen), 'hundreds' (supine lying, hips and knees at 90 degrees), and 'leg
stretch' (straight-leg raise position).
Analysis: Pre- and post-training RDMQ, NPRS, PSFS and muscle thickness were compared with two-tailed Wilcoxon signed rank tests on a
per-protocol basis. Association between change in muscle thickness and change in pain and disability was analyzed using
Spearman's correlation.
Results: Thirty participants were recruited and 25 reassessed. Completing participants were mean(SD) 29.3(10.0) years old with 71(68)
months duration cLBP and attended 5.0(1.0) classes. Pre- and post-intervention RMDQ scores were respectively 6.0(2.3) and 2.8(1.7)
[p=0.0005], NPRS were 4.9(1.5) and 3.3(1.7)[p=0.002], and PSFS were 5.4(1.6) and 7.0(1.7)[p=0.0005]. TrA increased in thickness in both
sides in all test positions [all p<0.05]. Left OI thickness increased in all test positions [all p<0.05]; right OI increased in resting, 'imprint'
and 'hundreds' [all <0.05]. There was no correlation between changes in TrA thickness in resting and ´imprint´ and changes in pain and disability.
Conclusions: A 6-week Pilates programme reduces pain and disability, improves function, and increases TrA and OI muscle activity in
people with cLBP and mild disability. Changes in pain and disability are apparently unrelated to change in muscle activity. Future studies
could include randomised controlled trials of Pilates and further investigate Pilates' mechanisms of effect.
Implications: These findings support the use of Pilates mat exercise in cLBP and suggest clinical improvements can be achieved
without isolated deep abdominal muscle training.
Key-words: 1. Pilates 2. Ultrasound imaging 3. Low back pain
Funding acknowledgements: The project received no direct funding. Training facilities were provided free-of-charge by
and obliquus internus (OI) in people with chronic low back pain (cLBP) following Pilates training. In addition, to evaluate associations
between changes in pain and disability, and changes in TrA muscle thickness.
Relevance: Physiotherapists prescribe Pilates exercises for cLBP as they are claimed to increase deep abdominal muscle activity
and consequently reduce pain and disability. There is limited evidence to support these claims and no evidence that changes in pain and
disability are associated with changes in deep abdominal muscle activity.
Participants: Participants with non-specific LBP of >12 months duration were recruited from University staff and students via circular email.
Methods: A cohort of participants attended six once-a-week, one-hour duration, maximum ten participants, Pilates mat exercise classes.
They were encouraged to exercise at home twice weekly. Mat exercises loading trunk muscles with leg and arm movements were
taught, individually modified, and progressed, incorporating Pilates' principles of drawing-in the abdomen and maintaining a mid-range and
pain-free spine. The sole instructor was a physiotherapist and Pilates instructor. Data were collected in the week before and after classes
started and finished. Disability, pain, and function were assessed with Roland-Morris Disability Questionnaire (RMDQ), numerical pain rating
scale (NPRS) and patient specific functional scale (PSFS). Thickness of left and right transversus abdominis (TrA) and obliquus
internus abdominis (OI) was measured using real-time ultrasound imaging in functional postures supine resting, standing and standing lifting
one leg and Pilates exercises 'imprint' (drawing-in abdomen), 'hundreds' (supine lying, hips and knees at 90 degrees), and 'leg
stretch' (straight-leg raise position).
Analysis: Pre- and post-training RDMQ, NPRS, PSFS and muscle thickness were compared with two-tailed Wilcoxon signed rank tests on a
per-protocol basis. Association between change in muscle thickness and change in pain and disability was analyzed using
Spearman's correlation.
Results: Thirty participants were recruited and 25 reassessed. Completing participants were mean(SD) 29.3(10.0) years old with 71(68)
months duration cLBP and attended 5.0(1.0) classes. Pre- and post-intervention RMDQ scores were respectively 6.0(2.3) and 2.8(1.7)
[p=0.0005], NPRS were 4.9(1.5) and 3.3(1.7)[p=0.002], and PSFS were 5.4(1.6) and 7.0(1.7)[p=0.0005]. TrA increased in thickness in both
sides in all test positions [all p<0.05]. Left OI thickness increased in all test positions [all p<0.05]; right OI increased in resting, 'imprint'
and 'hundreds' [all <0.05]. There was no correlation between changes in TrA thickness in resting and ´imprint´ and changes in pain and disability.
Conclusions: A 6-week Pilates programme reduces pain and disability, improves function, and increases TrA and OI muscle activity in
people with cLBP and mild disability. Changes in pain and disability are apparently unrelated to change in muscle activity. Future studies
could include randomised controlled trials of Pilates and further investigate Pilates' mechanisms of effect.
Implications: These findings support the use of Pilates mat exercise in cLBP and suggest clinical improvements can be achieved
without isolated deep abdominal muscle training.
Key-words: 1. Pilates 2. Ultrasound imaging 3. Low back pain
Funding acknowledgements: The project received no direct funding. Training facilities were provided free-of-charge by
| Original language | English |
|---|---|
| Title of host publication | Physiotherapy |
| Volume | 97 |
| Edition | S1 |
| Publication status | Published - Jun 2011 |