Pilates - any proper evidence for efficacy?

[apocrypha]

My physiotherapist has recommended pilates to me, but I'm struggling to find any real reasearch showing the benefits of it. The aim is to strengthen my lower back muscles and improve my posture to aid my recovery from decompression & hemiotomy due to a ruptured disc.

Since I no longer work at a university I have very limited access to online publications and the very few articles I've turned up on PubMed all require payment to view in full. I've found nothing in the Cochrane Reviews.

All the local websites offering pilates classes are deeply into the who CAM thing, and thus completely untrustworthy. The wiki article on pilates is obviously under the control of CAM proponents and comes across as very unbiased, and has no working links to genuine research on the efficacy of pilates.

All of this is making me deeply suspicious that pilates is another unproven bit of nonsense that sometimes does the right things but for the wrong reasons, much like chiropracty.

Does anyone know any different? And I specifically mean know of reliable research, not anecdotal stories about how it helped your uncle Bob once.

Edit: If anyone has online journal access through ScienceDirect because of their work etc, then I'd be eternally greatful for a copy of this article:

"The effectiveness of Pilates training in healthy adults: An appraisal of the research literature
Journal of Bodywork and Movement Therapies, Volume 11, Issue 2, Pages 106-110
L. Bernardo"

[stray]

Umm, your own therapist recommended it to you.. what more do you want? No need to be an egghead about it. It's not much different than time tested ideas like yoga, just more specific. Like many fitness regimens, the thing you should watch out for are people capitalizing on a good thing, and are unqualified. Not the thing itself.

[edit] ahem, just to add, you're more likely to get "my uncle bob did it" info here than you are from your therapist. like all health related matters though, maybe you should get a second opinion from another therapist. that's your best bet, if you're worried. not the internet. :)

[apocrypha]

Well, the physiotherapist in question is employed by a private hospital, not the NHS, for starters. I also, at first, didn't question the recommendation because, as you say, she's my physiotherapist.

Secondly, I'm not being an egghead - I simply want to know if there is any real evidence for this therapy or not. I want evidence that it's better than, for instance, just going swimming regularly for instance, or using an elipitcal trainer. There are no free pilates classes available and I don't want to needlessly pay money for something unessecary. There are no accredited pilates qualifications. You can't get a real medical school to teach you pilates techniques.

The second opinion thing is a very good call - I'll phone up the NHS physiotherapist I was seeing before I got referred to this private one.

Plus, asking here has a good chance of a well-informed response. I know there's people like Jimbo frequenting these boards who are trained and knowledgeable, plus how might have access to proper research :P

Edit: Your point about yoga is taken, but if you search the Cochrane reviews for yoga then there's actually a lot of research been done on the efficacy of it for various conditions, and this just isn't true for pilates.

[K9]

I can only offer anecdotal evidence I'm afraid, but based on the people I know who do pilates, and the little of it that I have done myself, it is a pretty good system.

[Nebu]

"The effectiveness of Pilates training in healthy adults: An appraisal of the research literature
Journal of Bodywork and Movement Therapies, Volume 11, Issue 2, Pages 106-110
L. Bernardo"

Here is the abstract from the article. 

Summary: Pilates has gained momentum and attention in the past 5 years as a
modality for improving flexibility, strength and mind–body awareness. What is not
revealed, however, is the scientific basis for this practice. The two-fold purpose of
this review was to (1) critically appraise published research on Pilates in healthy
adults and (2) propose future research options for this method in healthy adults. An
extensive literature search was conducted, using Pilates as the search word. A total
of 277 articles were found. Thirty-nine articles and abstracts were published in
refereed, professional journals, of which there were only three clinical trials in
healthy adults. The strengths of these three clinical trials were the (1) use of
established measurements for stated outcomes and (2) documented need for
research in this area. The weaknesses were (1) lack of true experimental designs, (2)
small sample sizes, and (3) lack of a defined method of Pilates. There is cautious
support for the effectiveness of Pilates in improving flexibility, abdominal and
lumbo-pelvic stability and muscular activity, primarily due to a lack of sound
research methodology surrounding each study. Utilizing a true experimental design
and stating the Pilates method utilized can strengthen and improve future Pilates
research in healthy adults.

Seems to me that they weren't able to find much more than you could. 

I'm also glad that you're skeptical of a physiotherapist.  I encourage people to be skeptical of any healthcare professional (even me!).  If you're not sure, GET A SECOND OPINION from a trained professional.  I think that any core-strengthening training will help with strength and flexibility, but you'll need a program tailored to your specific needs. 

I'm in no way an expert in this area, but will do my best to help with opinions.  Feel free to PM me.

[apocrypha]

Thanks Nebu. That abstract does indeed match what I was finding. I guess I really wanted to know if my research-hunting skills were just rusty or not 

The NHS physio I saw before my op is away for until the 30th, so I'll call him then and keep researching in the mean time.

[JWIV]

I thought P90X was the official exercise program of F13   

[Hindenburg]

It is, but it would probably kill apocrypha.

[Nebu]

It is, but it would probably kill apocrypha 90% of the computer nerds here.

Fixed.

[schild]

It is, but it would probably kill apocrypha 90% of the computer nerds here.

Fixed.

Great, now I'm tempted to do it, while smoking, just because you said that.

[Nebu]

Great, now I'm tempted to do it, while smoking, just because you said that.

Then you'd be in the 10% that survived!

[bhodi]

Just see if you can make it through that 'baseline test'. I barely made it, doing the minimums in some cases - and I consider myself a 'fairly' fit individual. I did OK on some of it, pullups for example, but that sit against the wall for 1-2 minutes left me in tears.

[Hawkbit]

Offtopic, sorry, but what's the other big workout program that's free and online?  The workouts are titled after women's names, iirc.  I think you can spend $25 or $10,000 depending on what equipment you want.

[CharlieMopps]

dude, it's fraking exercise. Exercise is beneficial for almost every sickness known to man. If you don't like Pilates, try chopping wood. That's what I do. It's good exercise and scares the crap out of the neighbors when you do it at 5am while smoking a cigar.

[Merusk]

Chopping wood is not advisable with a bad back, I'd think.  Which is Acro's problem.

Hell, I wouldn't swim with a bad back, either.

[Mosesandstick]

Chopping wood is not advisable with a bad back, I'd think.  Which is Acro's problem.

Hell, I wouldn't swim with a bad back, either.

Why? I've got a poor back and the only thing that gets to me in the pool is swimming flat-out (because I use a 2-stroke rhythym and keep twisting to the same side).

[Fraeg]

It works but don't just go to the phone book and lookup Pilates


Research studios.  You want to go to a place that has experience working with people like us (those with f'd up discs).  I go to a place that is run by a woman who has been an occupational therapist for about 20 years.   When I came in to talk to her and described my injuries, she knew what to avoid.    A regular ol pilates class will do something you really don't want to be doing with bulged/compressed discs.

How has it been for me?  Very very good, I started out working one on one with a instructor who was very aware of my backs issues, and was very careful to not have me do anything that would cause a flare up.   Eventually I was mainstreamed into a class that included several other people with similar issues.

good luck

[voodoolily]

The experience I've had with Pilates has been solely floor-based exercise (not the machines). It did wonders for strengthening my core muscles, from my rectus abdominus up to my diaphragm. The benefits have lasted for years after I stopped, too. Even when my fitness levels drop significantly, my core strength remains noticeably high in comparison.

The floor-based exercises were more fun for me than yoga, which is the most boring exercise a person do can besides tai chi (imo). There was only one guy in my class, so it might be a nice way to meet teh ladies, if that's your gig. 

Edit: I think the point of Pilates isn't to strengthen your back per se, but to strengthen the rest of your torso so that your back muscles aren't doing work they're not supposed to.

[voodoolily]

Oh, also, if you still know the proxy address thingy of your old university, you should be able to access JSTOR online. Not sure if there'll be any articles there, but I did this for quite awhile after I'd left academia.

[Salamok]

Chopping wood is not advisable with a bad back, I'd think.  Which is Acro's problem.

Hell, I wouldn't swim with a bad back, either.

I suppose it depends on what is wrong with your back to make it "bad". I've always found swimming to be pretty good at relaxing/stretching the body out and generally very good for my lower back.  Not sure how well freestyle would strengthen lower back muscles though (probably need some dolphin kick to stress that area).

Then again i have never had a disk problems and any back problems (laziness induced back pain and an occasional pulled muscle) I have had over the years have always been a result of weak abs which I would say swimming does improve fairly well.

[Murgos]

The floor-based exercises were more fun for me than yoga, which is the most boring exercise a person do can besides tai chi (imo).

Tai Chi boring?  I'm guessing you never did push hands?  My only experience with tai chi was with my kung-fu sifu as a core & strength balance thing so maybe he 'spiced it up' but it wasn't that boring.

[voodoolily]

Tai chi is basically meditation. I think I'm too "western" (read: Type A) to appreciate its benefits.

[Righ]

Pilates of the Caribbean, apparently.

[Signe]

Pilates of the Caribbean, apparently.

HA!  This is why I married you!  (and that other thing.  You know.)

[apocrypha]

ROFL Righ 

Thanks for the responses folks. I am rapidly becoming set in the opinion that I don't want to spend the large amounts of money on what is, basically, just exercise. I'm an opinionated old curmudgeon with a serious bias against CAM and if I don't believe that something is evidence-based I won't give it any respect, however well it would likely work for me. I'm at least self-aware enough to know that I have prejudices 

Going to talk with my NHS physio about it in a week or so but in the mean time I'll just stick to slowly increasing the amount of general activity I do and letting my pain guide me

[Arnold]

Offtopic, sorry, but what's the other big workout program that's free and online?  The workouts are titled after women's names, iirc.  I think you can spend $25 or $10,000 depending on what equipment you want.

That would be Crossfit.

BTW, I'd suggest deadlifts for the original poster.

[Cyrrex]

BTW, I'd suggest deadlifts for the original poster.

I'm not sure if that was a bit of snark, but I have been wondering at what the actual limitations are for whatever kind of physical activity you can undertake, Apocrypha.  Is it pain?  Damage to the muscles?  Damage to the discs themselves?  Some combination?  Reason I ask is because everything being suggested in this thread is ultimately some form of muscle strengthening and/or stretching actiivity.  If pain were the 'only' barrier, then a bit of weightlifting might not be out of the question.  I am assuming, however, that you have a major concern of re-injury in this case, but I don't really know much about back injuries like yours.

[apocrypha]

Well I've got 2 main problems.

First is that because of such a long period of forced inactivity I'm generally very weak all over, which puts me at high risk of normal sports injuries like sprains & ligament & muscle tears. Means I simply haven't got the muscular strength to protect myself from injury if I slip or fall or twist badly doing any kind of exercise, so I have to do lots of gentle exercise, slowly building up strength again.

Second problem is that my L5/S1 disc is ruptured and only has a fraction of its normal shock absorbing ability. That and there are still plenty of fragments of the disc in the area and around the nerves. Result is the same - if I do anything too sudden, too impacting, too strenuous then I risk further damage, plus the fragments still pressing on the nerve do cause a lot of pain still if I do the wrong things.

There's a third possible problem, which is that I may have something called spondyolisthesis (I think I've spelled that right) according to the neurosurgeon who operated on me. This is a developmental condition that means you have multiple small fractures in the back part of the vertebrae. He wasn't certain I had it but there were several indications. Again, this means that I need to really slowly and carefully build up the muscles around the spine, particularly the lumbar region, because if I do have it and it gets worse it means that the vertebrae can slip and then I'm looking at another world of shit and more surgery.

So my options are really limited at the moment. I'm pretty scared of doing the wrong thing so I'm just trying to do the fit-ball physio exercises I have as often as I can - I spend about 2-3 hours a day doing them at the moment - and not much else, and it's really boring! However, I am vastly improved compared to before the surgery. I can drive now (for 30-40 mins), I can cook, wash dishes, do laundry, have sex (occasionally), go for walks, and all sorts things I couldn't do before, so I'm not going insane with boredom any more. Plus it's making life a lot easier for my girlfriend which is good :)  Oh and I don't have to take bloody codeine any more, woohoo \o/

[voodoolily]

Maybe a water aerobics class would be good? Those are low-impact and actually kind of fun if you don't mind being surrounded by a bunch of little old ladies. 

[Hindenburg]

Given that he's about as old and strong as one, he'll fit in just fine. 

[slog]

More anectodal evidence.

My wife has been going to a class 3 days a week at Gold's Gym.  She has had excellent results.

[apocrypha]

Given that he's about as old and strong as one, he'll fit in just fine. 

Amazingly appropriate given that my online alias used to be granny 

[Cyrrex]

You should probably just do Pilates in the water.  With a spotter, a chiropractor and a midget handy.

[Hindenburg]

Fuck that, just do P90X and post the videos on youtube.

[apocrypha]

Lol :p

They'd be short videos and I'd have to get someone else to upload them to YouTube cos I'd be dead