Pilates, McKenzie Therapy, and Functional Restoration More Effective Than Others in Reducing Chronic Low Back Pain

Pregnant Women in a pilates class practising exercises with her teacher
Study authors conducted a systematic review and meta-analysis to determine the effect of different exercise treatments on pain intensity in adults with chronic low back pain.

Pilates, McKenzie therapy, and functional restoration were found to be more effective than other exercise programs in reducing pain intensity and functional impairment among individuals with chronic low back pain (LBP), according to findings from a systematic review and meta-analysis published in Journal of Physiotherapy.

Study authors searched publication databases for exercise treatments aimed at reducing pain intensity and functional limitations among adults with nonspecific LBP lasting at least 12 weeks. A total of 249 studies including 24,486 participants met the inclusion criteria for the review and 217 studies including 20,969 participants met the criteria for the network meta-analysis.

Mean age of the study population was 44 years; 44% were men; 87% had chronic LBP; and 31% had long-duration pain.

A total of 507 treatment groups were identified. The majority of studies (n=126) compared exercise with nonexercise treatments; few studies (n=91) only compared different types of exercise interventions.

Study authors included 11 types of exercise in the analyses, including core strengthening, mixed type, general strengthening, aerobics, Pilates, stretching, other, yoga, functional restoration, McKenzie therapy, and flexibility.

The largest change in pain intensity compared with minimal treatment was observed for Pilates (mean difference [MD], -21.8; 95% CI, -29.6 to -14.1; I2=91.1%), McKenzie therapy (MD, -14.1; 95% CI, -27.7 to -0.4; I2=71.2%), stretching (MD, -14.0; 95% CI, -21.1 to -6.8; I2=54.6%), general strengthening (MD, -13.4; 95% CI, -20.6 to =6.2; I2=79.8%), and core strengthening (MD, -12.8; 95% CI, -17.8 to -7.9; I2=82.3%).

For pairwise comparisons, the greatest difference in pain intensity was for Pilates (MD, -18.3; 95% CI, -23.4 to -13.1), McKenzie therapy (MD, -17.6; 95% CI, -33.6 to -1.5), and functional restoration (MD, -29.0; 95% CI, -41.0 to -17.0).

Compared with minimal treatment, Pilates was observed to best improve functional impairment (MD, -13.1; 95% CI, -18.6 to -7.7; I2=88.3%). For pairwise comparisons, the best results were observed for functional restoration (MD, -25.3; 95% CI, -38.1 to -12.5) and McKenzie therapy (MD, -16.1; 95% CI, -19.5 to -12.8).

There was significant study heterogeneity observed in this analysis.

The study authors concluded, “This analysis should help guide primary care clinicians in their patient management and referral practices.”


Hayden JA, Ellis J, Ogilvie R, et al. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. J Physiother. 2021;67(4):252-262. doi:10.1016/j.jphys.2021.09.004

This article originally appeared on Clinical Pain Advisor