We always recommend movement and strength work as complementary additions to chiropractic care. Pilates is one of the better-studied options for this, and for many of our patients it is a practical way to hold onto the progress we make in the treatment room. The research backs this up, and understanding why the two work so well together is useful whether you are a patient, a Pilates instructor or someone considering either for the first time.
Why a stable core is not the same as a strong one
Most people think of core training as building strength. In a clinical setting we are usually more interested in control: the ability of the deep stabilising muscles to switch on at the right time, in the right order, to protect the spine during movement. After an injury or a long period of pain, that timing often breaks down. The muscles are still strong, but they fire late or in altered patterns, and the spine loses the steady support it relies on.
A chiropractic adjustment restores segmental joint mobility. When a spinal segment is restricted, the surrounding muscles compensate by tightening or guarding, which feeds back into that loss of control. A 2024 bibliometric analysis of chiropractic research found that 90% of clinical practice guidelines recommend spinal manipulative therapy for low back pain and 100% for neck pain (Trager et al., 2024). These are first-line, non-pharmacological recommendations. Chiropractic addresses the joint restriction directly. The question then becomes: what is the best way to rebuild the deep control around it? This is exactly what Pilates is designed to do.
Why we often recommend Pilates as active care
Pilates trains the lumbopelvic stabilisers through slow, controlled movement with a constant emphasis on breath, alignment and deep abdominal activation. Once joint mobility is restored through an adjustment, those muscles need to be retrained, and the clinical evidence that Pilates does this well is strong.
A 2022 network meta-analysis published in the Journal of Orthopaedic & Sports Physical Therapy compared different exercise types for chronic low back pain. Pilates ranked among the most effective interventions for reducing both pain and disability, alongside core-based and mind-body exercise (Fernández-Rodríguez et al., 2022). This is the same kind of comparative evidence that places movement-based care at the front of the queue for back pain.
A 2023 systematic review and meta-analysis pooled data from 19 randomised controlled trials and 1,108 patients with chronic low back pain. Pilates produced a large, statistically significant reduction in pain and a meaningful improvement in functional disability compared with controls, although the effect on general quality of life was less pronounced (Yu et al., 2023).
For our patients, this means Pilates is not just a nice suggestion. It is one of several evidence-based active care options that can extend the benefit of what we do in the clinic.
How Pilates targets the muscles that protect your spine
When we talk about “core strength” in a clinical setting, we mean the coordinated activation of the muscles surrounding the lumbar spine and pelvis: the transverse abdominis, multifidus, internal and external obliques, rectus abdominis and erector spinae. These muscles do not just produce movement. They stabilise the spine during every activity, from picking up a child to carrying shopping up a flight of stairs.
A 2017 electromyography (EMG) study published in the Journal of Manipulative and Physiological Therapeutics measured trunk muscle activation during classical Pilates mat exercises in both healthy people and those with chronic low back pain. The criss-cross drove the strongest trunk flexor activity, the single leg stretch loaded the abdominals and obliques, and the dead bug emphasised the obliques. Importantly, the researchers found that these exercises recruited the lumbopelvic stabilising muscles even in a participant’s very first session, in both groups (Pereira et al., 2017).
That last point matters. It is one of the reasons we often recommend Pilates as graded active care. A beginner can start with low-demand movements that gently switch on the stabilisers, then progress toward exercises that challenge them at higher loads as control improves. The progression is built into the method.
How Pilates compares with other exercise
A fair question is whether Pilates is better than other forms of exercise. The honest answer from the research is that it is roughly as good, not magically superior, and that is reassuring rather than disappointing.
A 2023 systematic review with meta-analysis in Musculoskeletal Care compared Pilates against general exercise, direction-specific exercise and spinal stabilisation work for chronic low back pain. It found no strong evidence that any one approach clearly beat the others, and concluded that treatment should be matched to the individual (Wong et al., 2023). A 2024 randomised controlled trial in Clinical Rehabilitation compared Pilates with a home-based exercise programme in 145 people with chronic low back pain. Both groups improved, Pilates held a small edge on pain and disability, and it produced a clinically meaningful gain in quality of life (Tottoli et al., 2024).
The practical takeaway is the one we give in the clinic: the best exercise is the one you will actually keep doing. Pilates is one good option among several. Yoga, progressive strength work, walking and swimming all have evidence behind them, and the right choice depends on your goals, your budget, how easily you can get to a class and what you genuinely enjoy. For some people a studio class is ideal, for others a home programme or a different form of exercise fits their life better, and that is fine. If you like Pilates and attend regularly, it is an excellent choice. Consistency matters far more than picking the theoretically perfect modality.
Beyond the low back
Spinal health does not exist in isolation. Pilates places heavy demands on posture, scapular control and neck position, which is why its benefits are not limited to the lower back.
A 2025 systematic review and meta-analysis in BMC Musculoskeletal Disorders examined Pilates for chronic neck pain across eight randomised controlled trials and 439 participants. Compared with no treatment, Pilates produced a clinically significant reduction in neck pain and improved disability, with benefits that carried through to follow-up (Lazoura et al., 2025). For patients whose neck pain is bound up with posture, rounded shoulders and forward head position, this fits what we see in practice: improving deep control and postural endurance tends to settle symptoms that stretching alone does not.
This is why we often recommend Pilates as part of a broader plan rather than isolated exercises. A well-structured class trains posture, breathing and core control together, reinforcing the work we do across different areas of the spine.
What we tell our patients
Based on the research and what we see in practice, here is the guidance we give:
Start after your acute phase is managed. Pilates works best as active care and maintenance, not as a first response to an acute flare-up. Get the problem assessed and treated first, then build Pilates into your routine as you improve.
Consistency over intensity. The trials that show the strongest results involve regular practice over several weeks, not occasional intense sessions. One or two classes a week, kept up over time, beats a sporadic hard effort.
Quality of movement comes first. Pilates rewards control, not strain. If you cannot hold your alignment and breathing during an exercise, regress to an easier version rather than pushing through. This is where a good instructor earns their keep.
Pay attention to asymmetry. If one side consistently feels weaker or tighter in a particular exercise, mention it at your next appointment. It may point to a joint restriction we can address, which often unlocks progress that core work alone could not.
Do not push through sharp pain. The safety profile of Pilates in clinical trials is excellent. But sharp or radiating pain during a movement is a signal to modify and to get assessed, not to grind it out.
Use Pilates to extend the benefit of your adjustments. Think of chiropractic as restoring the mobility and Pilates as training your body to hold and control it. The two together produce better long-term outcomes than either alone.
A note for Pilates instructors
If you teach Pilates, the clinical evidence behind your work is strong and worth sharing with your clients. The research consistently shows meaningful improvements in pain, function and core control across a wide range of people.
Where we can add value is with clients who are stuck. If someone has been practising regularly and certain movements are not improving, or they report persistent one-sided tightness or a recurring niggle, a chiropractic assessment can identify whether a joint restriction is part of the picture. We are happy to work alongside instructors and welcome referrals in both directions.
Where chiropractic and Pilates fit together
In practice, the patients who do best are usually the ones doing both. We get a restricted joint moving again, and their Pilates gives the deep stabilisers something to build on, so the improvement sticks instead of fading between visits.
If you already do Pilates but a niggle keeps coming back, or one side never quite loosens off, it is worth having the joint looked at. A restriction is the kind of thing core work cannot reach on its own. And if you are already a patient, a regular class is one of the more reliable ways to keep the progress going.
Get in touch or book an appointment and we will take it from there.
References
- Fernández-Rodríguez R, Álvarez-Bueno C, Cavero-Redondo I, et al. Best exercise options for reducing pain and disability in adults with chronic low back pain: Pilates, strength, core-based, and mind-body. A network meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2022;52(8):505-521.
- Lazoura E, Savva C, Ploutarchou G, et al. Effectiveness of the Pilates method in patients with chronic neck pain: a systematic review with meta-analysis. BMC Musculoskeletal Disorders. 2025;26(1):629.
- Pereira ILR, Queiroz B, Loss J, Amorim C, Sacco ICN. Trunk muscle EMG during intermediate Pilates mat exercises in beginner healthy and chronic low back pain individuals. Journal of Manipulative and Physiological Therapeutics. 2017;40(5):350-357.
- Tottoli CR, Ben ÂJ, da Silva EN, Bosmans JE, van Tulder M, Carregaro RL. Effectiveness of Pilates compared with home-based exercises in individuals with chronic non-specific low back pain: randomised controlled trial. Clinical Rehabilitation. 2024;38(11):1495-1505.
- Trager RJ, Bejarano G, Perfecto RPT, Blackwood ER, Goertz CM. Chiropractic and spinal manipulation: a review of research trends, evidence gaps, and guideline recommendations. Journal of Clinical Medicine. 2024;13(19):5668.
- Wong CM, Rugg B, Geere JA. The effects of Pilates exercise in comparison to other forms of exercise on pain and disability in individuals with chronic non-specific low back pain: a systematic review with meta-analysis. Musculoskeletal Care. 2023;21(1):78-96.
- Yu Z, Yin Y, Wang J, Zhang X, Cai H, Peng F. Efficacy of Pilates on pain, functional disorders and quality of life in patients with chronic low back pain: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 2023;20(4):2850.