Context: Correcting lumbar hyperlordosis, a main cause of back pain, will reduce the stress on the lumbar spine thereby preventing future problems in back and lower limb. Clinical trials are lacking where mat Pilates, Egoscue exercises and lumbar stabilization exercises are compared for their effect on spinal malalignment.Aims: This study aims to compare the effectiveness of Pilates, Egoscue, and lumbar stabilization exercises for reducing hyperlordosis angle in asymptomatic individuals with lumbar hyperlordosis.Settings and Study Design: A randomized controlled trial conducted on volunteer participants from Health Science University of Belagavi.Materials and Methods: Asymptomatic individuals with lumbar hyperlordosis (n = 51) were randomly allocated to Pilates, Egoscue and Lumbar stabilization groups. Outcomes assessed were index of lumbar lordosis, pelvic tilt, and tolerance to exercise performance which was measured at baseline and after 4 weeks.Results: There was significant reduction in the hyperlordosis score (P < 0.001) in the three study groups when compared for pre-and post-intervention scores. However, more reduction was seen in the Pilates and Egoscue groups compared to the lumbar stabilization. Pilates and Egoscue groups were equally effective in Lumbar lordosis angle (P = 0.68) and pelvic tilt (P = 0.51). Participants of Pilates group graded the exercises with superior tolerance to performance (P < 0.0006) than Egoscue and Lumbar stabilization.Conclusion: Pilates group and Egoscue group were equally effective and superior to lumbar stabilization group in correction of hyperlordosis. Further, ease of performance of exercise was rated high for Pilates than the Egoscue exercise. These exercises should be included by the clinicians in preventive or corrective rehabilitation towards spinal posture malalignments (PDF) Comparative effect of mat pilates and egoscue exercises in asymptomatic individuals with lumbar hyperlordosis: A randomized controlled trial. Available from: https://www.researchgate.net/publication/338074140_Comparative_effect_of_mat_pilates_and_egoscue_exercises_in_asymptomatic_individuals_with_lumbar_hyperlordosis_A_randomized_controlled_trial [accessed Mar 15 2021].

Figures - uploaded by Peeyoosha Gurudut

Author content

All figure content in this area was uploaded by Peeyoosha Gurudut

Content may be subject to copyright.

ResearchGate Logo

Discover the world's research

  • 20+ million members
  • 135+ million publications
  • 700k+ research projects

Join for free

© 2019 Indian Journal of Physical Therapy and Research | Published by Wolters Kluwer ‑ Medknow 79

Comparative Effect of Mat Pilates and Egoscue Exercises

in Asymptomatic Individuals with Lumbar Hyperlordosis:

A Randomized Controlled Trial

Gayatri S. Kudchadkar, Peeyoosha Gurudut, Aarti Welling

Department of Orthopedic Physiotherapy, KAHER Instute of Physiotherapy, Belagavi, Karnataka, India

Original Article

INTRODUCTION

The prevalence of low back pain (LBP) in India is found to

be 6.2% in the general population and 90% in construction

workers.[1] It is estimated that 1 out of 25 people will leave

their job due to LBP.[2] Studies have shown that approximately

90.5% of people having LBP have alteration in the lumbar

spine alignment.[3] A study states that 70% of the population

Context: Correcting lumbar hyperlordosis, a main cause of back pain, will reduce the stress on the lumbar

spine thereby preventing future problems in back and lower limb. Clinical trials are lacking where mat Pilates,

Egoscue exercises and lumbar stabilization exercises are compared for their effect on spinal malalignment.

Aims: This study aims to compare the effectiveness of Pilates, Egoscue, and lumbar stabilization exercises

for reducing hyperlordosis angle in asymptomatic individuals with lumbar hyperlordosis.

Settings and Study Design: A randomized controlled trial conducted on volunteer participants from Health

Science University of Belagavi.

Materials and Methods: Asymptomatic individuals with lumbar hyperlordosis (n = 51) were randomly

allocated to Pilates, Egoscue and Lumbar stabilization groups. Outcomes assessed were index of lumbar

lordosis, pelvic tilt, and tolerance to exercise performance which was measured at baseline and after 4 weeks.

Results: There was significant reduction in the hyperlordosis score (P < 0.001) in the three study groups

when compared for pre-and post-intervention scores. However, more reduction was seen in the Pilates and

Egoscue groups compared to the lumbar stabilization. Pilates and Egoscue groups were equally effective in

Lumbar lordosis angle (P = 0.68) and pelvic tilt (P = 0.51). Participants of Pilates group graded the exercises

with superior tolerance to performance (P < 0.0006) than Egoscue and Lumbar stabilization.

Conclusion: Pilates group and Egoscue group were equally effective and superior to lumbar stabilization

group in correction of hyperlordosis. Further, ease of performance of exercise was rated high for Pilates

than the Egoscue exercise. These exercises should be included by the clinicians in preventive or corrective

rehabilitation towards spinal posture malalignments.

Keywords: Correction, Exercises, Hyperlordosis, Lumbar spine, Posture

Abstract

Address for correspondence: Dr. Peeyoosha Gurudut, KAHER Instute of Physiotherapy, Belagavi, Karnataka, India.

E‑mail: peeoo123@yahoo.com

Access this article online

Quick Response Code:

Website:

www.ijptr.org

DOI:

10.4103/ijptr.ijptr_38_19

Received: 20‑05‑2019, Revised: 08‑11‑2019,

Accepted: 10‑11‑2019, Web Published: 23‑12‑2019

How to cite this article: Kudchadkar GS, Gurudut P, Welling A. Comparative

effect of mat pilates and egoscue exercises in asymptomatic individuals

with lumbar hyperlordosis: A randomized controlled trial. Indian J Phys Ther

Res 2019;1:79-88.

This is an open access journal, and arcles are distributed under the terms of the Creave

Commons Aribuon‑NonCommercial‑ShareAlike 4.0 License, which allows others to remix,

tweak, and build upon the work non‑commercially, as long as appropriate credit is given and

the new creaons are licensed under the idencal terms.

For reprints contact: reprints@medknow.com

[Downloaded free from http://www.ijptr.org on Saturday, January 4, 2020, IP: 10.232.74.26]

Kudchadkar, et al.: Mat pilates vs. egoscue exercises on lumbar hyperlordosis

80 Indian Journal of Physical Therapy and Research | Volume 1 | Issue 2 | July-December 2019

with LBP has postural deviations in spine changing the

normal relationships between spine and pelvis.[2,4]

Maintenance of normal limits of lumbar lordosis is necessary

for obtaining ideal posture.[5] Lumbar hyperlordosis is an

acquired disorder having increased concavity posteriorly that

may be caused due to poor posture, inactivity, improper shoes,

etc.[6,7] This occurs to compensate the inclination of the sacrum

to get back its upward orientation.[8] Lumbar hyperlordosis is

characterized by muscle imbalance with the tightness of back

and hamstring muscles with weakness of abdominals.[6,9,10]

According to Kendall's theory, exercises are the commonest

method to correct abnormal posture, with stretching of

shortened soft tissue structures and strengthening the weak

musculature.[11] Pilates exercises aim at promoting good posture

by improving the strength and exibility of the muscles around

the lumbar spine.[12] Various studies have shown its effectiveness

in the management of lumbar hyperlordosis in the immediate

postpartum period,[9] LBP [13] and chronic mechanical neck

pain.[14] Lumbar stabilization exercises are motor control

conventional exercises that provide internal stabilization at

spine and trunk enhancing the control of the neuromuscular

system, strength, and endurance.[15,16] Literature has shown it

to be effective in LBP,[17] and in spinal and the pelvic pain.[18]

A novel form of exercise known as the Egoscue

exercises, was developed where focus was to target the

musculoskeletal dysfunction with the theory to bring

back the postural balance through corrective exercises. It

is suggested to be effective in rectifying poor posture.[19,20]

To the best of our knowledge and literature search, only

one study has been published to evaluate the efcacy of

Egoscue exercises in chronic hip and knee pain and is

found to be effective.[21] However, no study has been done

to see the effect of these exercises on spinal malalignment.

Further, there was paucity of literature where comparison

was done between the Pilates and stabilization exercises

on hyperlordosis correction. Hence, the present study was

undertaken to compare the effects of the exercises on correction

of lumbar lordosis. The aim of the study was to assess and

compare the effectiveness of Mat Pilates, Egoscue exercises

and Lumbar stabilization, in reduction of lumbar lordosis

angle, anterior pelvic tilt and to see the tolerance to exercise

performance (TTEP) in asymptomatic individuals with

lumbar hyper‑lordosis.

MATERIALS AND METHODS

Study design and ethical consideration

The study was a parallel design randomized controlled

trial conducted on volunteer participants from constituent

colleges of Health Science University, Belagavi, Karnataka,

India from April 2018 to March 2019. The study was

approved by the Institutional Research and Ethics Committee

(KIPT/183/14/05/18). The trial is registered with the Clinical

Trial Registry‑India (CTRI/2018/07/015086). All the individual

participants in this study gave written informed consent.

Participants and randomization

All individuals with lumbar hyperlordosis were screened

for inclusion and exclusion criteria. Individuals were

informed about the aims and procedure of the study and

were included if they had positive prone hip extension

test,[22] no physical complaints at spine, within the age group

of 18–40 years, and anterior pelvic tilt angle of >13°.[23]

Individuals were excluded if they had any history of back

injury, LBP having localized or radiating pain, undergone

treatment for LBP in past 6 months, and practiced any kind

of exercise or sports activity during last 6 months.

Sample size calculated was fty‑one (51), based on the

previous literature considering effect size with α value 1.96

and β value 0.842.[8] Allocation to the groups was done

using lottery method. The subject randomly picked up the

chit, with each number corresponding to the group.[24] The

individuals were subsequently allocated into three study

groups, viz. Pilates, Egoscue, and Lumbar stabilization

groups with 17 in each group [Figure 1].

Measurement of treatment outcomes

Degree of lumbar lordosis using index of lumbar lordosis

A 61 cm Surveyor's exi curve was used. It was molded to

the curve of the spine and traced on a paper to calculate

the index of lordosis. Maximum width and the total length

of the curve were measured. The formula used was θ° = 4

(arc tan [2H/L]), where L = vertical line joining the T12 and

S2 vertebrae and H = maximum width that is the deepest

part of the curvature [Figure 2a].[25]

Percentage of lumbar lordosis using index of lumbar lordosis

Same instrument and procedure as used for the degree

of the lumbar lordosis except for the formula used:

IL = lumbar width/lumbar length × 100 [Figure 2a].[26]

Anterior pelvic tilt using pelvic inclinometer

The subject was asked to stand with the feet shoulder‑width

apart. Even pressure was applied to both the arms of the

inclinometer at anterior superior iliac spine and posterior

superior iliac spine, with a bubble in the center the reading

was then measured in degrees [Figure 2b].[27]

Tolerance to exercise performance using Borg's scale

The scale consists of 6–20 scores on which the words are

printed as "very very light" at 7 and "very very hard" at 19.

[Downloaded free from http://www.ijptr.org on Saturday, January 4, 2020, IP: 10.232.74.26]

Kudchadkar, et al.: Mat pilates vs. egoscue exercises on lumbar hyperlordosis

Indian Journal of Physical Therapy and Research | Volume 1 | Issue 2 | July-December 2019 81

In this scale 6 states no exertion and 20 states maximum

exertion.[28] This was done to guage the difculty level

of the exercises that were performed in each group and

to nd which exercises were graded with more ease of

performance.

Intervention

Table 1 shows exercise and dosage including the

progression for 3 study groups.

Common intervention

The common treatment given to the participants of

the three study groups consisted of stretching exercises

[Table 1]. The passive stretching was given to hamstring,

ilipsoas, rectus femoris and tendo‑achilles muscles

bilaterally.[29,30] Three stretches were given with each stretch

was held for 30 s.

Pilates group (

n

= 17)

Individuals in this group received Mat Pilates exercises

with each week having a different set of exercises

[Ta ble 1 and Figure 3]. [7,9,31] Each exercise was performed

for 5 times.

Egoscue group (

n

= 17)

The Egoscue group received a total of 10 exercises which

included static back alone and with breathing, abdominal

contraction while in the static back position, abductor press,

overhead extension, elbow curls on wall, static wall, upper

spinal twist, pelvic tilts, supine groin progressive, and air

bench exercises [Table 1 and Figure 4].[19]

Lumbar stabilization group (n = 17)

The Lumbar stabilization group received stabilization

exercises which included crook lying, crook lying with

one leg extended and resting down on couch, prone

Figure 1: CONSORT chart

[Downloaded free from http://www.ijptr.org on Saturday, January 4, 2020, IP: 10.232.74.26]

Kudchadkar, et al.: Mat pilates vs. egoscue exercises on lumbar hyperlordosis

82 Indian Journal of Physical Therapy and Research | Volume 1 | Issue 2 | July-December 2019

lying with arms at the side and head turned to opposite

side, quadruped position with head in neutral, supine

lying with one knee exed resting on couch and other

knee exed to be held without support, supine lying

with both the legs extended and one leg raise, sitting on

chair erect, plank position, sitting erect on Bobath ball

[Ta ble 1 and Figure 5].[16]

Exercises in all the three groups were done on alternate

days for 3 times in a week for a period of 4 weeks with

stretching prior to the exercises.

Statistical analysis

Statistical analysis was done using R software version 3.5.1

(2018, Vienna, Australia). Normality distribution was

assessed using the Kruskal–Wallis test. Comparison

between the groups was done using independent

t‑test/Mann–Whitney U‑test and within the group with

Paired t ‑test/Wilcoxon sign rank test. Comparison of the

difference in pre‑and post‑between the groups is done by

ANOVA. P < 0.05 was considered as statistically signicant.

RESULTS

Table 2 provides details on the demographic prole and

the baseline characteristics of participants.

There was a statistically signicant reduction in the mean

of Index of lumbar lordosis (degree and percentage) and

anterior pelvic tilt scores among all the three groups, when

compared for pre‑and post‑intervention scores indicating

improvement with all three forms of exercises. For TTEP

in Pilates Group, the P value was signicant (P < 0.0006);

but the P value for Egoscue group and lumbar stabilization

groups were 0.1559 and 0.7768, respectively, which was not

statistically signicant [Table 3].

Index of lumbar lordosis (degrees and percentage) and

pelvic tilt for Pilates group (P < 0.0001) and Egoscue

group (P < 0.0001) were significantly different from

Lumbar stabilization group [Table 4]. However, there

was no signicant difference between Pilates group and

Egoscue group (P = 0.68) in degrees, (P = 0.9361) for

percentage and (P = 0.51) for pelvic tilt. The lumbar

lordosis angle (degrees and percentage) and pelvic tilt

reduced in all the 3 groups, but more reduction was seen

in the Pilates group and Egoscue group when compared

to the lumbar stabilization group.

For TTEP in Pilates group, the P value was (P < 0.0006)

in the Pilates group. But the P value for Egoscue group

Figure 2: (a) Calculation of index of lumbar lordosis, (b) Measuring

the pelvic tilt with the pelvic inclinometer

b

a

Table 1: Exercise chart

Groups Pilates group Egoscue group Lumbar stabilization group

Common

intervention

Stretching for Hamstring muscle, Rectus femoris muscle, Iliopsoas muscle, Tendoachillis muscle

Exercises Week 1: Leg slides, hip release, knee to chest,

spinal rotation, single knee extension, cat stretch,

neutral to imprint [Figure 3a]

Week 2: Imprint table top position, ab prep, Imprint

table top toe touching floor, imprint table top

knee extensions, spine twist, Ab prep in table top

position, bridging [Figure 3b]

Week 3: Half roll back, pull up; pull up with leg

extension, swimming exercise, single leg extension,

leg circles, and single leg stretch [Figure 3c]

Week 4: Bridging on the ball, spine stretch forward,

single leg lift, double knee lifts, upward dog, and

shell stretch [Figure 3d]

Static back and static back with

breathing, abdominal contraction

while in the static back position,

abductor press, overhead extension,

elbow curls on wall, static wall, upper

spinal twist, pelvic tilts, supine groin

progressive, and air bench [Figure 4]

Crook lying position, crook lying

with one leg extended and resting

down on the couch, prone lying with

arms at the side and head turned to

opposite side, quadruped position

with head at neutral, Supine lying with

one knee flexed resting on couch and

other knee flexed to be held without

support, supine lying with both the

legs extended and one leg raise, plank

position, erect sitting on chair, sobath

ball [Figure 5]

Dosage Each exercise was performed for 5 times Week 1: 3 times with 30 s hold time

Week 2: 5 times with 30 s hold time

Week 3: 15 times with 30 s hold time

Week 4: 20 times with 30 s hold time

Week 1: 3 times with 30 s hold time

Week 2: 5 times with 30 s hold time

Week 3: 15 times with 30 s hold time

Week 4: 20 times with 30 s hold time

[Downloaded free from http://www.ijptr.org on Saturday, January 4, 2020, IP: 10.232.74.26]

Kudchadkar, et al.: Mat pilates vs. egoscue exercises on lumbar hyperlordosis

Indian Journal of Physical Therapy and Research | Volume 1 | Issue 2 | July-December 2019 83

and lumbar stabilization groups were 0.1559 and 0.7768

respectively which was not statistically significant

[Table 3]. Ease of exercise performance was graded

during the exercise and the individuals in Pilates group

were able to tolerate the exercise better while Egoscue

exercise group found the exercises to be difcult to

perform whereas in lumbar stabilization group graded

the exercises to be constant throughout the exercise

time.

Table 2: Summary of the demographic data and the baseline

characteristics

Factors Group P

Group A Group B Group C

Gender, n (%)

Male 6 (35.29) 2 (11.77) 2 (11.77) ‑

Female 11 (64.71) 15 (88.23) 15 (88.23)

Age# 23.94±1.30 22.71±1.49 22.77±1.35 0.0261*

BMI# 26.91±4.23 24.41±3.03 23.18±4.90 0.0347*

#Kruskal‑Wallis test, *The significance. Group A indicates the Pilates

Group, Group B indicates the Egoscue Group and Group C indicates the

lumbar stabilization Group

Figure 3: (a) Pilates week 1 exercises (i) Hip release (ii) Spinal Rotation (iii) Cat stretch (iv) Neutral to imprint (v) Knee to chest (vi) Single

knee extension (vii) Leg slides, (b) Pilates week 2 exercises (i) Bridging (ii) Spine twist (iii) Imprint table top position (iv) Imprint table top knee

extension(v)Imprinttabletoptouchingoor(vi)Abprepintabletopposition(vii)Abprep(c)Pilatesweek3exercises(i)Halfrollback(ii)Single

leg extension (iii) Single leg stretch (iv) Leg circles (v) Pull up (vi) Pull up with extension (vii) Swimming extension, (d) Pilates week 4 exercises

(i) Bridging on ball (ii) Double knee lift (iii) Upward dog (iv) Spine stretch forward (v) Shell stretch

d

c

b

a

[Downloaded free from http://www.ijptr.org on Saturday, January 4, 2020, IP: 10.232.74.26]

Kudchadkar, et al.: Mat pilates vs. egoscue exercises on lumbar hyperlordosis

84 Indian Journal of Physical Therapy and Research | Volume 1 | Issue 2 | July-December 2019

DISCUSSION

The present randomized controlled trial was done to

compare the effect of Pilates exercises, Egoscue exercises

and lumbar stabilization exercises in individuals with

lumbar hyperlordosis.

The result from the statistical analysis showed that the

Pilates group and Egoscue group were better in the

reduction of lumbar lordosis and anterior pelvic tilt as

compared to lumbar stabilization group. Further individuals

in the Pilates group reported better TTEP than the other

groups.

Lumbar hyperlordosis could have been reduced with Pilates

intervention due to the following reasons. Hyperlordosis

is characterized by tightness of the lumbar multidus,

thoracolumbar fascia, erector spinae, rectus femoris and

iliopsoas along with weakness of abdominal muscles, pelvic

oor muscles and asymmetrical tension in lumbo pelvic

region. Pilates exercises focus on core and breath control

that activates local muscles especially the diaphragm, lumbar

multifidus, pelvic floor muscle, transverse abdominal

muscle, and the obliques.[6] Another possible reason for the

change in lumbar lordosis angle and the anterior pelvic tilt

could be that Pilates exercises involve muscle conditioning

Figure 4:Egoscueexercises(a)Staticback(b)Staticbackwithabdominalcontraction(c)Abductorpress(d)Pelvictilts(e)Staticextension(f)

Elbowcurls(g)Airbench(h)Staticwall(i)Overheadextension(j)Spinaltwist(k)Supinegroinprogression

d

h i j

k

c

g

b

f

a

Figure 5: Lumbar stabilization exercises (a) Crook lying (b) Supine

lying with leg raise (c) Crook lying with Ext (d) Prone lying (e) Plank

position(f)Quadripod position(g) Supinelyingwithonekneeexed

(h) Sitting on Bobath (i) Sitting on chair

d

h i

c

g

b

f

a

e

e

[Downloaded free from http://www.ijptr.org on Saturday, January 4, 2020, IP: 10.232.74.26]

Kudchadkar, et al.: Mat pilates vs. egoscue exercises on lumbar hyperlordosis

Indian Journal of Physical Therapy and Research | Volume 1 | Issue 2 | July-December 2019 85

that focuses on recruiting most abundantly used motor

units. Type I bers are recruited the most in day to day

activities which are abundant in mitochondria, oxidative

enzymes, and capillaries. Pilates exercise mainly focuses on

Type I bers, thereby improving the strength and endurance

of these bers at the lumbar spine. This improvement

will enhance synchronous stimulation of these motor

units conditioning the muscles that are responsible for

maintaining lumbar lordosis.[9]

A study was conducted by McNellis et al. to check the

effectiveness of Pilates exercises on lumbar hyperlordosis.

The ndings of the study showed improvements in the

lumbar hyperlordosis after 4 weeks.[31] Another study was

done to show the efcacy of Pilates exercises on lumbar

hyperlordosis immediately after the postpartum period

and found a signicant decrease in lumbar hyperlordosis.[9]

Similar improvements in another study were noted after

8 weeks of Pilates exercises on lumbar lordosis correction.[7]

The ndings of these studies were in accordance with the

ndings of the present study.

However, literature also shows studies with contradicting

results using Pilates as an intervention for lumbar spine

posture correction. Yi‑lang et al . conducted a study where

Pilates exercises were given in older adults. No signicant

change was seen in lumbar posture which was unexpected

nding according to authors. The reason for no change in

the lumbar angle was mentioned to be probably because

individuals were not encouraged to maintain good posture

while doing activities of daily living. However, present

study showed positive results in which young participants

were included as compared to the above‑mentioned study

where older adults formed the study population.[32] Another

study was done to see the effect of Pilates on spine posture.

The change was seen in the thoracic curve and length of

the spine while the minimal change was seen in lumbar

lordosis and pelvic tilt. This insignicant improvement

could be due to the fact that the exercises were performed

only once in a week.[33]

In the present study Pilates exercises also showed

improvement in an anterior pelvic tilt. This could be due

to the fact that Pilates exercises focus on posterior pelvic

tilt. Posterior pelvic tilt has been promoted to cause

co‑contraction of the local stabilization musculature.

This will recruit abdominal muscles thereby preventing

excessive anterior pelvic tilt which will reduce the lumbar

hyperlordosis.[34] Habibi et al . stated that the weakness

of anterior pelvic muscle causes an increase in lumbar

lordosis. Secondly, hamstring muscle is connected to the

Table 3: Comparison of pre‑ and post‑intervention for 3 study groups

Time

points

Group

Group A Group B Group C

Mean±SD P Mean±SD P Mean±SD P

TTEP#

Pre 9.94±2.13 0.0006* 16.06±1.68 0.1559 6.24±0.44 0.7768

Post 8.06±2.05 15.35±1.69 6.29±0.47

ILL

Pre 48.88±4.13 <0.0001* 47.07±5.31 <0.0001* 45.71±6.34 0.0091*

Post 39.16±4.35 38.09±6.08 43.43±6.04

LLC

Pre 32.16±8.25 <0.0001* 32.4±9.21 <0.0001* 29.85±7.54 0.0004*

Post 23.26±8.21 23.62±10.18 26.66±7.49

PT

Pre 25.04±3.03 <0.0001* 21.38±4.40 <0.0001* 21.29±5.10 <0.0001*

Post 18.53±3.04 15.45±3.85 19.21±5.42

#Wilcoxon sign rank test, *The significance. Group A indicates the Pilates Group, Group B indicates the Egoscue Group and Group C indicates

the lumbar stabilization Group. TTEP: Tolerance to exercise performance, ILL: Index lumbar lordosis (degrees), LLC: lumbar lordosis curve in

(percentage), PT: Pelvic tilt (degrees), SD: Standard deviation

Table 4: Comparison of between group differences for all the outcome measures

Group A Group B Group C

Outcome Difference Relative change (%) Difference Relative change (%) Difference Relative change (%) P

TTEP# 1.88±0.99 −18.91 0.71±2.02 −4.4 −0.06±0.66 0.8 0.0005*

ILL 9.72±1.93 −19.90 8.98±2.48 −19.10 2.28±3.17 −4.99 <0.0001*

LLC 8.91±2.21 −27.67 8.61±2.24 −26.74 3.19±2.92 −10.69 <0.0001*

PT 6.51±1.40 −26.00 5.93±1.58 −27.74 2.08±1.60 −9.77 <0.0001*

#Kruskal‑Wallis test. Group A indicates the Pilates Group, Group B indicates the Egoscue Group and Group C indicates the Lumbar stabilization Group.

TTEP: Tolerance to exercise performance, ILL: Index lumbar lordosis (degrees), LLC: lumbar lordosis curve in (percentage), PT: Pelvic tilt (degrees),

*Statistically significant

[Downloaded free from http://www.ijptr.org on Saturday, January 4, 2020, IP: 10.232.74.26]

Kudchadkar, et al.: Mat pilates vs. egoscue exercises on lumbar hyperlordosis

86 Indian Journal of Physical Therapy and Research | Volume 1 | Issue 2 | July-December 2019

pelvic bone. Changing the length of hamstring can change

the position of pelvis thereby correcting and changing the

spinal curvatures.[35]

The main motive of the Egoscue Method is to apply

corrective exercises to get the whole body or the spine

closer to "ideal" posture which will help in reducing the

pain. In the present study, the exercises selected were mainly

focused on the lumbar and pelvic region. This might have

corrected the posture at the lumbar spine and the pelvis

in turn reducing the curvature of the lumbar spine and

pelvic tilt. The exercises included have caused more of

the posterior tilting at the pelvis than the anterior tilting.

Egoscue exercises have stretched and strengthened the

muscles effectively in order to correct the spine and the

pelvis posture. They are majorly corrective exercises and

the main focus of these exercises is that it corrects the

whole body posture.[19]

Literature suggests corrective exercises to improve

posture positively and since Egoscue exercises are similar

to corrective exercises it has also shown beneficial

effect. A study was conducted by Yazidi et al . to see

the effectiveness of corrective exercises on thoracic

kyphosis and lumbar lordosis which showed signicant

improvements after 8 weeks.[8] These results were similar

to the present study as the corrective exercises focuses on

the strengthening, endurance, and exibility of the muscle

which will accelerate the posture correction.

Till date, only one study has been published on Egoscue

exercises. A study was conducted to see the effect of

Egoscue exercises in hip and knee pain conducted for

2 weeks. Signicant improvements in pain and function

were seen. This change was due to the correction of

the malaligned posture which will reduce the overuse

or increases the activity of underused skeletal muscle to

correct the muscle imbalance.[25] Similar effect might have

occurred in the present study as there was a change in

lumbar spine posture.

Lumbar stabilization exercises are said to reduce the load on

the spine and reduce the stress on the spinal structures.[36]

Stabilization exercises have been planned to improve the

neuromuscular control system and perfect the dysfunction.

Lumbar stabilization exercises help in enhancing motor units

which are regulated by a large unit muscle system as well as the

local muscular system. This helps in building up the postural

control of the muscles of the trunk and abdominal.[37]

In literature review done so far on the efcacy of lumbar

stabilization exercises on the lumbar spinal curve shows

contradictory results. A study was conducted to see the

effect of abdominal strengthening on lumbar lordosis and

pelvic tilt which did not show any change in lumbar lordosis

angle, the reason could be that the protocol used mainly

focused on abdominal muscle rather than focusing on

trunk extensors and hip muscles to correct the imbalance.[10]

Another study was done to see the effectiveness of lumbar

stabilization, Pilates exercises and dynamic strengthening

exercises in LBP. The findings showed that lumbar

stabilization was superior then Pilates and Dynamic

strengthening exercise group. This indifference could

be due to the fact that the outcome measures used were

different in both the studies and the study population

included was patients with LBP.[16]

In one of the study, the authors have concluded that

Pilates‑based exercise program was feasible for the elder

population.[32] In present study Pilates exercises were

progressed from simple form to advanced form across

4 weeks. Individuals in Egoscue exercise group found the

exercises to be difcult to perform with more soreness

due to longer and static hold time, however lumbar

stabilization group graded the exercises to be constant

throughout the exercise time, although the exercises were

given in a progressive manner by increasing the number

of repetitions.

This study had limitations like the follow up was not done

to better understand the carryover effect and recurrence

rate. Standard outcome measures like X‑ray could have

been used to measure the angle of lordosis. Other

curvatures of the spine could have been assessed as change

in one spinal curvature will change the curvature at the

other spinal levels.

More studies using Egoscue exercises can be conducted on

the different patient population. Electromyography can be

used to study the muscle activity of abdominal and the trunk

extensor muscles during the Egoscue exercise. Comparative

study between older and younger individuals can be done

for LBP or posture corrections using the same exercises.

CONCLUSION

Pilates exercises, Egoscue exercises, and Lumbar

stabilization exercises for 4 weeks were all effective in

reducing the lumbar hyperlordosis angle and anterior pelvic

tilt. However, Pilates group and Egoscue group were found

to be equally effective and superior to lumbar stabilization

group. Further, ease of performance of exercise was rated

highest for Pilates followed by lumbar stabilization which

was followed by the Egoscue exercise.

[Downloaded free from http://www.ijptr.org on Saturday, January 4, 2020, IP: 10.232.74.26]

Kudchadkar, et al.: Mat pilates vs. egoscue exercises on lumbar hyperlordosis

Indian Journal of Physical Therapy and Research | Volume 1 | Issue 2 | July-December 2019 87

Pilates and Egoscue exercises proved to be effective for

lumbar hyperlordosis correction but Pilates was with lesser

discomfort as compared to Egoscue. Hence, these exercises

should be included by the clinicians or exercise therapist

in preventive rehabilitation or corrective rehabilitation

towards spinal posture malalignments.

Declaration of patient consent

The authors certify that they have obtained all appropriate

patient consent forms. In the form the patient(s) has/have

given his/her/their consent for his/her/their images and

other clinical information to be reported in the journal.

The patients understand that their names and initials will

not be published and due efforts will be made to conceal

their identity, but anonymity cannot be guaranteed.

Acknowledgment

We are grateful to the head of the institution for granting

us permission to conduct the study and use the research

related infrastructure. Our heartfelt thanks to the Health

minds team for statistical analysis and helping us in writing

the manuscript. We are thankful to all the individuals for

participating in the study, without whom the study would

not have been possible.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conicts of interest.

REFERENCES

1. Gupta S, Azhar M. LBA as an increasing health problem in India. Jk

Sci 2016;18:172‑5.

2. Guimond S, Massrieh W. Intricate correlation between body posture,

personality trait and incidence of body pain: A cross‑referential study

report. PLoS One 2012;7:e37450.

3. Candotti CT, Noll M, Marchetti BV, Rosa BN, Medeiros MD, Vieira A,

Loss JF. Prevalence of back pain, functional disability, and spinal

postural changes. Fisioterapiaem Movimento 2015;28:711‑22.

4. Kroll PG, Arnofsky S, Leeds S, Peckham D, Rabinowitz A. The

relationship between lumbar lordosis and pelvic tilt angle. J Back

Musculoskelet Rehabil 2000;14:21‑5.

5. Song MY, Chung WS, Kim SS, Shin HD. Correlation between obesity

and lumbar lordosis in obese pre‑menupausal Korean females. J Korean

Orient Med 2004;25:43‑50.

6. Serola Richard J. Device and method for reducing lumbar lordosis while

supine and supporting the lumbar curve when seated. Honolulu, HI:

United States Patent US; 1993. p. 5201761.

7. Samira MS, Laleh B. The impact of 8‑week selected Pilates exercises on

lordosis correction and BMI in female teens aged 15‑18. Biol Forum

Int Joint 2015;7:1267‑71.

8. Yazidi AG, Mohammadi M. The effect of corrective exercises on the

thoracic kyphosis and lumbar lordosis of boy students. Turkish J Sport

Exerc 2017;19:177‑81.

9. Mahdavinejad R, Rezaei SS. Pilate's selected exercises effects on

women's lumbar hyperlordosis in immediate post‑partum period. Asian

J Multidiscip Stud 2014;2:48‑53.

10. Levine D, Walker JR, Tillman LJ. The effect of abdominal muscle

strengthening on pelvic tilt and lumbar lordosis. Phys Ther Pract

1997;13:217‑26.

11. Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA.

Muscles: Testing and Function, with Posture and Pain (Kendall,

Muscles). Philadelphia: Lippincott Williams and Wilkins; 2005.

12. Muscolino JE, Cipriani S. Pilates and the powerhouse–I. J Bodyw Mov

Ther 2004;8:15‑24.

13. Stolze LR, Allison SC, Childs JD. Derivation of a preliminary clinical

prediction rule for identifying a subgroup of patients with low back

pain likely to benet from Pilates‑based exercise. J Orthop Sports Phys

Ther 2012;42:425‑36.

14. de Araujo Cazotti L, Jones A, Roger‑Silva D, Ribeiro LHC, Natour J.

Effectiveness of the Pilates Method in the Treatment of Chronic

Mechanical Neck Pain: A randomized controlled trial. Arch Phys Med

Rehabil 2018;99:1740‑6.

15. Cynn HS, Oh JS, Kwon OY, Yi CH. Effects of lumbar stabilization

using a pressure biofeedback unit on muscle activity and lateral

pelvic tilt during hip abduction in sidelying. Arch Phys Med Rehabil

2006;87:1454‑8.

16. Bhadauria EA, Gurudut P. Comparative effectiveness of lumbar

stabilization, dynamic strengthening, and Pilates on chronic low back

pain: Randomized clinical trial. J Exerc Rehabil 2017;13:477‑85.

17. Stanford ME. Effectiveness of specic lumbar stabilization exercises:

A single case study. J Man Manipulative Ther 2002;10:40‑6.

18. Ferreira PH, Ferreira ML, Maher CG, Herbert RD, Refshauge K.

Specic stabilisation exercise for spinal and pelvic pain: A systematic

review. Aust J Physiother 2006;52:79‑88.

19. Egoscue P, Gittines R. Pain Free: A Revolutionary Method for Stopping

Chronic Pain. Bantam; 2000. p. 90‑105.

20. Egoscue P, Gittines R. The Egoscue Method of Health Through

Motion. William Morrow Paperbacks; 1993.

21. Zachary V. "The Effect of Egoscue Corrective Exercises on Chronic

Knee and Hip Pain". Brigham Young University ‑ Provo. All Theses

and Dissertations 2014:5280.

22. Murphy DR, Byeld D, McCarthy P, Humphreys K, Gregory AA,

Rochon R. Interexaminer reliability of the hip extension test for

suspected impaired motor control of the lumbar spine. J Manipulative

Physiol Ther 2006;29:374‑7.

23. Preece SJ, Willan P, Nester CJ, Graham‑Smith P, Herrington L,

Bowker P. Variation in pelvic morphology may prevent the

identication of anterior pelvic tilt. J Man Manip Ther 2008;16:113‑7.

24. Crossman A. Simple Random Sampling; 2018. Available from: https://

www.thoughtco.com/random‑sampling‑3026729. [Last accessed on

2018 Apr 08].

25. Seidi F, Rajabi R, Ebrahimi TI, Tavanai AR, Moussavi SJ. The Iranian

exible ruler reliability and validity in lumbar lordosis measurements.

World J Sport Sci 2009;2:95‑9.

26. Hinman MR. Interrater reliability of exicurve postural measures

among novice users. J Back Musculoskeletal Rehabil 2004;17:33‑6.

27. Alviso DJ, Dong GT, Lentell GL. Intertester reliability for measuring

pelvic tilt in standing. Phys Ther 1988;68:1347‑51.

28. Ritchie C. Rating of perceived exertion (RPE). J Physiother 2012;58:62.

29. Covert CA, Alexander MP, Petronis JJ, Davis DS. Comparison of

ballistic and static stretching on hamstring muscle length using an

equal stretching dose. J Strength Cond Res 2010;24:3008‑14.

30. Kisner C, Colby LA. Therapeutic Exercise: Foundations and

Techniques: Stretching for Impaired Mobility. 6th ed. Phildelphia: F.A.

Davis Company; 2012. p. 108‑12.

31. McNellis JL. The Effect of the Pilates Training Program as a

Therapeutic Intervention for Lumbar Hyperlordosis in Asymptomatic

men and Women. Southern Connecticut state university: Proquest,

Umi Dissertation Publishing; 2013.

32. Kuo YL, Tully EA, Galea MP. Sagittal spinal posture after Pilates‑based

exercise in healthy older adults. Spine (Phila Pa 1976) 2009;34:1046‑51.

[Downloaded free from http://www.ijptr.org on Saturday, January 4, 2020, IP: 10.232.74.26]

Kudchadkar, et al.: Mat pilates vs. egoscue exercises on lumbar hyperlordosis

88 Indian Journal of Physical Therapy and Research | Volume 1 | Issue 2 | July-December 2019

33. Schroeder J, Grenz K, Schaar H, Liebig M, Braumann KM. Pilates

can affect sagittal spinal alignment: An observational study. J Spine

2014;3:1‑5.

34. El‑Hamalawy FA. A newly developed exercise program for treatment

of mechanical low back pain associated with accentuated lumbar

lordosis. J Am Sci 2011;7:58‑70.

35. Manshouri M, Rahnama N. Effects of swimming technique backstroke

on lumbar lordosis and BMI in females. Int J Sports Sci 2014;4:115‑20.

36. Wells C, Kolt GS, Marshall P, Bialocerkowski A. Indications, benets,

and risks of Pilates exercise for people with chronic low back pain:

A Delphi survey of Pilates‑trained physical therapists. Phys Ther

2014;94:806‑17.

37. Cho I, Jeon C, Lee S, Lee D, Hwangbo G. Effects of lumbar

stabilization exercise on functional disability and lumbar lordosis

angle in patients with chronic low back pain. J Phys Ther Sci

2015;27:1983‑5.

[Downloaded free from http://www.ijptr.org on Saturday, January 4, 2020, IP: 10.232.74.26]

  • Niteesh K Choudhry
  • Constance P. Fontanet
  • Roya Ghazinouri
  • Arnold Milstein

Background Low back and neck pain (together, spine pain) are among the leading causes of medical visits, lost productivity, and disability. For most people, episodes of spine pain are self-limited; nevertheless, healthcare spending for this condition is extremely high. Focusing care on individuals at high-risk of progressing from acute to chronic pain may improve efficiency. Alternatively, postural therapies, which are frequently used by patients, may prevent the overuse of high-cost interventions while delivering equivalent outcomes. Methods The SPINE CARE (Spine Pain Intervention to Enhance Care Quality And Reduce Expenditure) trial is a cluster-randomized multi-center pragmatic clinical trial designed to evaluate the clinical effectiveness and healthcare utilization of two interventions for primary care patients with acute and subacute spine pain. The study is being conducted at 33 primary care clinics in geographically distinct regions of the United States. Individuals ≥18 years presenting to primary care with neck and/or back pain of ≤3 months' duration were randomized at the clinic-level to 1) usual care, 2) a risk-stratified, multidisciplinary approach called the Identify, Coordinate, and Enhance (ICE) care model, or 3) Individualized Postural Therapy (IPT), a standardized postural therapy method of care. The trial's two primary outcomes are change in function at 3 months and spine-related spending at one year. 2971 individuals were enrolled between June 2017 and March 2020. Follow-up was completed on March 31, 2021. Discussion The SPINE CARE trial will determine the impact on clinical outcomes and healthcare costs of two interventions for patients with spine pain presenting to primary care. Trial registration number: NCT03083886

The aim of the present study was to compare three different forms of exercises namely lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain (LBP) in terms of pain, range of motion, core strength and function. In this study, 44 subjects suffering from non-specific LBP for more than 3 months were randomly allocated into the lumbar stabilization group, the dynamic strengthening group, and the Pilates group. Ten sessions of exercises for 3 weeks were prescribed along with interferential current and hot moist pack. Pain was assessed by visual analog scale, functional affection by modified Oswestry Disability Questionnaire, range of motion by assessing lumbar flexion and extension by modified Schober test and core strength was assessed by pressure biofeedback on day 1 and day 10 of the treatment. There was reduction of pain, improvement in range of motion, functional ability and core strength in all the 3 exercise groups. The improvement was significantly greater in the lumbar stabilization group for all the outcome measures, when compared the posttreatment after 10th session. Pairwise comparison showed that there was greater reduction of disability in the Pilates group than the dynamic strengthening group. It was concluded that the lumbar stabilization is more superior compared to the dynamic strengthening and Pilates in chronic nonspecific LBP. However, long-term benefits need to be assessed and compared with prospective follow-up studies.

  • Igsoo Cho
  • Chunbae Jeon
  • Sangyong Lee Sangyong Lee
  • Gak Hwangbo

[Purpose] This study examined the effects of lumbar stabilization exercises on the functional disability and lumbar lordosis angles in patients with chronic low back pain. [Subjects] The subjects were 30 patients with chronic low back pain divided into a lumbar stabilization exercise group (n = 15) and a conservative treatment group (n = 15). [Methods] The lumbar stabilization exercise and conservative treatment groups performed an exercise program and conservative physical treatment, respectively. Both programs were performed 3 times a week for 6 weeks. The degree of functional disability was assessed by the Oswestry disability index, and lumbar lordosis angles were measured by plain radiography. [Results] The Oswestry disability index decreased significantly in the both groups; however, it was significantly lower in the lumbar stabilization exercise group. The lumbar lordosis angle increased significantly in the lumbar stabilization exercise group after treatment and was also significantly greater than that in the conservative treatment group. [Conclusion] Lumbar stabilization exercise is more effective than conservative treatment for improving functional disability and lumbar lordosis angles.

  • Jan Schröder Jan Schröder

Purpose: "Pilates" is known to be a gentle technique of strength training with an emphasis on the deep trunk muscle layers. Positive influences on spinal form parameters are assumed. Methods: Spinal form parameters of 24 female volunteers (10 Pilates / 14 controls) were measured before and after a definite Pilates program (12 units, 60 minutes each, once a week) by means of video raster stereography (Formetric®-system), and analyzed using 2-way ANOVA. Results: We found significant (p<0.05) spine shape changes in the form of spinal erection (decreasing thoracic angle, increasing spinal length) after Pilates-based training exercises. Conclusions: We consider the controlled spinal shape adaptations – apparent in an erection of spinal alignment in the sagittal plane – to be valid and specifically exercise-induced, supporting a basic idea of the Pilates training concept.

Lumbar lateral X-ray radiography is considered as a golden standard method in lumbar lordosis measurement. However, this method has a number of problems such as being time-consuming, being expensive and causing potential harms. We suggest flexible ruler as a safe, easy-to-use and inexpensive tool instead. Using this method is specifically advantageous in extensive researches and repeated measurements. The current study is accomplished in two parts: intra-tester and Inter-tester evaluation of reliability as well as validity of flexible ruler. Two groups of 20 and 25 healthy men were tested by the two testers; the lumbar lordosis was measured twice for each subject with a time-lag of one minute. Lumbar lordosis of 20 healthy men was measured once for intertester reliability appraisal. Flexible ruler method validity was assessed while testing 10 subjects suffering from Low Back Pain (LBP). Lumbar lordosis was measured from T12 down to S2, using the method proposed by Youdas. Based on the ICC test, flexible ruler Intra-tester reliability was obtained 0.92 for the first tester and 0.89 for the second one. Likewise, Inter-tester reliability was calculated as 0.82. Validity between lumbar lordosis measurement with flexible ruler and x-ray was 0.91. These results indicated that Iranian flexible ruler could be used effectively for lumbar lordosis measurements and is a valid, assured, portable and noninvasive tool with high appraisal of reliability and validity.

  • S. Gupta
  • M.A. ud din Darokhan
  • O. Singh
  • J. Muzaffar

Low back pain is an extremely common health problem throughout the world. It is one of the common causes of activity limitation and work absentism and hence cause of great economic burden on the country. Low back ache has multifactorial etiology. This observational study was conducted from June 2013 to June 2014, to know about the clinical trends of low backache in patients requiring admission and its distribution with respect to age, sex and occupation. 180 patients were enrolled in this study at department of orthopaedics G.M.C Jammu. In this study low back ache was more common in third and fourth decade, more in males but with female preponderance in the geriatric age group. Low back ache was more common in non sedentary occupation group. Duration of low back ache was mostly two months to two years. Many etiologies were observed as a cause of low back ache like lumbar spondylosis, prolapsed intervertebral disc, senile osteoporosis, spinal canal stenosis, compression fracture, spondylolisthesis, tuberculosis, lumbar strain etc.

  • Penny G. Kroll
  • Shara Arnofsky
  • Stacey Leeds
  • Amanda Rabinowitz

The purpose of this study was to investigate the relationship between clinical measures of pelvic tilt angle, range of pelvic movement, and the lumbar lordosis category observed in normal, healthy, asymptomatic volunteers. A total of 54 subjects, 38 females (average age 24.7 +/- 3.24 years) and 14 males, (average age 25.77 +/- 5.13 years) were tested. Using methods previously described in the literature, subjects were divided into three groups according to the type of lordosis they exhibited: 1)decreased lordosis, 2) normal lordosis, 3) increased lordosis. Angles of resting, maximal anterior, and maximal posterior pelvic tilt positions were measured using a goniometric technique. A weak correlation was found between resting pelvic tilt position and lumbar category, with a significant difference in resting pelvic tilt between subjects with increased lordosis and those with decreased lordosis. No significant relationship was demonstrated between lumbar category and available total pelvic ROM or pelvic ROM in anterior or posterior direction.

  • Luciana de Araujo Cazotti
  • Anamaria Jones Anamaria Jones
  • L.H.C. Ribeiro
  • Jamil Natour

Background Neck pain is a common occurrence and affects about 70% of individuals at some point in their lives. It is a frequent source of disability and a key reason for seeking medical attention. The Pilates method, a physical activity program that aims for body awareness through the harmonization of body and mind, has been widely used to improve physical fitness and rehabilitation in general. Although the symptoms of neck pain are common in the population, there is very little literature on the effectiveness of the Pilates method as treatment for neck pain. Objectives The aim of this study was to assess the efficacy of the Pilates method on lessening the pain and improving function and quality of life, as well as reducing the consumption of analgesic in patients with mechanical-postural neck pain. Methods Sixty-four patients diagnosed with mechanical-postural neck pain were selected. The selection criteria were the following: Individuals complaining of neck pain for a period over three months, both genders, ages between 18 and 65. All individuals diagnosed with the following were excluded: fibromyalgia, traumatic spinal injuries, infections and inflammation of the cervical spine, cervical pain radiating to the upper limbs, those who initiated or changed their physical activity regimen in the three months prior to the study, individuals with visual deficiency not corrected by the use of glasses and those who presented diseases of the central nervous system. Patients were randomized into two groups: Pilates (PG) and control (CG). PG attended two sessions of Pilates per week, for 12 weeks. CG remained on the waiting list for Pilates. Both were instructed to use acetaminophen 750 mg every six hours for the pain, and the consumption of the drug was controlled. Both groups were assessed for pain (numerical pain scale - NPS), function (Neck Disability Index - NDI) and quality of life (SF-36). This was a single blind evaluation at baseline (T0), 45 days (T45), 90 days (T90) and 180 (T180) days after the start of the study. Results Thirty-two patients were randomized in each group. Initially they were homogeneous in relation to demographics and clinical characteristics. The only exception was the body mass index (BMI), with the PG showing higher BMI than the CG. Regarding the assessment between groups over time (ANOVA), statistical differences were identified for pain (p<0.001), function (p<0.001) and the SF-36 functional capacity (p=0.019), pain (p<0.001), general health (p=0.022), vitality (p<0.001), mental health (p=0.012), with the PG constantly achieving the best results. The consumption of pain medication was lower among those in the PG than in the CG (p=0.037). Conclusions The Pilates method is effective in the treatment of chronic mechanical-postural neck pain, presenting improvement in the levels of pain, function, quality of life (functional capacity, pain, general health, vitality and mental health) and reducing the consumption of analgesics. References Acknowledgements Thanks CAPES for granting a scholarship to Luciana de Araujo Cazotti. Disclosure of Interest None declared

  • Pete Egoscue

A review by Samantha Berg M.Ac., L.Ac. and Kevin Meddleton M.Ac., L.Ac, Alaska Center for Acupuncture 907-745-8688 www.AlaskaAcupuncture.com Life is movement and movement sustains life. In the "Egoscue Method of Health Through Motion" Pete Egoscue teaches his readers how to take responsibility for their own state of wellness by adding movement back into their lives. Egoscue, an "anatomical functionalist" has spent over two decades studying the relationship between the body's structure, and function and what happens to this relationship in the face of lifestyle devoid of proper movement. Egoscue introduces his readers to the idea that all of the body's systems are designed to work together. He then goes on to illustrate how misalignment in one area of the body can cause pain or discomfort in another location. For example, a hip rotated foreword on one side or tilted underneath can lead to knee pain, back pain or shoulder pain. Egoscue presents several illustrations showing the body in proper alignment, and he explains what happens when the body is subjected to a lifestyle devoid of exercise or full of repetitive, unbalanced movements. Having worked with many professional athletes over the course of his career, Egoscue encountered numerous clients who had chosen to have joint replacement surgery. Invariably, surgery did not correct the underlying imbalance, forcing the patient to return for another surgery, often to another area of the body. In the example above, replacing a knee in a patient whose cartilage has been eroded due to hip misalignment temporarily relieves the pain, but it does not correct the hip problem.

Background The effectiveness of Pilates exercise for treating people with chronic low back pain (CLBP) is yet to be established. Understanding how to identify people with CLBP who may benefit, or not benefit from Pilates exercise, and the benefits and risks of Pilates exercise will assist trial design.Objectives To establish a consensus regarding the indications, contraindications, and precautions of Pilates exercise, and the potential benefits and risks of Pilates exercise for people with CLBP.MethodsA panel of 30 Australian physical therapists experienced in the use of Pilates exercise were surveyed using the Delphi technique. Three electronic questionnaires were used to collect participant opinions. Answers to open-ended questions were analyzed thematically, combined with research findings, and translated into statements about Pilates exercise. Participants then rated their level of agreement with statements using a 6 point Likert scale. Consensus was achieved when 70% of panel members agreed or disagreed with an item.ResultsThirty physical therapists completed the 3 questionnaires. Consensus was reached on 100% of items related to the benefits, indications, and precautions of Pilates exercise, 50% of risks, and 56% of contraindications. Participants agreed that people who have poor body awareness and maladaptive movement patterns may benefit from Pilates exercise, while those with pre-eclampsia, unstable spondylolisthesis, or a fracture may not. Participants also agreed that Pilates exercise may improve functional ability, movement confidence, body awareness, posture, and movement control.Conclusions These findings contribute to a better understanding of the indications, contraindications, and precautions of Pilates exercise, and the benefits and risks of Pilates exercise for people with CLBP. This can assist in future trial design examining the effectiveness of Pilates exercise.