Yoga or Pilates for Back Pain?

An anatomy woman holds a side plank position.
An anatomy woman holds a side plank position.. Angela Coppola/Dorling Kindersley/Getty Images

Yoga or Pilates for Back Pain?  Which Is It?

Many people rave about Pilates, claiming that it saved their back or improved their posture in a major way.  Others are practically married to yoga, saying nothing else comes close to giving them the pain relief they seek.  

Which is it?  Is one method better for your back than the other?

Yoga Joe

Believe it or not, Joe Pilates evolved his work from yoga (along with martial arts and a number of other rigorous physical disciplines).

Born in the late 1800s and living into the mid-20th century, Pilates started life as sickly child, according to the website Jillian Hessel Pilates. To mitigate this, and build strength, he took up bodybuilding, yoga, wrestling, gymnastics and martial arts.  

Joe had to forge his own individual pathway to health by weaving these practices together, along with the study of anatomy.  For him, these disciplines all lacked one important feature: A strong set of core muscles. Over time Joe developed his method, which was originally called "Contrology," from these early explorations.  

During World War I he worked with prisoners of war - many of whom had been injured and were very weak - to get them moving.  He rigged bed springs up in such as way as to provide both support and resistance for movement, and his "patients" got better.  This was the start of the method that today is known as Pilates, especially that aspect of the work that is done in a studio with spring-driven machines.

From Yoga to Pilates - The Elephant's Journey

An example of a yoga posture that may have been adapted for Pilates is the elephant. The elephant is done on the reformer, a specialized piece of Pilates equipment, and looks a lot like Downward Facing Dog pose. Although the elephant takes place in the same position as Down Dog, it can feel quite different while you are performing it; done correctly it releases tension in the low back, increases awareness of the shoulder girdle, and can get you to walk away with very sore abdominal muscles.

That is not to say yoga does not strengthen core posture muscles. But working the core is a key primary intention of Pilates, while in yoga it is one of a number of benefits. Both systems will likely increase flexibility, strength, balance and coordination; both can be helpful in reducing or preventing back or neck pain. 

Pilates for Back Pain Research

As of 2015, few studies on the benefits of doing Pilates for back pain relief have been done.  Those that have don't have much to report.  For example, a review by Wells, et. al, entitled "Effectiveness of Pilates exercise in treating people with chronic low back pain: a systematic review of systematic reviews," published in the January 19, 2013 issue of BMC Medical Research Methodology concluded that due to the small number of studies, as well as poor quality of the studies that were found, Pilates could not be recommended for reducing pain and disability in people with chronic low back pain.

And a 2015 Cochrane Database Review did not find conclusive evidence that PIlates is superior to other forms of exercise for low back pain.

Yoga for Back Pain Research

For yoga, the picture is a little brighter.  A review by Crow, et. al, called "Effectiveness of Iyengar yoga in treating spinal (back and neck) pain: A systematic review" that was published in the January 2015 issue of the International Journal of Yoga looked at 6 studies involving a total of 570 patients.  The researchers found that in the short term, Iyengar may be effective for treating chronic spine pain.  The review did not find evidence for yoga as a back treatment in the long term, though.

Similarly (but not exactly the same,) a review conducted by Cramer, et. al. that was published in the 2013 issue of the Clinical Journal of Pain found strong evidence that yoga is effective in the short term.  It also found moderate evidence for long term use.  The researchers concluding remarks recommend yoga as an "additional therapy for low back pain."  This review was entitled, "A systematic review and meta-analysis of yoga for low back pain."

The choice between yoga and Pilates for back pain may come down to personal preference.  Quite often yoga provides the opportunity for a spiritual experience, while Pilates tends to keep focused mainly in the physical realm. There may be other reasons to choose one over the other, as well


Cramer, H, et. al. A systematic review and meta-analysis of yoga for low back pain. Clin J Pain. 2013 May;29(5):450-60. doi: 10.1097/AJP.0b013e31825e1492.

Crow, E.M., et. al. Effectiveness of Iyengar yoga in treating spinal (back and neck) pain: A systematic review. Int J Yoga. 2015 Jan;8(1):3-14. doi: 10.4103/0973-6131.146046.

Wells, C., et. al. Effectiveness of Pilates exercise in treating people with chronic low back pain: a systematic review of systematic reviews. BMC Med Res Methodol. 2013 Jan 19;13:7. doi: 10.1186/1471-2288-13-7.

Who was Joseph Pilates? Jillian Hessel Pilates. Accessed December 2015.

Yamato, T.P., et. al. Pilates for low back pain. Cochrane Database Syst Rev. 2015 Jul 2;7:CD010265. doi: 10.1002/14651858.CD010265.pub2.

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