Combined Effects of Yoga and Pilates versus Conventional Exercises on Pain, Core Strength, Kinesiophobia, and Disability in Patients with Chronic Non-Specific Low Back Pain: A Randomized Controlled Trial

Low back pain (LBP) is one of the most common musculoskeletal disorders and the leading cause of disability worldwide. The WHO highlights LBP as a major contributor to years lived with disability, and the GBD 2021 analysis confirms it remains the single leading cause of disability globally, with prevalence expected to rise due to ageing and sedentary lifestyles. LBP is classified by duration into acute (<6 weeks), sub-acute (6–12 weeks), and chronic (>12 weeks). Etiologically, it is categorised as specific (disc herniation, infection, fractures, tumors, inflammatory disorders) or non-specific, where no structural pathology is identified. Non-specific LBP accounts for nearly 85–90% of cases, making it the most common form. NSLBP presents as pain, stiffness, or discomfort between the lower ribs and gluteal folds, often associated with reduced mobility and functional limitations. Diagnosis is primarily clinical, focusing on ruling out red flags such as trauma, fever, neurological deficits, or malignancy. Imaging is generally discouraged unless red flags are present, as many findings are incidental. LBP imposes a major socioeconomic burden through healthcare costs, absenteeism, and productivity loss. In India, prevalence is high, and recurrence rates range from 24–80% within one year, highlighting its chronic and relapsing nature. Management includes pharmacological, surgical, and conservative approaches, but guidelines strongly recommend conservative care as the cornerstone. Conventional exercise programs (aerobic training, flexibility, core strengthening, motor control) reduce pain and disability but may not adequately address psychosocial factors like fear-avoidance and stress. Yoga, combining postures, breathing, and relaxation, has shown small to moderate improvements in pain, function, and psychological well-being. Pilates, emphasising deep trunk stabilisers and controlled movement, improves spinal stability, neuromuscular control, and functional outcomes.  While yoga addresses biopsychosocial aspects and Pilates targets core stabilisation, studies on their combined application are limited. A yoga–Pilates fusion program may provide a more holistic intervention by integrating physical, psychological, and functional benefits for chronic NSLBP.

Need for the Study

Chronic non-specific low back pain (CNSLBP) is a highly prevalent, recurrent, and disabling condition that creates substantial personal as well as socioeconomic burden. Although exercise therapy is strongly recommended as a key component of management, conventional exercise programs often have limited effectiveness in addressing the psychosocial factors and neuromuscular impairments associated with chronicity.  Yoga, by promoting relaxation and mental well-being, also contributes to activation and stabilization of important musculature. Pilates, on the other hand, is particularly effective in strengthening deep core muscles and enhancing neuromuscular control. The integration of yoga and Pilates may provide a synergistic and more holistic approach, potentially leading to better functional outcomes, greater confidence in movement, reduced fear of activity, and improved long-term adherence compared to conventional exercises alone. Since there is a lack of sufficient research evaluating the effectiveness of such a combined protocol, the present study is justified to investigate its efficacy in individuals with CNSLBP.

Aim

This study aims to evaluate the combined effect of yoga and Pilates compared with conventional exercises on pain, core strength, kinesiophobia, and disability in patients with chronic non-specific low back pain.