Important note: this article is for information only and does not replace medical diagnosis or treatment. If you have acute pain, radiating pain, or pain accompanied by loss of strength or changes in sensation, see your doctor before starting any exercise programme. The exercises and recommendations described here are a guide and must be adapted to each case under qualified supervision.

Chronic musculoskeletal pain is one of the biggest health burdens in Spain. Low back pain affects 18.3% of the Spanish adult population. Neck pain, 23.6%. And more than 25% of adults live with some form of chronic pain, according to the Pain Barometer study published in BMC Public Health (2024). Anti-inflammatories bring relief and physiotherapy helps, but neither solves the underlying problem if the muscles that stabilise your spine are weak, your joints are stiff and your movement patterns are dysfunctional.

Reformer Pilates offers a different approach. It does not treat pain as a symptom to be silenced, but as a signal that your body needs something it is not getting: controlled movement, strength in the right places and a posture that respects the biomechanics of your spine. This guide covers everything you need to know about how the Reformer addresses each type of pain, with the scientific evidence behind it.

What the most recent scientific studies say

In a network meta-analysis of 118 trials (9,710 participants), Pilates was the exercise most likely to reduce pain (93%) and disability (98%) in chronic low back pain, ahead of strength training, yoga and general exercise.
Source: Fernández-Rodríguez R et al. (2022). Journal of Orthopaedic & Sports Physical Therapy, 52(8):505-521.
A meta-analysis of 19 trials found that Pilates produces a significant improvement on the VAS pain scale (SMD = −1.31; p < 0.00001) and in functional disability on the ODI (MD = −4.35; p < 0.00001).
Source: Lin HT et al. (2023). Int J Environ Res Public Health, 20(4):2850.
Reformer Pilates notably improves pain, active coping strategies (with no change in passive ones) and sleep quality, and reduces kinesiophobia in patients with chronic musculoskeletal pain. Programme: 6 weeks, 2 sessions of 45 min/week.
Source: Şahan N, Uluğ N, Özeren A (2025). BMC Psychology, 13(1):836. DOI: 10.1186/s40359-025-03207-9.
Pilates produced statistically significant improvements in pain and functional capacity compared with usual care between weeks 4 and 15 of training.
Source: Wells C et al. (2014). PLOS ONE, 9(7):e100402.

Why Reformer Pilates Is Different for Managing Pain

Key answer: Reformer Pilates lets you work lying down, removing the gravitational load on the spine. Its spring system provides variable resistance that adapts to each person, and the exercises activate the deep stabilising muscles that the conventional gym does not train.

Reformer vs the Conventional Gym

At the gym, most exercises are done standing or seated, with direct gravitational load on the spine. Weight machines work isolated muscles through predetermined ranges of movement. For a painful spine, this presents two problems: constant axial compression and the lack of integrated work for the stabilising muscles.

The Reformer lets you work lying down (removing the gravitational load), with variable spring resistance (adjustable to the millimetre) and in functional movement patterns that involve several muscle chains at the same time. For someone in pain, that means being able to strengthen without compressing, and to work the whole body without overloading the affected area.

Reformer vs Mat Pilates

Mat Pilates uses body weight as its main resistance. Many classic mat exercises (roll up, hundred with extended legs, teaser) involve loaded spinal flexion that can be problematic for people with low back pain, a herniated disc or neck pain. The Reformer solves this: its straps, springs and carriage allow every exercise to be modified so that it is safe and accessible even for people with an active condition.

Mendonça et al. (2023), in a systematic review published in Healthcare, found that patients who practised Reformer Pilates maintained their improvements in transversus abdominis and lumbar multifidus activation in the long term, while those who did only mat Pilates lost part of those gains after the programme ended.

Reformer vs Physiotherapy Alone

Manual physiotherapy (massage, mobilisation, electrotherapy) is essential in acute phases and for functional diagnosis. But physiotherapy alone has a limitation: the patient receives treatment passively. The Reformer complements physiotherapy by adding the active component: strengthening, motor control and body awareness. The best results come from combining both.

The Science Behind Pilates and Chronic Pain

Key answer: A network meta-analysis of 118 trials with 9,710 participants (Fernández-Rodríguez et al., JOSPT, 2022) identified Pilates as the exercise most likely to reduce pain (93%) and disability (98%) in adults with chronic low back pain, ahead of strength training, yoga and general exercise.

The scientific evidence on Pilates and chronic pain is solid and growing. These are the reference studies:

Cochrane review by Yamato et al. (2015). The most cited reference in this field. It analysed 10 randomised controlled trials with 510 participants and concluded that Pilates is superior to minimal intervention for reducing low back pain and disability. None of the trials reported adverse events, confirming the method’s excellent safety profile.

Meta-analysis by Patti et al. (2024), published in Disability and Rehabilitation. It reviewed 36 papers and included 19 trials in the quantitative analysis. It concluded that Pilates significantly reduces low back pain compared with no exercise and with non-specific exercise. The average pain reduction was clinically relevant.

Network meta-analysis by Fernández-Rodríguez et al. (2022), published in the Journal of Orthopaedic & Sports Physical Therapy. It compared Pilates, strength exercise, core work and mind-body therapies across 118 trials with 9,710 participants. Pilates ranked among the most effective options for reducing pain and disability, with optimal programmes of 1 to 2 sessions a week of under 60 minutes for at least 3 to 9 weeks.

Randomised clinical trial by De Araujo Cazotti et al. (2018), published in Archives of Physical Medicine and Rehabilitation. It included 64 patients with chronic mechanical neck pain. The Pilates group (2 sessions a week for 12 weeks) improved significantly in pain, function, quality of life and reduced use of painkillers.

The convergence of these results points to a clear conclusion: Pilates, especially on machines, is an effective, safe and evidence-based tool for managing chronic musculoskeletal pain.

Reformer Pilates for Back Pain

Key answer: Pilates reduces low back pain by an average of −29 points on the VAS scale and disability by −4.73 RMDQ points compared with minimal intervention (Huang J and Park HY, 2023, Physical Activity and Nutrition). The most effective programmes include 1-2 sessions a week for 3-9 weeks.

Back pain is the most studied indication and the most common among students who come to our studio. The Reformer addresses the three main causes: deep core weakness, joint stiffness and compensatory movement patterns.

Priority exercises include Footwork (unloaded strengthening), Pelvic Curl (spinal articulation and glute activation), Chest Lift (assisted abdominal strengthening) and Pulling Straps (strengthening the posterior chain). Progression runs from supine positions with light resistance to more complex loaded exercises.

If back pain is your main concern, we have dedicated a full article to it with 7 detailed exercises: Pilates for Back Pain in Madrid: 7 Reformer Exercises That Work

Reformer Pilates for Neck Pain

Key answer: Pilates reduces chronic neck pain with a mean difference of −1.49 points compared with a control group, with an even greater improvement at medium-term follow-up (MD: −2.54). Source: Lazoura E et al. (2025), BMC Musculoskeletal Disorders 26:629.

Neck pain has a different origin from low back pain, but shares the same underlying mechanism: a combination of muscle weakness (deep cervical flexors), joint stiffness (thoracic spine) and dysfunctional postural patterns (forward head, raised shoulders).

The Reformer addresses neck pain through cervical decompression exercises, strengthening of the scapular stabilisers (Chest Expansion, Pulling Straps), opening of the anterior chain and mobilisation of the thoracic spine. Most of the exercises are done with the head supported, removing the gravitational load on the neck.

Kim et al. (2025), in Isokinetics and Exercise Science, showed that 6 weeks of Reformer Pilates improve the craniovertebral angle, neck function and balance in people with forward head posture.

See our complete guide: Pilates for Neck Pain in Madrid: Relieve Neck Tension with the Reformer

Reformer Pilates for Low Back Pain

Chronic low back pain is the indication where the evidence for Pilates is most robust. The meta-analysis by Patti et al. (2024) and the Cochrane review by Yamato et al. (2015) confirm that Pilates significantly reduces low back pain and disability.

The Reformer is particularly effective for low back pain because it lets you activate the transversus abdominis and the multifidus (the main lumbar stabilisers) in unloaded positions, with millimetre-precise resistance progression. Key exercises include Pelvic Curl, Supine Leg Series, Knee Stretch and Footwork.

The most common mistakes that make low back pain worse (too much rest, premature impact exercise, not strengthening the core) are covered in detail in our dedicated article: Pilates for Low Back Pain in Madrid: Strengthen Your Core and Say Goodbye to Pain

Reformer Pilates for a Herniated Disc

A herniated disc requires the most careful approach of all. Medical clearance and an instructor who knows the exact diagnosis (location, size, neurological symptoms) are essential.

Büyükturan et al. (2023) showed in the Journal of Comparative Effectiveness Research that clinical Pilates is safe and effective for patients with lumbar disc herniation, with significant improvements in pain, disability, flexibility and muscular endurance.

The Reformer offers specific advantages for a herniated disc: fully unloaded work, spinal decompression through axial traction, strengthening of the muscular corset that protects the disc and re-education of motor control. Loaded spinal flexion, rotations against resistance and movements that reproduce radiating pain are avoided.

All the information on recommended exercises, exercises to avoid and how we adapt classes is here: Reformer Pilates with a Herniated Disc: What You Need to Know

Reformer Pilates for Sciatica

Sciatic pain (radiating along the sciatic nerve, from the lower back down to the foot) can have several causes: a herniated disc compressing the nerve root, piriformis syndrome (the piriformis muscle compressing the sciatic nerve as it passes through the buttock) or lumbar spinal stenosis.

The Reformer lets you tackle sciatica on two fronts:

Decompression. Axial traction exercises and unloaded positions reduce the pressure on the nerve root. This brings relief during and after the session.

Strengthening the glutes and external rotators. In sciatica caused by piriformis syndrome, strengthening the glutes and balancing the rotator muscles of the hip reduces mechanical compression of the nerve. Exercises such as Footwork, Pelvic Curl (with specific glute activation) and piriformis stretches on the Reformer are especially useful.

The exercises avoided at first are deep loaded hip flexion (which can tension the sciatic nerve), aggressive hamstring stretches and any position that reproduces the radiating pain.

As always, sciatica requires a prior medical diagnosis to determine the cause and rule out serious conditions.

Reformer Pilates to Improve Posture

Posture is not only about appearance. Poor body alignment is the underlying cause of many chronic pains: excessive thoracic kyphosis contributes to neck and shoulder pain, lumbar hyperlordosis overloads the discs and facet joints, and a forward head multiplies the load on the neck muscles.

González-Gálvez et al. (2020), in Scientific Reports, showed that a Pilates programme reduces thoracic kyphosis, lumbar lordosis and pelvic tilt. Li, Omar Dev and Soh (2024), in BMC Sports Science, Medicine and Rehabilitation, confirmed in a review of 9 studies with 643 participants that Pilates is effective for correcting postural deformities.

The Reformer systematically works every muscle chain involved in posture: deep core, thoracic extensors, scapular stabilisers, glutes, hip extensors. And it does so with the mechanical feedback of the apparatus itself and the instructor’s correction.

Our detailed guide with 6 exercises, realistic timelines and progression: How to Improve Your Posture with Reformer Pilates (Complete Guide)

How Often to Practise Depending on Your Type of Pain

Key answer: For chronic pain, the most effective studies used 2-3 sessions a week of 45-60 minutes for a minimum of 6 weeks. For maintenance, 1-2 sessions a week are enough. The optimal frequency depends on the type and intensity of the pain.

The optimal frequency depends on the phase you are in:

Active pain (initial phase). 2 sessions a week is the minimum effective dose according to the literature. Miyamoto et al. (2016), in Physical Therapy, showed that 2 Pilates sessions a week produce significant improvements compared with a control group. This frequency lets the body recover between sessions while keeping the stimulus needed to get stronger.

Improving pain (intermediate phase). 2 to 3 sessions a week. As symptoms ease, increasing the frequency speeds up structural changes. The network meta-analysis by Fernández-Rodríguez et al. (2022) put programmes of 1 to 2 sessions a week as the minimum, but those with 2 to 3 sessions showed superior results.

Maintenance (pain controlled or absent). 1 to 2 sessions a week are enough to maintain the core strength, joint mobility and postural awareness that prevent relapses. Chronic low back pain has a high recurrence rate, and regular exercise is the best preventive tool.

Indicative timelines.

Weeks 1 to 3: less muscle tension, better mobility, partial pain relief.
Weeks 4 to 8: measurable core strengthening, consistent pain reduction, improved function.
Weeks 8 to 12: structural changes, visible postural improvement, significant reduction in the frequency and intensity of pain.
From week 12: consolidation of results, transition to maintenance.

Your Recovery Plan at Pinar Pilates

At Pinar Pilates, at Calle del Pinar 8, 28006 Madrid, in the heart of the Salamanca district, we have designed an environment that supports recovery from chronic pain:

Personalised initial assessment. Before your first class, we want to know your history, your diagnosis, your limitations and your goals. If you have medical reports, bring them. This information lets us place you in the most suitable class and brief the instructor on the adaptations you need.

Groups of 8 people maximum. For pain management, individual supervision is not a luxury, it is a necessity. With no more than 8 students per session, our instructors can watch and correct your execution in every exercise, adjust the spring resistance and offer alternatives when an exercise is not right for your case.

More than 40 classes a week. Consistency is the most decisive factor for getting results. With more than 40 classes a week, finding 2 or 3 slots that fit your schedule is easy.

Qualified instructors. Our team is trained in functional anatomy and musculoskeletal conditions. They know how to adapt the Pilates repertoire for people with low back pain, neck pain, a herniated disc or sciatica. They do not apply a generic programme: they observe, adjust and progress according to each student’s response.

An average of 4.9 out of 5 on Google (more than 490 reviews). Our students’ experience backs up what we do. Many arrive with chronic pain and, after several weeks of regular practice, report a significant improvement in their quality of life.

See our prices: 4 classes a month for €100, 8 classes for €150, 12 classes for €200, unlimited for €250, or a drop-in class at €30. You can try your first class at 50% off for just €15

Frequently Asked Questions

Can I do Reformer Pilates if I have acute pain?

It depends on the cause. If the acute pain is muscular (a contracture, overload), the Reformer with light resistance and gentle exercises can be beneficial. If the acute pain is due to a herniated disc with nerve involvement, an inflammatory joint process or a fracture, you need a medical assessment before any exercise. As a general rule: if the pain is intense, new or accompanied by neurological symptoms (tingling, weakness, loss of sensation), see your doctor first.

Does Reformer Pilates replace physiotherapy?

No. Reformer Pilates complements physiotherapy, it does not replace it. Physiotherapy provides the functional diagnosis, manual treatment in acute phases and the passive techniques that prepare the ground. The Reformer provides the active component: strengthening, motor control and body awareness. The best results for chronic pain come from combining both.

Do I need to bring a medical report to my first class?

It is not compulsory, but it is advisable if you have a specific diagnosis (herniated disc, stenosis, scoliosis, protrusions). Having that information lets us adapt the exercises with greater precision and safety. If you only have general discomfort with no diagnosis, you can start anyway.

How much does treating pain with Reformer Pilates cost?

Reformer Pilates is not a medical treatment, but a form of therapeutic exercise. Prices at Pinar Pilates range from €100 a month (4 classes) to €250 a month (unlimited). A drop-in class costs €30. Your first class at 50% off for just €15 is a good way to start and see whether the method helps you.

Is Reformer Pilates safe for people with chronic pain?

Yes. The Cochrane review by Yamato et al. (2015) recorded no adverse events in any of the 10 trials analysed. The study by Büyükturan et al. (2023) reported no negative effects in patients with a herniated disc either. The safety profile of Reformer Pilates is excellent, provided it is practised with qualified supervision and with the adaptations each condition requires.

Which type of pain improves fastest with Reformer Pilates?

Chronic low back pain has the most evidence and, in our experience, responds fastest (4 to 6 weeks). Neck pain usually needs a little longer (6 to 8 weeks) because the muscles involved are smaller and the postural patterns of the neck take longer to change. Pain associated with a herniated disc has a more variable course and depends largely on the severity of the injury and the individual response.

Want to start moving without pain? Book your first class at 50% off at Pinar Pilates and see how the Reformer can help you.

Call us on +34 611 994 729 if you would like to ask anything before booking. We are at Calle del Pinar 8, Salamanca district, Madrid

Related articles from our pain and rehabilitation series:

Pinar Pilates · Salamanca district, Madrid

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