Pilates has gained popularity for its benefits in reducing pain and disability among people with low back pain. However, conflicting evidence exists regarding its efficacy for musculoskeletal conditions in the upper and lower limbs.

Investigate the effect of Pilates on pain, disability, quality of life, and physical function in people with musculoskeletal conditions in the extremities.

A systematic review and meta-analysis of experimental studies using Pilates for musculoskeletal conditions in the extremities. Our outcomes included pain, disability, quality of life, and physical function. We searched eleven databases from inception to December 2023. Evidence was synthesised as standardised mean differences (SMD) with 95% confidence intervals (CI) using random-effects models. Risk of bias was assessed using the Revised Cochrane risk of bias tool or the ROBINS-I tool. GRADE was used to determine evidence certainty.

Eleven studies (n = 444) were included. Studies had moderate to high risk of bias. Pilates lessened pain (5 studies; SMD 1.41, 95% CI, 0.54–2.28), and disability (5 studies; SMD 0.83, 95% CI, 0.15–1.50), and improved quality of life (2 studies; SMD 2.10, 95% CI, 0.34–3.86) compared to the control group. The effect of Pilates on strength compared to the control the group was estimated to be small (3 studies; SMD 0.35), with unclear true effect due to uncertainty (95% CI, -0.27-0.98). The effects of Pilates on further aspects of physical function, including balance, proprioception, and range of motion remain unclear due to a lack of data which prevented meta-analysis.

Pilates was found to lessen pain and disability and improve quality of life in people with musculoskeletal conditions in the extremities compared to control. However, this evidence is of a very low certainty. The effect of Pilates on physical function remains uncertain. The evidence supporting the superiority of Pilates over other exercise interventions is inconclusive.

PROSPERO (CRD42022375925).