Most people with lower back pain have already tried something, rest, a course of physio, avoiding certain movements, waiting for it to settle. Pilates may not be the first option they consider. Among women in their 40s and 50s in particular, it should be. A 2025 meta-analysis of 93,021 women found that 57% of perimenopausal women experience back pain, compared to 42% premenopausal, a significant increase linked to hormonal changes affecting connective tissue and muscle (PMC12