Should the abdomen be relaxed or contracted during Pilates exercise for low back pain? 

A randomised trial from Brazil tackles a longstanding assumption in Pilates-based rehabilitation: that consciously contracting the abdominal wall during exercise enhances outcomes. 

The study compared two otherwise identical Pilates programs for low back pain: one performed with the abdomen deliberately contracted (often described as ‘drawing in’ or activating the deep abdominal muscles) and one performed with the abdomen relaxed. 

Participants were randomly allocated to either approach and completed a structured Pilates program delivered over several weeks. 

Outcomes included pain and disability along with relevant secondary measures. 

The findings were surprising. Both groups improved but there was negligible added benefit from deliberately contracting the abdomen. 

In other words, instructing participants to maintain abdominal contraction did not substantially improve outcomes compared with performing the exercises with the abdomen relaxed. 

The improvements observed appeared attributable to the Pilates program itself rather than to specific cueing about abdominal activation. 

These results challenge the widely held belief that abdominal ‘bracing’ is a necessary component of effective Pilates-based rehabilitation. 

For clinicians, the implications are important. 

Emphasising abdominal contraction may not enhance clinical outcomes and could add unnecessary cognitive load for some patients. 

The trial supports a more flexible, less prescriptive approach to motor control cueing during Pilates, suggesting that movement quality, dosage and adherence may be more important than maintaining constant abdominal activation. 

The findings may simplify clinical practice without reducing benefit. 

How should cyclical electrical stimulation be used in stroke? 

Dr Katharine Scrivener MACP (Monash University) and colleagues provide a practical guide to cyclical electrical stimulation for improving strength and activity after stroke. 

Drawing on their recent Cochrane review, which found moderate- to high-certainty evidence that electrical stimulation improves muscle strength and activity performance, the authors translate research into clinical recommendations. 

Guidance is provided on patient selection (particularly those with severe weakness), electrode placement, parameter settings, fatigue management and outcome measurement. 

They reinforce that electrical stimulation is most effective when delivered frequently (around five sessions per week for five weeks) and embedded within a progressive rehabilitation program. 

With relatively low-cost equipment and minor adverse events, cyclical electrical stimulation is positioned as a feasible option for targeting severe post-stroke weakness. 

How can we help prostate cancer patients access the best physiotherapy services? 

In a qualitative study led by Alesha Sayner MACP and colleagues from the University of Canberra in collaboration with Victorian health services, 29 Australians undergoing prostate cancer treatment described their experiences accessing physiotherapy. 

Four themes emerged. 

Many patients were unaware that physiotherapy could help manage distressing symptoms. 

Supervised pelvic floor muscle training (ideally commenced preoperatively) was seen as vital but difficult to perform without skilled guidance. 

Transperineal real-time ultrasound was highly valued for improving confidence and technique. 

Finally, access was inequitable, with public and regional settings characterised by long waitlists, workforce shortages and travel burdens. 

Physiotherapists should advocate for early – ideally preoperative – referral for people undergoing prostate cancer treatment and ensure that care is delivered by clinicians with specific training in male pelvic health, particularly in supervised pelvic floor muscle training and transperineal ultrasound. 

They should also provide clear, evidence-based education and adherence supports and work to improve referrer awareness and service pathways – especially in public and regional settings, where access to appropriately skilled providers is limited. 

How should long COVID patients be managed? 

The Invited Topical Review revisits the physiotherapy response to COVID-19 and its longer-term consequences. 

It synthesises emerging evidence on rehabilitation for people recovering from acute infection and living with persistent post-COVID symptoms. 

Key themes include graded exercise approaches, management of breathlessness and fatigue, and the importance of interdisciplinary models of care. 

The review reflects on lessons learned during the pandemic (rapid guideline development, telehealth expansion and workforce adaptability) and considers how these innovations can strengthen rehabilitation services beyond COVID. 

What should physiotherapists know about burnout? 

In this issue’s editorial, Ky Wynne APAM from RMIT University examines the growing problem of burnout in physiotherapy. 

Burnout is linked to early attrition, reduced empathy, impaired clinical reasoning and poorer patient outcomes. 

The editorial synthesises evidence showing that burnout prevalence is commonly estimated as eight to 23 per cent, with some subcohorts reporting rates approaching 60 per cent. 

Burnout appears consistent across countries and practice settings. Contributing factors include high workloads, capped financial progression, administrative burden, moral distress and limited career pathways – particularly in private practice and early career roles. 

The editorial outlines practical strategies at individual, workplace and system levels, including resilience training and reflective practice, mentoring and flexible workloads, clearer progression pathways, remuneration reform and embedding psychological readiness training in university curricula. 

The message is clear: burnout is both a personal and a systemic issue requiring coordinated reform. 

What are the recent highlights in low back pain prevention and management? 

Across prevention and treatment, the most consistent benefits come from exercise combined with education, with psychologically informed approaches offering the greatest and most durable improvements for people with persistent pain. 

In contrast, medicines and invasive procedures provide small and often clinically unimportant benefits while exposing patients to greater risk and cost and should therefore play only a limited, time-restricted role. 

No single non-pharmacological modality is clearly superior, reinforcing that outcomes are driven more by engagement, adherence and alignment with patient goals than by technique choice. 

Digital health and AI-enabled delivery models show promise for improving access, consistency and long-term support rather than increasing treatment efficacy per se. Inequities in care for older adults, young people and Indigenous and underserved communities call for culturally safe, equity-oriented and co-designed models of care. 

For clinicians, the key takeaways are: prioritise reassurance, movement, self-management and psychologically informed care; avoid low-value pharmacological and invasive treatments; and tailor care to the individual’s context.

 Clinical Associate Professor Mark Elkins APAM is the scientific editor of Journal of Physiotherapy. Follow the Journal on X @JPhysiother and be sure to read the research at journal.physio