Objective: The aim of this paper is to systematically review all controlled clinical trials of Pilates to treat low back pain. Data sources: A systematic review of nine databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, Pedro, Rehadat, Rehab Trials) was conducted and the reference lists of all the papers were checked for further relevant publications until May 2010. Study selection: A first selection was performed by means of title and abstract. A second selection was made by means of predefined inclusion criteria: randomized controlled clinical trials testing Pilates in patients of any age or sex with low back pain. Data extraction: Data relating to changes in body function, quality of life and pain from the included studies were independently extracted by the reviewers on a standardized form. Study quality was assessed using the Oxford scale. Data synthesis: Four eligible randomized controlled clinical trials (n = 4) involving Pilates for the management of low back pain were included. The methodological quality of the RCTs was relatively low, varying from 1-4 on the Oxford scale. All studies were heterogeneous in terms of population of patients, control groups, inclusion and exclusion criteria, and outcome measures making a meta-analysis not feasible. Although there is some evidence supporting the effectiveness of Pilates in the management of low back pain, no definite conclusions can be drawn except that further research is needed with larger samples and using clearer definitions of the standard care and comparable outcome measures. Conclusions: There is a wide diversity in research investigating the clinical and cost-effectiveness of Pilates in patients with low back pain.