Comparing the Benefits of Aquatic Physiotherapy vs. Pilates-Based Physiotherapy on Spinal Alignment and Core Strength in Children with Cerebral Palsy

Abstract

Background: Cerebral palsy (CP) is a leading cause of motor disability in children, frequently associated with impaired spinal alignment and reduced core strength that compromise posture, functional independence, and quality of life. Aquatic physiotherapy and Pilates-based physiotherapy are increasingly applied in pediatric rehabilitation, but direct comparative evidence of their relative efficacy remains limited. Objective: To compare the effects of aquatic physiotherapy and Pilates-based physiotherapy on spinal alignment and core strength in children with CP. Methods: A randomized controlled trial was conducted with 40 children aged 5–12 years diagnosed with CP. Participants were randomly assigned to either aquatic physiotherapy or Pilates-based physiotherapy for 12 weeks, with three 45-minute sessions weekly. Spinal alignment was assessed using standardized postural analysis tools, and core strength was evaluated using manual muscle testing and tone assessment. Pre- and post-intervention data were analyzed using paired t-tests, with p < 0.05 considered significant. Results: Both groups demonstrated significant improvements in spinal alignment and core strength. Aquatic physiotherapy produced greater improvements in spinal alignment (mean change +25, p = 0.02), while Pilates-based physiotherapy yielded superior gains in core strength (mean change +33, p = 0.03). Conclusion: Both interventions are effective but show domain-specific benefits. Aquatic physiotherapy enhances spinal alignment, whereas Pilates training more effectively strengthens the core. A combined approach may optimize rehabilitation outcomes in children with CP.