Objective: To describe the use of Pilates therapy and sacro-occipital technique in the management of a 39-year-old woman with scoliosis who had undergone spinal fusion many years earlier. Clinical features: The patient had progressive severe low back pain that had worsened over the years after her surgery and had prevented her from activities such as carrying her son or equipment necessary for her job as a photographer. Intervention and outcome: The patient was provided a series of Pilates exercises used to overcome her chronic habituation and muscle weakness. Although this therapy went on for some time, she did begin to stabilize and increase physical activity. At present, she is no longer limited in her physical activity, although she still exhibits some symptoms from her scoliosis. Conclusion: The addition of Pilates therapy can be useful to care for patients with chronic low back pain and deconditioning.