Pilates + Physical Therapy
Joseph Pilates, a German medic who trained in boxing and gymnastics, developed Pilates as a form of exercise in the early 20th century. As a child, he suffered from various illnesses and though he had no formal training, was fascinated with the study of human movement and dedicated to improving his physical fitness. Pilates believed that postural dysfunction and inefficient breathing techniques contributed to poor health. Originally called “Contrology”, he considered the method a holistic approach to movement, incorporating mind, body and spirit.
Initially conceived as a sequence of bodyweight exercises performed on a mat, Joseph Pilates invented several pieces of equipment (apparatus) over the years. The Reformer and The Cadillac were both developed from his experimentation with springs attached to hospital beds, and The Chair was inspired by…you guessed it, a living room chair! As its popularity grew, The Pilates Method became mainstream, offered in gyms, studios and taught as an adjunct in physical therapy clinics.
The benefits of Pilates may seem clear. The most commonly mentioned reasons people do Pilates is to improve core strength and stability. Less obvious are two important reasons I suggest Pilates to my patients:
Pilates is a method of exercise that emphasizes on breathing with movement. The ability to coordinate respiration during movement is essential for everyone, yet many are challenged by this seemingly simple act. The muscles of respiration contribute to stabilization, so if respiration is altered, spinal stability will be compromised.
Pilates can be modified for various levels of recovery and fitness. While mat-based Pilates exercises might seem easy, sequences can actually be more challenging than those performed on a Pilates apparatus since participants must control their bodies without any external assistance. The various Pilates apparatuses can be used to increase the challenge of an exercise or to provide assistance to complete a movement. Depending on how the springs on an apparatus are set, there may be an increase in resistance for a focus on strength or a decrease in resistance for improved control. Springs may also be used to provide support, making an exercise more accessible to a healing body.
While its popularity has increased, Pilates as a method of exercise has become less defined over the years. Today, virtually any type of movement performed on a Pilates Reformer or mat can be labeled Pilates and, without experience working with a qualified instructor, you may never know the difference. When your doctor recommends the method, a coworker suggests Pilates because, “it worked for me,” or you choose to do Pilates independently with an online video, you are applying a very broad exercise method to a condition that may require a little more specificity and individualization. In fact, many mat or equipment-based Pilates exercises are flexion-based and are not only inappropriate for some patients, but actually contraindicated (e.g. herniated disc, osteoporosis). Exercises that focus on strengthening the back of the body (posterior chain) may exacerbate other conditions (e.g. stenosis, spondylolisthesis).
As a physical therapist who is Board Certified in Orthopedics, I use my Pilates training to enhance my educational foundation in anatomy, kinesiology, and pathology. In the United States, there is a large discrepancy in the training involved to qualify as a Pilates instructor. Some instructors train with Master Instructors and participate in educational programs that include a basic study of anatomy with observation and practice hours. These programs may also involve an overview of specific injuries and provide information on what types of exercises should be avoided. Other instructors, including those at TherapydiaSF, are licensed physical therapists looking to expand their exercise instruction techniques as a complement to their physical therapy education. On the other end of the spectrum are those who take a weekend class or do some training on their own to teach Pilates.
Modern day Pilates varies dramatically from what its creator originally taught. A savvy, educated consumer should know what to look for when choosing the right class or instructor.
If you’re looking for a form of exercise to support your recovery, start with a physical therapist who is trained in Pilates. Your goal may be to return to work with your Pilates instructor, but a thorough assessment with a medical practitioner (e.g. your physical therapist) will help identify potentially harmful exercises and highlight what you should focus on during your Pilates sessions with your trainer. A successful treatment strategy often includes work with both a physical therapist and a Pilates instructor open to collaborating.
If you are healthy, pain-free, and looking for a challenging workout, you have a variety of options. Many clients continue their work with Pilates instructors who are also physical therapists based on our ability to recognize and address potential injury risks. Group classes might also be a consideration for a more affordable option and for a more social experience. Classes vary in style and are less individualized, so if you are looking for more guidance, we recommend one-on-one training.
Pilates should never replace work with a qualified rehabilitation specialist trained to treat injury. Nor should someone with an injury attempt to use self-guided Pilates exercises to treat or manage their injury. If your physician has recommended Pilates, or you need a specialized program, find a physical therapist with training in Pilates. You will receive a thorough examination that will help the therapist develop a treatment plan and determine if you are appropriate to begin work with a Pilates instructor, or if you should start with Pilates-based physical therapy.