Pilates + Physical Therapy

Pilates Physical Therapy San Francisco

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.

The Educated Therapist

Let’s face it. Most physical therapists aren’t winning any sales and marketing awards. Most of us have don’t have a business background and typically enter this profession based on a love of health, exercise and helping others. In school, we don’t really have time to cover anything beyond examination and treatment of our soon-to-be patients. We graduate, enter the world of health and wellness as practitioners of physical therapy, and soon realize the competition is fierce. In San Francisco, a city with something for everyone, there are individuals providing health and wellness services that seem in direct competition with everything we offer. There are personal trainers, massage therapists, Muscle Activation Therapists, Sports Therapists, Neurokinetic Therapists, Core Activation Therapists, and more. Have you ever stopped to consider who is best trained to help you heal? While these practitioners may indeed be skilled at the services they offer, based on our level of education and training, physical therapists are in a league of our own.

The other day, I had a pleasant conversation with a gentleman who was interested in learning more about the field of physical therapy. A seemingly intelligent man, he’d also had personal experience as a recent physical therapy patient. At some point in our conversation, he stopped me and asked, “Do you have to have some sort of certificate to be a physical therapist?” My jaw dropped.  It was then and there I realized how physical therapists have done such a terrible job of informing the public of what we do, what we can offer, and why we should be considered the practitioners of choice for musculoskeletal health.

So here’s what you should know: physical therapists go to school for 7-8 years. This includes 4 years of undergraduate education, heavily based in science (physics, chemistry, microbiology, exercise physiology, etc.), and 3-4 years of graduate-level education. Students graduating from physical therapy programs in the United States today earn a Doctor of Physical Therapy. The first Doctorate program in Physical Therapy was started in 1993 at Creighton University in Nebraska and, as of 2015, all accredited and developing physical therapist programs are DPT programs. Often part of a medical school, PT programs teach physical therapy examination and treatment, as well as courses in Anatomy, Neuroanatomy, Pathology, Pharmacology, Radiology and Differential Diagnosis (how I determine if a symptom may be something more serious—and outside of my scope of practice—than run-of-the-mill back pain). In fact, when I attended UCSF in the early 2000’s, the physical therapy students were the only students who performed full cadaveric dissections. Other programs used the cadavers we spent our first foggy summer in San Francisco dissecting. It was also the start of our collaboration with the first year medical students, where we 2nd year PT students helped teach the medical students musculoskeletal anatomy. Most recently, residencies and fellowships after graduation have grown in popularity to provide advanced training for physical therapy school graduates.

Beyond our formal education, physical therapists are licensed by the state in which we practice and are held to a high level of professional conduct that includes requirements for continuing education every year. Most courses are held on the weekends and many physical therapists travel great distances to take courses of interest. This year alone, PT’s from TherapydiaSF will take courses in San Francisco, San Diego, Montana, and Las Vegas. Some physical therapists also opt to enhance their degree and training by completing board certification in different areas of practice, including Orthopaedics, Pediatrics, Women’s Health, Neurology and 4 other areas of specialty practice.

The next time someone suggests physical therapy, please consider our extensive training and education and know that we have the education, expertise and dedication to help you work, play and move without pain.



On the Run with TPSF: How to Avoid Running Injuries

This issue of On the Run is written by Lindsay Haas, PT, DPT, OCS.  Lindsay is a physical therapist at TherapydiaSF and enjoys working with runners, dancers, and all athletes for rehabilitation from injury and improved sport performance.

The good news is that you signed up for a race.  It may be your first or your twenty-fifth, but you are ready.  Of course you want to stay healthy.  Especially when you are gearing up and looking forward to completing your upcoming race!  The bad news is that rates of injuries in runners is high, and its even higher when training for an event.

The #1 risk factor for injury in running was a history of injury, usually within the past 12 months (1).  Most injuries in running are caused from overuse, which is defined as repetitive microtrauma to the musculoskeletal system.  Increased training loads (such as running more when training for an event) can exacerbate an old injury.  Also, you may have changed your running pattern to compensate for your previous injury and as a result overloaded another part of your body and created a new injury.

The second highest risk factor was the weekly distance.  Runners who complete more than 40 miles per week were found to be more likely to sustain an injury (2). When you run more, you can overload the musculoskeletal system to the point where it can’t recover, thus creating an injury.

So how do you stay healthy throughout your training?

1.  Change it up.  Since most running injuries are caused by overuse and repetitive strain, its important to introduce variety to your training.  You should already be active in strength training (shown to decrease the risk of injury and improve performance!) but you should also be changing up your runs.  Try running on trails, or try altering your pace.  Even if you’re not participating in a training program that incorporates tempo runs and speedwork, there should be some variety in your runs.

2.  Watch your form. It is important to have good running form.  Your cadence is the number of steps taken per minute, and should be more than 170 steps per minute on both feet.  If its too slow, you may be putting too much stress on your body.  Increasing your cadence will help with over-striding.  Focus on taking short quick steps and keeping your feet under your hips.

3.  Treat injuries before they start.  Don’t wait until something hurts.  Using ice and self-myofascial release (such as the foam roller) are good tools for when you are sore, but there are ways to be proactive as well.  Listen to your body, if you need to adjust your workout or take a day off its okay.  When you are running keep track of your heart rate and level of fatigue to know if you need to slow the pace or even stop for the day.  If you are feeling sharp or stabbing pain, you need to stop. Avoid the ‘three too’s’: too much, too soon, too fast.  Pushing yourself too hard can compromise your ability to recover.

Still worried about getting injured while training?  Schedule a Fitness Screen with one of TherapydiaSF’s physical therapists.  We will identify any potential risk factors to injury or decreased performance and create a customized exercise program to help you meet your training goals.


(2) Walter SD, Hart LE, McIntosh JM, et al. The Ontario cohort study of running-related injuries. Arch Intern Med. 1989;149:2561–4.


Yoga for a Healthy Spine

Yoga can be a wonderful tool to ease discomfort and increase flexibility in the spine, but only when proper alignment and technique are applied. In this 4-week series, we will explore the spine’s range of motion and strengthen core muscles to help keep the spine safe.

Yoga for a Healthy Spine

Yoga can be a wonderful tool to ease discomfort and increase flexibility in the spine, but only when proper alignment and technique are applied. In this 4-week series, we will explore the spine’s range of motion and strengthen core muscles to help keep the spine safe.

Yoga for a Healthy Spine

Yoga can be a wonderful tool to ease discomfort and increase flexibility in the spine, but only when proper alignment and technique are applied. In this 4-week series, we will explore the spine’s range of motion and strengthen core muscles to help keep the spine safe.

TPSF @ lululemon Run Club-Grant Avenue

This week, TPSF will be supporting the weekly lululemon run from the Grant Avenue store.  Stop by to say hello, ask questions about an injury, or get some advice about running from our physical therapists who specialize in the treatment of runners!

6:10 pm injury talk

6:20 pm warm up

6:30 pm choose 3, 4.5 or 6 mile run

Yoga for a Healthy Spine

Yoga can be a wonderful tool to ease discomfort and increase flexibility in the spine, but only when proper alignment and technique are applied. In this 4-week series, we will explore the spine’s range of motion and strengthen core muscles to help keep the spine safe.

Fit as a…fiddle?



Body image has been a hot topic over the past several years. Recently, many companies have run advertising campaigns to promote healthy body types in reaction to the extremely thin models who have been so prevalent in the media.

The recent video of dancer Misty Copeland has had a huge impact on the dance world and has made us think about the concept of an ideal dancer’s body.  I remember not too long ago, when “athletic body type” was considered a euphemism for “thick” or “heavyset.”  I hope you agree that while Misty is certainly athletic, she is neither thick nor heavyset.

Beyond the notion of an ideal body type, I’ve recently been thinking about the concept of fitness. I blame this partly on recently reading The Sports Gene by David Epstein, and also having just returned from a continuing education class filled with practitioners who each work with a different clientele, including college athletes, golfers, yoga practitioners, and the general population, some more active than others.   As I thought about the baseball pitchers, cyclists, runners, and CrossFit participants with whom we each work, I could easily identify ways they are fit, but I also thought of areas where they may be deficient.  I began to wonder about fitness.

When someone is decribed as “fit”, what does that really mean?  Does it mean the same thing to everyone?  There are different dictionary definitions of fitness, some of which brought a smile to my face:

1. The condition of being physically fit and healthy (I’m going to need a little more here…).

2.  Good health or physical condition, especially as the result of exercise and proper nutrition (ok, we may be getting somewhere…).

3.  The capacity of an organism to survive and transmit its genotype to reproductive offspring as compared to competing organisms (well….I bet you know plenty of people who have the capacity to transmit their genotype to reproductive offspring who you would not call fit).

So, we’re back to the drawing board with defining fitness.

Is a body builder with bulging biceps and massive quads more fit than a marathon runner?

Is Tiger Woods more fit than Serena Williams or Michael Phelps?

What does it mean to be fit?  Ah…what I would do to take a camera out onto the streets of San Francisco and ask people this question (stay tuned…).

As we think about each of the athletes and their respective sports, it quickly becomes clear that fitness is hard to define and describe.  While the bodybuilder might have larger muscles that allow him to lift heavy weights, the marathon runner would certainly show greater cardiovascular endurance across those 26.2 miles.  Tiger Woods and Serena Williams both demonstrate amazing muscular development and precise hand-eye coordination, but if he had to run around the golf course like she does the tennis court, could Tiger keep up with Serena?  Michael loves the game of golf and, like Tiger, has an amazingly strong core, yet I wouldn’t want either one of them representing the other’s sport in competition.

This is an important topic to me both personally and in my work with athletes of all ages, skill levels, shapes and sizes.  To me, there is no one definition of fitness.  I believe that fitness is a balanced combination of strength, stability, balance, flexibility, and endurance…and maybe even mindfulness.  What the general population thinks of as an ideal of fitness may actually be a person who excels in the sport in which they train, but has severe and potentially harmful imbalances in some of the categories mentioned above.  The fittest people with whom I work are those who enjoy a variety of exercise and sporting activities.  These are the folks who are rarely in our studio for treatment, except for the occasional tune up after having changed their routine. Often, the people who appear most physically fit are those who are plagued with injuries related to imbalances in overall fitness.

I’ve learned that there is no one ideal body type just as there may be different ideas of fitness.  I encourage my clients to be successful in their rehab and develop and improve their fitness by recommending a three key steps:

1. Move well and move often.

2. Find something you enjoy doing.

3. Mix up your routine—your body will thank you for it.

So, what does fitness mean to you?

And, in case you were wondering where “Fit as a fiddle” came from…

Alphabet Soup


Are more letters better?

The question brings to mind the popular AT&T commercial currently airing which features a guy in his 30s sitting around a table in a classroom with a group of four kids.  He asks similar questions, “Is bigger better?”, “Would you rather be faster or slower?”, “Would you rather have more or less?” while the cameras roll, catching the excited answers of the kids and his deadpan responses.  I bet if he asked those kids (or a group of adults, for that matter) if more letters behind a name were better than fewer letters, they would all agree that more is better.  But is that really the case?  Are the number of letters after a therapist’s name  related to their skill as a physical therapist?

No other profession knows their alphabet better than healthcare.  Only in healthcare do you find such a mix of letters designating specific licenses, degrees, and certifications extending beyond a practitioners name, often coming close to Twitter’s 140 character count limit.  Sitting around the table at the Sports Physical Therapy Section conference in Las Vegas one year, several of my colleagues and I began quizzing one another on just what all of those letters meant.  One physical therapist even had a running list he kept on his iPhone where he wrote down every combination of letters he came across after someone’s name.  We stumped each other with a few, which made me wonder if consumers were just as confused by all of those letters.

In this month’s edition of Today in PT, writer Terese McUsic describes several different certifications and states, “PTs are increasingly finding that adding specialty designations can increase their patient base and enable them to explore cutting-edge therapies.”  John Lowman, PT, PhD, CCS, chairman of the American Board of Physical Therapy Specialties claims that certification can increase credibility in the eyes of referral sources though, from my experience, referral sources rarely know what even the most common physical therapy credentials stand for.

A statement I hear with increasing frequency is, “He’s a DPT.”  No, he’s a PT.  The fact is, most consumers believe that a physical therapist with a DPT is more skilled than one who earned their Masters of Science or even Bachelor’s Degree in Physical Therapy.  I would argue that the difference in degree is more a reflection of how long the therapist has been practicing, since the DPT degree was far less common as little as 10 years ago.  However, this is not an article meant to discuss the value of a DPT, but rather to point out that referral sources and patients alike need to be informed about the various credentials after your name, and how those certifications may not only differentiate you as a therapist, but also influence your treatment philosophy and style.

Credential List (special thanks to Bryce Taylor, PT, MS for helping out with this list):

PT-physical therapist (not personal trainer)

MS-Masters of Science

DPT-Doctor of Physical Therapy

DPTSc-Doctor of Physical Therapy Science

DHSc- Doctor of Health Sciences

DHS-Doctor of Health Sciences

CCS – Cardiovascular and Pulmonary Certified Specialist

ECS – Clinical Electrophysiologic Certified Specialist

GCS – Geriatric Certified Specialist

NCS – Neurologic Certified Specialist

OCS – Orthopaedic Certified Specialist

PCS – Pediatric Certified Specialist

SCS – Sports Certified Specialist

WCS – Women’s Health Certified Specialist

FAAOMPT-Fellow of the American Academy of Orthopedic Manual Physical Therapists

FAPTA- Fellows of the American Physical Therapy Association

DMT-Doctor of Manual Therapy

MOMT- Master of Orthopedic Manual Therapy

CSMT- Certified Spinal Manual Therapist

GDMT- Graduate Diploma in Manipulative Therapy

MCSP- Member of the Chartered Society of Physiotherapy

CFMT-Certified Functional Manual Therapist

COMT- Certified Orthopedic Manual Therapist

OMT-Orthopedic Manual Therapist

MDT- Mechanical Diagnosis and Therapy

CMP-Certified Mulligan Practitioner

ATC-Athletic Trainer

CSCS-Certified Strength and Conditioning Specialist

CLT- Certified Lymphedema Specialist (not to be confused with Certified Lab Technician)

CPE- Certified Professional Ergonomist

CVT- Canine Physical Therapist (yes, our best friend needs PT too!)

CERP-Certified Equine Rehabilitation Practitioner

CDMS- Certified Disability Management Specialist

LMBT- Licensed Massage and Bodywork Therapist

MMT- Master Massage Therapist

LMT-Licensed Massage Therapist

RYT-Registered Yoga Teacher

CPI-Certified Pilates Instructor (though there is no one Pilates Certification Board)

PES- Performance Enhancement Specialist

HFS-Health Fitness Specialist

ART-Active Release Technique

CKTP- Certified Kinesiotape Practitioner

CGFI-1- Certified Golf Fitness Instructor Level I

Unable to find these: