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An Open Letter to Well-meaning Physicians and Well-educated Patients: Volume 1, Pilates

pilates“My doctor said I need Pilates.”

“I have a prescription for Pilates.”

“I’ve been doing Pilates for months and I’m not getting any better.”

Well-meaning physicians and motivated, educated patients frequently make this assertion without a full understanding of what Pilates really is.  My hope with this post is to explain a bit more about Pilates and why the method may or may not be the best treatment for you.

1.  Pilates is an exercise method 

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 asthma, rickets and rheumatic fever. Though he had no formal training, Pilates was dedicated to improving his physical fitness and fascinated with the study of human movement.  He believed that postural dysfunction and inefficient breathing techniques contributed to poor health. Seems like he was onto something here, right? When he emigrated from Germany in the 1920s, Joseph and his wife Clara developed a following in the dance community in New York City.  As its  popularity grew,  The Pilates Method became mainstream, offered in gyms, studios and often taught as an adjunct in physical therapy clinics.

2.  Pilates is not synonymous with core stabilization

When physicians write “Pilates” on a prescription for physical therapy, it is likely that they are recommending core stabilization for their patient.  However, Pilates is too broad a term to use when making suggestions regarding a patient’s rehabilitation without a full understanding of all of the factors that may contribute to a person’s injury.  Not everyone with back pain has a weak core (GASP!) and not everyone has tight hamstrings…more on this in a future post.

3.  Pilates is not synonymous with rehabilitation  

Several years ago I sat in on a meeting of a group of local Pilates instructors to discuss forming a collective. During the meeting, I was surprised to hear such disagreement between instructors about what they actually do.  One in particular was adamant that she provided rehabilitation for her clients.  Another well-known instructor was equally vocal stating that Pilates instructors teach a method of exercise that may be helpful as clients work to rehabilitate an injury, but they do not, in fact, provide injury rehabilitation.  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 fairly large discrepancy in the training involved to qualify as a Pilates instructor.  Some instructors train with Master Trainers and participate in educational programs that include a basic study of anatomy with observation and practice hours.  These programs may also involve education about specific injuries and assessment of abnormal movement patterns and provide information on what types of exercises should be avoided.  Many instructors, like myself, are licensed physical therapists looking to expand their exercise instruction techniques.  On the other end of the spectrum are those who take a weekend class, or do some training on their own to teach Pilates. A physical therapist is best trained to perform a full physical examination to determine the most appropriate routine of core stability exercises, or whether stabilization is even the correct treatment for the patient.

4.  Pilates is not appropriate for everyone

Unfortunately, as its popularity has increased, Pilates as a method of exercise has become less defined over the years. Now, 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 a physician recommends the method, a coworker suggests Pilates because, “it worked for me,” or you choose to do Pilates independently with a video, you are applying a very broad exercise method to a condition that may require a little more specificity and individualization.  In fact, many Pilates exercises, both mat-based and on the equipment, are flexion-based and not only inappropriate for some patients, but actually contraindicated (e.g. herniated disc, osteoporosis).  Exercises that promote strengthening the back of the body (posterior chain) may exacerbate other conditions (e.g. stenosis, spondylolisthesis).

Take home message:

Pilates is too broad a term to use when making suggestions regarding a patient’s rehabilitation.

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.  A successful treatment strategy often includes work with both a physical therapist and a Pilates instructor open to collaborating in order to best help their client.

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.