Pilates Based Rehab

Hi Bruce
I enjoyed reading this post. My experience of PT’s applying the Pilates method to their rehab work is in some cases, based on as little as a weekend course in Pilates.

Your piece does not mention the positive role Pilates can have when taught in a safe, professional studio environment by an Instructor who has completed hundreds of face to face lecture content hours and at least 200 hours supervised teaching experience. Joseph didn’t develop Pilates with PT’s in mind and I believe its application benefits from different types of teachers coming from all sorts of backgrounds.

Melissa

Agreed.

Hi Bruce,

I read your post with some interest and concern as it appears you did not do your homework. As the previous owner of the Pilates Trademark and a physical therapist who had a full Pilates studio as part of my PT practice since 1990 and as someone who has taught Authentic Pilates to hundreds of PT through continuing education courses since the early 1990’s I can say that your statements on the history of Pilates as well as the method itself are not accurate.

Having taken over the original Pilates studio I am in possession of thousands of photographs, films and blueprints, audio tapes and his original manuscripts and can tell you that Mr. Pilates did clearly define and document his method. Before loosing the Trademark in a court battle in 2000 I ensured the quality and training in his method. It was after the loss of the trademark and the miss use of the name that the quality of the teaching became an issue. Since anyone can now say what they teach is Pilates there is very little that the public can do to differentiate when it comes to this name. Also the Pilates boom as you call it did not really start until the late 1990’s to the early 2000’s.

Even you have added to the principles from what has been traditionally taught so it is clear that you do not have a grasp of the authentic method and a clear understanding of the the methodology as Mr. Pilates taught it. Your statement about the use of the springs and equipment “use springs and gravity to either assist the individual in completing movements successfully or give resistance to make the movement more challenging. ” also show you lack of understanding of the method. The use of the springs allows for a balance between the powerhouse of the anatomy muscles (core, isometric) and the periphery muscles of the extremities (isotonic), Mr. Pilates spent over 50 years fine tuning his methodology (I would call that formally designing his program) and inventing over 20 different exercise apparatus to allow his clients to achieve physical and mental conditioning. Also his terminology may not be scientific (core and powerhouse) but the work of Richardson, Jull, Hodges and Hides as well as many others have definitively linked the actual anatomical structures. Also the powerhouse and core are only part of the method and before Pilates became popular it was not in the vocabulary of most PT’s except for those giving lip service to proximal control for fine distal motor control besides those practicing NDT who were not working with the orthopedic/ outpatient populations seen in PT practices today. These principles as Mr. Pilates taught were not part of the PT curriculum 25 years ago or even today as I take many PT interns and unless they have been exposed to pilates inside or outside of school have no real understanding of the core, powerhouse or proximal control for fine distal motor control.

His whole system is based on allowing each individual the ability to gain the maximum benefit by being able to do the same basic movements in many different configurations using the many different apparatus he developed with the use of springs and gravity to fine tune the motor repatterning that is required for learning and change with the ultimate goal of them being able to independently do an advanced mat workout on their own.

As far as your comments about Pilates and PT as also not accurate. Mr. Pilates was teaching his innovative method when PT’s were rehabilitation aids and had very little training. Mr. Pilates claimed he was 50 years ahead of his time and since PT’s and the motor control people are embracing his method and concepts today I would say he was right. Mr. Pilates was working with all types of clients including
lymph edema, low back pain, arthritis, cancer, fibromyalgia and osteoporosis, post surgery and sports and dance injuries long before PT’s in private practice or the hospital setting were.

Since PT’s are not trained in teaching exercise a the level that we teach our instructors I can say with confidence that when it comes to teaching the Pilates method unless a PT has been properly trained he/she is not necessarily the best person to be working with people using this method. The majority of our patients would not need our services if they were actively practicing the Pilates method on a daily basis taught by a qualified instructor PT or not. The method is only as good as the teaching. The problem with many PT’s is that they take a weekend seminar and then think they are proficient since they have the PT training. To become a good Pilates instructor takes 100’s of hours of learning, observation and teaching. Pt’s should either train properly or leave the teaching of Pilates to those who have the proper training. Doing Pilates based exercises is not the same as understanding the methodology of a comprehensive system of exercise with hundreds of exercises and variations and modifications depending on the needs of the client. Can a PT with a weekend or two of training also be a good dance teacher or and martial arts teacher, or a Feldenkrais practitioner or Alexander teacher? Or can a Chiropractor or a personal trainer (Pilates included)with a few weekends of cont ed be a good PT?

Sean

I can not tell the diffence from “authentic pilates” and what is done today. Clinically I have treated many disasters that came to me from Pilates classes, instructors and based rehab. From the rehab side they often missed or did something dumb on a spring loaded table.
Please share with our profession so PTs can define “pilates” so we can then study and understand what is effective.
I am personally interested in the equipment the Joe invented I can find evidence of only patent. I love to discuss off line.

I would agree from experience that only Pilates instructors with 100’s of hours of supervised training can teach “true” Pilates well.
I think using the team approach between the Physical Therapist and the Pilates instructor is best. Because PT’s are already great at teaching motor control, weekend course. Many of our patients require supervised “core” training for back, neck, shoulder…injuries both repetitive and traumatic. Unless trained otherwise, Pilates instructors should not be “treating” anyone with a medical diagnosis. This is where the team HANDOFF is important. The MD, PT, Chiro decides when it is safe to work with a practitioner who does not have 100’s of hours of training on pathology, histology, Anatomy/physiology and rehabilitation.
Thanks for the article.
http://www.ptsportswellness.com
http://www.ptjess.com

Ageed

Agreed

A healthy debate to be having- here in Australia there is a strong move towards pilates and physiotherapy being almost synonomous and i think this is a problem for both- neither is truly able to appreciate the art of the other.
The debate of classical vs clinical/ contemporary pilates comes back to a question of what basic cue you’re using for abdominal activation- classical pilates as Mr Pilates taught used the cue of ‘flat back’ where as later as we learnt more anatomically we realised that the lumbar spine was not actually flat, hence the ‘neutral spine’ cue. In the end, it all comes down to what the person in front of you needs- what do you see in their body statically and dynamically, what is weak and are they aware of how to move their body, can they respond appropriately to simple cues and what functional outcome is needed at the end of the exercises? Selection of pilates exercises either on the mat or using the various apparatus Mr Pilates created requires reasoning to the same level as selecting manual techniques, which requires experience, practice and feedback! Spending time with an experienced pilates teacher can show you just how attuned and perceptive you can become to human movement and movement correction- and just because you’ve got a degree it doesn’t mean you’re somehow going to be a gifted Pilates teacher. If you do want to practice the art of Pilates teaching then master it, and do the long training required. If not, don’t dabble- there are so many different exercises you can prescribe to your patients that fulfill their precise and unique needs that are Physio-specific- and you have the freedom to be creative here- without needing to give them a system and a name.

Lissanthea
Do you really think of what system or method your treatment originates? I often did know the origins of my interventions Cyriax, Paris. Bobath, PNF, Muscle Energy…….After all theses years I am comfortable with practicing PT.

Hi Bruce,
I’m not quite sure what your question is asking but yes, certainly I want to know how someone got to thinking that this method of training/ treatment was effective. From where in that person’s brain the seed of ‘i wonder what might happen if…’ originates is fascinating. This appears to be missing or inferred in the Pilates Method since Pilates himself did not document a great deal of his philosophy. My assumption is that he gleaned knowledge of human movement from his own physical shortcomings and refined that later in his work with athletes- primarily martial artists and boxers i think- Pilates actually didn’t like working with dancers!
With regard to PT i personally feel that the knowledge of ‘why’ allows my brain to integrate new information in to the clinical reasoning processes i already have and make careful decisions based on this information, on the patient before me and their narrative and my own previous clinical experience. Is that what you’re getting at?

I am saying I do not know where I learned my interventions from. In 30 years I learned from many sourses and masters. I would not know a trade marked tech from one I made up. I never practiced Pilates I always practiced Wilk.
My advice to all is be your own person. Learn from many masters and speak in your own voice.
PT is a lot like jazz to me.

I am in full agreement with Sean’s comments. I appreciate the clarifications to the original article. I agree that there were many flawed statements and the writer seemed to be speaking from a fairly uniformed point of view.
Our PT status does not make us qualified to instruct in the Pilates method of exercise. As an avid Pilates practicer (not practitioner) and DPT I feel perfectly comfortable saying this. I think that the best advise to a PT who is curious about Pilates would be to find an authentic or classically trained Pilates Instructor and go take a few private lessons. I think that is the only way to truly grasp the complexities of this very robust, well developed and well defined system of total body conditioning. You have to get it into your own body to be able to actually conceptualize the work of Joe. He was way, way ahead of his time. Then, if you want to incorporate it into your practice find a reputable certification program!

Define reputable.

My understanding from the original article was:
1. Only medical professionals should treat those who are injured! Non-medical professionals are not qualified to treat injuries- no matter what Pilates class they’ve taken!
2. There is no exact definition of “Pilates” – Polestar, Windsor, whatever you call it…. Pilates is NOT trademarked or consistently defined. It can essentially be anything, and is not consistent among all. As medical professionals, we should use language and terms that are actually defined and accepted within the medical community!
3. Joseph Pilates did incooperate many key concepts that we as therapists use today (ndt, neuromuscular re-ed), thus “pilates-based” therapy. Again, a loose term of concepts that the original poster incoorporates and adapts as a critical thinker when treating patients, not as a recipe of one specific program vs another!
4. OP never states that just because you are a PT, then you are qualified to teach pilates…..but you’d better be qualified to teach motor control, neuromuscular re-ed, etc!

5. For those who state that the original poster has an uniformed point of view….ummmmm YES!!!! That’s the point! There’s a lot of VERY different Pilates programs out there. If we as medical professionals can’t decipher it all, then how do we expect the general public to? However, original poster is not saying all Pilates is bad…. he’s simply stating that there are a lot of VERY different Pilates programs out there (who knows what is right and wrong?). However, some of the general concepts are good, and can be adapted by PTs to fit patient need and be incooperated into a well-rounded PT program.

Those who are “more informed,” please enlighten us as to which programs are clearly defined to be “true Pilates” AND consistently accepted among medical professionals. I’d enjoy seeing this evidence.

I always hear Joe was a head of his time. We do not know what he did beyond his writings and few released videos so the myth of Joe out lived the reality of his true accomplishes. PT has great masters alive and deceased that were diligent reseachers and authors that will never be a myth because we have their legacy accepted in our profession.
This whole Pilates nonsense fools the public, allows minimally trained instructors to do God knows what and PTs to take a lazy redundant approach to PT care.

As a current DPT student who plans to spend her final month of schooling in a “directed practice” focused on Pilates-based rehab (location TBD), I am appalled by all of the above bickering. Why can’t both PTs and CPIs (certified pilates instructor) embrace eachother’s strengths and weaknesses? PTs are increasingly hiring on CPIs to continue patient care on a cash-pay basis post rehab or referring patients to them. This provides a stable clientele and opportunities for collaboration between individuals trained in much different environments. In addition, more and more PTs are interested in Pilates. That should elate, rather than threaten, CPIs. As is usual with research, it is slow to follow this quickly growing realm of rehabilitation. The same thing occurred when Tai-Chi and Yoga were first popularized in clinical settings. However, just last month in the Journal of Orthopedic and Sports Physical Therapy, there was a meta-analysis on the use of Pilates-based rehabilitation in patients with chronic low back pain. If it is getting the attention of reserachers, Pilates is likely also likely intriguing clients. As predicted, the article did not show significant differences between traditional rehab and Pilates-based rehab. It didn’t show Pilates to be a miracle treatment, just equivalent. However it also showed no adverse effects of using Pilates. PTs are not flocking to Pilates because it offers a bigger and better outcome. They simply see its applicability to many different patient populations. They also see its potential for creating a lifelong fitness and core stability program for patients predicted to be non-compliant with HEPs and later return for treatment. For the sake of those patients, keep an open mind. If you are unfamiliar with Pilates methods, by all means, don’t try to use it in your practice. Similar to our overused modalities, positive effects will not be seen if used incorrectly and it is not appropriate for everyone. Yet don’t be afraid to find someone who is Pilates trained (through whichever company that may be. My training started through Balanced Body, but I hear good things about Stott and more) and incorporate them in your clinic. You will likely hear outstanding reviews from your patients and quickly notice the potential use of Pilates in physical therapy practice.
I hope more PTs will comment on this article in HELPFUL ways and ignore Bruce’s final comment (above). May we continue to marvel at intelligence post-mortum. Sometimes death leads to discoveries beyond our comprehension.