One PT decided to check the method out for herself

By Rosalyn Wasserman, PT

With all the buzz about Pilates lately, I decided to join this fitness craze about 18 months ago. Founders Joseph Pilates and wife Clara (a trained nurse) incorporated aspects of yoga, boxing and the martial arts into this fitness form; it is considered a mind-body exercise. Although he had childhood asthma and rickets, Joseph Pilates overcame these health obstacles and was robustly healthy as an adult.

After delivering two babies and being diagnosed with asthma as an adult, I thought the core strengthening and breath control of Pilates seemed ideal for me. However, I'd sustained a knee injury requiring an ORIF (plate and screws still in) and wondered how well Pilates could be modified for orthopedic limitations.

Making Modifications

Fortunately, my local health club offered an excellent instructor who has a medical background and manages beginner through advanced class participants easily by suggesting modified positions as needed.

Unfortunately, I've encountered other instructors who have minimal training; a troubling number of class participants get hurt in these classes and don't seem to return. Often, these people had been referred to Pilates by their physicians, who had heard Pilates was "good for bad backs."

I was able to modify exercises because I am a PT and know my body's orthopedic limitations. While delighted with my own Pilates fitness outcomes, I am concerned with what I observe in some local classes and with people who use home videos without receiving basic instruction first.

Multiple Pilates methods exist, some developed from instructors who either learned from founder Joseph Pilates or one of his students. Offshoots of these styles have also been created. Usually full certification for instructors is a long and expensive process; class fees for these instructors are often higher and are tailored to athletes such as dancers and gymnasts. Other basic-instructor training can be completed in a weekend course; often, these are the choice of health club instructors.

Lately, of great concern among physical therapists and others who are well-trained in Pilates is osteopenia and osteoporosis. Physical therapist and osteoporosis expert Sara Meeks, PT, suggests that therapists investigate safe Pilates with author and lecturer Sherri Betz, PT. Betz integrates Pilates and PT principles with exercise modification for those at risk of fracture.

Osteoporosis is rampant in this country and affects both women and men, old and young. An added question for therapists is, "At what point does someone with osteopenia develop osteoporosis?"

Some classic Pilates exercises, for example "rolling like a ball" and "clapping like a seal," are obviously contraindicated for osteoporosis. Other exercises, like an unmodified "hundred" and most forward-flexion moves, are contraindicated for osteopenia and osteoporosis; neutral or spinal extension movements are better.

"I think the alignment, breathing and core control of Pilates are excellent for people with osteoporosis to increase postural awareness and do bone loading in correct alignment," said Betz. "Research has shown that increased spinal extensor muscle strength resulted in increased spinal bone density and decreased fracture risk," she added.

Getting Into Teaching

Betz is on the board of the Pilates Method Alliance (PMA), a non-profit organization that offers information, standards of practice, liability insurance, and a national certification examination. In addition to being a Polestar Pilates educator, Betz teaches Pilates mat classes in a large health club, which helps her maintain a pulse on fitness-industry trends.

"Through the PMA organization, I can reach thousands of Pilates teachers and fitness instructors. I also served on the exam committee and provided medical information and safety/contraindications for special populations. We have a whole section of questions on the new PMA Pilates certification examination on this topic," Betz noted.

Polestar Pilates rehabilitation-certified, LaVerene Pyle, MPT, teaches Pilates and yoga to PTs, PTAs, OTs, COTAs, athletic trainers and massage therapists for the International Weightlifting Association Inc. (IWA). This type of training costs about $2,500. Pyle said she has implemented Pilates in a wide range of settings, from a private-practice physical therapy office with a fully-equipped Pilates gym to an outpatient neurological clinic in a hospital using mat and physioball exercises only. She currently teaches yoga and Pilates classes at a yoga studio and uses Pilates at an outpatient private practice in North Carolina.

Pyle applies Pilates principles to most of her patients who have neck and back pain. She also uses Pilates for those who have difficulty dissociating a limb from a stable trunk; for example, patients with shoulder impingement. Pyle includes contraindications for osteoporotic patients in the Pilates classes she teaches.

Some Pilates instructors think that no pregnant woman should undertake Pilates; others think that, with modifications, Pilates can be helpful both for breathing control and pelvic-muscle strengthening. Pyle said she makes sure her pregnant patients or class participants have the approval of their obstetricians before doing Pilates. She then adapts the exercises as needed.

Another new trend is merging Pilates with therapy or exercise balls. It can be more of an intense and aerobic workout; and safety modifications are more difficult because of the dynamic component added with the moving surface of the therapy ball.

"For high-level patients or at the other end of the spectrum, patients who are unable to lie supine, the exercise ball gives a bit more dynamic surface in which to work the core," Pyle said. Regardless of a therapist's Pilates training, Pyle advises therapists of all disciplines to attend a class for themselves before referring patients.

• For more information, contact www.pilatesmethodalliance.org or Sherri Betz, PT, at www.therapilates.com

Rosalyn Wasserman lives in the Asheville NC, area.