PTs should not underestimate the differences between movements for fitness and therapy

By Barbara Wintroub

The use of Pilates as a rehabilitative method for physical therapists is growing rapidly. One of the main reasons is because it has brought PTs back to looking at the whole body instead of a specific area in order to stabilize an injury.

In many cases, a shoulder issue, for example, could be attributed to incorrect positioning, or it could be due to a weak scapula or tight pectorals. It is not always just the shoulder itself; body misalignment can also be a contributing factor.

In the past, physical therapists often concentrated first on getting rid of inflammation and then strengthening the affected area. But through the Pilates method of proper alignment, core strength and focused breathing, they can now center on the way a client's joints are structured. And they find, much of the time, it is incorrect alignment of the joints that causes some muscles to over-fire or under-fire, causing the injury.

Pilates is also popular because it is easy on a client's body, as the equipment used can assist as well as resist a movement. This allows patients with weakness to accomplish movements they may not ordinarily be able to do.

I've heard several PTs say that Pilates even makes rehabilitation of a patient easier on their own bodies. In many therapy sessions, PTs are physically mobilizing parts of a client's body and can sometimes injure themselves doing so. Pilates can reduce the amount of physical effort a PT must exert, and therefore reduce the risk of on-the-job injury.

Education Becomes Crucial

In tandem with the rise of Pilates in physical therapy practice, it is critical to stress the importance of proper Pilates education and certification.

Therapists looking to add Pilates to their practice must understand that Pilates for rehab is different from Pilates for general fitness. PTs must know how to change an exercise in order to create a positive movement experience for a specific patient, or know when to substitute another exercise altogether.

Pilates instructors for fitness may not recognize that. They may know how to modify, but don't know the complexities of physical therapy and how to best utilize the Pilates exercises in that setting.

In addition, critical-thinking skills are imperative for PTs using Pilates. In many of the classes I offer for PTs, I'll take a classic Pilates exercise and then tell my students: "OK, that's the exercise. Now what if the patient has some type of condition?"

It could be anything–internally rotated shoulders, osteoporosis, lower-back pain, anything. A therapist must know what to do –how to modify and how to cue–in order to facilitate an improved functional outcome in a multitude of situations.

Pilates also makes patients accountable for their own movements. This is a good thing because they're more invested in their healing process. But again, a PT's critical reasoning skills will determine how effective this can be. Patients' expectations are often that it is entirely up to the therapist to rehabilitate the injury. They'll come in with the mindset of "here's my arm—let me know when it is fixed," much like if they were getting a car repaired.

In Pilates, a therapist can ask specific questions about how a movement feels and where a patient is taking a specific movement. This transfers responsibility to patients, to understand how their body initiates a particular movement. Therapists with good critical thinking skills understand that they are not giving them the movement–they are posing the proper questions in order for a patient to earn it.

Using the Mind and the Body

The mind-body element in rehabilitation also differs from that in general fitness. Therapists need to realize it is not only the exercise that facilitates a positive movement experience, but also the core principles of the method: concentration on the quality of the movement (not number of repetitions) and focused breathing. Breathing is an essential part of the success of Pilates. It transports blood to the injured area and is also a relaxation mechanism. You can't get to an area that is holding tension and expect to heal that area without relaxation. Relaxation comes with proper breathing.

Balancing Principles and Exercise

The educational program that a physical therapist undertakes for Pilates certification must stress the aforementioned principals on top of learning both the exercises and the anatomical implications of the exercise.

My program for physical therapists is a combination of classwork, observation, critical analysis and examinations. It also follows all guidelines and requirements established by the Pilates Method Alliance (PMA).

After therapists have completed our Comprehensive Teacher Training School, they will be able to take PMA's National Pilates Certification exam. Although the PMA has a strict regimen, I chose to be a member because I truly believe that the standardization it is seeking to put in place creates a safe, effective structure for PTs to follow.

On that note, it is important for physical therapists enrolled in a Pilates instruction program to realize that many educators are not part of the PMA and may therefore offer a different certification program. Some educators may offer certification in as little as a few weekend courses. Physical therapists should take notice.

There's a big difference between adding some Pilates moves to your practice and truly understanding the therapeutic principles of the method. Pilates done correctly can be a truly amazing form of rehab. Done incorrectly or ineffectively, it can lead to client disappointment and possible injury.

In my program–and in some others—there are more than 400 hours of work to complete before the therapist is actually ready to take the PMA test. That's the same as many other therapeutic certifications in the industry.

I truly feel that, properly educated in Pilates, a physical therapist will be well-equipped to create a practice with great rehabilitative results and a loyal client base.

Current trends indicate that the timing may never be better for therapists to consider incorporating Pilates into their practice than right now.

With the public perception that medical health care in our country is slipping, the cost of medical insurance rising, and the amount of insurance reimbursement declining, many Americans are willing to pay for preventive programs. Pilates falls into that category and can be a very lucrative adjunct to a therapist's practice.

In addition, many of those taking a more proactive role in their own wellness are baby boomers. They want to stay healthy, but much of the weight-bearing exercise they did 30 years ago is now too hard on their bodies.

This group is also one of the most influential economic forces in the United States and many have the disposable income to spend on their own wellness. Pilates is a perfect fit for this demographic, both as a method of rehabilitation and as post-rehab activity.

Barbara Wintroub is the owner of Retrofit Pilates, which offers comprehensive Pilates training and certification programs for physical therapists. She graduated from California State University, Northridge, with a degree in kinesiology, and has a post rehabilitation certification through the AAHFRP. She can be reached at bwintroub@retrofitpilates.com