Physical fitness is the first requisite of happiness," said the late Joseph H. Pilates, founder of the Pilates method. Even though he published his progressive philosophies in his book, Return to Life, in 1945, many teachings still ring true today. Over the past 15 years, Pilates has become much more mainstream, with actors, models, dancers and athletes practicing and promoting the benefits of the method. However, as more people are trying Pilates, the true form has become obscured at times.
The Pilates Method
The Pilates method, developed over a 60-year period by the German-born Pilates, is a system of therapeutic exercises designed to stretch, strengthen and balance the whole body with an emphasis on the breath, mind, alignment and coordinated, flowing movement. Like physical therapy, the Pilates method places a strong emphasis on balancing muscular forces around the joints to promote more efficient and pain-free functional movement. Pilates promotes healthy movement of all the joints and muscles of the body in order to create balance and uniformity throughout.
Pilates himself was an athlete, innovator and physical therapy pioneer with a passion for and knowledge of the human body that was well beyond his level of education and time. His definition of physical fitness was "the attainment and maintenance of a uniformly developed body with a sound mind fully capable of naturally, easily and satisfactorily performing our many and varied daily tasks with spontaneous zest and pleasure." Although quite superfluous in his description, the importance of functional skills is evident, which is consistent with functional physical therapy goals.
The Pilates system continues to promote strengthening of the more intrinsic, stabilizing muscles in order to promote joint health and improve biomechanics. Many physical therapists have found the Pilates system to be a useful tool in their practice. With the common goals of increasing flexibility, strength and circulation, improving joint range of motion, facilitating proper muscular alignment and neuromuscular patterns and heightening overall body awareness and body mechanics, one question remains: How can you incorporate Pilates into your physical therapy practice?
Pilates-Based Physical Therapy
Pilates-based physical therapy (PBPT) is an approach to healing grounded in the moving body, using the therapeutic movements and techniques of classical Pilates as well as traditional physical therapy interventions. Pilates-based physical therapists generally use Pilates as their main exercise modality, replacing more traditional exercise machines with Pilates equipment.
PBPT is founded on the idea that a movement-oriented approach to PT can offer patients an opportunity to experience success with movement. When patients have a positive movement experience, a shift can occur in the perception that movement causes pain.
Therapists should have completed a thorough Pilates teacher training program. Being a niche practice, it's imperative to fully understand and embody the Pilates method. The most intensive and all-encompassing Pilates teacher training programs consist of 450 to 950 hours of internship and pedagogy and cost from $5,000 to $12,000.
Purchasing the main pieces of Pilates equipment for a clinic can be costly; however, compared to professional-quality fitness equipment, the price seems more reasonable. Approximate cost of clinic/studio-quality Pilates equipment:
• Universal Reformer: $3,000 to $5,000;
• Cadillac/Trapeze Table: $3,000 to $6,000;
• Wunda Chair: $900 to $1,200.
Pilates Equipment in a PT Clinic
For PTs who would like to incorporate Pilates into the traditional clinic setting, but not make it the primary modality, there are less expensive, shorter training options. However, it's imperative to have adequate knowledge of the Pilates system before purchasing and using Pilates equipment with your patients. It's important to understand all aspects of the equipment and ensure that all staff members who will be using the equipment are also adequately trained.
Today's spring-loaded Pilates equipment has evolved over the decades to facilitate recovery from a variety of different injuries and coordination difficulties. Spring tension gives the body proprioceptive feedback, which in turn stimulates the postural system. Effective and appropriate stabilization and sequencing can then be trained so that these new skills are easily integrated into daily life. Many Pilates exercises are performed lying down on the equipment, which can facilitate a gentle progression from non-weight-bearing to full weight-bearing activities. The Pilates equipment is versatile, allowing for most body types, sizes and conditions to be comfortably accommodated. The springs provide two types of feedback for the patient: support for those who are unable to independently perform certain movement patterns efficiently and resistance for when strengthening is needed.
Incorporating Pilates Mat Exercises
Pilates mat exercises are an accessible way to incorporate the Pilates method into the PT clinic. The mat work and fundamental exercises are helpful in teaching patients transversus abdominus activation and how to properly access all of the core musculature. PTs are able to teach these exercises in most clinical settings and can also include these exercises in a patient's home exercise program.
A common misconception is that Pilates work involves fit-balls, bands and other fitness equipment. These are not classical Pilates tools, however it's reasonable to say that Pilates may have influenced the development of these products. With the proper training, PTs may choose to teach some of the Pilates fundamentals and movement skills with fit-balls and bands, especially when classical Pilates equipment is unavailable.
Along with the mat work, there are several small and relatively inexpensive pieces of classical Pilates equipment that work well in the PT setting.
Magic Circle: a flexible metal ring with padded handles designed to build strength in the hip abductors and adductors, tone the arms and strengthen the muscles of the neck.
Foot Corrector: designed to strengthen the feet and build support through the lower extremities. It enhances and supports the arches of the feet.
Ped-o-Pull: originally designed by Pilates for clients who were professional singers. This apparatus increases postural awareness and strength, assists in teaching breath control and improves scapular stabilization.
Whether you are practicing in a fully equipped Pilates-based PT clinic, or just use the mat exercises to teach core work, there comes a point where a patient must be discharged. Time constraints in the clinic may limit the amount of sessions you can spend with the patient on specific core-strengthening exercises. Other patients may benefit from the alignment and postural training of Pilates to maintain the gains obtained in PT and prevent re-injury post physical therapy.
When referring a patient to a Pilates class or instructor, it's important to ensure your patient is in good hands. Pilates is an unregulated field, which can make the search for a properly qualified instructor challenging. The best resource for finding a qualified instructor is the Pilates Method Alliance (PMA) website (www.pilatesmethodalliance.org).
PMA is the professional organization and certifying agency for the Pilates profession, establishing standards and promoting the Pilates method. Instructors are only able to say they are PMA-certified after completing the only psychometrically validated, third-party professional certification exam in the Pilates field.
Benefits for PTs and Patients
The growing popularity of Pilates has made it a common term in many fitness centers and rehabilitation facilities. PTs preferring an alternative approach to the diagnosis and treatment of injuries will enjoy using this holistic method to promote health and healing.?Pilates is inherently integrative. Though it can address a variety of pathologies very specifically, the system consistently demands whole-body movement, awareness and connection. Such movement integration is not only an effective approach to local injury, it engages the patient's whole body and mind in the healing process.
This type of engagement can be both enjoyable and empowering, which increases the likelihood of completing a prescribed course of treatment and compliance with a home exercises program. PTs using Pilates have the benefit of giving their patients a system of movement that can be used and developed over a lifetime.
Mischa Decker, co-owner of InsideOut Body Therapies (www.insideoutbodytherapies.com), earned a DPT from Duke University School of Medicine and a BS in exercise and sport sciences from the University of Florida. Decker is a PMA®-certified Pilates teacher trained at The Pilates Center of Boulder. She also completed The Pilates Center master's program and is a faculty member of The Pilates Center. She co-leads the InsideOut Body Therapies Pilates teacher training program and is director of the InsideOut Body Therapies Pilates-based physical therapy program.