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What is Clinical Pilates?

Updated: Jan 25

Joseph Pilates physical therapy

Joseph Pilates, the creator of the Pilates method, was a gymnast and boxer that developed his method of strengthening and conditioning the body while imprisoned in an internment camp during WWI. Joseph later immigrated to the United States and along with his wife Clara opened the first Pilates studio in 1926 in New York City. Legendary dancers George Balanchine and Martha Graham became early devotees, sending their students in flocks to his studio for training and rehabilitation. The socialites soon followed. Nearly a century later, there are over 11 million people practicing Pilates regularly and 14,000 instructors in the United States.


Joseph Pilates’s original exercises consisted of 34 mat exercises that can be performed with no equipment or apparatus. These exercises are described in Joseph’s book “Return to Life through Contrology” (Contrology was the original name that Joseph gave to his method). He also created exercises to be performed on wooden, spring-loaded apparatuses that he invented. The most prevalent of these is the Reformer. 


However, the Pilates method encompasses much more than exercises. Rather it is the embodiment of 6 principles that together with movement create a holistic mind-body approach: 


Pilates reformer bastrop
  • Breathing: Joseph stressed that before anything else, a student must learn to breathe properly. Exercises are coordinated with the breath. This is widely regarded as the most important principle. 

  • Concentration: Pilates is as much of a workout for your mind as your body. Exercises must be performed with full attention and awareness. You will find that many Pilates studios minimize distractions including even music. 

  • Centering: Strength and stability are sourced from the “powerhouse” or “core,” which include the abdominal, back, and gluteal muscles.

  • Control: Every exercise must be performed with complete muscular control. All parts of the body are managed with intent whether it is moving or still, contracted or relaxed. 

  • Precision: There is an ideal alignment and placement of each body part during the exercise. The student must use full awareness to achieve optimal technique in order to break compensatory movement patterns.  

  • Flow: Exercises are performed with fluidity, grace, and ease. 


Modern Pilates studios have since expanded their exercises beyond the original repertoire to the effect that exercises may vary across studios. However, the 6 principles created by Joseph Pilates steadfastly remain. 


Clinical Pilates uses the Pilates approach to help patients rehabilitate from specific injuries and movement dysfunctions. Care is one-on-one and initiated with a thorough examination by a licensed clinical professional such as a Physical Therapist. The clinical professional creates an individually-tailored program to help the patient reduce pain, recover from injury/surgery, improve posture and joint alignment, and get back to usual activities without pain and restriction. This may be paired with other modalities such as myofascial release, manual therapy, or dry needling in order to achieve optimal results. 


What is it about Clinical Pilates that makes it perfectly designed for physical therapy?


clinical pilates bastrop
  • Addresses asymmetries and imbalances. Our bodies can be quite asymmetrical due to adaptations created by the physical demands of our lives causing varying degrees of strength and flexibility across joints and between the left and right sides of the body. Pilates addresses asymmetries and imbalances by lengthening and strengthening along all myofascial chains evenly and both sides of the body independently.  


  • Focuses on core strength and control. The concept of the “Powerhouse” which encompasses the abdominal, back, gluteal muscles as well as the deep core stabilizers is essential to the Pilates repertoire. By strengthening the Powerhouse, we are able to provide centralized support for their body, improve our spine, leverage strength, and provide a stable axis so that we can achieve optimal mobility in our limbs. Using the Pilates apparatuses, such as the Reformer, enhances the process of building core strength by providing the challenges of instability and closed-kinetic chain exercises. This paired with adjustable resistance to progress and regress as appropriate provides a challenging, yet pain-free, movement experience. 


  • Improves alignment and articulation of joints. Suboptimal joint alignment can lead to conditions such as osteoarthritis, cartilage/labral damage, tendinopathy and ligament damage. Pilates promotes awareness of how to move in lengthened ranges while still maintaining stability and joint congruency. This means that optimal contact between two bones is maintained throughout a motion thereby preventing injury and stress on the joints. 


  • Develops proprioceptive and kinesthetic awareness. Proprioception is our sixth sense allowing us to know where our joints are in space. This is related to kinesthesia which is awareness of our body in motion. Pilates is focused on internal sensations with careful cues and imagery. The pace of sessions are slow and the movements and cueing are subtle enough to help develop the skill of body awareness and ability to self-adjust in order to to enhance alignment and appropriate muscle recruitment without compensatory patterns. 


  • Release of unnecessary tension. Pilates seeks to achieve the most efficient motion, which means instructors cue to release tension in areas where it is not serving a purpose. Instructors are trained in the use of imagery to help students achieve the desired movement quality in order to move with fluidity, grace, and ease. It is essential to learn to release tension that may be causing strain and leading to pain and injury. 


  • Breath training. The first thing you will learn in a Pilates session is how to breathe properly and maintain a full breath while challenging your body through movement. Dysfunctional breathing patterns such as breath-holding, shallow breathing, or overuse of accessory muscles can inhibit core stability and create tension and pain. As Joseph Pilates famously wrote, "...above all, learn how to breathe correctly."


Studies have shown that Pilates is effective for improving core strength, flexibility, posture, and balance. There is some evidence showing that Pilates can be more effective than regular standard of care for decreasing pain and improving function in those with low back pain, although due to heterogeneity and flaws in the studies the evidence is still considered low quality. 


If traditional Physical Therapy has not worked for you in the past, don’t give up. Try Clinical Pilates for a new approach to rehab and recovery. An even better idea is to be evaluated and address movement and mobility issues before symptoms ever arise. 




Angel Young, PT, DPT, is a physical therapist and owner of Bodylove Physiotherapy & Pilates, a mobile and virtual physical therapy practice specializing in 1-on-1 sessions using Clinical Pilates, Dry Needling, Myofascial Manipulation, Manual Therapy, and Redcord serving Bastrop and Smithville, Texas. She is a certified Pilates instructor through Polestar Pilates, which has been a leader in Pilates for Rehabilitation education for the past 30 years. She is passionate about helping people feel strong, capable, and wonderful in their bodies.



Sources:

1. Natour, Jamil, et al. “Pilates Improves Pain, Function and Quality of Life in Patients with Chronic Low Back Pain: A Randomized Controlled Trial.” Clinical Rehabilitation, vol. 29, no. 1, Jan. 2015, pp. 59–68, doi:10.1177/0269215514538981.


2. Cruz-Ferreira, Ana et al. “A systematic review of the effects of pilates method of exercise in healthy people.” Archives of physical medicine and rehabilitation vol. 92,12 

(2011): 2071-81. doi:10.1016/j.apmr.2011.06.018


3. Ellin, Abby. “Now Let us All Contemplate Our Own Financial Navels.” The New York Times, The New York Times Company, 21 June 2005, https://www.nytimes.com/2005/07/21/business/now-let-us-all-contemplate-our-own-financial-navels.html.


4. “History of Pilates”. Pilates Method Alliance, Pilates Method Alliance, pilatesmethodalliance.org/history-of-pilates.


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