Applying the Approach
Pilates principles and exercises have been modified using recent research in the rehabilitation field, and involve a biomechanical approach to develop muscular support around the spine, build muscular endurance and strength, and lengthen tight connective tissue. The Five Basic Principles involve the core position, and optimal postural alignment and biomechanical sequencing are key components of the exercises.1 The approach includes motor learning and control principles with feedback provided by instructors, and deliberate practice with conscious attention to body position and sequencing assisting with development of more efficient motor patterns.(2)
Pilates exercises can be used in the management of acute and chronic injuries. With decreasing insurance coverage, higher co-payments, and increased need for longer-term rehabilitation, Pilates is a valuable rehabilitation extension. The natural linkage from supervised exercise in the physical therapy clinic to community fitness is opening doors for physical therapists to practice in fitness and wellness environments. Rehabilitation Pilates instructors have the responsibility of establishing safe exercise programs tailored to clients’ unique requirements related to spinal or joint dysfunction, medical conditions, or postsurgical requirements. Clients often seek assistance from physical therapists after experiencing increased pain as a result of working out alone, without guidance/supervision, or in group classes. Clients with long-term chronic problems such as multiple sclerosis, inflammatory arthritis, or post-spinal surgery are also more comfortable with the supervision of a physical therapist, and they benefit from the supported positions and equipment available in the Pilates repertoire.
My personal practice scenario is based out of an established Pilates training studio with a wide variety of clientele. My client base extends from teenagers with scoliosis and growth spurts to geriatric clients wanting to maintain an active lifestyle. I offer consultations for exercise program development, which may also include advice on what types of provisions are most suitable. Options such as group mat or reformer classes are popular as the expense is less; however, clients with more complex needs will generally benefit from individual instruction, until they learn and understand the basic exercises and are able to monitor their body position adequately. Clients with less-involved diagnoses may be suitable to work with certified Pilates instructors, while clients with chronic musculoskeletal dysfunction such as post-spinal surgery need to be monitored during individual sessions by physical therapists. Consultations are also a valuable option for fitness programs when clients develop pain as a result of a vigorous sporting session, a slip and fall, or other incidents, with appropriate advice if further medical evaluation is needed. If the client needs hands-on intensive physical therapy, we refer to other physical therapy providers in the area. Additionally, clients and staff members have the support and confidence of working with physical therapists in the studio and during prevention programs, which adds a vital component to the overall studio atmosphere.
Creating a Fitness Repertoire
Some clients prefer the continuation of fitness programs with one person. Patient satisfaction is related to continued care and confidence in their providers,3 and once clients develop a trusted relationship, they are often hesitant to change instructors. Even in group classes, the continuation of care allows the fine-tuning and adjustment of exercises to efficiently provide an individualized approach while addressing the need for clients to work out in a cost-effective manner.
A Pilates-based fitness practice is possible using matwork exercises with the assistance of small props such as Flex-Bands®, Mini-Stability Balls™, barrels, larger exercise balls or Stability Balls™, Toning Balls™, and Fitness Circle® resistance rings, or it can involve larger equipment such as the Cadillac, Reformer, or Stability Chair™, which provides spring resistance or assistance to movement. Matwork exercises are useful for home programs and larger group classes, but in some cases they are more challenging for individuals with decreased core strength. The Cadillac, Reformer, and Chair provide alternatives for more or less supported exercises, and are very useful for individuals with mobility issues. Home care programs are possible with the equipment being available in space-efficient models. One of the key components is selecting exercises carefully, and modifying them for different postures, impairments, and goals. A progressive program is imperative to match the client’s improvement and meet their goals. The skills required for this type of function involve knowledge of biomechanics, an ability to analyze movement patterns, strong teaching skills, and additional training specific to the rehabilitation setting.
Building a fitness clientele and reaching into the community with a Pilates-based fitness program
There are a number of methods involved in building a fitness clientele, including referrals from physicians and chiropractors. Web-based referrals are also increasingly important. Some physical therapy clinics offer group mat classes as an adjunct and transitional program for patients; however, Pilates studios are an ideal start point for a rehabilitation fitness practice. New clients, with a history of injuries or chronic pain, often choose to start with a Pilates rehabilitation instructor.