Pilates and Physiotherapy

19 June 2021

What Is Pilates?

Pilates is a unique body conditioning exercise. By bringing it into its correct neutral alignment, it rebalances the body. It does so by targeting the deep postural muscles (transverse abdominals and muscles of the pelvic diaphragm). In essence, pilates challenges the core muscles and builds strength from the inside out. This will help a person to reshape their body, adding to a leaner and more toned figure. It boasts of a perfect balance between strength and flexibility, whilst relieving unwanted stress and tension.

Pilates is a growing trend in Western countries amongst athletes and celebrities. It is also gaining popularity in the treatment of peripheral and spinal musculoskeletal dysfunction. Today, pilates is evolving and is taught worldwide in gyms and hospital, benefiting millions of people. The aim of this article is a brief introduction to pilates and its clinical benefits in physiotherapy.


Pilates was first discovered in Germany in the early 20th century by a keen diver, gymnast, and boxer by the name of Joseph Pilates. Joseph Pilates had spent the majority of his childhood fighting rickets, asthma and rheumatic fever. This fuelled his desire to become physically immune to these ailments. Through studying a variety of different disciplines (yoga, Zen) he brought about this new notion of exercise. During the war he practised his theory of exercise, and became involved in the rehabilitation of war victims. Once the war ended, Joseph Pilates relocated to New York. He soon went on to open the first pilates studio attracting elite actors, dancers and athletes.

Clinical Pilates vs Pilates

Clinical pilates is used to treat people with musculoskeletal injuries. It is conducted by a physiotherapist certified with clinical pilates certification. If a person experiences an injury or repetitive injuries, they may have joint stiffness, muscle spasms, poor posture or abnormal movement patterns as a result of the injury. It is therefore important to first treat the above complaints before commencing pilates.

In addition, certain pilates exercises may aggravate the symptoms. An example is someone who may experience a back strain, due to too much extension in the lower back. Such individuals may have an exaggerated lordotic postures and therefore extension pilates exercises may not be advisable. This is something that would not be picked up if a person was to attend a routine pilates class. Such classes conducts a combination of both flexion and extension exercises.

Selecting The Right Type Of Pilates

It is important to select the right type of pilates exercise, as well as the correct and appropriate level of exercise prescribed. Routine pilates may be too challenging for a person with back pain. This will cause the individual to compensate and utilise stronger global muscles as opposed to the core muscles, and therefore negating the benefits of the pilates exercise. As a secondary result, a person may start to experience muscle spasm in the global muscles due to the increased exertion. The physiotherapist will test your muscle strength and range of movement. After that, he/she will be able to ensure that the exercises are appropriate and although challenging not detrimental to recovery.

Added Benefit Of Clinical Pilates

The added benefit of clinical pilates to routine pilates is that it is more individualised to the person and their problem. In addition, it can also be more functional. For instance, if someone is keen to return to an activity or a sport (swimmer, footballer, dancer) the standard exercises can be modified by the physiotherapist to strengthen the core muscles whilst carrying out the aggravating movement. This could mean that the core muscles of a footballer is challenged as he kicks, dribbles a football, and not just in static postures.

What Can Pilates Treat?

Peripheral Injuries

When dealing with peripheral joint/ muscular injuries e.g. ankle instabilities the ankle is the main focus of the treatment. This makes sense and is always a good place to start to strengthen and rehabilitate local structures. However the research is beginning to move towards looking at the whole picture. Improving an individual dynamic control of their movements, will mean that person is less likely to sustain injuries. There is a growing trend to rehabilitate athletes whilst incorporating pilates-based exercises. This is to teach a person to move more efficiently. Pilates can be used to treat hip, shoulder, knee and ankle injuries.

Spinal Injuries

Pilates in conjunction with manual joint mobilisations and soft tissue release is an effective way to treat back pain.

Time and time again the research has shown that any form of back pain leads to a loss of function of the deep muscles (multifidus) of the spine at that level. Unfortunately these muscles do not have the capacity to turn back on again, once the initial episode of back pain has resolved, and therefore these muscles require specific training to reactivate and stabilise the spine. These muscles without exercise will continue to waste further in the long-term. Subsequent muscle spasm in the global and more superficial muscles will also be experienced. This predominately occurs as a mean to stabilise the back in the absence of the deep muscle activity. Such individuals will report recurrent flare ups of back pain in the year due to the ongoing weakness of the spine.

In addition to weakness, back injuries usually occur after an extended period of time, in a bad posture, excessively loading the joint.

How Does Clinical Pilates Help?

Clinical pilates is a form of exercise that both facilitates the strengthening of these deep muscles whilst educating a person where a neutral spine lies. In time a person will feel that there back is stronger, as they become more aware of what sitting or standing in a good posture entails.

In the long term they will also have the endurance to sustain these better postures for longer periods, through conducting the exercises.

One-to-one sessions with a physiotherapist or very small classes is initially strongly recommended, especially so for a person who is new to pilates. This is to ensure a person can be taught the correct techniques and the 5 concepts of pilates accurately (breathing, neck, rib pelvis position and stabilizing). Pilates can be tricky and done incorrectly easily. Close supervision is needed to prevent faulty patterns from being learnt.

Benefits Of Pilates

  • General fitness and body awareness greater strength and muscle tone
  • Improved flexibility
  • A flatter stomach
  • Improved efficiency of the respiratory, lymphatic and circulatory systems
  • Better posture and awareness
  • Less incidence of back pain
  • Increased joint mobility
  • Lower stress level

Which Clients Would Benefit From Pilates?

  • Males and females
  • Pregnant: Pre and post natal
  • Athletes and dancers
  • Amputee and stroke rehabilitation clients
  • Elderly
  • Children aged 12 and above

Clinical pilates therefore targets the musculoskeletal injury more specifically. The physiotherapist is able to identify your posture type, establish the mechanism of injury, understand what the peron is aiming to return to and work out which exercises would be of more benefit to the individual. Clinical pilates looks at treating the cause. It is also used to select the appropriate repertoire of exercises to strengthen the injured areas and even be done for injury prevention.

If your suffering from recurrent episodes of back pain or peripheral injuries – Clinical Pilates may be just what you need!