Marc A. Pierre, MS, PT, acquired an interest in physical therapy the hard way: He lived it, one painful movement, one excruciating exercise at a time.

But thanks to a deep appreciation for the benefits of Pilates, Pierre has found an easier way to introduce physical therapy to a group of patients who might otherwise be reduced to a life of suffering.

Disaster Strikes

Pierre, currently a partner at the Center for Physical Health in West Los Angeles, Calif, was studying chemistry at Virginia Tech University in the mid-1970s when tragedy struck and his life came crashing down to earth—literally. While working a summer construction job, Pierre’s scaffolding broke and sent him tumbling three stories to the solid terrain below. Only the ground escaped unscathed. Pierre suffered fractures to virtually every part of his body, with the spine, the ribs, left elbow, and left pelvis taking the brunt of the punishment. What followed were numerous reconstructive surgeries and a prolonged period of rehabilitation.

No one looks forward to putting the pieces back together, but Pierre admits it could have been worse. He maintains he might not have made it, had it not been for the quality of care and the people administering it.

“Physical therapy was an area I was not aware of and didn’t know anything about,” admits Pierre, a native of Paris, France. “The people and the treatment were a shining part of a very difficult time in my life in terms of the awakening of possibilities of doing something more in life with who I was.”

A New Passion is Born

Rather than spending his time in a laboratory filling test tubes and swabbing cultures, Pierre saw a chance to help others the way others had helped him. His physical therapists gave him hope; they gave him encouragement; they gave him a raison d’etre. The least he could do was return the favor.

“There was a combination of compassion and care to the treatment I received after my accident,” he recalls. “At the same time, there was an obvious knowledge base of what was needed to be done and the ability to direct and push patients forward at a time when they might not have the desire to because of the circumstances.

“In my case, I was fairly significantly traumatized and had a difficult time seeing there was much of a future,” adds Pierre, 50. “I think there are times when you get embroiled in the immediacy of a situation, the illness, or condition and lose sight that there is a possibility of regaining a quality to your life.”

Pierre took a year off to recuperate, finished his undergraduate work in chemistry, then went to work for a northern Virginia hospital where he spent time as an aide and drove a van for disabled people. Driven by his passion to enter the field of physical therapy, he applied for various master’s level programs. His interest was drawn to the master’s program at the University of Southern California (USC) in Los Angeles, which at the time was stationed at the Rancho Los Amigos Rehabilitation Center in Downey, Calif, a county rehabilitation center that doubled as a teaching facility. Pierre completed his master’s work in physical therapy and then relocated to Nashville, where he began working at Nashville General Hospital, which provided the perfect start to his career.

“I saw everything there,” he remembers. “It was a tremendous start for me. You got to do a lot of things that were fairly advanced in terms of what you would not allow a physical therapist to do anymore from a liability perspective. It gave me a terrific foundation.” The experience also showed Pierre what could happen when a physical therapist isn’t afraid to think outside the box. In essence, if it benefits the patient, the rewards will always outweigh the risks.

Introduction to Pilates

After returning to Southern California and spending 9 years at the Arthritis and Back Pain Center in Santa Monica, Pierre began his relationship with the Center for Physical Health in 1994. And with it came his first taste of how an 80-year-old system of movement called Pilates could be used as an adjunct to the general therapeutic physical therapy regimen.

Pilates as an exercise regimen isn’t new. In fact, Joseph Pilates, the creator of the exercise phenomenon, began using it to treat dancers, athletes, and even injured World War I soldiers as early as the 1920s when he was a hospital orderly. But rarely had it been used in a physical therapy setting. That all changed when Pierre began working at the Center for Physical Health, which was leasing space to a Pilates teacher.

Pierre was exposed to Pilates a few years earlier through one of his patients—a woman who was severely injured in a car accident. When he saw the positive impact the less-invasive program had. “Because of the pain she was suffering, she was quite literally bedridden for almost a year. But she described how she was able to regain her ability to walk and then function to a certain extent using this method called Pilates. It piqued my interest, and I decided to get into it more.”

After taking Pilates insruction for 3 years, Pierre stood convinced of its viability as a rehabilitation tool. “I was very impressed with what it did for me,” he notes. So impressed, in fact, that the Pilates program immediately became a staple at the Center. The program’s unique aspect is that—with modifications—it fits comfortably into the overall physical therapy curriculum.

“Various modifications had to be made to take what was mostly utilized by dancers and athletes and bring it down to the more-difficult patients we tend to see at the Center,” Pierre explains. He was able to break down various exercises considered “traditional” or “standard” Pilates movements and match them to the individual’s levels of capability. By gradually increasing the level of performance, Pierre showed the patient the value of the program. This made the patient feel better about himself, which in turn convinced him to work harder and progress further.

“For our patients, we needed to figure out how we could make this work for the individual in terms of where they were starting and what their capabilities were,” notes Pierre, who says patients usually receive only two or three carefully monitored therapeutic sessions of Pilates per week.

Advantages of Pilates

What makes Pilates such a key addition to any rehabilitative health program? One of the major factors is that many of the exercises can be done in the supine position.

“Pilates lends itself to establishing a strong center foundation from which you can then move the extremities—the arms and the legs—because you now have a stable initiation of movement,” Pierre insists. “What’s appealing is that a fair amount of work can be done in the lying position with the appropriate equipment on the floor. Patients are able to do things without having to deal with the forces of gravity.

“That was really an attractive aspect for us,” he adds, “because it gave us access to a segment of the population that normally would have a difficult time lifting weights or working on gym-type equipment where they had to be able to either sit or stand. Some people are not able to function with the effect of gravity.”

Making Pilates part of your rehabilitative health facility isn’t cheap, but the majority of the expense comes at the outset.

The biggest cost will come from employing a physical therapist who’s certified in Pilates. Pierre calls this the “marriage of both worlds,” because the practitioner will have the level of training and capability in terms of the foundations of a physical therapist on which he or she can then add the tools of Pilates and adapt it more readily.

“Anyone who has an underlying foundation of medical conditions and pathology, and has an understanding of anatomy and biomechanics to a certain extent, is going to be more effective in applying the work,” Pierre insists.

Other than standard equipment associated with the Pilates program, the outlay is relatively small. Pierre estimates that the initial expenditure can be as little as $3,000 or as much as $10,000–15,000, depending on how elaborate you want to be. The investment is relatively small for various resistance machines that emphasize the core, on which Pilates exercises can be performed. Naturally, the larger and more complex the machine, the greater the cost.

Traditional Pilates programs are outfitted with a Reformer ($2,000–4,000), a piece of equipment on which the patient lies supine on a mobile platform and uses his legs to press against a metal bar. Since the platform is spring loaded, the resistance can be changed to meet the patient’s needs. There is also the Pilates Chair, which has a spring-resisted platform that can be pushed by the legs from either a sitting or lying position. This apparatus can cost from $700–1,200.

Finally, there’s the Cadillac table, developed by Joseph Pilates himself to help soldiers who were injured during World War I. Pilates originally built a cage to fit over a bed and suspended cables that could be pulled by the patient to increase muscle strength and speed rehabilitation. The modern version, often described as “The Rack,” because it resembles something one might find in a medieval torture chamber, features a cage-like structure that fits over a table. Also known as the “trapeze table” and costing anywhere from $1,000–4,000, it is home to a multitude of disciplines.

There are also a huge number of innovative variations on the original Pilates concepts and designs. Many different products originally adopted for multiple use by PTs have also been utilized for the performance of Pilates exercises. Some equipment is so large it would only be useful in clinical settings. Other forms of equipment can be used by the patient in the home. Some manufacturers offer consumer models.

Insurance Coverage

Since Pilates is not a separate exercise option, but rather a modality that lies in the therapeutic exercise component of rehabilitation, health insurance companies are fine with it as long as the regimen is delivered by an appropriate licensed certified professional. Pierre says it’s akin to asking your insurance company if it will cover the use of progressive resistance machines or free weights. According to Pierre, “Pilates is a tool that is implemented in the therapeutic exercise component of a rehabilitation program.”

While Pilates has been the answer to many of the challenges Pierre faces every day, he knows there’s more that can be done.

“The greatest challenge is in dealing with some of the underlying problems that come to us,” he admits. “For us, it’s a lot of pain-type situations regarding back problems, neck problems, shoulder injuries, and some of the neurological problems like multiple sclerosis or Parkinson’s disease, and getting the patient to effectively utilize the equipment where it does not aggravate their condition or set them back in terms of flare-ups, which can be very discouraging.”

Pierre vividly remembers how he felt 30 years ago after his accident and how the tender touch of a few physical therapists led him through a very dark tunnel. Thanks to Pilates, he’s helping a new generation of patients see the same rehabilitative light.

Dave Cater is a contributing writer for Physical Therapy Products.