Evidence shows that Pilates can be an effective treatment tool for various sports injuries.

Athletes and rehab practitioners of today recognize the benefits of rehabilitation programs that involve strength and flexibility training, as well as balance and efficient movement patterns. Pilates incorporates these components and offers new treatment options in sports rehabilitation.  

Pilates in Rehab

Megan Lewis, PT, ATC, ART, CPI, treats athletes of all ages at Sports and Orthopedic Leaders (SOL) Physical Therapy Inc, Oakland, Calif. Whether her patients are high-level athletes preparing to get back into their game after an injury, or a weekend athlete who is returning to her tennis game after a surgery, Pilates provides a plethora of treatment interventions.

“I’ll typically start with some mat concepts that include exercises they can do at home,” says Lewis. “I also use the [Pilates] equipment for muscles that we see are not working or movements that we see as compensatory or insufficient. For example, the patient’s gluts may not be firing when performing squats, so I’ll come up with a few exercises using the Trapeze Table, or Cadillac, in order to fire those muscles in certain patterns and isolate the muscles and use the springs for resistance. I might try this lying down, prone, or standing. We try to get into the most functional position for the patient’s particular sport.”

Of the six physical therapists (PTs) on staff at SOL Physical Therapy, Lewis is the only one certified in Pilates. She sees patients for initial evaluations, as well as patients going through traditional physical therapy programs. The other PTs refer their patients to Lewis for Pilates treatment if they feel the patient’s condition would benefit from the Pilates program. All patients referred to Lewis are seen on an one-on-one basis for 1 hour. Lewis concentrates on muscle imbalances and strengthening neuromuscular programming to improve functional movement problems, especially after an injury.

“The interaction between me and the patient during the Pilates session is very in-depth, versus taking a Pilates group class,” says Lewis.

Pilates addresses the athletic patient’s needs in all phases of rehab, from the most acute phase to advanced functional re-education. The benefits of Pilates are being accepted and understood by more and more physicians. “We have physicians that refer patients to SOL strictly for Pilates treatment and it’s usually clients with low back injury,” says Lewis.  

Lewis begins treating athletes by reviewing the initial evaluations from the other PTs at SOL, and based on that evaluation, she becomes familiar with the patient’s sport, whether it’s tennis, swimming, or biking, etc. If the athlete is a runner, she might direct the patient to perform single-leg squats, during which she looks for certain weaknesses or dysfunctional coordination patterns that have formed due to an injury. Her main goal is to figure out what the issues are so that she can come up with a program to access and treat those problematic muscles and eventually have the athlete return to their sport without pain. According to Lewis, twice a week visits are optimal.

“Athletes are used to pushing heavy weights, being in the gym, and working with their trainer on physio balls and bosu. When we slow them down, and we are working on more isolated transverse abdominals, or the deep pelvic floor muscles, it’s initially very frustrating for them. They’re used to seating,” says Lewis. “However, they find it challenging once they get into deeper core muscles. It’s amazing to see that sometimes these athletes are at such a high level, but they’ve missed the basics. Certain habits are formed over the years—certain muscles have been compensating for the weaker ones and they have been training the same way for years. This is usually how an injury begins.”

Lewis develops exercises on Pilates equipment with an aim to provide patients with exercises they can do on their own after official treatment visits have finished. While she prescribes exercises using the mat and physio ball, she prefers to use the Reformer due to the numerous options of exercises that can be imitated with machines at the gym.

“With the reformer, I can simulate exercises that can be done in a home program, such as a row or lat pull down,” says Lewis. “Exercises on the reformer can be done lying on the back, sitting, or standing, and the springs are used for resistance. Throughout the exercises, you can help the patient focus on the core muscles and neutral spine.”

Lewis’ background as both a physical therapist and a certified Pilates instructor help her provide a comprehensive treatment program for all of her patients. Compliments from patients about her program at SOL include a decrease in pain, and improved balance, posture, and strength.

“With a background in physical therapy, you receive great training in performing patient evaluations. For example, you may have a better understanding of the body’s movement when performing a rotator-cuff test. Though I’m sure that Pilates training is improving, having a physical therapy background allows me to fully analyze dysfunctional movements of the body and understand diagnoses from physicians,” says Lewis. “The Pilates training has a big impact as well when assessing movement, movement awareness, and coordination of muscles. Instead of looking strictly at the joint, you are also assessing the quality of movement.”

history lesson

Joseph Pilates developed his form of body conditioning more than 80 years ago, but only recently have PTs discovered its rehabilitation benefits. The German-born Pilates formulated the techniques to overcome his own ill health while locked away in a British internment camp during World War 1.

An ardent follower of both eastern and western philosophies, as well as a gymnast, boxer, and circus performer, Joseph Pilates blended yoga and karate, and used his western research to create a system designed to strengthen the body and mind. He used the system to create individualized programs for patients suffering from war injuries. Using springs from the bottom of beds for resistance, Pilates designed exercises that soldiers could do for rehabilitation.  

In 1926, Pilates emigrated to the United States and opened a fitness studio in New York City. Here his exercises and concepts were quickly embraced by the dance community. Dancers have a reputation for being a challenging population to work with because they are always pushing their bodies to the limits. Pilates’ program and individualized exercises brought many dancers back to the center by challenging them to discover their mind/body connection. 

Pilates developed more than 500 exercises on four different pieces of equipment. He saw a biomechanical problem and developed an exercise to try and facilitate strengthening while focusing on the core. PTs with backgrounds in biomechanics and motor control are perfect candidates to become Pilates instructors of the future.

Pilates has recently taken on a trendy aura, spurred by celebrity devotees. In 2000, a New York federal district court judge increased the discipline’s popularity when he ruled that Pilates, like karate and yoga, is a type of exercise, not a trademark. Celebrity practitioners and trademark freedom help, but Pilates’ continuing success will be based on good outcomes and positive word of mouth.

Pilates work consists of key principles, including: centering, concentration, control, precision, breath, and flow. These principles encourage the mind to guide the body with all movement, while maintaining focus on the body’s core—the area around the midsection providing muscular stability and strength. Pilates emphasized the power of breath, as he believed that proper breathing was the foundation of any exercise or movement.  

The movement patterns are multidimensional and functional, ensuring efficient and effective musculoskeletal use. A regular exercise program can often detect weaknesses and imbalances in the body, if an area is weak and overloaded, the risks of injury increase. Pilates identifies muscular imbalances associated with injury—a key problem—while continuing a regular training program. Postural re-education, another important physical therapy goal, is incorporated into most Pilates rehab programs.

Traditional exercise often involves identifying, then training isolated, deconditioned muscles, usually in a single plane of motion. Acknowledging these isolated deficits is important and working to improve the strained muscles should involve a blend of coordination, balance, and kinesthetic awareness, since many sports skills are complex, multiplanar movements. A Pilates practitioner evaluates the faulty movement pattern and then breaks it down into smaller units that fit into the repertoire of Pilates exercises. Training starts in a less challenging environment where parts of the task can be broken down and the orientation to gravity is changed to disrupt unwanted movement strategies. Verbal and tactile cues are effective in this new orientation where it is difficult to resort to old habits.

The concept of functional re-education is important to return athletes back to their activities. Pilates-based exercise allows the athlete to retain and then transfer these movement patterns to outside of the practice environment and into the sport-specific skill. Pilates-based exercise can be incorporated into any sports rehabilitation program with the proper approach.

Adriana Wells, PT, is a certified Pilates rehabilitation practitioner in Los Angeles.