Ken Endelman, founder and CEO of Balanced Body Inc, Sacramento, Calif. talks about Pilates trends in the physical therapy field.

How has the integration of Pilates evolved in the past few years within the rehabilitation industry?

It has exploded in the last 3 to 4 years. For many therapists, it has gone from a small adjunct to the main focus of their practice. The PT community seems to be realizing that Pilates contains the same principles already ingrained in most orthopedic therapy. If you think about how the basic Pilates principle of core stabilization addresses posture, muscle performance, and motor control, you can see it revolves around the same concept that forms the basis of most orthopedic rehabilitation and therapy.

Versatility is another reason for its rapid growth. PTs are using Pilates to treat everything from back problems to fibromyalgia to neuromuscular disorders like autism. And now we're starting to see it used even more broadly, for example in treating cancer survivors as they begin postprocedure rehabilitation. It's really exciting to see Pilates advance within the rehab industry like it has.

(For PTs who are still new to Pilates) What are the aspects of Pilates that make it useful/effective for rehabilitation?

It's a very versatile and effective rehabilitation tool, as just mentioned. One reason is that Pilates trains PTs to look at the whole body, not just the afflicted area. In the past, many therapists evaluated a new client by first identifying a region of pain, and then focusing on rehabilitating that area. A Pilates-based therapist looks at it differently. For instance, a shoulder issue could be attributed to problems elsewhere in the body—such as incorrect spinal positioning or dysfunctional movement patterns. So, Pilates helps PTs both centralize an injury and identify its source.

It's also very gentle on the body. You can use equipment like the Reformer or Trapeze Table (Cadillac), which have springs to help assist or resist a movement. This lets patients undertake movements they may not ordinarily be able to accomplish due to various weaknesses within their bodies.

How do you recommend that PTs get started in offering Pilates within their facilities?

First, get well trained in Pilates. Many educational facilities—Balanced Body University is ours—work with clinicians. PTs are already ahead of the curve from an anatomical and biomechanical knowledge standpoint, and that's half the battle. So, PTs can begin taking courses, immediately apply that knowledge to their practice, and then continue their education as their schedule allows.

An alternative path is to hire someone externally to come in and provide Pilates sessions. Business challenges exist with each model (financial and time investment to get trained, versus paying and insuring a third party), but we've seen both models succeed.

What are some of the barriers/challenges that PTs face when first considering Pilates as a treatment option for their patients?

Like every facility that seeks to implement a Pilates program, rehab or otherwise, the main challenges at the onset are money and floor space. How much do I have to spend on equipment and training? How soon will I regain my initial investment? How much equipment do I need, and will it fit? Those are the usual questions I hear in the beginning of the process.

Make a business plan or amend your current plan to include Pilates. Look at your client demographics and local competition, and decide how you will differentiate your service offering. Then, look at your cash flow and capital equipment needs, and play with some return-on-investment models.

Many Pilates manufacturers have online tools to help you figure this stuff out. At Pilates.com, we have both a floor space configurator that helps our customers see what kind of equipment will fit in their allotted space, and an ROI calculator that shows how long it will take to recoup that initial investment. Tools like these go a long way toward helping PTs evaluate the addition of Pilates to their practices.

What are two to three of the most frequently asked questions by PTs when it comes to purchasing Pilates equipment?

Well, I can tell you some of the questions they should be asking:

• Can it accommodate different body types and sizes?
  Every clinician knows that they will be dealing with bodies of all shapes and sizes— often from small children to large athletes. In order to be effective and cost-efficient, your equipment must be able to adjust to fit all sizes and body dynamics.
• "How strong are the springs?
  Pilates is a resistance-based exercise method. It is the springs that assist and resist the movements you'll have your clients make. It is absolutely crucial that these springs be incredibly strong, since your clients will be in a variety of positions that can lead to injury if the springs become weak, or worse—break. Look for springs that have been thoroughly tested for durability and consistency.
• "How easy it to get off and on?
  Look for Reformers or equipment that is high enough off the ground to make it easy for clients—particularly older or injured clients—to get on and off without fear of injury.

Describe the main Pilates equipment that is needed/recommended for most treatment programs.

Pilates Reformer

It all starts with the Reformer, which is the most popular piece of equipment used in Pilates. It's a gliding carriage attached to rails inside a rectangular frame. The carriage is connected to springs, with pulleys and ropes attached to the frame. Depending on your client's condition, they can lie supine or prone, sit, or kneel on the carriage while performing exercises. It is a great diagnostic tool for therapists. You can watch how a client puts his or her spinal movements together in flexion, extension, rotation, and lateral flexion, and when they are combining it with upper- and lower-body movements. You can also use the equipment to replicate daily activities or sports-specific movements for both assessment and rehabilitation.

Trapeze Table (Cadillac)

The Cadillac is a horizontal tabletop surrounded by a four-poster frame with an assortment of bars, straps, springs, and levers. It's great for initial patient evaluations as well as for teaching patients how to attain neutral spine. And, like the Reformer, the springs provide assistance and exercises are gentle on the joints. Because of its raised height, it is especially good for working with older adults or wheelchair transfers.

Combo Chair

The Combo Chair provides a great Pilates-based workout within a small footprint. It resembles a stool with a split pedal at the bottom. Handles, chair backs, rotational disks, and other accessories can be added for increased variety. The Pilates Chair activates the lower back, buttocks, shoulder, transverses abdominals, and pelvic region; and heightens neuromuscular coordination. It's really great for your postrehab patients. You can do exercises by sitting on the chair and pressing down on the steps or pedals. You can also do them lying on the floor, standing up, or lunging forward.

Daniel Wilson is a contributing writer for Physical Therapy Products.