Most people all over North America are familiar with Pilates – it is still is one of the fastest growing exercises in the world. And millions more have experienced the physical fitness benefits of added strength, length, and agility that it provides.

But few know that Pilates is rapidly rising in another area – rehabilitation from injury.

The Culprit: Muscle Imbalances
Many injuries are caused by muscular imbalances within our bodies. And many things cause these imbalances – our posture, the way we walk, bend over, sit, lie down, or work out – basically the way we move. Most of us move incorrectly in some way or another, which puts too much pressure on some muscles and weakens others, causing an imbalance.

Take the back, for example: the way we move may put too much pressure on the spine, while weakening the pelvic muscles in the front of the body or vice-versa. Either scenario creates an imbalance, which means the body is much more perceptible to serious strains, pulls, tears or worse.

Pilates exercises promote an even musculature throughout the body by strengthening the core. The core is considered the “center” of the body and consists of the deep abdominal muscles along with the muscles closest to the spine. Pilates also stresses spinal and pelvic alignment, which is critical in getting us to move the way we’re supposed to move to avoid injury.

A Flexible Form of Rehab
These are big reasons why physical therapists all over the globe are now using Pilates as a form of rehabilitation. Kris Bosch, president of Northstar Pilates in Buffalo, NY, says Pilates is tremendously effective for other reasons, too.

“Part of its success is indeed based on the approach to the principles of Pilates – core strength, an even musculature, etc. But another reason is that it provides a greater degree of flexibility than most conventional forms of physical therapy. This is true because Pilates exercises can be modified for each person and still be extremely effective. You can go from basic movements to very advanced, depending on how a patient needs to progress or how badly they are injured.”

Conventional physical therapy, on the other hand, often involves patients being given a set of exercises that may be too hard for them to tolerate, says Bosch. It might be because they cause too much pain, or perhaps they are not aware of how to correctly position their body for maximum results – something that Pilates teaches you to do.

Positive Movement Experiences
In addition, with Pilates, clients become responsible for their own rehabilitation. It is not just coming to a therapist, lying down and having them do all the work. With Pilates a patient learns where their body is in space and to identify the best movement sequence. All these factors contribute to a positive movement experience, which Bosch says greatly facilitates a recovery.

“When you create a positive movement experience, you are able to take a step forward without pain. The more you move without pain, the more confidence you gain. And the more confidence you gain, the more likely you are to try another movement or exercise. That’s a very healthy rehabilitative cycle.”

Most Pilates exercises are performed on a mat or piece of equipment called a Reformer (a sliding carriage inside a long frame connected to springs, ropes and pulleys). One of the nice things about Pilates, Bosch says, is the way you can combine the Reformer and mat together as a solid 1-2 approach:

“It’s nice to get them on the Reformer first, because the springs on the Reformer assist the movements they attempt. This gets them out of bad or incorrect movement patterns they’ve developed which probably led to the injury in the first place. Then, as they progress and are no longer experiencing pain, they can use the mat for home exercises to continue their rehab, strengthen those muscles and prevent further injury”.

Rehab vs. Conventional Exercise
If you have injured yourself and are considering Pilates, it’s important to make sure that your instructor has physical therapy experience. “There’s a big difference between teaching Pilates as a form of exercise and using it as form of therapy,” says Bosch. “The principles of Pilates are awesome for rehabilitation, but if they aren’t used in conjunction with proper therapy techniques it could aggravate the injury. Before you start, make sure you ask your instructor if he or she has physical therapy training.”

by Ken Endelman

fibromialgiapilatesAccording to the National Fibromyalgia Association, Fibromyalgia Syndrome (FMS) is an increasingly recognized chronic pain illness characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances. While the cause of FMS is still unknown, the disease affects between 6-12 million in the U.S. alone. It is most common in women between 25-50 years of age. Symptoms of FMS can include headaches, sensitivity to temperature, restless leg syndrome, irritable bowel syndrome, tingling or numbness sensations, painful menstrual periods, and cognitive memory problems.

Many who suffer from FMS tend to believe that exercise will increase the pain they are already experiencing. However, current research suggests that low impact aerobic exercise, such as Pilates, can be done without increasing pain. For some, it can actually increase their pain threshold. However, gradual progression, ideally supervised by a Physical Therapist, is key. It is suggested to begin with exercising 3-5 minutes 3 times a week then progressing to 30 minutes 4 times a week.

Pilates emphasizes the connection of the mind and body, being a huge benefit to those with FMS. The client’s ability to participate in an exercise program from which there is no exacerbation of symptoms can greatly improve their sense of well being. Pilates also allows for the improvement in articular mobility of the spine in a very gentle and supported environment. Clients with FMS will improve best with personalized programs, which can be accomplished with Pilates. The focus should be on gentle stretching exercises and focus on deep, core stabilization work for both pelvic and scapula stabilization.

Triathletes must achieve optimal biomechanics to perform well in their varying activities and prevent overuse injuries. Imbalances in flexibility, strength, and agility can lead to poor movement patterns, causing loss of efficiency and injury.

Pilates is an excellent method to improve balance by optimizing postural positioning, core strength, stabilization, and flexibility in a low impact environment. The essence of Pilates is control of position and precision of movement. When the core is strong, the extremities can function at their optimum.

The triathlete places a wide range of stresses on their body. Pilates provides the development of improved body awareness, functional strength and flexibility by focusing on the stabilizers in the hips, torso, and shoulders. This ability to differentiate movement can make a significant impact on energy conservation for any athlete.

One of the most important areas for any triathlete to focus on is the hip joint. Triathletes generally train the primary muscles (flexors/extensors) of the hip. Often overlooked is the supporting hip musculature (abductors, adductors, and rotators) that assists the larger primary movers. Imbalances in muscles such as tightness and weakness limit the effectiveness of the larger muscle groups.

Good flexibility of the hip musculature can take minutes off the bike leg for a triathlete and assist in avoiding injury, but poor flexibility can cause minor serious issues. The following are examples of how an inflexible Piriformis can adversely affect cycling position:

  • Excessive loading of the bursae and muscle-tendon junction at the hip can cause bursitis and tendonitis of the Piriformis.
  • Lateral or rotational rocking of the pelvis can cause lumbar fatigue and spasm.
  • Lateral tracking of the knee can cause patellofemoral pain.
  • Piriformis compression over the Sciatic nerve track can cause Sciatica.
  • Poor saddle position due to tight Piriformis decreases power and causes a higher aero-bar position, creating greater aerodynamic drag.

Good strength and coordination in the hip musculature can take minutes off a run and help prevent injury as well. Lack of strength/coordination in the Piriformis muscle can produce:

  • Abnormal loading of the posterior Gluteus Medius and secondary hip rotators, causing bursa and tendon inflammation.
  • Poor stabilization of the sacro-iliac joint, creating hypermobility and pain.
  • Weak Piriformis, which contributes to decreased power of hip extension and reduces running speed and endurance.
  • Excessive internal rotation of the femur during stance phases of gait contributing to instability of the knee, which can cause rotational injuries of the knee.

Working on Piriformis mobility, coordination and strength will improve hip stability and tracking of the femur. This increases the ability to transfer power and improve aerodynamics on the bike and enhance the effectiveness of the stride on the run. Remember the core holds the pelvis, allowing everything else to function.

An accurate assessment of client limitations by a Physical Therapist is the key to great results. Pilates is an excellent exercise method, but it is the instructor’s knowledge, skill, and ability to adapt to the needs of each client that provides the greatest results.

Footwork using jump board, on heels. Used with permission. This figure is available on (www.topicsingeriatricrehabilitation.com)

Osteoporosis and reduction and/or prevention of worsening symptoms are imperative to those practitioners and trainers who assist the elderly in rehabilitation or training in order to improve their quality of life. Physical therapists, health care practitioners, exercise physiologists, kinesiologists, and trainers alike should be familiar with osteoporosis/osteopenia and the indications and contraindications of exercise for this population. Studies looking at Pilates and its effects on osteoporosis have been published, with overwhelmingly favorable results (including but not limited to prevention of continued bone loss and improved quality of life and perceived physical function). Researchers have specifically examined Pilates in comparison with other exercise interventions – and the overall effect and results have also been favorable. These articles indicate the benefits of exercise and the utilization of exercises in the Pilates repertoire for promoting good bone health.

A recent case study has demonstrated that Pilates exercise intervention can help reduce the effects of osteoporosis and reduce the progression of osteopenia in a 52-year-old man, Mr. H. Mr. H was diagnosed with osteoporosis/osteopenia at 34 years old. His medical history includes bilateral total hip replacements because of his poor bone density, a rotator cuff repair, and a torn Achilles tendon. His orthopedic history had been quite extensive. In 1998 after magnetic resonance imaging was performed, it was revealed that he had avascular necrosis in both hips. He was immediately prescribed a series of medications to increase his blood circulation. This intervention was not successful, and his symptoms actually worsened.

Toward the end of 1999, he was limping badly and having to utilize a cane. It was at this time he decided to interview doctors in Louisiana, Dallas, and New York areas and finally settled on a doctor in New York who was both an MD/orthopedic surgeon and a biomechanical engineer. He had invented a new type of hip replacement with a different point of view regarding “weight bearing.” He was also the only doctor who had at the time performed a bilateral replacement at the same time.

Surgery was performed in February 2000. Three years later, his MD noted that his bone density was significantly worse. He was given Fosamax (alendronate) and testosterone. In 2008, he was not very active and was still having back issues and mobility challenges. He came to Core for gait training and overall conditioning. Working with our team, he discovered Pilates! By 2013, he could no longer be prescribed Fosamax because 10 years was the limit. Once he was taken off the Fosamax, his bone density testing got much worse and fell into the osteoporosis range. Mr H. was instructed to start a specific Pilates repertoire focusing on exercises designed and executed for a client with osteoporosis. He was retested in 2014, and his results for bone mineral density improved (0.815 to 0.893) to the point where his diagnoses was reduced to osteopenia. In addition, Mr. H reported a significant reduction in pain and improved strength, flexibility, posture, and overall well-being.

Pilates continues to receive attention in the field of rehabilitation – with good reason. Recent research supports Pilates as an appropriate intervention for common orthopedic injuries.


Pilates-integrated Physical Therapy is traditional Physical Therapy incorporating equipment. Pilates equipment helps physical therapists manipulate gravity and supply assistance to movement that might normally be too fatiguing to execute. It is also combined principles of breathing, core strengthening, alignment, integration, and spine articulation that involve body and mind.

Pilates can be modified to create positive movement experience for special populations that cannot be overheated or fatigued such as Multiple Sclerosis and Parkinson’s. The ability t modify a functional activity- like sit-to-stand, reaching, rotating, and walking within the Pilates environment is key to a successful movement experience. The ability to grade difficulty using springs, levers, and gravity require the education of a Physical Therapist. This provides a continuum that can help patients reach their ultimate rehabilitation goal – the successful restoration of function.

Pilates training for Physical Therapists necessitates skill levels that far exceed the normal memorization of a cookbook Pilates repertoire. It requires critical reasoning to identify objectives, match patients’ goals, design an intervention, and create modifications to facilitate a positive movement experience, as well as adjust the program daily to progress the patient towards function.

Clinically, Physical Therapists have noticed a range of successful outcomes with patients suffering a variety of ailments- from Parkinson’s Disease to chronic low back pain- with the help of Pilates!

The need for pelvic floor muscle exercise to help bladder control

In Arnold Kegel’s landmark article published in 1948, pelvic floor muscle exercise was an effective treatment and preventative measure for urinary incontinence, mild to moderate pelvic organ prolapse, and loss of sexual desire. Since then, the medical literature has only further established pelvic floor exercise as first-line treatment for the aforementioned disorders; the Cochran Review, for example, has published support for the recommendation of pelvic floor muscle exercise as first-line conservative therapy for women with stress incontinence, urge incontinence, and mixed incontinence. Despite this, these patients are generally not offered, and therefore do not participate in, an organized program of pelvic floor rehabilitation before using medication and/or surgery to address these problems. Barriers to care involve social, economic, and cultural factors, such as the embarrassing nature of such symptoms, accessibility of health insurance, and the surging prevalence of pharmaceutical and surgical interventions to treat bladder control.

With that in mind, patients and physicians need to realize that treatment of bowel or bladder control issues is within the scope of health care services. There is a notion that a nonmedical intervention is an inappropriate or suboptimal means of treatment, and it is important that we reconsider this perspective. As healthcare costs continue to skyrocket, we need to examine the possibility that some conditions may be best addressed outside the scope of medication or surgery.

How can Pilates help?

A recent study by Bruce Crawford, MD, further supports pelvic floor exercise as an effective preventive and first-line therapeutic strategy for pelvic floor disorders. Crawford’s team used electromyographic (EMG) recordings to test the effectiveness of Pilates compared to traditional Kegel exercises. The team found that patients were able to increase pelvic floor EMG activity from 10 mV during the isolated Kegel to 30 mV during the pulse of the Pilates movements. In other words, subjects were able to concentrate his or her fitness efforts more efficiently. And after six to eight weeks of training, subjects increased pelvic floor strength by 33% and improved bladder symptoms by 74%.

These results highlight the importance of considering pelvic floor muscle fitness training for patients with these disorders. Such a fitness training program is offered at AATB Pilates, and we would be more than happy to put you in contact with our exceptional Pilates instructors. Pilates is a proven way to combat pelvic dysfunction and bladder control challenges and may provide a less strenuous solution than surgery and medication.

Scoliosis is a chronic spinal condition in which the spine has an abnormal sideways curvature. Although is often seen as an adolescent issue, scoliosis certainly affects the adult population, particularly in the development of spinal arthritis and adult degenerative scoliosis (ADS). Current advances in the orthopedics sector of medicine, such as sclerosing injections for the spine and extremities, may help lessen the pathologic changes of aging, such as instability of intervertebral segments or extremity joints due to damage or deterioration. These advances, however, come with risks, especially for older adults. Surgical interventions are similarly controversial for adults with scoliosis.


Therefore, the relatively low risks of nonconservative procedures make it well worth the adult with minor to sever scoliosis to seek other forms of conservative intervention, such as the Pilates Method. Conservative care for adults with scoliosis emphasizes the minimization of symptoms and the maximization of function in the roles of daily life. The Pilates Method, specifically, is designed to both assist and challenge the patient. This environment traditionally progresses from the establishment of a stable skeletal base to a dynamic, moving base of support that can withstand external forces generated from one’s body weight or the resistance of a spring system.

The Pilates Method has evidence supporting its use for much of the musculoskeletal system along with neurological implications of benefits. Studies citing the benefits of Pilates have included thoracic mobility, lumbar spine stability, upper and lower extremity functional improvement, and the enhancement of brain activity and prevention of cognitive decline and dementia.

For those with ankle mobility issues, it is essential to work on the correct type of footwork to see improvement. Basic footwork can be done on the foot bar of the Pilates reformer machine, or the jump board, an attachment the reformer. In both scenarios, Pilates can help increase the mobility of one’s ankles, hind feet, and fore feet. In addition, this footwork strengthens the muscles in one’s feet and ankles and improves balance and proprioceptive awareness.


The foot and ankle contain 33 joints and over 100 muscles, tendons, and ligaments – here’s to the health of your feet! We put a lot of demand on them and they deserve to be treated well. Below are some basic footwork exercises to begin working on your ankle mobility.






Heels                                                                        Toes/Prehensile






V feet                                                                          Wide/2nd Position

Starting Position: Knees bent at no more than 90 degrees. The lumbar spine is in a neutral position, and heels are in line with the ischial tuberosities (“sit bones”).

Foot and Leg Positions:

  • Heels: place the center of heels on the footbar with parallel legs.
  • Toes: Place balls of the feet on the footbar with heels slightly raised.
  • Prehensile: The heels are underneath the bar, wrap balls of feet around bar. Heels reach under bar as knees bend.
  • V Feet: Balls of feet on bar with heels partially raised and pressed together, legs turned out and knees bent.
  • Tendon Stretch: Lift/Lower. Push carriage back by straightening knees and rising onto balls of feet. Lower the heels, lift the heels, and bend knees to return.
  • Wide/2nd Position: Heels wide on footbar, legs turned out with knees bent. For a deeper knee bend, heels can be placed on the footbar directly above the reformer frame or at the ends of the footbar.
  • Running in place: Balls of the feet on footbar, push carriage back by straightening knees, dorsiflex and drop one heel under the bar while bending the other knee.

Cueing and Imagery:

  • Engage the abdominals before you push back; draw navel towards spine, draw hip bones together.
  • Maintain a neutral position of the spine and pelvis throughout the exercise.
Pilates is often recommended for clients with low back pain because of its emphasis on core strength and stability. Pilates can be very helpful for many clients with back pain, when principles and exercises are carefully and appropriately applied. Pilate exercises carelessly taught can cause or exacerbate back pain.


According to modern biomechanical research, the functional stabilization muscles of the spine work most efficiently when the spine and the pelvis are in neutral position.

Common Diagnoses and Usual Symptoms:

  • Nerve Symptoms: The most important first step is to try and find a position of the back and pelvis that causes the least nerve irritation and to work in a way that does not cause the nerve to flare up during or after the session. Nerve symptoms are most commonly caused by disc injuries, spinal stenosis, or muscle spasms.
  • Disc Injuries and Degenerative Disc Disease (DDD):  Disc injuries most commonly cause pain when they protrude toward back and put pressure on the nerves running through the spinal canal. Spinal flexion increase disc pressure, while a neutral spine or spinal extension decreases disc pressure.
  • Spondylolisthesis and Spondylolysis: This is a condition where one vertebrae slides forward on the vertebrae below it, and becomes unstable. The vertebrae are at risk of sliding and pinching the spinal cord in the process. Work in neutral or with a slight posterior tilt, avoid spinal extension and avoid loading at the front of spine.
  • Spinal Stenosis, Arthritis, and Degenerative Joint Disease: All of these conditions involve deterioration of the joints of the spine, either through development of bone spurs in spinal nerve canals or on body of vertebrae. Work in neutral or with a slight posterior tilt and avoid spinal extension.
Exercise during pregnancy is an important part of maintaining a healthy lifestyle. However, the physical changes that accompany pregnancy may require mothers to modify their exercise routines during their pregnancy and immediately after delivery. With proper supervision, our instructors at AATB Pilates will help keep you safe and active during and after your pregnancy.

First trimester, up to 12 weeks

During the first trimester, there are no specific contraindications as far as body positions or specific exercises. Exercise should be based on the energy level of the mother and geared to minimize fatigue. Some women continue on with all of their normal routines while others may experience fatigue, nausea, and disturbed sleep that limits their ability to perform at their previous level.

The primary exception to this rule is in high risk pregnancies, such as first pregnancies in women over 35, women with a history of miscarriages, or women who are undergoing in vitro fertilization. In these cases, if may be in your best interest to minimize your routine until you are past the 12 week mark.

Exercises to focus on during the first 3 months

Early in pregnancy is a great time to develop a program that will address the key needs of the pregnant woman. These exercises include:

  • Pelvic floor exercises
  • Adductor work (use a small ball between the knees in leg work)
  • Abdominal strengthening
  • Core stabilization
  • Arm and upper back strengthening
  • Lower back and chest flexibility
  • Decrease inversion exercises such as short spine stretch and rolling exercises
Months 3 to 5

Sometime around the end of the third month or during the fourth month, it will become uncomfortable to lie on your stomach. Prone work should be discontinued. Your abdominals may begin to feel a bit out of touch as the abdomen stretches and the pregnancy starts to show. During the fifth month, the uterus will be large enough to start putting pressure on your arteries that run along the inside of the spine, so exercises while lying on your back should be limited.

Months 6 to 9 

At this point in the pregnancy, the size of your abdomen will start to affect your ability to flex your spine and deeply flex your hips. The hormone relaxin is starting to circulate in the body at higher levels, leading to a loosening of the ligaments around the joints. This can lead to a lack of stability around the pelvis, which can cause low back, sacroiliac joint, and hip problems to flare up. To accommodate these changes, think about using a wider leg position on leg and foot work and focusing on increasing stability of the pelvis and hips (with adductor, abductor, and light abdominal exercises).


Once the baby is born, you can start doing simple core activation, pelvic floor, and pelvic stability work as soon as you feel like moving. If the delivery was vaginal, you will be able to return to a beginning level routine as soon as you feel like moving. If you had any episiotomy repairs, you may want to minimize hip adduction and anything uncomfortable for four to six weeks until the area begins to heal. If the baby was delivered by caesarian section, strenous exercise is usually not suggested for six to eight weeks following delivery. Gentle core work is very helpful but it is not recommended to put stress on sutures that are healing.


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