Uses of Pilates in Rehabilitation

History and Background of Pilates

Pilates, a method of exercise focusing on the body’s core consisting of the abdominal and back muscles is named after its creator, Joseph Pilates. Born in Germany in 1880, he was an ill child whose life was limited by rickets, asthma and rheumatic fever. In attempting to overcome his physical restrictions he explored diving, bodybuilding and gymnastics as well as exercises that were influenced by the Greeks and Romans. In addition he delved into Eastern and Western philosophical thought.

In 1912 he began working with the disabled on a simple mat but eventually designed an apparatus that was probably fashioned around a hospital bed and differs little from those in use today . The equipment, or apparatus as it is referred to, consists of simple springs, pulleys and work either with or against the forces of gravity helping those unable to raise their bodies against gravity to progress with exercises. The springs and gravity can therefore be adjusted allowing safe movement and can be increased to progress the patient/client. However, many of the exercises are still done on a simple mat .

In 1923 Joseph Pilates immigrated to the US and began work with the dance community. Some dancers involved with his work include George Balanchine and Martha Graham who began to find that the use of Pilates methods led to a faster recovery during rehabilitation and increased their performance. Joseph Pilates believed that his techniques should be accessible to people of all ages with or without disability and therefore, they were based on simple principles of movement. At that time the concept of rehabilitation was in the early stages of development and there were few people involved in the field.

During his lifetime he developed more than 600 exercises for the different apparatuses he invented based on eight fundamental principles to guide exercises he called contrology . Pilates, himself wrote very little about his work, so much of what is now known is what has been verbally passed down through the generations. Some reinterpretations have occurred. All still focus on using intrinsic muscles to align and maintain the body in correct posture. His philosophy was to train the body from the inside out through stabilizing the pelvis and then training the core muscles to both move and stabilize the entire body .

By the 1990’s Pilate’s exercises began to be introduced into the rehabilitation setting and are now being used in the areas of general orthopedics, geriatrics, chronic pain centers, and in neurological rehabilitation . His exercises, referred to as simply “Pilates” are commonly employed to benefit the following injuries and disorders: “Chronic neck and back pain” Sciatica

Joseph Pilates developed what were known as the “Eight Principles of Training ,” although today many variations have been developed. In their most simplified form his basic tenets are as follows:

  1. Concentration : All exercise begins in the mind. Pilates’ method uses visualization and imagery as a tool to link the mind and body.
  2. Control : Physical movement is first controlled by the mind. Each exercise is executed with control and without momentum.
  3. Centering : All movement comes from the core. By strengthening this area first, we stabilize the torso so that other muscles can then strengthen and become more flexible.
  4. Breath : Breath oxygenates the blood and reinforces the mind/body connection. Pliates uses diaphragmatic breathing and forced exhalation and coordinates the breath with each movement.
  5. Flow : All exercises are performed gracefully, with fluidity.
  6. Precision : By concentrating on the movement, participants can coordinate movement with breath, improve control and increase kinesthetic awareness.
  7. Relaxation : Moving without tension creates more body awareness and concentration.
  8. Stamina : Exercises are designed to improve muscle endurance through the core and other muscles that support muscle movement.

Benefits of Pilates

Pilates is now one of the most popular forms of exercise today with nearly 500 studios teaching a form that has originated from Joseph Pilates. In recent years, chain fitness centers have begun to incorporate Pilates-inspired exercises into their programs. But the exact Pilates method is a registered trademark and the genuine training requires 600 hours of training and a resulting certificate. Unlike aerobics, cardio kickboxing, or spinning, Pilates relies more on gradual, methodical placement and movement. Pilates can be tailored to age, ability and presence of current or prior injury. Physical therapist, sports injury experts and chiropractors have found Pilates training an effective way to help patients recover from and prevent soft-tissue injuries. Anecdotal and scientifically-based evidence demonstrates relief from arthritis, back and neck pain .

Pilates develops core strength by integrating the trunk, pelvis and shoulder girdle. It is through emphasizing proper breathing, correct spinal and pelvic alignment and concentration on smooth, flowing movement that practitioners, clients and patients begin to connect with their own body, gaining an understanding of where it is in space, and how to control it . It is important to understand that Pilates for general exercise differs from Pilates for physical therapy rehabilitation.

Brent Anderson, PT, OCS, president of Polestar Education, a Pilates-based rehabilitation, fitness and training institute in Miami, Florida states: “When you’re talking about Pilates for rehab, you’re talking about modifying the exercise, If you use it correctly and are able to provide that positive movement experience, your client’s outcome physically and emotionally is going to be much greater. It is more about the principles of the exercise than the actual repertoire .” Due to the ability to work on the Reformer apparatus which essentially eliminates the effects of gravity, many can work on movement patterns without excessive cardiovascular stress and can undertake more exercises without the adverse affects that other forms of exercise performed against gravity can cause.

Scientific Studies Conducted

It is important to be aware that despite the fact that forms of Pilate’s exercise have been in use for more than 80 years, that currently there is only minimal scientific evidence that actually documents its efficacy. This is not to say that Pilates is not effective in the use of physical therapy and other forms of rehabilitation and strengthening, but rather to point out that only a few evidence-based articles exist as of this writing.

Smith and Smith published an article in Topics in Geriatrics Rehabilitation and also published a Pilates spiral bound 223 page book in 2005 . Their book, Pilates for Rehab targets the professional fitness practitioner and physical therapist who wishes to incorporate Pilate’s principles and exercises into rehabilitation and strengthening programs .

A study was conducted in 2005 to determine whether the participation of 10- to 12-year-old girls in a four week Pilates program could lower the BMI of the girls . The students were recruited from YMCA programs in Houston, Texas and the young participants expressed enthusiasm for the classes, which they attended regularly.

Findings indicated that those who participated in the program saw a small reduction in their BMI with the heavier girls seeing the most reduction in weight. The study indicated that Pilates might be a useful tool to increase activity and reduce obesity in youth.

Another randomized control study was conducted to determine the efficacy of Pilates-based therapeutic exercise to help patients with non-specific chronic low back pain . The study results demonstrated that a 4-week treatment program of Pilates was more helpful in the treatment of a randomized group of participants than other exercise programs in reducing pain and disability levels.

The hip extensors and the gluteus maximus have a significant role in stabilizing and controlling the lumbar-pelvic region. The gluteus maximus also helps transfer load from the lumbar spine to the pelvis and lower extremities. It is not surprising, therefore, that when there are structural alterations in the lumbar-pelvic musculature that low back pain tends to result.

Although it would seem that specific exercise training, such as Pilates which emphasizes lumbar-pelvic stability and strengthening the gluteus maximus would help reduce chronic low back pain, no scientific study has yet been conducted to concretely prove this theory.

Specifically designed therapeutic approaches that enhance spinal stability and neuromuscular control that facilitate the co-contraction of the deep abdominal and the paraspinal muscles (muscles along the side of the spine) help to stabilize lumbar spinal segments.

People with diagnoses of spondyloysis or spondylolisthesis (disc problems) have been found to have a reduction of pain when these muscle groups are strengthened, according to a study conducted by O’Sullivan . Because Pilates exercises target core strength, it makes sense that focusing on breathing and stabilizing sequences involving the abdominal and paraspinal muscles can help people who suffer from low back pain.

Another pilot study conducted in southern California at Mount Saint Mary’s College found that the forward flexion of the spine which usually occurs at the hip at L4-5 and L5-S1 was positively increased after a 45-minute Pilates exercises routine on the Reformer apparatus (see following diagrams).

The study demonstrated that changing movement strategies to eliminate harmful forces can allow people to progress more than with traditional exercise. An additional community-based study also proved effective in increasing the flexibility of the trunk of the participants .


Anderson nicely sums up two basic assumptions made in Pilates in the following quote: “1) Movement exists within each person and 2) that the ability to heal lies within each individual.” It is hoped that ongoing research will continue to scientifically explain the manner in which this happens in Pilates. In the meantime, people across the country are enjoying and benefiting from the flowing movements of Pilates.

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  1. Anderson B, Spector A. Introduction to Pilates-based rehabilitation, Orthopaedic Physical Therapy Clinics of North America, Complimentary Medicine. 2000;9:3:395-410.
  2. Ibid.
  3. Pilates JH, Miller WJ. Result of contrology. In: Return to life through contrology. New York: JJ Augustin; 1945.

4.Crews L. Pilates: Philosophy and biomechanics. American Fitness. 2006;May/June.

  1. Ibid.
  2. Ibid
  3. Ibid.
  4. Pilates Incorporates Mind and Body.Harvard Women’s Health Watch. 2000;7:6:6.
    1. Wilson D. Pilates provides effective rehabilitation for both body and mind. Advance Magazine. 2005.
  5. Ibid.
    1. Smith E, Smith K. Integrating Pilates-based core strengthening into older adult fitness programs: implications for practice. Topics in Geriatric Rehabilitation. 2005;21:1:57-67.
    2. Ibid.
  6. Smith R. Pilates for Rehab: A guidebook to integrating Pilates in patient care. Phys Ther. 2006;86:10:1451.
  7. Russel J, Jonker M, et al. Effect of 4 Weeks of Pilates on the body composition of young girls. Preventive Medicine. 2006;42:177-180.
  8. Rydeard R, Leger A, Smith D. Pilates-Based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. Orthop Sports Phys Ther. 2006;36:7:472-484.
    1. O’ACSullivan PF, Phyty GD, Twomey LT, Allison GT. Evaluation of Specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine. 1997;22:2959-2967.
  9. Anderson, B, Davis, C (ed). Pilates Rehabilitation. In Complementary Therapies in Rehabilitation: Evidence for Efficacy in Therapy, Prevention and Wellness. Thorofare, NJ:Slack Inc.;2004.
  10. Segal N, Hein, J, Basford J. Effects of Pilates training on flexibility and body composition: an observational study. J Arch Phy Med Rehabil. 2004;85.
    1. Anderson, B, Davis, C (ed). Pilates Rehabilitation. In Complementary Therapies in Rehabilitation: Evidence for Efficacy in Therapy, Prevention and Wellness. Thorofare, NJ:Slack Inc. 2004.

By Nancy Tounge SPT (Student Physical Therapist)