A GAME CHANGER: PILATES IN REHABILITATION
An edited version of this interview was originally printed in our 2012-2013 catalog.
Should you add Pilates to your practice? Why not ask someone who has successfully done it? Recently we talked with Lindy Royer, PT, PMA-CPT, Balanced Body Master Instructor, and owner of Park Meadows Pilates and Physical Therapy in Lone Tree, Colorado, to look at how Pilates is changing the face of rehabilitation. Here’s what she had to say.
Why is Pilates such a good fit for the PT market?
As Joseph himself said in “Return To Life Through Contrology” : “Contrology is complete coordination of body, mind, and spirit. Through Contrology you first purposefully acquire complete control of your own body and then through proper repetition of its exercises you gradually and progressively acquire that natural rhythm and coordination associated with all your subconscious activities.”
A successful rehabilitation program must include all the aspects that Joe incorporated into the Pilates Method: strength, coordination, balance, motor control, flexibility, breathing, and conscious and unconscious mastery of functional movement. Including Pilates in a Physical Therapy program provides practitioners with all the tools they need to elevate their rehab program and be successful with more patients.
With Pilates, a PT can integrate whole-body postural and movement assessment, movement re-education, and re-assessment - almost simultaneously. Pilates training also gives us more effective ways of communication with patients in a way they can understand. This is critically important, because no matter how skilled you are as a therapist, the patient's body is ultimately their responsibility, so the more they understand, the better they do, and the more compliant they are with attendance and home program.
Do Pilates-based PTs have an advantage over non-Pilates-based PTs?
Definitely! A skilled Pilates-based PT is equipped with a variety of tools for improving patient outcomes.
1) Whole-body integration: This is the ability to see the relationships between structures and systems that result in getting to the cause of a problem, and not just treating a symptom. For example, a knee pathology could be the result of faulty biomechanics and movement patterns in the hip or foot. Pilates is the perfect environment for assessing, reeducating and correcting the cause of the pain, rather than simply putting a band-aid on the symptom. With Pilates, we are able to create an individual treatment program specific to each patient's needs, resulting in better long term outcomes in less time.
2) Pilates apparatus has a wide range of applications that seamlessly move a patient from assistive movement activities through to resistive and extremely challenging activities. You can assist someone who's just beginning to use a limb again after a stroke or surgery, or you can challenge a world-class athlete...and everyone in between. Additionally, we can place the patient in many different relationships to gravity, giving them guidance and support as they break dysfunctional movement patterns. This is a huge benefit because much of what we do as PTs is reeducation of dysfunctional patterns in the body, and it's this reeducation that provides lasting benefit for our patients. If we skip this step, you can be guaranteed they’ll be back with the same complaint - or perhaps a new problem - later on down the road.
I think most PTs think in terms of “exercises” to give their patients, rather than diagnosing and treating “movement.” Using our knee analogy a patient may be given a closed chain exercise such as a squat to strengthen their legs after an injury or surgery. With Pilates, we can start with footwork in an assisted environment on the Reformer or Trap Table and move through a wide range of variations and challenges into very challenging versions like lunges on the chair. And because we're using Pilates as our framework, we’re also integrating the movement into the whole body/mind continuum -- something that is often overlooked in a non-Pilates situation. What is the rest of the body doing while the lower body is moving? How is the spine aligned? Is there trunk support? Is the shoulder girdle under abnormal tension? How about the breathing? Is the leg aligned correctly through the range of motion we’re training? What’s the patient's awareness of the movement? Do we understand how the trunk, hip, knee and ankle work together? All these things can be addressed using the Pilates Method, resulting in a more complete, whole body, experience that produces superior results.
3) Communication: As PTs, we’re trained to communicate scientifically with each other and with other health-care providers. Unfortunately, this form of communication, while necessary professionally, is not effective for communicating with our patients. In order for a patient to take responsibility for their own rehabilitation, they have to understand what’s going on. Pilates, when taught correctly, provides us with powerful and effective communication strategies to really help our patients understand their body in a way that makes sense to them.
After just one session, many of my new patients have thanked me for explaining their body to them in a way they can understand. They complain that their doctors and other therapists are speaking to them in terms that they cannot comprehend, but they are too embarrassed to ask questions. One patient, who's in her 60s, recently said to me, “I’ve been afraid of my body my whole life. Thank you for helping me not be afraid!” This is powerful stuff!
4) Patient awareness: Many common pathologies are the result of our movement and postural patterns, and not from injury or trauma. Back pain, knee pain, tennis elbow, plantar fasciitis, and shoulder impingement are often caused by muscular, connective tissue and postural imbalances. The Pilates environment gives the patient a heightened sense of awareness of their specific imbalances -- this carries over into their everyday activities more consistently than any other form of movement. It allows the patient to sense what’s happening in their own body on a deeper level than “exercise,” and then make changes. If you’re not aware of your movement and postural patterns, you can’t change them. Awareness is not enough, however. The beauty of Pilates is that it also provides us with simple and effective action the patient can take to correct their imbalances at home. It's a perfect marriage of mind and body.
Can Pilates add additional revenue streams to your practice?
Yes. In our practice, we offer a variety of small group classes of no more than 6 students. Our entry-level classes are post-rehab oriented, providing a safe environment for a variety of pathologies. Some clinics successfully offer specific classes for back care or osteoporosis, for example, however I’ve found that this can be frustrating for some patients if their schedules don’t work with the class times.
Whatever works for your practice is the way to go -- Pilates is a great way to convert a patient who may otherwise come for only a few visits into a long-term-cash-paying customer. The patient develops trust during the treatment/rehab phase, and enters Pilates classes with more confidence, knowing that their Pilates classes are taught by a Physical Therapist or Pilates Certified instructor who is a rehab-specialist. Many of them who stray away and try other studios come back to us and say they won't do it again!
In my practice, we find that offering workshops for common pathologies is also a good revenue creator. “Pilates for Osteoporosis,” or “Pilates for Back Pain” are popular. This theme can branch out in multiple directions including sports and recreation: “Pilates for…” golf, tennis, hiking, swimming, cycling, dance, triathlon…the list is as endless as your imagination!
Do Pilates and mind-body exercise complement other therapeutic modalities? How so?
Pilates is the perfect complement to all of the modalities we use in Physical Therapy. Manual therapy in particular comes to mind. Using Pilates as a reeducation process following appropriate manual therapy techniques is very powerful, as it allows the patient to have a positive movement experience with awareness of the new movement pattern. This reinforces corrected joint and connective tissue patterns that lead to lasting movement health. It also puts more personal responsibility back on the patient. When they understand that they are ultimately “driving the bus,” as we like to say in my practice, they’re more engaged in their own rehab process, and become partners with us, rather than relying on us to “fix” them.
What kind of maladies and or injuries have you successfully used Pilates?
We see everything from back pain and post-surgical rehab patients to neurological disorders such as stroke and multiple sclerosis. And we see patients across a wide age range. At the moment, our youngest patient is in her late teens, and our oldest is in his 80s. All of these patients participate in a Pilates-based program.
Some of our greatest success stories are with patients who came to us because they’d “tried everything” without success and found the Pilates approach to be their solution. Many of these are back and neck pain patients.
I credit my own recovery from a severe knee injury just over three years ago to this work. I had injured my knee while skiing. The MRI revealed a torn meniscus, partially torn ACL, torn MCL and some arthritic changes [no surprise there, since I’m on the far side of 55!]. I clung to the fact that my ACL was only “partially” torn, and decided that this was a marvelous opportunity to really embody the Pilates-based rehab approach for myself. I did not schedule surgery immediately, even though my knee was functionally unstable, and surgery was initially recommended.
Over the next summer and fall, I rehabbed my knee using exactly the approach we use for our patients, and I was skiing again by the end of the next winter without a brace. I have continued to do all of the activities I love to do in the mountains of Colorado without further problems. The caveat to this is that I have also remained consistent with my Pilates program!
What are mandatory pieces of equipment for a PT looking to add Pilates to his her practice?
Depending on your practice, there’s a wide variety of apparatus to choose from. If you have a population who has limited transfer abilities, and who requires assistance, a Clinical Reformer is a must. This provides an elevated surface ideal for transfers. A Trap Table/Cadillac is also wonderful, not only because of the height of the table, but also because it’s a stable surface to work from, and there's a wide variety of movement applications to select from -- very assistive to incredibly challenging. We’ve also found the CoreAlign to be a fantastic tool, as it helps activate core stability and provides balance and postural training in a functional position. It’s a great addition to any Physical Therapy practice.
For space-constrained facilities are there smaller pieces of equipment out there that a PT can add?
The Combo Chair or EXO Chair can fit in a small space, although they don't offer the variety of assistive exercises that we get from the Reformer or Trap Table. The Springboard fits easily into most spaces and works well in a rehab setting. I’d also suggest The Pilates Arc -- lightweight and versatile. The Arc is perfect and cost effective for adding a group experience to your practice. The new Orbit is another piece that offers a huge variety of movement options while taking up little space -- another great piece for groups. The Pilates Magic Circle and Foam Roller round out the list.
Since PTs already have a good knowledge of anatomy is the training/education cycle easier/shorter?
A PTs knowledge of anatomy, biomechanics, the rehab process, and their understanding of pathologies gives them a good background when coming in to the Pilates environment. However it still takes time for PTs to learn to integrate what they know into a whole-body movement approach. I find that it takes about the same time for PTs to really embody the Pilates Method as it does a non-PT. They’re just learning different aspects of the method. I’ve trained many PTs over the years, and we frequently discuss the fact that what we're learning about movement from the Pilates perspective is not what we were taught in PT school. So from that aspect, it’s a level playing field for all students.