Typically, when we think of physical rehabilitation we think of physical therapy. However, with the exceptional rise in the popularity of Pilates over the past ten years, awareness of its rehabilitative effects has increased. Doctors recommend Pilates to their clients with foot, knee, back, shoulder, neck pain and more. Physical therapists are integrating Pilates equipment and exercises into their practices, and many are trained as Pilates instructors as well. This interesting and growing relationship between Pilates and physical therapy is what we will look at more closely in this article.
Before we get underway, I want to say that there is no intention here to imply that Pilates and physical therapy are the same or interchangeable, but rather to look at the mutually beneficial relationship between the two -- for clients, therapists and instructors -- as well as distinctions that need to be made with regard their approaches and limits in addressing health and dis-ease. Also, please note that in this context we are talking about experienced Pilates instructors who are comprehensively educated in Pilates methodology, exercises, and equipment.
To get a clearer look at the differing roles of Pilates instructors and physical therapists, how rehabilitation is approached differently between the two, and how they can successfully working together I turned to Dr. Brent Anderson. Dr. Anderson is the founder, president, and CEO of Polestar Pilates. He is a licensed physical therapist and orthopedic certified specialist with a PhD in physical therapy. Polestar Pilates has for many years been at the forefront of the dialogue between Pilates and physical therapy. I start our interview by asking Dr. Anderson to clarify some key roles and terminology between Pilates and physical therapy.
Defining Rehabilitation and Who Gets to Do It
So often, we have advertising promoting Pilates as good for rehab of this or that -- knees, backs, necks, shoulders, etc. But Pilates is a method of fitness; and the scope of practice for a Pilates professional specifically excludes claiming to diagnose, prescribe, treat or rehabilitate any injury or disease (this is true for all non-licensed fitness professionals). So I asked Dr. Anderson, What is the relationship between rehabilitation and physical therapy and what the appropriate use of the term rehabilitation?
Rehabilitation, Dr. Anderson says, is the medical arm of restoring function. "You have to be a licensed professional to say you offer rehabilitation. Physical therapists, chiropractors and speech therapists, for example, are licensed so they can offer rehabilitation. Since they are not licensed, Pilates, yoga, movement instructors in the United States cannot say they offer rehabilitation. To get even more specific, physical therapists are the licensed professionals who can offer rehabilitation through physical therapy and physical therapy is exclusive to them."
What Pilates teachers can do, Dr Anderson suggests, is say they provide post-rehabilitation or wellness education. We are talking now about legalities in the United States because, as Dr. Anderson points out, "these rules have been defined by the states and the professions and all the lobbying that goes on to protect their special interests". They do not apply in most other countries.
Pilates Has Roots in Rehabilitation
It is quite relevant, Dr. Anderson points out, to look at the history of Pilates in terms of rehab. Rules regarding scope of practice and what can and cannot be called rehabilitation were not in place when Joseph Pilates began to develop his work in WWI as a prisoner on the Isle of Man. Pilates took injured and sick people through exercises with the definite intention of rehabilitating them. Later, as Pilates' studio in New York City grew, it was in large part because Joseph and his wife Clara were rehabilitating dancers. Pilates Elders Carola Trier, Ron Fletcher, and Eve Gentry were among many dancers who went to Joe for rehab.
Further, Pilates equipment was designed to address rehabilitation -- to take people through ranges of motion they couldn't do against gravity. Dr. Anderson gives an example: "if you could not hold your arm up against gravity, you could suspend the limb. You could lay on your side with your arm connected to a spring or a chain, and you could move your arm forward and backward without the effect of gravity on it and start reengaging muscle fibers. That's the trapeze table. And on the reformer, if you couldn't stand or squat on your legs, you could set it to a lower spring and still have the closed chain effect of squatting and moving. So Joseph Pilates' work had an element of rehabilitation built into it."
Next, Two Views of Pilates in Physical Therapy Today