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Monday Medical: Using Pilates in physical therapy

Susan Cunningham
For Steamboat Pilot & Today

After an injury or surgery, pain and weakness can result in faulty movement patterns. But incorporating Pilates’ techniques through physical therapy can help restore proper movement while building strength.

“Pilates focuses on improving core stability, so the rest of the body can move properly,” said Carolyn Dieter, a physical therapist with UCHealth SportsMed Clinic in Steamboat Springs and Oak Creek. “When you don’t have that stable base, you’re more prone to faulty movement patterns and compensation, and those can lead to potential injuries.”

What is Pilates?

This set of exercises, developed by Joseph Pilates, focuses on breathwork, aligning the head, spine and pelvis, and establishing core control.



Some exercises are done on a mat, while others are done with specific equipment.

Who can benefit?

While precautions may be necessary when working through certain injuries or conditions, almost anyone can benefit from Pilates.



“Exercises can be performed in different orientations to gravity and with different pieces of equipment, so you can modify exercises to make them appropriate to pretty much anyone,” Dieter said.

And Pilates isn’t just for the uber-fit: Exercises can be tailored to different ability and fitness levels.

Why does Pilates help?

By stopping faulty movement patterns and helping the body learn to move properly again, Pilates can help reduce abnormal forces in the body throughout the day.

“Over time, you’re going to reduce risk of injury by learning to move properly,” Dieter said.

Through the imagery and cueing that are key to Pilates, Dieter helps patients relearn those proper movement patterns.

“You may feel gripping in the hip flexors, but a subtle cue can change that gripping,” Dieter said. “Patients are often surprised how moving properly without that little bit of compensation feels different and removes pain.”

When is Pilates useful in physical therapy?

Dieter incorporates Pilates moves with most of her patients, especially those suffering from hip and low back pain.

“I teach Pilates very early on in the physical therapy process because it is about learning very specific movements and control, which you then incorporate into more advanced exercises later,” Dieter said. “Having that foundation and control early on in the rehab process can be very beneficial.”

What should I expect in physical therapy?

Patients usually start doing Pilates exercises while lying down, then progress to a more functional and weight-bearing stance. A common exercise is to lie on the back with a neutral spine and pelvis, and move the legs in different ways to learn how to dissociate the hips from the pelvis.

“Oftentimes, the pelvis will move with the limb rather than being stable with the spine, so you get a lot of extra motion and stress in the spine because they’re not dissociating properly,” Dieter said. “Those exercises help teach you how to move the hips separately from the pelvis and spine.”

For the best results, Dieter encourages patients to aim for two 30- to 60-minute Pilates sessions each week.

Can Pilates be frustrating to learn?

In a word, yes. But the pay-off is worth it.

“I try to tell people up front that they’re not powering through these exercises but are being mindful and putting a lot of thought into them, while learning to be more efficient,” Dieter said. “It is likely going to be frustrating in the beginning when you’re waking up muscles that haven’t been used properly, but once that connection gets built, it’s going to get a lot easier.”


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