What Pilates does in rehabilitation, and what it does not

Pilates gets talked about in two unhelpful ways. Either it is the answer to every back in the country, or it is stretching for people who do not want to lift weights. Neither is right, and the useful version sits between them.

What it actually is

Pilates is a method of exercise built around quality of movement rather than quantity. The emphasis is on control, on working from the centre of the body outwards, on breathing, and on being aware of where your body is in space. Joseph Pilates developed it in the early twentieth century, and its use in rehabilitation grew out of that emphasis on control.

The exercises can be scaled from very gentle to genuinely demanding, which is the reason it works for such a wide range of people, from somebody in their eighties recovering their confidence to an athlete adding it to a training programme.

What the evidence supports

For persistent lower back pain, exercise is the intervention with the best support, and NICE guidance recommends exercise programmes as a core treatment. Pilates performs about as well as other forms of exercise in that context. It is not superior, but it is not inferior either, and the version of exercise that someone will actually keep doing is worth more than the theoretically optimal one they abandon in three weeks.

That is the honest framing. If you enjoy Pilates, it is a perfectly good way to manage a back and to maintain the mobility and control that keep it manageable.

The benefits people report most consistently are core and general strength, flexibility, better awareness of their own posture, improved balance and coordination, and a period of concentration that most describe as the most relaxing hour of their week.

What it does not do

It does not replace progressive strength training when that is what you need. If you are rebuilding a quadriceps after a knee replacement or an anterior cruciate ligament reconstruction, at some point that muscle needs to be loaded heavily and specifically, and Pilates on its own will not get you there.

It is also not a diagnosis. If you have pain that has not been assessed, starting a class and hoping is a gamble. Find out what is wrong first, then choose the exercise that suits it.

Mat work and the reformer

Mat work is what most people picture, done on the floor using body weight and small pieces of equipment.

A reformer is the piece of apparatus that looks faintly alarming the first time you see one. It has a carriage that slides on rails against a system of springs and pulleys. The resistance is adjustable, which means it can be set very light for someone in early rehabilitation or heavy enough to challenge an athlete.

That adjustability is the reason it is useful clinically. It allows exercises to be performed lying, sitting or standing, it provides stability challenges that the floor cannot, and it can reduce the load through a joint rather than only adding to it. After knee or shoulder surgery in particular, a reformer allows movement to start earlier and more safely than it otherwise could.

Classes or one to one

A general class is fine if you are broadly well and want to get stronger and more mobile. If you have a current injury, a recent operation, arthritis in a joint, or pain that changes with particular movements, a one to one session with a clinician who has assessed you is a much better use of your money for the first few weeks.

The right sequence is usually assessment, then a period of individual work, then a class once you know what to avoid and how to modify it.

If you are not sure where you sit, an assessment through musculoskeletal physiotherapy will tell you, and post-operative orthopaedic rehabilitation and strength and conditioning programmes cover the heavier work where that is what the situation calls for. Contact reception for current class times and availability at our Haslemere clinic.