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When Pilates is Dangerous

Originally posted on October 24, 2011

By Jonathan Oldham, MSPT

Pilates is geared to the needs of the individual. I was reminded of this at the Ron Fletcher Pilates Conference in May. I attended a workshop presented by Sherri Betz, PT, and entitled Fletcher Pilates for Osteoporosis. I was more convinced than ever that a traditional” approach to Pilates is not for everyone. Traditional Pilates is a formulaic presentation of the Pilates work in which a series of exercises are performed in a specific order. Although this approach is helpful for a new teacher to organize their teaching, and is usually safe for someone with no physical issues, Mr. Pilates probably would not have taught this way. Joseph Pilates would have taught to the individual in front of him.

Traditional mat work emphasizes rounding the back, but for anyone with fragile bones (diagnosed with osteopenia or osteoporosis), this movement is contraindicated, and may be downright dangerous. However, individuals can continue a rigorous Pilates practice without being in danger of spinal fractures.

Hip Hinge Exercise

I was discussing this idea with a very healthy Pilates client, an avid runner who does not have any significant pain or dysfunction, but does have osteopenia. We decided to implement some of Sherri’s suggestions. We practiced, for example, hip hinging while maintaining a flat back -something hard to do and definitely challenging to the core – but which does not allow rounding the back.

After each session this client always felt better, but when we avoided doing flexion exercises, not only did she feel better, she actually felt taller after the session. She seemed relieved not to have to do a lot of curling exercises. I think intuitively she knew that those exercises were not good for her.

Looking at her posture, I realized that she did not need to practice exercises that rounded the upper back. Her upper back was already rounded. In the past, my training as a Pilates teacher would have compelled me to present the entire body of work to her even though it was not necessarily good work for her body. With this new insight, I feel free to teach to the individual. As for the client I mentioned, we have completely shifted her Pilates practice, and are making great headway in her core strength, posture, and motor control while supporting her bone health at the same time. I have made similar adjustments in my classes with a similar positive result.  Thank you, Sherri for clearing up this issue for me.


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