Physiotherapy is a medically necessary form of treatment that encompasses various areas of application as a holistic approach to maintaining, improving and restoring physical function and mobility. In prevention, therapy and rehabilitation, active forms of therapy are used in particular in combination with manual and physical therapy. In this way, injuries or illnesses can be prevented, healing processes supported and body awareness, strength, endurance, mobility and coordination trained and improved. Physiotherapists are increasingly using exercise programs based on the Pilates method to expand their therapeutic range. The Pilates training concept has many parallels to physiotherapeutic therapy methods and offers therapists and patients new and more extensive possibilities for a holistically oriented therapy structure.

The six basic principles of Pilates therapy

Joseph Pilates developed the exercise form (see the Contrology Reformer method) as "complete coordination of body, mind and soul". Pilates therapy is based on six basic principles:

• ConcentrationAttentive, conscious perception of the movements
• CenteringStrengthening the center of the body (powerhouse)
• Control: Consciously controlled movements
• Posture: Precise posture when performing the exercises
• Breathing: Conscious breathing in harmony with movements
• flow: Flowing, supple movements

The Pilates method is a systematic, comprehensive whole-body workout based on a combination of strengthening, stretching and resistance exercises with static and dynamic as well as concentric and eccentric movements. The body is viewed as a unified whole and no isolated muscle groups are trained. Instead, Pilates training uses special exercises on the mat, with small equipment or by using a large piece of equipment (e.g. a reformer) to promote functional movement sequences, general flexibility, strength and core stability with a very low risk of injury. During training, breathing and movements are specifically harmonized to ensure a controlled, slow and flowing execution of exercises and to improve body awareness and perception. In particular, the focus is on strengthening the center of the body (powerhouse) with the deep back muscles, the hip, abdominal and pelvic floor muscles. In addition to the goals of increasing strength, flexibility, body control and coordination, the controlled mobilization of the spine during Pilates training improves posture and has a positive effect on back problems. The improvement in body awareness is accompanied by a general metabolic stimulation and a balance of physical and mental components that contribute to relaxation, help to reduce stress and can therefore improve the quality of life.

Pilates and physiotherapy

Although Pilates is not a physiotherapeutic or medical therapy concept, the basic principles and objectives of the Pilates method and physiotherapeutic exercise and treatment principles are similar. Since the beginning of the 2000s, an increasing number of Pilates programs have been offered in numerous physiotherapy practices and in the corresponding specialist departments of many clinics. Specialists are also increasingly advising patients with certain medical conditions to do Pilates training.

But what role and importance does Pilates have in physiotherapy? Pilates exercises can be adapted to individual goals and needs under expert physiotherapeutic guidance and can therefore improve and simplify therapeutic care. In this way, people with illnesses and limitations can find their own personal health training, as can rehabilitation patients and recreational or competitive athletes. The experience of physiotherapists with the integration of Pilates training into their therapeutic work is consistently positive. In the context of physiotherapy, the original Pilates method is given a modern interpretation and purposeful integration into therapeutic processes. The holistic basic principles of Pilates in the treatment of various musculoskeletal disorders are implemented and at the same time the requirements of physiotherapy are met. In addition to prevention to maintain health and performance as well as the treatment of acute or chronic illnesses, it can also be used in various phases of rehabilitation to regain physiological mobility and resilience in the context of everyday activities or to achieve individual performance goals. Children and adolescents as well as adults can train strength, endurance, coordination and flexibility with expertly guided Pilates as part of their sporting development. Pilates training can be used in physiotherapy as a preventative, therapeutic and rehabilitative measure for many different illnesses and complaints, thus providing therapists with a valuable addition to their range of services.

State of research

In international clinical research, there is an increasing number of studies on the effects and possibilities of Pilates exercises in the treatment of many diseases, in rehabilitation, in prevention and in sport. Even if peer reviews for quality assurance are mostly lacking, studies with varying degrees of evidence prove the far-reaching benefits of the Pilates method for all age groups, for different physical abilities and for various therapeutic and/or sporting goals. In particular, the reduction of pain and limitations in people with musculoskeletal disorders are the subject of the studies. Numerous studies have focused on non-specific chronic back pain and lumbar spine syndrome as well as, for example, the influence of Pilates on overcoming pain-related fear of movement or on fall prevention. The effectiveness of Pilates in neurological rehabilitation, e.g. for Parkinson's disease, multiple sclerosis and fibromyalgia, is also examined and it is shown that specific Pilates exercise programs have a positive influence on pain, physical function and quality of life. Pilates can also be used as an effective measure to increase physical activity and improve exercise tolerance in chronic diseases (chronic cardiovascular diseases, chronic respiratory diseases, diabetes mellitus, cancer).

Further studies, in particular high-quality RCT studies (Randomized Controlled Trial), are necessary in order to be able to investigate the issues of indication and effectiveness in more detail. Previous findings allow the clear conclusion that Pilates has a high therapeutic potential and can help to increase patient compliance.

Indications: Pilates in physiotherapy

The indications and possibilities for the use of Pilates in physiotherapy are wide-ranging and expand the therapeutic range extensively. The list of some exemplary clinical pictures should make it clear how versatile Pilates training can be used. The Pilates method in physiotherapy, e.g. for

• Diseases of the musculoskeletal system (cervical spine, thoracic spine or lumbar spine syndromes)
• Chronic non-specific back pain
• impingement syndrome
• sciatica
• Instability of the ISG
• Arthrosis in shoulder, hip or knee joints
• Hypo-mobility of the spine
• Hyper-mobility of the spine
• Spondylolisthesis
• Sports injuries
• Post-operative rehabilitation after disc surgery
• Post-operative rehabilitation after endoprosthetic treatment of knee or hip joints
• Post-operative rehabilitation after tendon or ligament surgery
• MS patients
• Parkinson's patients
• Fibromyalgia patients
• Oncology patients
• Rheumatoid arthritis
• Fall prophylaxis (geriatrics)
• Gynecological / urological indication
• Pre- and postnatal incontinence
• Improvement of stress resistance
• Postmenopausal complaints such as sleep quality, anxiety, depression and fatigue
• Work-related physical complaints
• Poor posture (muscular imbalance)
• Muscle shortening

Pilates in snow sports: prevention of winter sports injuries

Swiss hospital intensive care units are very busy in winter due to a large number of skiing accidents. In 2019, Suva recorded a total of 14,870 skiing accidents. Winter sports enthusiasts can prepare for the slopes with targeted exercises. Michael Brunner, sports instructor and training manager Polestar Pilates Switzerland from Spirit Studio in Basel, emphasizes: "Pilates specifically promotes awareness and increases the strength of the local stabilizers. Supplemented with proprioceptive strengthening exercises for the lower extremities, this training is the ideal prevention and preparation for safe winter sports."

The research results support Brunner's statement; the body regions most affected by snow sports are: Knee (30%), head (14%), shoulder (11%), thumb (8%). In a study by Griffin et al. the 4 categories of risk factors for injuries are described: Equipment, anatomical conditions, hormonal and biomechanical factors. In the area of biomechanics, these are primarily the level of strength and neuromuscular control, which is described as the unconscious activation of the stabilizing structures of the joints in response to sensory stimuli (= proprioception).

Only the interaction of the factors of strength and neuromuscular control leads to good functional joint stability. In the statement of the Hunt Valley Consensus Conference of Noncontact ACL Injuries, the improvement of body control was named as one of the main factors for preventing injuries.

Conclusion: Extended, valuable therapeutic options with expert therapists

The Pilates training method has been successfully used internationally for many years in physiotherapy and sport with a wide variety of target groups to expand the range of therapy and training on offer. This expansion offers patients of all ages and abilities a more far-reaching, holistic and individualized therapy for faster recovery and efficient improvement of the physical situation. For physiotherapists, the advantages lie in a more comprehensive range of services, extended therapeutic options and increased patient satisfaction. Pilates as a holistic training program can help to train the whole body and create a healthy balance between strength, stability, flexibility and endurance under the guidance of competent physiotherapists or after instruction as a home program. In addition to the positive physical effects and the increased enjoyment of exercise, the psychological effects of relaxation, stress reduction and improved quality of life should not be underestimated.

However, Pilates is not a panacea for everyone. If you have unclear health conditions or chronic or acute illnesses such as inflammation, herniated discs or osteoporosis-related changes to the spine, you should always consult a specialist before starting Pilates training.

The term "Pilates" is not protected and there are no binding, standardized training guidelines. Legally, anyone can call themselves a "Pilates trainer" or "Pilates expert" and run a Pilates studio even without training. Patients and clients who want to use Pilates in physiotherapy should therefore make sure that they choose a suitable therapist who has extensive Pilates training, often comprising several hundred hours.

The Pilates training method has been used successfully for many years to expand the range of therapies and training offered in physiotherapy.

The indications and possibilities for using Pilates are wide-ranging and expand the therapeutic range extensively.