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Physical Therapy IS Pilates & Pilates IS Physical Therapy Because......Biomechanics Are Biomechanics

Updated: Aug 14, 2023

Joseph Pilates called his work "Contrology" NOT Pilates

There is NO mystery to Pilates (only Joe's legacy)

There is NO elitist aspect to physical therapy

Despite how both fields of practice view themselves as part of the healthcare industry

Most physical therapists have gone through their degree programs and have practiced for some time, several years in fact. At some point, they decide to seek a Pilates certification to enhance their practice because it helps them to expand the various modalities with which would be available to them, to design rehabilitation protocols. This is a great avenue, as a practitioner, to enhance the quality of care with which they could improve on, for their patients, concerning the uniqueness of the Pilates equipment. Regarding patient care, physical therapists are taught to focus on their patient's injuries and not to treat the patient as a whole being. Meaning, even though their knee injury will change the compensation patterns over time, in the kinematic change of motion in their leg during movement, the therapist only has a very limited amount of time to help their patient, so all their efforts are laser focused on the injury or condition. Contributing to that narrow focus, for patient care, is the present standing with which therapists must challenge insurance companies to even be approved to treat their patients, in a reasonable number of sessions, as insurance companies now dictate patient care.

However, the discussion of insurance companies and patient care is a whole other blog post topic to tackle, maybe even two or three, and an essential topic on direct access to physical therapists within the first 30 days of necessary treatment.

Conversely, as a Pilates teacher, I was taught to see the client, before me, as a whole person, a multifaceted and unique individual. I learned that our clients are more than their injuries and the pain they come to see me for. This didn't change how I see patients when I entered school after 15 years as a Pilates teacher, cultivating all the nuances and uniqueness that my Pilates world taught me. Initially, In fact, it was a detractor to my learning the didactic curriculum, in contrast with the years I spent practicing in a Pilates studio. This granted me the experience of learning in a "Pilates lab-like" environment. So, what school DID show me was, biomechanics in the physical therapy-world is the SAME biomechanics in the Pilates-world. Human beings can ONLY bend their elbows and knees in one direction. If perhaps through an acute injury, their elbows or knees go in the opposite direction, then for certain, they MUST seek the care of an orthopedist, first, and subsequently, a physical therapist for rehabilitation, with or without a doctor's referral, within the first 30 days. Although, Joseph Pilates had no science and/or medical background, he gained his knowledge of health and the human body by learning and appreciating movement through many movement disciplines and practicing on his own body, learning to live an exceptionally health life, in body, mind, and spirit. Additionally, he spent his childhood, sickly and lost his left eye when he was 5 years of age. (1)

In the truest spirit of movement, Pilates and Physical Therapy are one in the same and what makes them different is ONLY the intention to which movement is practiced. Both disciplines are based in the science and physiology of movement. Physical therapists have more tools at our disposal, and incorporate differential diagnosing, coupled with advanced treatments and therapies not available to Pilates teachers due to state board licensing. And, legally, physical therapists are allowed to place their hands on their patients whereas Pilates teachers are prevented from this manual technique.



The union of those two physical acts are what both disciplines are based on: neuromuscular repatterning and rehabilitation as well as increased endurance and strength. As I have always told my clients, over the years, "It is ONLY exercise". AND IT IS! True, physical therapists have a state board license, and we must meet certain criteria to achieve our license, but, the bottom line of both areas of practice is....MOVEMENT. The DIFFERENCE is the language, terms and intentions.

Regarding their clients, the division line between the two fields of practice is how Pilates teachers help their clients. They have an enormous advantage in the tools they have to work with, for neuromuscular rehabilitation. He specifically designed his equipment for very specific purposes, concerning varied injuries and general exercise, with each piece within his system, to be used in a manner which he deemed to have a purpose in approaching exercise and rehabilitation and the whole set of apparatuses are an integrative systematic approach to movement and rehabilitation.

Today, Pilates teachers use Joseph's unique spring-mechanized, geometrically shaped equipment with his original purposes in mind. However, in general, most physical therapists, and now more Pilates teachers, do not have the training from the Pilates world from "The Pilates Elders". "The Pilates Elders" have extensive knowledge of Joe, his work history, when he was alive and working, and are at some level either have been a direct student of Joe's and/or apprenticed with a first generation teacher.

Today, physical therapists do not have a deep understanding of how his geometric equipment should be utilized. The Pilates method, originally named by Joe as "Contrology", has been taught by our "Elders", and second generation teachers, which they have contributed extensively to the historical knowledge and imbued our Pilates world with an extensive historical perspective which is not honored by the physical therapy world of practitioners. For example, a common misconception is that The Universal Reformer is only meant for traditionally prescribed squats. This IS NOT the original intent. How he designed movement on all his equipment pieces was to challenge, exercise, and rehabilitate his clients. His initial choices, for equipment assistance, depended on what his client's specific challenges were. He specifically targeted a person's ability to restore function, when "restoring function" wasn't truly a medical construct with the direct meaning as it is used today. Joseph made clear that movement and exercise were the foundational underpinnings of health, in all areas of one's life, everyday and without exception. He even practiced his mat routine when he was a prisoner of war during World War I and trained other prisoners in his method. (2)

Knockaloe internment camp, Isle of Man, as it was in 1915

Photograph by Knockaloe Charitable Trust

For Joe, health & wellness were inextricably linked and to achieve one meant a person was successful in achieving the other. He also specifically designed his equipment for very distinct purposes with each piece of his system of apparatuses to be used in a manner which he deemed to have a purpose in approaching a specific exercise for rehabilitation from one aspect of movement.

For example, the Wunda Chair was originally designed for a client, who resided in New York. They wanted a piece of equipment that they could have in their home. Joseph Pilates created that specific chair and also ensured it functioned as a piece of furniture which encouraged upright posture by designing it as such. If a person takes a traditionally designed Wunda Chair and turns it on its side, they will be able to sit on it, and it will have its own cushion. (3) The below sketches show the beginnings of a patent that Joesph sought for his Wunda Chair.

For a detailed about Joseph Pilates and his historical records - please visit the below link

A Wunda Chair demonstration - please open the link below in a new


Along the same lines, he designed a bed which did not have the same appeal though he explained its purpose for better sleeping. Its name "The Bednasium" was not well received, and hence, did not flourish as a complimentary piece of equipment, for overall health. (4)

For a demonstration of the Bednasium - please open the link in a new wondow

Additionally, his Universal Reformer, is about alignment, seen in the gravity-eliminated, transverse plane. Foot-ankle-knee-hip/pelvis-spine-temporomandibular alignment which also gives the therapist the ability to see a patient's line of gravity, as it has been displaced against what should be normal alignment. And, his sequencing of exercises begins with "footwork". What is "footwork"? Footwork is about gait and ambulation in the anti-gravity plane despite it looking like "squats" in the gym (and it is squats in the gym; known as plie's for dancers). It is also about his history of some reflexology, or rather quite specifically, his understanding of how the foot has many points of contact that can be stimulated to help "awaken", or rather stimulate the feet, in the beginning of the Universal Reformer's repertoire.

Youtube video of Joseph Pilates working with his student on his Universal Reformer

Técnicas de Joseph Pilates hospedan

Joseph's life was dedicated to attaining and maintaining the best health possible. To accomplish this, along his life span, he developed a multitude of machines and small equipment pieces to enhance one's health. It would enhance and augment the world of physical therapy and rehabilitation.

And yet, the Pilates world is not well received by most physical therapists, as a whole and as a profession. This needs to change. It will only change if physical therapists and Pilates instructors, as we are working for the same goals, need to be willing to reframe what they know and be receptive to learning new ideas and listening to each other.



1) Ewing, Elaine. The history of Pilates by ELaine Ewing. Rhineback Pilates: . Date accessed: August 6, 2023.

2) Olarunshola, Yosola. The exercise phenomenon of born in a prisoner-of-war camp. National Geographic. November 29, 2021; Accessed August 6, 2021.

3) Rhineback Pilates. Original Pilates Patents | Pilates History Research. Rhineback Pilates. . Accessed August 6, 2023.

4) Lamb, Kira. Why Joseph Pilates' legacy will live forever. Kira Lamb. . Accessed August 6, 2023.


For a significant, indepth, history lesson on Joseph Pilates' life, please visit the following websites:

Dr. Erica Nelson, PT-DPT, MSSM, BSc, MLD

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