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The What, Who, How, and Why of Pilates from a Pelvic Floor Physical Therapist: Part 2

Last time we discussed what Pilates is. Now let’s address the question:

Who is it “for”?

I prefer the question, who can it help? Perhaps your goal is to get out of a chair with less assistance or run a 5k after delivering a baby— maybe you want to increase your hip mobility to polish your rock climbing technique, or maybe you just love the performance of Pilates itself and want to enhance your skill. Perhaps you are looking to increase your fitness level and find a sustainable way of consistently exercising to improve overall health and wellness. Maybe you have chronic headaches from sitting at a computer all day or maybe you have never felt comfortable or safe exercising because of a health condition. If any of these scenarios sounds vaguely familiar, Pilates may be for you.

Pilates was popularized by dancers and actors and so has developed this reputation of being exclusively for a specific body type, gender, socioeconomic status, and physical fitness level. But really, it has it’s roots in rehabilitation and can be beneficial to nearly anyone, regardless of body type, gender, age, physical function, experience level, and even income.

Body type

Imagine a Pilates student. What do you see? A pair of Lulu leggings, lean figure, able-bodied, caucasian? This is an extremely unfortunate stereotype in that it creates a perception of divide, specificity, and exclusivity. This image separates those who “fit” the Pilates “look” from those who don’t, designates a particular type of body that should practice Pilates, and suggests that only those who meet the physical criteria are invited to the party. Nothing could be farther from the truth.

Pilates is for any and all bodies; it is for EVERY body. And nobody should be made to feel that their body is not appropriate to participate. This goes for individuals of all shapes, sizes, and physical function. So why does this homogenized body image persist? One suggestion for why many (but definitely not all) longtime Pilates students tend to appear on the slender side actually has more to do with postural effects of the program, which places a heavy emphasis on lengthening and alignment of the musculoskeletal system. How the joints are stacked in relationship to each other has a lot to do with how our frame is perceived by the outside world, and thus, exercise that targets posture can impact our outward appearance and body shape. This is discussed in greater detail in our upcoming post on “Postural Corrections.”

While a consequence of practicing Pilates may be a longer, leaner looking frame, any and all body shapes and sizes are appropriate for the practice of Pilates. Pilates is designed to be modified to the individual participating, so in an almost paradoxical sense, Pilates is “one size fits all,” meaning any body can participate. Every exercise can be custom tailored, and my hope is that all bodies feel welcomed to try Pilates on themselves.

Unfortunately, there are not many popularized images of individuals with disabilities participating in Pilates; however, these folks may find Pilates to be a particularly beneficial means of engaging in physical activity. Because Pilates has such a diverse range of exercises and equipment, nearly everything can be modified to the physical capabilities of each body. Some physical therapy clinics are exclusively Pilates-based rehabilitation centers, and use the equipment and principles of Pilates to restore physical function to patients with neurological disorders and other physical limitations. So body type is not a barrier to practicing Pilates. If you have a body, you are a potential Pilates student.


Although women tend to gravitate toward Pilates, a good number of founding members of Pilates were male, including Joseph himself, and many professional male athletes across a wide range of sports use Pilates as cross-training. In fact, many of the Pilates exercises are inspired by martial arts and gymnastics, which often achieve higher proportions of male participation than Pilates. There is no reason why the demographics in Pilates studios should be so lopsided.

At PiLadies & Gents, LLC we are pelvic floor trained PTs, and we specialize in returning clients to function despite chronic pelvic pain and other conditions. Everyone has a pelvic floor and so we train male and female clients alike, and we have seen similar benefits in clients equally across genders. So gents, we welcome you enthusiastically to give Pilates a try! It might just surprise you.


Pilates traverses the lifespan. From pediatric to geriatric, Pilates has its place. It is a fantastic way to teach children to move their bodies in a coordinated way and reduce risk of injury while they are participating in sports and other recreational activities. While young bodies tend to rebound quickly from injury, they also tend to sustain more minor injuries due to higher levels of activity and less developed movement systems. I can recall repetitively spraining my ankles as a young one, which placed me at increased risk of chronic ankle instability as an adult. Participating in an exercise program like Pilates to teach me proper gait mechanics and stabilize my hypermobile joints would have been appropriate early preventative care to support the longevity of my musculoskeletal system.

Similarly, Pilates is extremely appropriate for maintaining strength, mobility, and independence into the later years of life. Many older folks have the perception that they aren’t mobile enough to practice Pilates; however, this perception comes from envisioning what they’ve seen in media, which is typically Pilates adapted for young adult fitness and is only one small fraction of how Pilates can be applied. Pilates programs can also be designed deliberately and safely with the older adult in mind. Often aches and pains associated with aging, like the discomfort associated with osteoarthritis (OA), limit our motivation for exercise. Equipment-based Pilates offers a gravity-reduced or eliminated way to move, decreasing stress on painful joints, while still mobilizing them, increasing the lubrication between joint surfaces, and thus decreasing pain and simultaneously building strength. Ever heard the phrase “Motion is Lotion?” One of the best things we can do for OA is to stay active, but learn not to overdo it. Kind of like Goldilocks; find that “just-right” balance. Training with a Pilates instructor, particularly one with a geriatric focus, can help you find that sweet spot.

Health Considerations

Because Pilates training incorporates modules on anatomy, function, and exercise precautions and contraindications for common health conditions, it is perhaps one of the most suitable forms of exercising safely with a health condition. Every Pilates school varies slightly in its curriculum, but in order to pass the National Pilates Certification Exam (NPCE) and achieve the title of Nationally Certified Pilates Teacher (NCPT) an instructor must complete 450 hours of comprehensive training on all Pilates apparatuses, as well as demonstrate mastery of principles of the movement system, exercise modification, and common musculoskeletal pathologies by passing a written board exam. Also, in order to maintain their certification, instructors must complete continuing education hours every two years, which are overseen by the National Pilates Certification Program (NPCP).

Thus, Pilates instructors are consistently improving their movement analysis and updating their personal training skills. They are well-versed in their scope of practice and know how to identify when a referral to another provider (like a physical therapist or physician) might be appropriate. For these reasons, individuals with health conditions or physical limitations can feel confident that their instructor has the qualifications to guide them through an exercise program safely. Finding an instructor who specializes in Pilates for your particular concern (neurological disorders, pregnancy/postpartum, scoliosis, osteoporosis, etc) may be even more reassuring that you are receiving the appropriate programming. While modification may be warranted given different health conditions, health conditions should not be a barrier to participating in Pilates.


Pilates is an excellent way to learn how to move the body. It is a movement retraining system after all. Many times we assume that if we have poor coordination or balance, we should not participate in something like Pilates, which attracts a lot of athletes and dancers— very skilled, advanced movers. But one of the many reasons that these folks can be attracted to Pilates is to improve their coordination!

If you have never really participated in sports or regular exercise, Pilates may be the best, safest way to get your body moving and develop motor skills, regardless of your stage of life. So don’t let your experience level deter you from trying Pilates. Most classes are stratified based on experience level so it is relatively simple to find a class intensity suitable for your present skill. Of course, individual training sessions will be even better suited to finding the appropriate level of challenge for you.


It is true that private lessons on Pilates equipment will generally cost you a little more than a standard monthly gym membership. Just like personal training sessions at a gym cost you more than independently using their equipment. This expense accounts for the expertise of the instructor and the equipment. However, expense is relative to value. If you have pain and dysfunction and a series of private pilates sessions teaches you to move your body more efficiently to reduce discomfort and restore you to participating in activities you enjoy, then maybe the benefit is worth the cost.

At PiLadies & Gents, LLC we are physical therapists and Pilates instructors, providing skilled one-on-one instruction, modifying exercise to your needs on that particular day for that specific task. We take a lot of pride in providing a safe, skilled, effective movement experience at a fraction of the cost of formal physical therapy. We believe that feeling good and being able to do the activities you need or want to do is priceless, but that’s a value determination that only you can make for you.

Our advice is to take advantage of sales when they crop up to test out an equipment Pilates session and see what you think. Experiencing it for yourself will be far more convincing than any words read on a screen.

Now, while apparatus instruction tends toward the more expensive side due to the costs of the equipment itself and the higher cost of instructor training relative to other forms of personal training, mat classes are generally quite affordable. Because less equipment is required, mat classes can be taught to larger groups, reducing the cost per person. It also makes mat classes more widely available, in both live and virtual settings. And this is a great segue way to our next question. Return next week for more information on how to access Pilates…

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