Cover Story: Above and Beyond

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April 2005

By Ben van Houten

Beyond Physical Therapy uses Pilates to get patients back on their feet.

Cindy Wood still laughs in amazement as she relates the story. Early in the existence of her rehab facility, Beyond Physical Therapy, Marina del Rey, Calif, a male athlete limped in complaining of upper neck and ankle pain. “His surgeon had told him there was nothing more he could do for him,” says Wood, a physical therapist and owner of the 5-year-old facility. “So I started working on his neck first. By the time I got around to the ankle a few weeks later, he said his pain there was completely gone—even though I hadn’t done anything to it.”

No, Wood is not a miracle worker, despite this apparent “miracle” cure. She is simply a physical therapist using the Pilates method of physical and mental conditioning to help rehabilitate injured patients. Wood, a 1991 graduate of California State University-Long Beach, along with her 30-person staff, is one of a growing number of PTs using this ever-popular exercise method to treat everything from lower back pain and musculoskeletal injuries to arthritis and neurological diseases. No longer just a series of trendy exercise videos, Pilates is actually being used more and more by facilities such as Beyond Physical Therapy to improve performance in athletes following injury. Pilates, which trains patterns of movement as opposed to isolating individual muscle groups, can lead to fewer injuries, better coordination, and improved strength and flexibility, according to Wood. “If you’re treating a shoulder, you’re treating the patient’s trunk at the same time,” she says. “No other form of rehabilitation works that way.”

PILATES: TRAINING THE CORE
According to Wood, Pilates reintroduces movement with nondestructive forces early in the rehabilitation process, which leads to an overall faster healing time. “It can literally cut the rehabilitation time in half, from 6 months to 3, for example,” she says. “Most people who come here get better faster.” Wood, who has been involved in sports medicine for 15 years, claims that Pilates is the best system for retaining long-term benefits to the muscles and joints. “Ultimately, you can increase muscle strength much faster than through traditional sports medicine,” she says.

Developed by German-born Joseph Pilates in the 1920s, the system incorporates elements of yoga along with his own ideas on fitness. The method focuses on postural symmetry, abdominal and spine stabilization, mind/body control, and utilizing the complete range of motion of all the body’s joints. “You’re really integrating both the upper and lower extremities along with the trunk,” says Wood. “You’re not just isolating certain muscle groups, which a lot of physical therapy does for sports injuries.” She adds that strong, lean muscles with equal strength ratios usually result.

As a form of rehabilitation, Pilates has typically been used for treating injured dancers. For example, dance medicine programs became quite popular in hospitals and clinics in the 1980s. But in the 1990s, says Wood, more rehab practitioners started to use the method for the treatment of orthopedic injuries, chronic pain, and neurological diseases. That is because Pilates integrates the entire body. “It incorporates all levels,” says Asha Habas, a Pilates instructor and PT at Beyond Physical Therapy. “Physical, mental, and emotional levels are used, and it aligns the body back to its center or core.”

Habas, in her fifth year of Pilates instruction, says she has never been involved in an area of physical therapy that has been better for both instructor and patient. “This is what I feel most passionate about,” she says.

The “reformer” approach, which utilizes some of the equipment designed by Joseph Pilates focuses on stability and control of the body.

Pilates is designed to integrate mind, spirit, and physical body. “You’re training your body to work together as one. All of your body parts and muscle groups,” says Wood. “It can make you stronger, give better balance and coordination, and help with stability. The stronger your trunk and abs are, the stronger your arms and legs are.”

Other PTs seem to agree with Wood. “It’s one of the better treatment methods for rehab,” says Sherri Betz, PT, of TheraPilates Physical Therapy & Gyrotonic Clinic, Santa Cruz, Calif. “When you strengthen the body’s core, in theory you can help heal injury and also offer better balance to prevent falling, for example, in osteoporosis patients. The manner in which Pilates supports abdominal stability and protects the spine is really unmatched.” The system ultimately works by strengthening the stabilizing muscles, which lie close to and support the spine, she adds.

A VARIETY OF EXERCISES
Beyond Physical Therapy uses a hands-on approach with its patients, says Wood. Instructors begin with hour-long consultation sessions that include a comprehensive evaluation of a patient’s physical status. At that point, the instructor combines the patient’s personal goals with a professional, customized program to help achieve them. “We really spend the time with the patient, getting their feedback and listening,” says Habas. “It’s all about goals, such as being able to swim or play basketball again, instead of simply having a healed foot or shoulder.”

Habas and the other eight Pilates instructors at the facility focus on a three-pronged approach to rehab, using equipment, mat exercises, or posture-building activities. The “reformer” approach, which utilizes some of the equipment designed by Joseph Pilates, focuses on stability and control of the body. “The equipment uses springs and gravity to assist injured patients in completing movements successfully,” says Wood. “We can alter the spring tension or increase the gravity level, allowing a patient to progress faster toward functional movement. In addition, we teach breathing exercises rooted in yoga along with ab, arm, and leg strengthening.”

The use of equipment is also an important marketing tool for the practice, according to Habas, since many people are familiar only with the floor mat version of Pilates exercises. “That’s a misconception, that Pilates is very hard to do,” she says. “But in reality, that’s because they might have had exposure only to the exercise videos that use the mat exercises. Patients are surprised to find out there is actual equipment involved that makes it much easier.” In fact, most of the practice’s Pilates workouts for rehab are done on the equipment.

The method taught at Wood’s facility is designed to keep patients’ joints in a neutral position, she says, which helps muscles avoid biomechanical stress and leads to better alignment. Also, through engaging the pelvis with the transverse abdominal muscles, optimal stability can be achieved. Finally, the Pilates breathing exercises are designed to help keep the lower abdominal muscles close to the spine, since breathing is directed laterally into the lower ribcage.

Beyond Physical Therapy also tailors a Pilates program specifically for osteoporosis patients. Like the other programs, it focuses on building strength, but it also stresses improving and maintaining correct posture. “We start that program using the same form as the other Pilates methods, at different levels,” says Wood. “Basically, through the weight-bearing exercise, patients can improve the quality of their joints and also produce compression through the spinal area. It’s a powerful and safe method of treating the disease.”

Beyond Physical Therapy owner Cindy Wood, PT, assists patient Steven Stockton with an exercise on a Pilates machine.

Wood also notes that Pilates can be used to rehabilitate patients with compression fractures in the spine. “We can actually create programs for any type of sports injury,” she says. “We see the method as very versatile.”

Beyond Physical Therapy is a two-story, 3,107-square-foot facility that contains primarily Pilates equipment. The main floor features a gym with most of the equipment, as well as a wide range of traditional sports medicine machines and exercise aids such as medicine balls.

On the periphery of the main floor gym are seven private treatment rooms, where patients receive one-on-one instruction in individual Pilates sessions with physical therapists. Wood’s staff also offers several types of massage in these rooms. Additionally, patients can take Reiki sessions in this area of the facility. Reiki, which dates from 19th-century Japan, is a massage-like treatment that is designed to relax and heal the body, according to Wood. At Beyond Physical Therapy, the practice is used to treat acute and chronic conditions including arthritis, multiple sclerosis, and lupus.

The facility also contains a studio on its second floor for additional Pilates, mat, and yoga classes, she says.

Wood also notes that, because of Pilates’ growing popularity, more insurance carriers are offering to reimburse it in their policies. Beyond Physical Therapy is a Medicare provider and “accepts most insurance,” according to Wood. “More and more, Pilates is being recommended by health practitioners, so more insurance providers are covering it,” she adds. To that end, Beyond Physical Therapy recently became a provider of Pacific Health Care Systems, which covers more than 200 insurance companies in Southern California. Thanks to this addition, Wood’s facility is now able to be a provider for members of the Directors Guild of America and the Screen Actors Guild.

CHALLENGES
But even though the staff at Beyond Physical Therapy is clearly committed to using Pilates for rehab, there are some distinct challenges involved. Although Pilates is currently the subject of much medical research and could become more common among rehabilitation experts in the future, it is not necessarily widely accepted or even widely prescribed in the rehab community, despite its clear benefits. “We’re definitely not your typical clinic,” says Wood. “I also wouldn’t consider us to be a medical model. Rather, we’re doing what we think is the best way to treat injury.”

In addition to a possible lack of overwhelming scientific and clinical support for Pilates, there is the challenge of the exercise method itself, which presents rehab patients with a unique way of training. “It can be very difficult to teach someone about conscious-awareness,” says Habas. “You really have to learn to be ‘in the moment’ to do this successfully, and you also have to learn to breathe and move from the inside-out. It can be hard to teach someone that if they’re not used to it. It isn’t at all like using traditional weights, even though people are used to that approach. Honestly, I’d say it takes about 10 sessions for patients to fully grasp the principles behind Pilates. Not everyone has that level of patience.”

But for now, Beyond Physical Therapy has more than enough interest in its rehab methods. The practice began in December 2000, with just four people, notes Wood. “We now have more than 30 people here, and eight full-time Pilates instructors. There’s no doubt we’re in a growth trend right now.” Wood also states that the facility earns more than $1 million in revenue each year on average. “It’s significant revenue for an alternative rehab facility,” she says.

Going forward, she envisions more success and more interest from the rehab community. “You know, orthopedists love us, since we’ve had so many knee patients do well after going through our Pilates training,” she says. “I’d expect more of that, in all disciplines, as patients start to learn more about the benefits.”

Ben van Houten is a contributing writer for Rehab Management.

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April 2005