One of the challenges of teaching Pilates to patients is keeping all of your clinical skills front of mind. These skills include concepts of pathophysiology, pain science, biomechanics, load management and the biopsychosocial model to name but a few. When guiding a patient through a Pilates session, remembering the multitude of exercises, variations and cues, it can be easy to forget why the patient was doing Pilates in the first place.

Thinking about this ongoing challenge made be remember the 2001 classic film Zoolander. Stay with me here …

During the Slashie Award scene below,  male model Fabio receives his award and thanks the audience for confirming that he is now seen as an actor/model and not the other way around.

So, how is this relevant you may ask?

Providing patients with best practice Pilates requires the clinician to start each session reminding themselves that they are a Clinician/Pilates teachers and not the other way around.

As a clinician, we should use our knowledge of Pilates repertoire to select the most evidence-based exercises based on our initial assessment, patient goals and current rehabilitation guidelines. For example, in leading a patient with patellofemoral pain through a Pilates session, a Physio/Pilates teacher would first consider what does the evidence suggest regarding the management of this condition. Once established they would then go on to think about which exercise series, pieces of equipment and/or principles are best indicated.

This may be in contrast to the Pilates teacher/Clinician who may skip the clinical reasoning step and use less efficacious exercises such as reformer leg press on a high foot bar (loading the knee in higher degrees of knee flexion), reformer feet in loops (nice exercises but may take time away from other more valuable ones) and fail to provide the appropriate education regarding load management during the weeks ahead.

To continually remind yourself of your Clinician/Pilates Teacher status, here are a few key points.

Before each session review the following:

• the patient’s working diagnosis
• which outcome measures (subjective and objective) need to be assessed
• what your plan was following the last session

During each session, ensure you:

• Remind your patient (and yourself) of the session’s goals
• Reflect on your patient’s progress as if it is going to plan
• Provide the relevant education

At the end of each session:

• Highlight the positive aspect(s) your patient’s session (sometimes it may be that they turned up despite not feeling great)
• Discuss the main parts that need to be address i.e. single leg balance
• Establish a plan/goal for the next session i.e. introduce jump board exercises

I discuss this concept in more detail on the Pilates Essentials for Physiotherapists course.