Moving Pilates Methodology Forward

When I work with clients I find myself constantly adjusting and changing my plan to the needs of the person in front of me. It is mentally stimulating and my clients appreciate the dance and constant tailoring to their needs. When student’s observe me they have this startled look on their face thinking that they will never be able to achieve this. Over time, as they start to understand the complex decision making process of a Pilates Method teacher, they too start to problem solve and create layered and considered classes. In working with my students I have had to find ways to help them understand the “decision making tree” of  “if this then that”. In working with my students I realised that I needed to create a more specific tool to support their decision making and analysis.

I had to start by revisiting some fundamental questions: What is Pilates, what does the name mean and who and what does it incorporate? It made me stop and think that maybe it's time for a different perspective in how we train and consider what a pilates method practitioner does. The perspective I am proposing is to move away from labeling, towards a lens focusing on how Pilates practitioners approach their work within different contexts. In other words, identify the modality of a Pilates method practitioner from their perspective of problem solving. Let’s explore “what we do and why we do it”  rather than giving it a name or label. I am proposing that such an approach requires the development of a model of practice and, once established, that model then informs a practice framework for assessment and programmed interventions.

This article is intended to inspire a discussion and possible ways of moving the debate to looking through the lens of the practitioner and their rationale in the use of the equipment and repertoire they choose for their clients. Such an approach could support clearer communication of ‘what is a Pilates method practitioner’, and ‘what are the underpinning considerations in their decision making’. It could also help explain the process that supports the decision making tree that each pilates practitioner undertakes when developing a program and responding to the changing needs of their client.

Why use a model of practice?

A model of practice is used by different modalities to define and create boundaries between that profession and other professions or even within specialties within their professions. As Pilates professionals we are often trying to differentiate ourselves between different disciplines that use the name Pilates, but use the term in a different manner or context.

Occupational Therapists (OTs) use many different models of practice to differentiate their approach and focus from other disciplines when there is an overlap between their work. An example is the PEO model (Law et al.,1996) for OTs, which states that when an OT works with patients they are considering the Person, Occupation and Environment. Each element informs how the therapist then considers what is happening with their client and how they gather information to inform their interventions.

Physiotherapists often use the Biopsychosocial model (Engel, 1980) and at times Pilates practitioners refer to this model when working with clients with chronic pain.

Essentially a model of practice is the lens from which a particular discipline approaches their work. A model itself is not evidence based but rather a synopsis of the approach of the discipline that informs decision making. Once defined this informs the practice framework which that discipline uses with their clients. In the case of Pilates this is an overlay before we consider how we work with clients and that work, also known as the ‘process’, is informed by our Pilates principles.

Once a practitioner has identified their model and the collection of information an intervention would commence using what is known as a Practice Framework, which needs to be evidence-based.

Why is this important?

In establishing a Model of Practice we create a foundational lens to move away from the arguments about ‘What is Pilates’ or whether Pilates is evidence based. It allows us to clarify how we see the world and what makes a Pilates practitioner different from an allied health practitioner or fitness practitioner. Once we have this lens clarified we can then focus on the evidence base of how, and with any particular sub-specialisation of the profession ie; classical, contemporary, somatic and so forth.

A proposed concept of what should be considered in the development of the movement model for Pilates practitioners - the Model of Person, Activity and Movement (PMA).

This movement model is based on an assumption that “change happens through movement and movement heals.”(Pilates.J). The model assumes that the human condition “does” movement and our state of well being is contingent on “well doing”. This model would include elements beyond just the Person as detailed in the Biopsychosocial model. Separate to the components of the person is their movement and activity goals. Movement is where the Person and their state of health and activity goals overlap through movement. See figure one.

Figure 1

Practitioners from other contexts e.g. acute rehabilitation or fitness, approach their work differently when working with clients particularly to the use of movement e.g. a fitness practitioner would use an exercise lens and not a movement lens.

This model proposes three elements:

-       The person

-       The goals and activities of the person

-       Their movement and how movement patterns impact on the function and participation of that person in their goals and activities.

The elements of this model

The person in such a model requires us to take a holistic approach looking at the person and their health. The International Classification of Functioning, Disability and Health – ICF (WHO, 2001) developed a classification and explanation of the health and characteristics of a person and ways of examining how this impacts a person’s participation and function. The classification integrates the biopsychosocial model used by many practitioners and expands it to a more functional application to the person. In our proposed model we are stating that this is one of the elements that needs to be overlaid and integrated from a movement practitioners’ lens.

Movement of the person in the context of a movement studio and how that movement transfers or could be transferred into daily activities. The perspective of movement includes observations of the person’s health condition e.g. biomechanics, sensory systems, cognitive processing and the role of gravity. The process of movement is supported by a framework of assessment which would be linked to the scope of practice for a movement practitioner. For instance a Pilates movement practitioner draws upon detailed observational skills which are developed as part of their training and consolidated from professional experience.

Self efficacy of the person is built through intelligent movement interventions that support the achievement of movement or activity goals. The person is the central part of the process and the practitioner is a facilitator rather than an expert guru imposing solutions on the individual. This approach is an important distinction to an allied health/medical practice in which the practitioner as the expert and the client is required to comply with specific protocols. Lack of adherence to the program and protocols is considered a failure on behalf of the client. When following a movement model approach the client is the expert and that the practitioner is facilitating change through intelligent application of movement and modifications to the needs and goals of the client.

The context of the practitioner e.g. fitness, clinical or comprehensive Pilates method defines whether the Model of Person, Activity and Movement (PMA) is applicable.

Movement is different from exercise. It is important to note that we use the term movement rather than exercise or physical activity. Exercise should be considered an intervention strategy not the overall lens at which we are looking and assessing the person. Physical activity is any bodily movement that involves your muscles and expends energy. That includes simple movements such as climbing stairs, walking to work, raking leaves, strolling with your dog or playing with your kids. Exercise is physical activity that is planned, structured and repetitive. Examples include bicycling, swimming, using an elliptical trainer, brisk walking and running (Caspersen CJ, Powell KE, Christenson GM, 1985).   

A Pilates practitioner uses their movement lens when considering the clients health and movement goals but also how they explore and assess their client. For example, a movement practitioner uses dynamic movement assessment techniques not measures of exercise performance. Embodied movement is considered a key outcome for a client.

Context of the practitioner

I would propose that the use of this model could allow us to distinguish between three main contexts of practice. These contexts define the practitioner's relationship to the client but also the overarching focus. Each of which would then inform the focus and approach of that practitioner and application to the model to that professional discipline. The contexts I would consider are:

Acute rehabilitation - Defined by specific protocols for injury and in the context of an insurance based model for specified outcomes. In this context the practitioner may be using Pilates informed movement for working with a patient eg in the first three months post hip replacements. Practitioners delivering acute rehabilitation would be working within specific protocols and outcome is time limited defined more by the lens of another profession e.g. physiotherapy and application of modalities such as hands on manipulation, exercise and other mediums to specific body part of that person.

Pilates method - the practitioner using the Pilates method as the medium for their intervention and the relationship of client and practitioner is a continuum over a period of time. In this context the relationship and goals evolve and change in response to the clients evolving health and movement priorities.

Fitness - Involves an exercise based rather than a movement based lens. That is the assessments undertaken are primarily exercise driven e.g. the performance of a squat on the basis of endurance or strength. In this context the practitioner may use Pilates informed exercises or apparatus, but their lens is not of movement and therefore they are not working within the Pilates movement model.

Summary

Developing a Movement Model for Pilates Practitioners will support practitioners operating within the lens of movement, which is distinct from allied health or fitness practitioners. Such an approach allows us to define the idea of what Pilates is, upon which we can build clarity about the practice of Pilates. By having clearly defined terms of practice, it allows all movement professionals to work within the scope of our education and training. Models help to clarify the substance behind the labels of acute rehabilitation, Pilates and fitness for consumer protection and training. It allows us all to identify a distinction between Pilates method practitioners and Pilates as a marketing ploy. This proposal is not presented as a fete accompli but rather as a think piece to start discussions and develop ideas.

Watch this video with Carla Mullins now

Carla is the co-director and co-owner of Body Organics and Body Organics Education. She is also an educator, creator and designer of the Australian-made Markarlu. You can find out more bodyorganics.com.au/education/

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References

Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985 Mar-Apr;100(2):126-31. PMID: 3920711; PMCID: PMC1424733.

Engel G. The clinical application of the biopsychosocial model. Am J Psychiatry. 1980;137:535–544

Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The Person-Environment-Occupation Model: A Transactive Approach to Occupational Performance. Canadian Journal of Occupational Therapy, 63(1), 9–23. https://doi.org/10.1177/000841749606300103