ABOUT PHYSIO-LED PILATES

Further information

Over the years, many different approaches to Joseph Pilates' original exercises have prevailed.

The APPI (the Australian Physiotherapy and Pilates Institute) realised early on that Pilates has an important role to play in the prevention and rehabilitation of a wide range of injuries. It was also clear that in order to fulfil its enormous potential in the clinical arena, traditional Pilates would have to be modified.   The APPI has worked hard to achieve this, resulting in a graduated system of specific exercise rehabilitation progressing through to a highly functional and recreational program.

The overall aim of the APPI Pilates method is to develop the deep, postural 'core' muscles that support the spine throughout posture and movement, enhance normal movement patterns and improve overall body alignment. The final result is the creation of a body that is more efficient in daily activities and less prone to future  pains and injuries.

Once a stable 'central core' has been trained in static and dynamic postures, the APPI Pilates method progresses the aim and intensity of each exercise through use of differing levers (by using various arm and leg movements), positions (from lying, to standing, to sitting movements) and resistance.  The APPI Pilates method also trains this normal movement with appropriate breathing control which is the essence of the mind-body approach to Pilates.

The result is a system that works equally well for those recovering from injury and for those who are fit and well and want continue to be so.

The APPI Pilates method will help you to develop better posture, a strong foundation to support your back and a long, lean, muscular system which combines strength with flexibility. Thus you will achieve paramount body form, capable of creating optimal movement at all times with ease.

Physio-led Pilates fro Bone Health

Osteopenia means low bone mass. This means that the bone mineral density is lower than normal, but not low enough to be considered osteoporosis.

Osteoporosis is a condition in which the bones become so porous and weak that they are likely to break from a minor injury. A person with osteoporosis can break a bone from a minor fall, picking up a bag of groceries, or even from sneezing (in severe cases).

While the most common fractures occur in the hip, vertebrae (bones in the spine) and wrist, fractures can also occur in many other places. The areas mentioned have a high level of spongy/ trabecular bone which is more fragile than in other areas.

Bone density loss slightly increases as part of the natural ageing process. It is more rapid in women for several years after the menopause. Bone density loss can lead to osteoporosis. The main factors which tend to correlate with osteoporosis are genetic, gender, and age. However, there are many other conditions which can lead to osteoporosis at an earlier age, including breast and prostate cancer, diabetes, early menopause, eating disorders, auto-immune disorders, to name a few.

Osteoporosis is very common. 1 in 3 women over the age of 50 will experience osteoporotic fractures, and 1 in 5 men. Often, breaking a bone is the first sign that you have osteoporosis. Some people learn that they have osteoporosis after they lose height, because of one or more broken bones in the spine. The breaks can even occur without any noticeable pain.


Weight-bearing exercises will strengthen the bones.

Strengthening the muscles that hold the spine straight and upright is important. They are called your erector spinae.

If you have osteoporosis you need to remember an important rule when exercising or going about your daily activities. Avoid loading your spine into flexion (i.e. a forward bent position). Loading your spine in flexion can encourage crushing of the vertebrae at the front. So abdominal crunches and ‘hundreds’ with your head raised should be avoided.

Side bending of the thoracic (middle) and lumbar (lower) spine should be avoided, for a similar reason.




Someone with osteoporosis who has already experienced at least one vertebral fracture has a 500% increased risk of developing an additional fracture within 1 year.

There is a lot of evidence that Pilates can help. The main aim is to reduce falls and fractures.

Research shows that Pilates exercises working into extension decreases the rate of spinal fractures, while flexion exercises increases it.


The aim is to try:


  • progressively difficult postures that gradually reduce the base of support (the area between your feet);

  • dynamic movements that perturb your centre of gravity, ie. dynamic exercises to challenge balance;

  • to stress postural muscle groups, particularly including resistance work for the wrists and upper limbs;

  • to include weight bearing exercise for the hips, pelvis and spine;

  • to reduce sensory input (eyes closed).

‘Physio-led Pilates for Bone health’ covers all of these areas.

Melissa Robinson MCSP

I qualified as a Chartered Physiotherapist at St Thomas' Hospital in 1990 and have essentially worked in the speciality of musculoskeletal physiotherapy since then.

I have trained with the APPI to an advanced level, and now specialise in teaching Pilates to both the fit and well, and also to those with bone health issues, whether that is osteoporosis, some level of osteo-arthritis or age-induced balance and mobility issues.

I have found teaching Pilates to be highly rewarding - I have many clients who have recovered/improved from back pain, sciatica, spinal stenosis, trochanteric bursitis, neck pain and headaches to name a few. I have other clients who need a stronger core to cope better with their hobbies such as horse dressage, walking and running.

Pilates is beneficial to all.


Melissa Robinson MCSP

melissa@astilbe.co.uk