My Opinion on the Pilates vs Physio Debate

Over the past few years, the Department of Health introduced the review of natural therapies in its campaign to remove private health rebates for low-value care. From April 1, 2019, clients will no longer be able to claim a private health rebate for any service involving Pilates, regardless of who is instructing them. Over the last 24 hours, both the Australian Physiotherapy Association (APA) and Australian Pilates Method Association (APMA) have released their position statements. Unfortunately this has sparked an ‘us versus them’ mentality that affects me both professionally and personally.

I was trained through the APMA and was practising as a Pilates instructor long before I was a qualified and registered physiotherapist. I continue to feel the pull from both sides of the debate, despite working harmoniously within both industries for over 10 years, and I completely understand the arguments from both the Pilates practitioners and the physiotherapists.

Some in the Pilates industry may feel the APA is trying to steal the intellectual methodology of the Pilates Method and limit the credible use to physiotherapists. This is incorrect. The APA has taken a stand for its members and lobbied for exercise classes conducted by physiotherapists to be recognised by the Department of Health and therefore the Private Health Industry (PHI), on the basis that it is high-value evidence-based health care, and for this to be reflected in the ability of clients to claim a private health rebate. It’s as simple as that.

The Department of Health, the PHI and the APA have all agreed that physiotherapy is physiotherapy, and physio exercise classes can include exercises drawn from Pilates but must not consist solely of Pilates. Basically, in order for clients to claim a private health rebate, physiotherapists are no longer allowed to market any classes as ‘Pilates’ in any way, shape or form. Our clinical notes, advertising and timetable must reflect this. I must comply with the Australian Health Practitioner Regulation Agency, comply with the APA, comply with the Australian Physiotherapy Council and comply with the APMA. My responsibilities to my profession and my clients are huge and I am held legally accountable. What we could once call “Pilates” will now need to be called something along the lines of “Group Exercise Class” – which I feel is an accurate amendment. Physiotherapists and physiotherapy businesses will undergo huge changes over the coming months to adhere to these new guidelines, and quite rightly they should.

When I teach a ‘Pilates’ client, my exercise repertoire consists of things I have absorbed over the last 20 years from Pilates practitioners, musculoskeletal physiotherapists, sports physiotherapists, neuro physiotherapists, women’s health physiotherapists, strength and conditioning coaches, exercise physiologists, Pilates practitioners, yoga instructors, meditation practitioners, midwives, ballet teachers, dancers, running coaches…the list goes on. I utilise a vast array of equipment and props, some of which have been derived from Joseph Pilates’ traditional designs, many of which have not, and some that I have designed and created myself. I apply evidence-based knowledge to achieve objective and measurable improvements for my clients; I like to think I marry the science and the artistry. In saying that…I still consider myself a Pilates practitioner/instructor, yet will no longer be able to say I teach Pilates or mention it in my clinical notes or advertise Pilates as one of my offered services.

Industry shake ups happen from time to time, and I feel a PHI reform is necessary; I hate being a part of an industry where a client can do a ‘Pilates’ class at the gym with an instructor who attended a weekend training course, and receive a similar financial rebate as doing a Pilates class with a registered Pilates practitioner who has undertaken a recognised qualification, participated in countless hours of professional development and skill progression at considerable cost, and has thousands of hours of teaching and experience under their belt.

I cringe at seeing my extremely experienced and capable Pilates colleagues being overlooked by clients simply because they may not receive a financial rebate. I vividly recall the conversation I had with a new client who wished to start Pilates, and who chose to join a class taken by a new graduate physiotherapist with zero Pilates teaching qualification or experience, over a Pilates practitioner with 25 years in the industry, for the sole reason that they would receive a $6 benefit per class. This is a universal frustration across the industry for all suitably qualified and registered Pilates practitioners.

I also object to being made to feel guilty, by some in the Pilates industry, for having a physiotherapy degree, for what that brings and what ‘side’ of the debate they feel I must be aligning with. Even in writing this opinion piece, I am nervous about how it will be received by my peers. I am piggy in the middle and it’s not a nice place to be at the moment. I believe there is space for everyone.

I feel worried for my colleagues and mentors who have taught me as a client since I was 12 years old, and whom I have worked alongside professionally for 12 years. I empathise and understand the concerns of what these changes may do to your profession, business and livelihood. I promise to continue educating my clients to understand the immeasurable high value of a fully qualified and registered Pilates practitioner and to seek the appropriate teacher for them.

Give credit where credit is due – Joseph and Clara. I encourage physiotherapists who have been teaching Pilates as part of their treatment to research the history of Contrology (which later became Pilates) and how it was developed, shared and passed down through Pilates instructors of all backgrounds – what physiotherapists teach now is based on their work! Physiotherapists must not lay claim to pioneering the Method when this is simply not true.

With my physiotherapist hat on, and for practitioners who have a similar background/training to me, this outcome for the APA is both professionally and ethically appropriate. I think it’s a necessary change and welcome the reform. I also think it’s a positive outcome for my Pilates colleagues, as physiotherapists (and all other allied health practitioners) will no longer be able to use the term ‘Pilates’ in their marketing and clinical practice.

My primary focus is always: what will be best for this client? The client experience must always be the first priority. In my clinical experience, for so many years Pilates practitioners and physiotherapists have worked together to achieve great outcomes for their clients. It breaks my heart to think that this harmony and sense of community could be lost, ultimately because of a financial motivation. It is the responsibility of physiotherapists and Pilates practitioners to educate and empower their clients, to make the best decisions for the clients, with the clients best interests at heart.