OVERLAND PARK, KS — Pilates instructor Alyson Limehouse has a client with stage IV lung cancer. The client has side injuries from surgery relating to the cancer and is undergoing chemotherapy treatments. Instead of halting workout sessions, the two do a Pilates workout for 50 minutes and spend the rest of the time focusing on cancer-related injuries.

Limehouse, of Sunset Pilates Fitness, Palm Beach, FL, recently started Coping with Cancer Through Pilates, a program that focuses on patients in any phase of cancer. She works individually with clients, targeting problem areas and relieving fatigue and anxiety symptoms related to the disease.

“My studio is small,” she says. “When someone is in with cancer, I may or may not play any music. It's very quiet, very serene. They need that kind of peaceful, healing environment.”

Pilates is increasingly being used for rehabilitation, providing a growing revenue stream for club owners, but those revenues can be depleted if operators don't pay heed to potential liability issues.

Pilates advocates consider the exercise method a useful rehabilitation option because of its low-impact level. Rehab Pilates can treat a variety of ailments, such as neuromuscular disorders, Fibromyalgia and cancer.

Some of Limehouse's rehab clients attended her Pilates classes before they were diagnosed with cancer and then moved into her rehab classes. However, most of her rehab clients came to her after receiving their diagnosis. Limehouse, who received her certification from Polestar Education, charges $140 per 90-minute private session.

Aquahab, Cherry Hill, NJ, offers general rehabilitation services with a physical therapist. Many of the clients are nonmembers referred to the club by doctors. Charging between $55 and $85 a session, the club brings in $300,000 per year from rehab Pilates programming.

When patients are released from physical therapy, some of them choose to participate in Aquahab's Pilates rehab program, which is led by Pilates instructors who also have physical therapy training for post-rehabilitation. A few nonmembers join the club each month after participating in rehab Pilates sessions, says Matt Littman, president of Aquahab.

Clients at Sunset Pilates Fitness pay for their classes out of pocket, but many of the Pilates rehab clients at Aquahab are reimbursed by their insurance company, Littman says.

Rehab Pilates programming is great for both pre- and post-rehab patients. The programming allows therapists to give clients an exercise or movement they normally may not be able to do, says Ken Endelman, founder and CEO of Balanced Body, Sacramento, CA. Exercises are modified to meet the specific needs of each individual patient.

“If there is an impairment in the quality of your life as it pertains to movement, then Pilates is a pretty decent environment to reintroduce that,” says Brent Anderson, co-founder and president of Polestar Education.

Club owners who are considering adding rehabilitation to their Pilates programming, however, need to be cautious, Endelman says. Pilates fitness instructors using Pilates as a form of rehabilitation for members is a potential liability disaster.

Carol Tricoche, director of full solutions at Stott Pilates, Toronto, agrees, saying that club owners should offer Pilates rehab only if they have a physical therapist on staff. The Pilates rehabilitation program at Stott Pilates is specifically designated for licensed physical or occupational therapists, chiropractors and doctors of sports medicine. Improper training and credentials may lead to patients aggravating injuries further, leaving the instructor and the facility liable.

Amy Simelson-Warr, clinical supervisor in the rehabilitation and physical therapy departments for Aquahab, says: “Liability is an issue, certainly, if you have trainers that have no certification at all. I think that's an issue, but I also think, too, that there's always a potential to sustain an injury whether it's a strain or whatever else. It's all how you represent yourself.”

When a physical therapist also has certification as a Pilates instructor, it benefits both the instructor and the facility. Rehabilitation Pilates instructors receive more money (averaging at about $35 more an hour) than those who do not have both certifications. They also bring in a more diverse group of clients because they are treating a broader range of clients than those who are well and fit. And their broader area of expertise means that a club can often charge more for their services.