Thirty Pilates students sit on mats in the group exercise room at a health club. A young woman, who is trying to lose weight after having a baby via C-section, takes a seat in the back row and attempts to do the hundred, a traditional Pilates move. With her weak abdominal muscles, holding up her legs at 90 degrees is nearly impossible. Lower back pain then sets in as she attempts a rollup by relying on her momentum and the strength of her hip flexors.

This young woman is not alone. Nine million Americans strengthen their core muscles and improve their body's balance by participating in Pilates. However, only 30 percent to 40 percent of the 16,000 Pilates instructors in the United States are adequately trained, increasing the potential for injuries, says Kevin Bowen, a Pilates instructor who founded the Pilates Method Alliance (PMA), an association designed to protect the public by establishing certification and continuing education standards for Pilates professionals.

The prevalence of mat classes with large numbers of students and only one instructor just add to the problem. By teaching large mat classes in health clubs, Pilates instructors aren't able to give their students one-on-one attention to help them modify their moves to prevent injuries. With any exercise program, when the benefits are outweighed by the potential for injury, it becomes less effective, says Leslee Bender, founder of the Pilates Coach, an educational company based in Reno, NV.

“I don't believe that Joseph Pilates ever intended to have up to 30 people in a mat class,” she says. “What's happening is we're looking at it as a group fitness workout, and the perfection of movement in Pilates is being lost.”

To compound the problem further, many Pilates students walk into a class with a history of lower back pains, shoulder injuries or abdominal surgeries. Unknowingly, their instructors may ask them to do a rollup, which can injure the lower back, or do the hundred, which can strain the cervical spine. The human head weighs more than seven pounds, and it can be potentially dangerous for a Pilates student to keep their neck flexed for a long period of time, Bender says. While she doesn't have statistical evidence on the number of Pilates-related injuries, Bender says every chiropractor she talks to is treating patients who strained their lower back doing Pilates.

“It's crucial trainers know what kind of bodies they're dealing with,” she says.

Nora St. John, co-owner of Turning Point Studios, a full-service Pilates studio and teacher training center in Walnut Creek, CA, says she hears of more injuries now than she ever did years ago.

“Twice as many people are doing it each year, which is bound to increase the potential for injury,” she says.

Over the last two years, Pilates has gotten the reputation of being unsafe, which may be due to the popularity of the exercise method growing so quickly, St. John says. A landmark legal decision opened the flood gates for Pilates enthusiasts seven years ago when the federal court in Manhattan, NY, ruled that the Pilates Studio couldn't trademark the word “Pilates” because it was a generic term for an exercise method. When the four-year case was decided, the number of Pilates instructors and students skyrocketed.

“After the trademark lawsuit, everyone and their cousin was calling what they did Pilates,” St. John says. “Anyone who taught Pilates was able to get a job even if they weren't good at it. Pilates is a risky enough activity and needs to be taught by someone with a background in movement and anatomy.”

The booming popularity of Pilates is both good news and bad news for the industry, says Cedric Bryant, chief exercise physiologist for the American Council on Exercise. Pilates may have the reputation of causing more injuries than other types of exercise activities, but when it's properly taught, it actually carries a much lower risk, Bryant says. To reduce the potential for Pilates-related injuries, clubs and studios need to effectively pre-screen each new client, limit their class sizes and ensure their instructors have at least 400 hours of instruction consisting of a written class, observation and apprenticeship hours, Bryant says.

Personalized Pilates

To achieve maximum results for their students and avoid injuries, instructors must not take a one-size-fits-all approach to Pilates, says Michael Feigin, who owns four Half Moon Pilates studios with his wife, Lawson Harris. Each student has a different medical history and fitness level, and by not modifying the moves to suit the students' varying ability levels, the potential for injury can increase tenfold.

“The beauty of Pilates is that it can be made to tailor to muscle weaknesses and imbalances,” Feigin says. “It shouldn't be a cookie cutter workout.”

In the eight years Lawson and Feigin have operated their New York-based studios, they reported only two shoulder injuries. They attribute the low rate of injuries to their in-depth interview process with each new client and their rigorous instructor training program. Finetune Pilates Studio in Brooklyn, NY, also requires their new students to schedule a private session with a Pilates instructor to discuss their medical history, fitness level and goals for the classes.

Bryant advises fitness facilities and Pilates studios to conduct a pre-screening process with each new client before they even walk into a mat fundamentals course. Instructors should not only ask their students about their musculoskeletal problems and cardiovascular history but also question them about any medications they're taking that might impair their balance during a Pilates workout.

By learning as much as possible about each client, a teacher can personalize a Pilates workout for each exerciser and provide the best experience for each individual, Bryant says.

Bigger Isn't better

Imagine trying to learn how to ski for the first time by strapping on your snow skis, riding up the ski lift and bumbling your way down the mountain rather than enrolling in a small group lesson. The same principle applies to Pilates. Strong supervision is essential to prevent injuries and perfect movements, Bender says.

Bender, who teaches early morning Pilates mat classes at the Club Industry trade shows, says in a room of 100 individuals, only about 10 can do a rollup correctly by not using their hip flexors. During these sessions, Bender always has another qualified person walk around the room and make sure participants are doing the correct moves.

St. John says health clubs can take a page from Bender's book by asking a Pilates instructor-in-training to help with a large mat class.

“There are so many people training to be Pilates instructors, and it helps if the instructor can demonstrate the moves at the front of the room and then the assistant can offer another set of eyes and hands,” St. John says. “Then the Pilates instructor can serve as an involved teacher rather than just an exercise leader.”

Ideally, fitness facilities should limit their Pilates mat classes to 10 to 12 participants and their equipment-based classes to six participants, Bryant says. When health clubs or Pilates studios don't control the teacher-to-student ratio, the potential for injury can increase, he says.

“Without a low teacher-to-student ratio, it makes it virtually impossible for the instructor to give the individualized attention and supervision that's required to make for the best and safest experience,” he says. “The odds of someone doing an improper range of motion or using an improper technique all increases with lack of supervision.”

While it may be challenging for health clubs to limit the size of their mat classes, they can ask for an instructor-in-training to help with a large mat class.

Educating the Educators

Joseph Pilates, the founder of Pilates, required his students to spend two or three years in his studio before he released them to teach classes on their own. Now instructors can get certified in a single weekend. To worsen the problem, the Pilates industry had no national certification exam or educational standards until last year when the PMA began offering a standardized test for instructors. This exam consists of 150 multiple-choice questions and is divided into three major areas — assessment, teaching and reassessment. Bowen, who founded the PMA after he grew increasingly concerned about the future of the industry, hopes the certification exam will help set standards for quality Pilates instructors.

“There's been such a big explosion that group exercise instructors may read a book or watch a video and then say that they know how to teach Pilates,” he says. “Pilates uses exercises and equipment, but it's a specific philosophy, which has to do with holistic health, proper use of breath, precision, flowing movement and balance. If someone just takes a two-weekend course, it's difficult for them to impart that knowledge onto another person in a short period of time.”

Some Pilates teachers are simply “unknowingly incompetent,” he says. If a new Pilates student walks into a mat class and has lower back problems, a poorly trained or inexperienced Pilates instructor may not ask if he or she has been released by the doctor to exercise.

“A woman with osteoperosis may be forced to do something inappropriate based on standard protocols,” he says. “There have also been cases of private training where instructors haven't had sufficient knowledge and have done physical damage to people.”

To help reduce the number of injuries, more Pilates studios are offering comprehensive training programs. Carrie Cohn, co-owner of the Personal Best Pilates Studio in Overland Park, KS, didn't learn the philosophy behind Pilates exercises when she was first trained to teach Pilates. Since then, she has studied the philosophy and passes that knowledge along to the two instructors she and her sister train each year at their 5,100-square-foot spa-like studio. The students undergo 450 hours of instruction or nine months of training. Her sister, Amanda Jessee, a former college professor, teaches a 20-hour anatomy and biomechanics class so the instructors-in-training understand not only how to do the exercises, but also why they're important.

“Exercise should fit the person,” she says. “You shouldn't cram the person into the exercise. You need to look at which exercises will benefit them the best and find the best road to get them there.”

As the popularity of Pilates continues to climb, more health clubs are looking for Pilates instructors, and although it's important for these facilities to look for well-trained instructors, they don't always do so. St. John, who has been training Pilates students since 1999, receives phone calls nearly every day from fitness facilities looking for instructors.

“When they're looking for a Pilates teacher, some clubs seem more interested in a body than how trained that body is,” she says. “I'm shocked by how few calls I get for references for my students.”

With the right amount of instructor education and smaller class sizes, however, the number of Pilates-related injuries will take a nosedive across the country, Bender says. Then Pilates instructors can ensure that all their students, whether they're new moms who had a C-section or 70-year-olds with osteoperosis, can enjoy the benefits of a Pilates workout, and in the words of Joseph Pilates, “naturally, easily and satisfactorily perform their many and varied daily tasks with spontaneous zest and pleasure.”

Five Tips for Preventing Pilates Injuries

1. Offer an Introduction to Mat class to explain basic Pilates moves to new students. If possible, try to limit the number of students in this class, and make sure your instructors walk around the room and give personalized attention.

2. Make sure your Pilates instructors are well-trained, and check their references. Pilates training sessions range from a weekend course to 450 or more hours of instruction, so make sure your teachers are well educated about not only how to do the Pilates moves, but also why they're beneficial and how to prevent injuries.

3. Invite Pilates teachers-in-training to serve as assistants in your large mat classes. They can help spot incorrect movements and provide an extra set of hands and eyes.

4. Set up a personal meeting with each of your new clients to discuss their medical history, fitness level and amount of experience with Pilates.

5. Require students to sign up for a one-on-one training session on the apparatus before allowing them to attend group equipment classes.

Pilates Equipment Manufacturers

• AGM Group/Aeromat, www.aeromats.com
• Alcan Airex, www.alcanairex.com
• Balanced Body Pilates, www.balancedbody.com
• efi Sports Medicine, www.efisportsmedicine.com
• Hugger Mugger, www.huggermugger.com
• IM=X Pilates Inc., www.xercise.com
• OPTP, www.optp.com
• Peak Pilates, www.peakpilates.com
• PHI Pilates, www.phpilates.com
• Power Systems Inc., www.powersystems.com
• SPRI Products Inc., www.spridocts.com
• Stott Pilates, www.stottpilates.com

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