From Rehab to Pilates: Supporting Clients After Hip and Knee Replacements

Anastasiya Goers (00:02.608) Hi everyone, and welcome to the Pilates Bridge Life Expert Series. Today I’m talking to Sam Woods, and we’re going to be talking about going from rehab to Pilates, and specifically, we’re going to be discussing how Pilates teachers and studio owners can safely work with clients after hip and knee replacements. Because the reality is that there are a lot of people getting those types of surgeries these days, and a lot of the clients will come to Pilates, they are in the demographic of 55 plus, which is the age group where a lot of people unfortunately have to get those surgeries. So, I’m super excited about talking here with Sam today. And one of the reasons obviously she is an amazing educator. She’s a Pilates teacher, she’s a physical therapist, she owned a studio for a long time. She is the author of Pilates for Rehabilitation book. That gesture 2025, second edition. If anybody, there’s anybody that we can talk to about Pilates for rehab, Sam is the person. So I’m super excited to have you here, Sam. Thank you so much for coming.

Samantha (01:14.946) Thank you for inviting me, Anastasia. It’s a pleasure to be here.

Anastasiya Goers (01:17.388) So I would, you know, to get started, I would like you to kind of share a little bit about yourself, how you guys started with Pilates, physical therapy, and everything, and rehab.

Samantha (01:31.704) Sure, it goes way back. So when I was in college and undergrad, I knew I wanted to go into sports medicine, but I wasn’t really sure what capacity. So I was working as an athletic trainer at the training room at my college, and, you know, saw the physical therapists working, the surgeons, the trainers, and kind of just put all that together and decided, you know, physical therapy seems like the best fit for me.

I was also a fitness instructor back then. So this was way back in the day, many, many years ago. I taught high-impact aerobics and all those different, you know, step aerobics back then. And so before I went to physical therapy school, I really wanted to travel the world and, you know, get some experiences. And so the way to do that was I got a job working on a cruise ship teaching fitness classes. And lucky me, my roommate on one of these cruise assignments was a woman named Adele. And some of you may know that name Adele is now married to Raelle Izakowitz, who is the founder of Bassie Pilates. So I met Raelle, gosh, in the 90s, I guess it was early 90s. Anyway, long time ago. And I didn’t know who he was. He was this big Pilates guru. I just knew him as Adele’s boyfriend and later husband, but I told him that I was going to physical therapy school. That was my plan. And I remember he said, Sam, that’s so great. You know, you should really learn Pilates because the two complement each other so well. And I said, yeah, thanks, but no thanks. That Pilates stuff is for dancers and I really want to work with athletes. And he kind of just said, okay, that’s fine. So I go on to physical therapy school and I’m working in my first job with, I was working with the Phoenix Suns, which is a professional basketball team in Arizona. And our star player, Jason Kidd, point guard, broke his ankle. And his wife was a big Pilates practitioner. They had a reformer in their house. So she said, Sam, can you please teach Jason Pilates as part of his rehab so he can get back sooner? And it was like, okay, swallowed my pride, called rail and said, hey, about that Pilates stuff, can you still teach me that? So of course he laughed and generally said,

Samantha (03:56.13) Just excuse me, generously said, yes, of course. And that was kind of the start. So I moved back home, took the course with him, the Bassey teacher training, and just, it was like a light bulb went on for me in the physical therapy and rehab world. I was just so amazed with how many different exercises you could do on this one or two pieces of equipment and how adaptable it could be for many different patient populations, how it could you know, support the person in early stages of rehab, but then also really challenge them to get back to their sport as they progressed. So there, think I was only three years into being a physical therapist when I discovered Pilates and then just kind of shifted the way I practice from then on. So it’s been like about 30 years, I guess. Yeah. And I still, mean, real, I just cannot say enough about what an amazing mentor he’s been and thank him enough for.

Samantha (04:54.54) His guidance, his teachings, and his support of my career. It’s been amazing, as have many, I’ve met many wonderful people in the Pilates world that I’m very grateful to as well.

Anastasiya Goers (05:07.214) That’s awesome. And I want to take a quick break over here for everybody who’s joining us live. If you have specific questions that relate to our interview today with Sam, please make sure to leave them in the comments. We’re going to prioritize any questions that come in in the live chat. And we also have questions that were submitted ahead of time. So we’re going to try to get through as many of those as possible as well. But if you have questions, leave them. And if not,

Anastasiya Goers (05:35.296) Again, thanks so much for being here with us live or watching it afterwards and we’ll just continue with the rest of our conversation. So, before we get back to the actual rehab for knees and knee hip replacements, for a while you were running your studio and your studio was two decades, right? You were running for about two decades.

Anastasiya Goers (06:03.824) And in your studio, did you always integrate polities and physical therapy as both modalities?

Samantha (06:13.068) Yes, we did. Yeah, and we were one of the first studios to do that actually in the LA area, believe it or not, back 25, 30 years ago. Now a lot of studios do it, but it was kind of an unheard of thing back then, you know, to have Pilates as part of rehab.

Anastasiya Goers (06:30.522) So were all the instructors at your studio also physical therapists or some of them were just polities? Or yeah, how did you structure that?

Samantha (06:39.424) Yeah. So we had both. So we had kind of two parts to our clinic, you could call it. So we had physical therapists who were all trained in Pilates. Not all of them did a full certification program like I did. Some did other programs. My original partners were trained with Polestar and then I was Vassi, obviously. And then the other physios that were there, we would train them, like just kind of enough.

Samantha (07:04.748) You know, to know for what they would need for specific rehab on the knees and the hips and the back pain and all of that. And then we also had a Pilates studio kind of adjacent where there were Pilates teachers who were not physical therapists, but we would give them extra training on how to work with injuries. And we were really careful about the transition. So let’s say for example, you had a total knee replacement and you were my patient. And then it came time for you to be discharged.

We would encourage you to continue with the Pilates with the teacher, find out which teacher that was going to be, write out a plan, a program, and make sure that we had, you know, very consistent communication so that the client still felt very taken care of. And it was just like a kind of a seamless transition on their rehab journey.

Anastasiya Goers (07:52.804) So the part of the physical therapy was more of the actual medical orthopedic type of therapy prescribed, right? And then the pilates were the next step for the clients to continue.

Samantha (08:09.31) Yes, except that we did start the Pilates with them. The physical therapist started them on the Pilates and then they would just continue with it with the instructor if they chose to, not all did. But there was that option for them to continue, of course, on a cash basis because it’s not legal to bill insurance for that. And that, yeah, that’s how the transition kind of went. But we started, pretty much everyone did Pilates from very early on after their hip or knee replacement, some even the first day.

Anastasiya Goers (08:39.118) Okay, cool. So why do you think that we are seeing so many more clients with hip and knee replacements today? Why is this population growing so much?

Samantha (08:50.636) Yeah, you know, I think it’s really kind of a perfect storm of a lot of factors coming together. So first of all, we have an aging population that wants to stay active longer. So people aren’t just living longer. They want to exercise. They want to travel. They want to keep moving. They want to climb mountains and run marathons, you know? So joint replacements have become a way to maintain that, to be able to kind of maintain that quality of life.

Second, we’re seeing more joint issues, especially the weight bearing joints, like the hips and the knee damage, I think earlier in life. And this could be due to previous sports injuries, wear and tear, higher rates of obesity even of course contribute to this. So that means that people are needing these replacement surgeries earlier, at younger ages than in the past. Third, I think the surgeries have really improved. Just the improvement I’ve seen in the surgeries just from the 25 to 30 years that I’ve been doing this. Outcomes are more predictable. Recovery is a lot faster, a lot faster. And the implants last longer, whereas they used to be metal or cement. Now there are things like titanium and carbon fiber. So these materials that last a lot longer and you can heal a lot quicker. So both surgeons, because of that, both surgeons and patients are willing to do these replacements earlier in life than they used to be. And then I guess the fourth piece is insurance. I mean, we’re just being real about everything. So at least in the US, I know there’s some people watching from other countries, but in the US, health insurance is trending toward paying less and less for rehabilitation. whereas you may have, know, 20 years ago, someone got you know, three months of therapy or 12 visits or whatever it was after a joint replacement. Now it’s way less. So they are kind of being forced to be discharged earlier than they’re ready. So I think that, you know, if they, sometimes they’re discharged from physical therapy, shouldn’t say sometimes, quite often they’re discharged from PT and they’re, they’re still not fully strong and confident in their new knee or their new hip.

Samantha (11:16.184) So, you know, where do they go next? What do they do next? And I think the Pilates studio is a wonderful place for them to go, especially if it’s the type of studio that does this one-on-one care. And especially if it’s the type of studio that has, you know, extra training and knowledge and experience in dealing with injuries like these.

Anastasiya Goers (11:36.176) Yeah, I agree. it’s, I had in my personal life, I know people in my family who had the hip on your placement. That’s like really the discharge is so fast. But then afterwards, like, what do you do?

And you can’t, know, most clients or patients aren’t okay. They have their 10 visits, six visits, whatever it was of physical therapy, even 12, even three months. And then it’s like, well, you can’t go back to your sport yet. You can’t start running yet. So what are you going to do in that kind of interim? know, and Pilates is perfect. It’s low impact and skilled instructors and you know, all the things that all of you Pilates teachers already know about Pilates, but you don’t need me to list it.

Anastasiya Goers (12:19.184) So why do you think that even for studios that maybe don’t have physical therapy on site, they’re not trained, but they offer personalized Pilates training, why do you think it’s such a great opportunity for them to work with this population of the clients after hip and knee replacements? How can, do you think it can build a stronger studio for them?

Samantha (12:46.03) Absolutely. mean, and yeah, I love this question. It’s one of the things I love about you, Anastasia, that you have that business background as well, right? Because working with this population isn’t just clinically rewarding, because it is. You’ll see these people go from being, you know, not very strong and not very confident to going back to their sport, which is amazing, but it’s also incredibly valuable from a business perspective, right?

Samantha (13:13.644) They need you, right? These people really need you. Mean, Pilates is great, even if you’re just doing it. They want to lose weight. They want to get fitter. They want to look better, whatever. That’s great. But these people really need you. They need to rebuild their strength. They need to rebuild their confidence. They need to trust their body. So when you can support that process safely and effectively, you’re really making a huge impact on their quality of life. And then from a studio perspective.

These people tend to be very loyal, long-term customers. They’re not a client that’s just gonna come in for a quick drop in fitness trend type exercise. They’re invested in their health and they understand the value of a skilled instructor and guided movement. So once they find someone that they trust, they’re really willing to stick with it and stick around. And then there’s…

They also tend to be a population that thrives in a more personalized setting. So one-on-ones if you can, or small groups. And that can align really well with a sustainable model for a studio, especially if you’re not a studio that’s trying to compete with these, you know, large volume, low cost group classes. Yeah, exactly. And then they also have a huge referral base built in because if they do Pilates with you, you do good work.

Samantha (14:37.78) They get better, they go back, they tell their doctor, they tell their physical therapist, they tell their friends. And next thing you know, you have more of this population that possibly just had joint replacements coming to you.

Anastasiya Goers (14:51.054) Yeah, I think the referral from my experience of working in this studio that’s always been interesting because obviously people of a certain age, well, over here in South Florida, a lot of people live in the communities. There are a lot of 55 plus communities and they all discuss all the medical stuff. So every person will get a near hip replacement or their husband or somebody else, they’re going to come in and then it’s almost like a chain reaction. Then once the first one goes. all of their friends just because of the age and similar lifestyles that all kind of comes around and then obviously they have a great experience they know once they’ve tried Pilates they did personalized their private training maybe transitioned into small groups they can feel the difference in their bodies and they don’t want to stop and they just want to bring all their friends in everybody that they’re out and I’m sure the medical referrals that’s you know that’s a completely different thing so you also have a

Anastasiya Goers (15:46.298) Trust factor and medical professionals need to send their patients somewhere that they can get better because everybody knows they need to move, they need to build back strength. Otherwise, recovery is going to take longer for them or might not be as effective.

Samantha (16:03.234) Yeah. And I know the first, the first one can be scary as a studio owner or a Pilates teacher at a studio. The first joint replacement client could be really scary, but if you help them well, like the first joint replacement, then you’re going to have 10 more come in the door. Just like you said, like they talk to each other, right? So it’s, it’s, it’s, I think it’s a wonderful client base to have. Yeah.

Anastasiya Goers (16:29.988) Yeah, and also just to kind of bring back, just thinking about some of the conversations that I had with a few studio owners, my clients lately, because everybody’s so concerned. The studios that work a lot with the hip and knee replacements or personal, private kind of setting as opposed to more group athletic reformer type of settings, they are all, a lot of them are afraid of the comfort. Competition that’s coming in, right? The competing with those classes. However, differentiating yourself as a studio, as somebody who works with those types of clients, those types of conditions, that’s really the, this will never go away. There’s really no competition between what you can offer as a private experienced studio owner or teacher, as opposed to, you know, athletic, class-based studio that everybody does the same thing and there’s really no specialization there going on. So, leading into that, especially right now that everybody seems to be talking about polities, right? Everybody that you turn on TV or something. Yeah, it’s definitely a trending thing. Everybody’s something polities. But yeah, that’s definitely a way to specialize and keep yourself in the market. But let’s get back to the actual

Anastasiya Goers (17:55.696) Leave the business behind and get back to the actual teaching and working with the clients because that’s what a lot of our viewers want to know. So we have a client who comes in for the first time to apply to a They’re cleared by their doctor to come in so we know they’re good to go. It’s been hip and knee replacement. We can do like maybe one or both, depending on how you want. 

What are the most important things for the teacher to understand during that first session to make it as successful as possible for the client?

Samantha (18:33.484) Yeah. Yep. I think the most important thing for a teacher to understand is that not all hip and knee replacements are the same, right? And not all clients are at the same stage of healing. And I’m sure some of you hate that answer because you want me to just give you a like, but unfortunately, I can’t do that. So what’s the most important I think is really understanding who is in front of you. How old are they?

How active were they before the surgery, right? What were their activities in sports? What was their fitness level? What type of surgery did they have? And we can certainly go into some different types if you’d like. How far out are they from the surgery, right? Like how long ago was it? What has their rehab looked like so far? And where they’re at right now, are they still in pain or are they not in pain anymore? They’re just more in the rebuilding phase. So I think that’s really the first step. 

The second step would be to just kind of take a step back and realize respect that this joint has been surgically altered. So their range of motion, their strength, their balance, their proprioception, all of these things are going to be affected. And then of course, I guess, kind of going along with that, sometimes there are going to be specific precautions based on the type of surgery. So we’d want to avoid jumping into traditional exercises without thinking about whether they’re appropriate for that body. So this might be a good place to give an example. A really common one is total hip replacement. Where I practice in Southern California, kind of a bigger city, much bigger Los Angeles, and younger sort of orthopedic surgeons, the type of hip replacement, is called the posterior approach or posterior lateral approach isn’t done as much anymore. They’re doing more the anterior approach now because they heal quicker and you know, a few other reasons, which I’m not sure we’ll have time to go into. But anyway, let’s take the posterior approach hip replacement as an example, because it is still done very commonly around the world.

Samantha (20:49.576) Their precaution, one of them is that they’re not supposed to bend to do hip flexion past 90 degrees. Okay. So think about just sitting down on a low studio reformer, getting prepared to lie down and do whatever exercises footwork that would be contraindicated, right? For them to lie, sit down on the reformer because that’s more than 90 degrees of hip flexion. So better for them would be to start them on the Cadillac, which is a higher surface and they’re not going down below the 90 degrees. So, you know, that’s a simple example. Other precautions for that specific surgery is you don’t want to do a lot of internal rotation or adduction past midline. So you put all those three, those three things together, hip flexion past 90 adduction, past midline, internal rotation. Think of an exercise like mermaid.

Right? That would be something you would absolutely not do with a posterior approach hip replacement. So that’s one example for you. and then I think we also need to, you know, for an instructor who’s having someone with a joint replacement come in for the first time, realize that they’re still lacking confidence. So even if they tell you their rehab has been good, you know, they were a fit person, maybe the precautions part is over for their surgery.

Samantha (22:13.314) They may still not feel normal, even though they were discharged from physical therapy. They’re not really to get back to their sport. So our role is not just the physical exercises, but really helping them rebuild trust and confidence in their bodies. And I think Pilates does that so well through a lot of the core work that we do in the mind, body type stuff. And then finally, of course, it always comes back to clinical reasoning. So you want to ask not necessarily what exercise should I do? I encourage people to ask, what does this person need right now? You know, what are they lacking and how can I use Pilates to support that? So since I already gave a hip example, I’ll give a total knee replacement example, a very common, it’s not a precaution, but a common limitation I’ll say after a total knee replacement is they don’t have a lot of knee flexion.

Samantha (23:09.292) They don’t want to go into flexion. It’s like stiff and painful to go into knee flexion. Well, we need knee flexion at least 90 degrees, preferably more like 120 to 130 degrees to function, right? To go up and down steps, to get up and down from the toilet, these things we have to do every day. So we want to encourage that range of motion into flexion. So a fabulous way to do that is using the reformer, the person supine.

So there’s not a lot of compression on their joint because you don’t have gravity. And then I like to put the foot bar up higher so that it encourages, doesn’t force, but it encourages them to actively or what we can call actively assisted, active assisted range of motion, get more flexion in that knee. Does that make sense? Yeah.

Anastasiya Goers (23:58.414) Yeah. And would you put heavier springs for them in that case, just to kind of encourage a little bit more? Because sometimes it can be hard just to pull in the carriage if there’s not that much flexion there.

Samantha (24:08.65) Right, right. So yeah, a little heavier, but again, that’s going to depend on the stage of rehab they’re in and are they currently in pain because a heavier spring can make them feel more pain. So that would depend on the person and their symptoms. But yeah, if I can, if it’s, if it’s fine and it’s not going to exacerbate everything, then yeah, heavier springs, because even as you know, and I’m sure a lot of the teachers out there listening, you know, with doing footwork on the reformer since your line supine taking out the effect of gravity there’s way less load on the knee joint. So even loading up the springs heavier is still not as much as doing a squat standing against gravity.

Anastasiya Goers (24:49.36) Yeah, that makes sense. And then I know I want to touch base a little bit on the book, your second edition. So you mentioned there’s so many different variations of the surgeries and all the, you know, the posterior, anterior, all of that kind of stuff. then with the knee, also there are different options there as well. Is that something that’s covered in your book and how to work with all of these types of clients?

Samantha (25:19.278) Yeah, yeah, it is. It’s, I would say it is. First I’ll show you where it is, then I’ll explain it a little more. So in the last section of the book, section three, we call it, is organized by joint. So like the chapter on the hip replacement, there will be an explanation of what a hip replacement is, and then a table that tells you causes and risk factors, symptoms, precautions and contraindications. So in there I have both the anterior approach precautions and the posterior approach goals, and then a list of recommended exercises. The course that I teach though, like you really want to go more in depth on that. I teach a course for Bassey Pilates called Pilates for Injuries and Pathologies. And in that we go more in depth. So we do everything that’s in the book.

I’ll demonstrate certain exercises for this exact purpose and how to modify certain exercises to be appropriate for that client. So yes, there’s definitely some in the book, but it was almost impossible, I feel like, to go into the whole thing without doing live demonstrations and things. But there are photos in the book of the different exercises that you could do and then little notes with that exercise saying, you know, precautions or contraindications or when not to do that exercise. Yeah. Yeah.

Anastasiya Goers (26:48.08) That’s perfect. And the course that you do for Bossy, is that a live one in person or is it virtual or both? What’s the format?

Samantha (26:59.63) It’s both now, which is exciting. For 12, I’ve been teaching at 15, 15-ish years, maybe more. It was just live, which is fantastic. I prefer it live, of course, because I get to meet all these amazing teachers and really work with them hands-on and answer questions. But, you know, not everyone can attend these. They’re expensive. It’s a three-day course. may, we try to teach it all over the world, but, you know, some people live very far from where it is. They can’t travel. just…

Samantha (27:29.326) Starting last year, we released the online version of the course. And it’s, it’s basically the same. A few of the exercises are different because we, we can’t include the legacy program, Bassie’s legacy program exercises in that. But for the most part, the exercises are the same. The difference is just that, you know, you don’t get that one-on-one interaction with the other students or with me, and you can’t really ask, you know, specific questions. But other than that, it is the same content.

Anastasiya Goers (28:00.88) Awesome. There’s always going to be a need for education. Life in person is always best, but unfortunately, sometimes it doesn’t work for everybody’s schedule, but being able to learn from you, even if it’s in a virtual kind of environment, that’s perfect. So one of the questions, I wanted to bring up one of the questions that came in because we kind of touched a little bit on it.

Anastasiya Goers (28:28.652) And that was about contraindications. I know you mentioned that some of that is covered in the book and in your workshop as well. But if we just kind of go a little bit more of a blanket statement over here for knee and for hip, we can cover everything. Is there something that’s just like, okay, we’re just never going to do that or everything’s more like, it depends on the student.

Samantha (28:56.302) I hate to say it, but it kind of depends on the student. I mean, I guess the first thing that pops into my head as a blanket thing would be no high impact after a total joint replacement. So even for my husband, which some of you listening know, and I think this is maybe how you originally found me, Anastasia, was my husband at 52 years old had a total hip replacement. was anterior approach with the robot. So all the new fancy materials.

He was allowed to go back to his sport in three months, three months after surgery, like super fast. And he was fit and healthy before. So basically the doctor said he had an anterior approach as well. So he didn’t have those posterior precautions that I mentioned a few minutes ago. The doctor said you can do anything you want. Like he could start physical therapy. He was supposed to rest for two weeks. I think it was. And then he could start physical therapy. Of course I was in the room. Can we do Pilates?

Samantha (29:53.122) Yes, do Pilates like he’s like basically just don’t fall on it. So don’t do anything that’s like high impact or where there’s no control. So you can ride a stationary bike. That’s great for range of motion, but don’t ride a bike on the boardwalk where someone could pull in front of you and you fall. Don’t surf, don’t jump, play basketball. You know what I mean? So really just more high impact stuff is the only blanket one I can say.

Samantha (30:18.872) Post-op total hip from the posterior approach. I already talked about those contraindications. Big question I always get in my courses, well, for how long do they have to follow those precautions? That depends on their age, their fitness level, the surgeon’s specific precautions, the type of materials they used. And really the only way you’re gonna know that is to talk to the physical therapist or get the almost always, I hope the physician, the surgeon gives the patient a packet of information after their surgery that says for this long, avoid this, for this long, avoid this, et cetera. So if you can get the client to bring that into you, that’s super helpful as well and kind of read through it, you know, until you build up where you’ve seen so many of them and you know, the same doctors and the same physical therapist, then maybe you don’t need to do that every time. But in the beginning, I would absolutely suggest that.

Samantha (31:18.04) For anterior approach total hip precautions, often there’s none, like with my husband. Sometimes they tell them to avoid the combination of hip extension and external rotation. So kind of like an arabesque position. And then for total knee replacements, there’s usually not precautions, except for the one I already said, no high impact. They just tend to have a lot of pain.

Samantha (31:45.056) And it’s hard for them to get their range of motion back, especially the flexion, which is why I gave the little clue about sort of gentle ways to encourage more flexion. Sometimes when they’re older as well, they have them be non-weight-bearing or partial weight-bearing, meaning they must use a walker or a cane or crutches for a while to let the joint heal more. But that’s that’s kind of surgeon dependent and material implant dependent as well. So yeah.

I wish I could give a more direct answer, but that’s kind of the reality is not like, just like I said a few minutes ago, not every hip and knee replacement is the same. There’s different things we need to consider.

Anastasiya Goers (32:26.904) Yeah. And what would you say if somebody is coming in, not just after surgery, maybe it’s been like a year or like a year and a half, obviously they are way past their physical therapy and all of that. At that point, do you treat them as a regular client with maybe just working on their specific issues or you’re still building the sessions more focused on that specific joint replacement?

Samantha (32:52.096) I think it again depends on the person, but I would go back to clinically who is in front of you and what are their issues. So you might have a person who comes in a year after a hip replacement. And you know, I always get a history and I recommend all Pilates teachers do that. What surgeries or injuries have you had? And even if they say, I had a hip replacement five years ago. Do you have any issues with it? You know, do you feel like your range of motion is okay? Is your strength okay?

Samantha (33:19.21) You know, and if they’re like, it’s fine. There’s no problems then yeah, do pretty much do whatever. But a lot of times there will still be something like a common one for knees is they still have problems going downstairs. Upstairs is usually fine, surprisingly to some, but downstairs we have to use eccentric quad strength, which is kind of the last strength to come back. So then you can work on things like, full lunge on the chair, backwards step down, step ups, like things that are gonna help them overcome that limitation.

Anastasiya Goers (33:55.888) But as far as just the contraindications of maybe not, like I said, at that point they would kind of be cleared from most of this unless it’s something, you know, that, yeah.

Samantha (34:06.188) Yeah, if it’s been over a year, I would say they’ve been cleared. However, with a post-op hip posterior approach, I probably would never do something like mermaid, that example I gave you, because that’s just, A, they might not even be able to get into that position, right? That’s hard for people that haven’t had hip surgery sometimes to get into that position. So that’s probably not something I would ever ask them to do. You know, I would just do other things for my lateral flexion and rotation instead.

Anastasiya Goers (34:36.324) Okay, yeah, makes sense. All right, so let’s keep on moving and we’re covering a lot over here. I feel like we’re having like a mini workshop with you right now.

Anastasiya Goers (34:46.98) So what do you think are some of the red flags or common mistakes that maybe you’ve seen teachers, like mistakes make any mistakes or something that they should avoid?

Samantha (34:59.79) Okay. Yeah, I think one of the biggest mistakes is just not being familiar with the post-op surgical precautions, you know? So I think it’s really important that instructors, if you’re going to work with this population, educate yourself, you know? So those of you listening today, this is a step in the right direction. As we’ve mentioned, there are specific guidelines around certain types of surgery, and those can involve something as simple as position.

Like can they sit down on the reformer loading or weight bearing? So like the restrictions as far as do they need to be on crutches or a walker? and range of motion, of course, too. if a teacher’s not aware of these restrictions or precautions, they can do too much too soon or opposite. can be overly cautious and that can kind of prevent the client from progressing as soon as they should.

So I feel like it’s all, you know, comes back to education because the more you understand about the surgery, the limitations that they’re left with and the precautions, the more confident you’re going to feel as a teacher and the client really feels that, right? You want them to feel confident. You want them to feel like they’re in good hands, that you know what you’re doing. yeah, I think, you know, knowing

Samantha (36:25.71) Just building our knowledge base is so important as Pilates teachers, anything I feel like in the world. Like the more, I think one of RAIL’s things is that we should all be forever students, right? Where no one’s ever mastered everything. Like I learn stuff all the time from my students, from RAIL, from other practitioners. We all should be learning, always building our knowledge base. When you understand what’s safe and what to look out for, how to progress appropriately, then it kind of opens a whole new level of clarity in your teaching and that’s really what I strive to do in my course and in my book. And in even, you know, I do like some videos now that you can get. I have a bunch on YouTube that are just little kind of, you know, shorts on like, you know, here’s a good exercise for post-op knee surgery or here’s how to increase your range of motion, you know, just all different things. And then some more in depth.

Samantha (37:22.29) Ones that go into more detail from like rehab start to finish like a total hip one that are for purchase. And but you know, doesn’t just have to be my stuff either. There’s other courses out there that talk about clinical Pilates or Pilates for injuries, rehabilitation, that sort of thing. So the more you can learn, the more you can know, the more you understand the why and the how, right, then the more you can really work these clients safely and effectively.

Anastasiya Goers (37:54.072) Yeah, and I know I wanted to bring up something we were discussing right before we started recording today is because we were reviewing some of the questions that came in and some of them were very detailed and client specific, especially like I mentioned, ever client coming through the door is they going to be some there’s going to be something different about them. One when we just find athletic and all you know, ready to go and then the other person might have a whole bunch of stuff going on in their body between the pain, the nerve pain, the additional injuries that they have to deal with. And I know a lot of teachers really have this heart to help and to really work through a lot of those issues with the clients. However, where is that line that we have to draw? is the scope of practice of a Pilates teacher?

Kind of like really ends and we need to refer to a medical professional. Just teleclinic. Yes, we have the best intentions. We want to help the client, obviously to feel better. But, know, apply these teachers, unless you’re a physical therapist, you are not a doctor, you don’t have the training. So at what point do we have to refer out to help our client?

Samantha (39:10.092) Yeah. And I think again, that comes back to knowledge and educating ourselves because, know, I think something like a course like mine or the book Pilates for Rehab can give you enough information to kind of know these are the precautions, these are the goals, these are, you know, the person should be able to get back to full range of motion eventually and full weight bearing, all of that. Pain should obviously decrease as time goes on from the surgery. If any of that’s not happening.

I think it’s the job of the Pilates teacher to ask for help, because it is outside our scope of practice to diagnose, what’s going on here? You know, for example, they have nerve pain. Nerve pain’s a little outside our scope of practice. So I would at that point, hopefully as a Pilates teacher, and I know this is easier said than done, but hopefully y’all can get there, have a relationship with a physical therapist, you know, where you can…

I mean, I realize not every studio, not many studios have what we have where we had both in one and we can talk same day. But you know, network with a physical therapist, meet an athletic trainer, know, meet with them and be able to call them up and ask questions. You know, if something doesn’t seem right, right? Because the client should be getting better. I mean, Pilates should make them feel better. If anything is making them feel worse, something’s off.

And I don’t think it’s really our job. I believe it’s outside the scope of our practice to answer in your words, to just say, well, maybe it’s because I don’t know. can’t even make up anything. But I think that at that point, it’s better to, to consult, you know, someone who’s maybe, has the credentials or the qualifications to make that call. No, everyone’s going to have bad days. So I’m not saying if your client comes in one day and they’re like, I’m so sore today, you know,

Samantha (41:07.18) Whatever, maybe they did too much the day before, but if that keeps trending that way, that’s not good. And we might, we should get help to, figure that out. So that help could be if you have the relationship as a teacher with the ploddy, excuse me, with the PT great, or maybe just, you know, telling the patient, you know, this should really make you feel better. And I feel like we’re doing all the right things and you know, something’s not adding up. So I think you should go back and check your doctor or check with your PT and I feel like they’ll respect you even more for saying that.

Anastasiya Goers (41:40.154) Yeah, I agree. And it goes for all injuries or any types of things, not just the replacements, it’s just anything that’s going on because a lot of times clients will come in with their issues and sometimes I know that they will just ask for our teachers experience and how for that not understanding that that’s really outside the scope of a polite teacher to deal with those types of things. Right. I know I worked with a lot of several clients who had shoulder issues and just like, hurting, hurting, hurting, hurting. And then at the end of the day, the best result for them was to go and get an MRI and figure out what was going on because no amount of Pilates and proper training in proper form is going to change, yeah, fix a joint problem, right? It’s not going to happen. all right. 

Anastasiya Goers (42:38.596) I’m not going to ask probably about specific exercises. I know that was something that a lot of teachers want to ask. However, the Pilates system is so wide and every situation is going to be so different. But maybe do you have a preference on the specific Pilates apparatus or equipment that you like to start most of the clients on? If we have a fully equipped studio, you know, no limitations whatsoever. Do you have a preference?

Samantha (43:07.276) Well, for hip and knee clients, I love the reformer because as I mentioned, you know, lying supine doing something like footwork, which is really squats, right? It’s really the functional mechanic of squatting. You can do that really early on and start to teach those functional neuromuscular patterns when they’re still even in a non weight bearing or partial weight bearing status. So the reformer is great for that. It also gives such good support.

Samantha (43:36.446) And feedback and the way the springs work, can build strength in a controlled range and you can either set the spring so that they assist them or that they challenge them depending on what they need. Yeah, so I guess probably the reformer is the piece of equipment I use the most. Now, having said that, as I gave an example earlier about someone with a hip

Samantha (44:06.158) Yeah, that’s not supposed to go that low. Most, like in our clinic, we had one reformer that’s called the clinical reformer. That’s higher up off the ground for that purpose, for hip precautions, but also just to make it easier for older people that maybe can’t move that well to get on and off. So we would use that at first. I realize not every studio has that luxury of having a clinical reformer as well. So if you don’t then yeah, maybe you just start on the Cadillac, because that can be a great place to start as well. Matwork can be great too, know? Chair can be great. I mean, I love it all. It’s hard. It’s hard to really pick one.

Anastasiya Goers (44:44.14) Yeah, yes, every piece of apparatus has its purpose. So like you can really start here and there and everywhere and figure out what works with a specific client. Standing works better for them. Great. Sitting works better at the beginning. Go there, right? There’s so much that we can choose from.

Samantha (44:56.43) Exactly.  Right. But it all goes back to, yeah, and it all goes back to what do they need, you know? So maybe it’s someone who, like you just mentioned, standing exercises, who really needs to work more, you know, their pain’s gone, they’ve got their range of motion back, but now they need to work on their balance and proprioception. So standing leg press at the chair, you know, eventually things like step down and full, sorry, backwards step down and full lunge on the chair, skating on the reformer, those sorts of things can really not only build strength, but also work on their balance and proprioception, which is so important for any lower body injury, but especially when someone has a new hip or a new knee, they need to learn to balance on that side.

Anastasiya Goers (45:48.56) I want to ask one of the questions that came in from Tamlin. So since we’re talking about equipment, as a mat instructor, what would be the recommended exercises to do with the client post-hip or knee surgery? And we’ll discuss the big no-nos for strength and mobility over there. But if we’re talking just about mat.

Do you have a specific beginner go-to exercises to recommend to a teacher?

Anastasiya Goers (48:34.039) Yeah, maybe we’ll link to it in the description after the video. So is there, I know there was another question actually several people asked about, is kneeling contraindicated after total, after knee replacements or not? Or is it just uncomfortable?

Anastasiya Goers (49:24.304) But it’s like medically usually there’s no it’s not something that a surgeon will tell them what never kneel again in your life. I’m trying to pick out a last couple of questions for us to answer because there are like so many and we’re… I want… Yes. One thing, also one of the questions that came in, how soon after completing the, after the surgery and being cleared by the doctor, can the client come to Platt’s? Can they? Well…

Two-part, I guess I would say, can they start Pilates while they’re still in their rehab, right, doing their physical therapy, or do they need to wait for that to finish?

Anastasiya Goers (52:08.942) Yeah, because in physical therapy they mostly work only that one specific area, correct? Like so if it’s a knee, they’re working everything, knee flexion and everything, they’re not touching the rest of the body that’s still involved, right?

Anastasiya Goers (53:06.768) So to work like that, obviously it’s definitely, it’s a team approach if a patient or a client just coming in after the surgery. Do you have any specific recommendations on how teachers and specifically studio owners can build those relationships with medical professionals or position themselves as the knowledgeable?

An expert who can help those patients along the way. Just kind of build those relationships and become an authority on that.

Anastasiya Goers (56:22.03) Yeah, absolutely. Yeah, that’s a great idea. So coming up to the end of it, so for anybody who wants to expand their knowledge, and I know we discussed a little bit about it already, could you please tell us one more time how exactly they can learn from you? So I know we have a book which is probably available on Amazon, right? Anywhere else where all the books are available. So that’s just an easy way just to get a little taste of your book and of your knowledge.

But with more in-depth education, those workshops, where would an instructor go or teacher go to find those dates or sign up for the virtual workshop?

Anastasiya Goers (58:19.792) I’ll make sure to link to your website as well. It’s gonna be in the description of the video, your website, link to your book. Also make sure to follow Sam on her Instagram page and her YouTube channel, Because we can get this clips of videos to help to draw some inspiration for those types of clients or learn something new every time.

Thank you so much, Sam, for being here with me today, for sharing your knowledge. I just think maybe we’ll have a follow-up because I know we discussed some other different conditions and chronic pains and all of that. It’s just like the joint replacements is just like one little tiny part of everything that we see in the studio. So your wealth of knowledge for sure. So I appreciate your time sharing your knowledge with us.