Pilates Plan – Overweight, Back Pain


Mary is a 60-year-old beginner, she is 50 lbs overweight. She experiences back pain due to Stenosis and SI joint dysfunction. She has diabetes. She would like to feel better and become more active.

GENERAL CONSIDERATIONS AND COMMENTS: I would encourage Mary to pursue her goal of losing weight, and not through fad diets but permanent lifestyle changes. If Mary was my client, I would be a good inspirational role model as I have lost more than than 50 lbs and kept it off. I would be a fount of endless tips, habits to inculcate, as well as share healthy recipes after our Pilates session. I would encourage Mary to consult with a nutritionist/ join Weight Watchers or TOPS. I would also encourage Mary to think about and envision fun ways she might enjoy moving her body as she becomes lighter and fitter. Having a vision helps pull oneself forward.

Because of Mary’s diabetes, (assuming she has Type 1 Diabetes and takes injectable insulin, I would avoid exercising the muscle into which she has injected herself, never exercise when blood sugar high, but have some juice to hand if blood sugar gets low during our session and be on the lookout for sores/ unhealed wounds and make sure she is receiving wound care. Diabetic patients tend to have all sorts of complicating factors ( such as leg neuropathy), so I would always be checking into Mary’s health to be on the alert as to whether there are any exercises we should avoid in any particular week. I would always avoid exercises which would raise Mary’s blood pressure, which is likely to be on the high side. Otherwise, Diabetics can do a full range of exercises.

Because of Mary’s Stenosis and back pain, we will be avoiding back extension exercises and anything that causes her any further pain ( at the first sign of “ouch”, we back off and switch gears.)

GOALS OF TREATMENT: The goals of treatment are to both increase Mary’s overall strength and flexibility but most importantly alleviate Mary’s back pain, and ease in walking, movement and balance. This will be accomplished by some flex, but a good deal of spine neutral and spinal lift exercises.Most of Mary’s exercises will be done supine and sitting, certainly at the beginning of her treatment plan. By doing exercises in these positions, it will be easier for Mary to start activating her core and control the exercises. We want Mary to experience some “ wins” early on in her Pilates regimen, so achieving her goals do not seem out of reach, and she will keep going.


I would need a free standing evaluation of Mary’s current posture, walking and feedback of where she experiences back pain. I would show her how to do “ core activated walking” and see how well she can walk. I would give her a hand assist if necessary. At the end of our sessions, I would have her repeat the walking to see if her movement is easier. Doing Reformer foot exercises is where the initial emphasis would be to start Mary’s Pilates program. It is where as a beginner she will immediately experience some wins and is easier to accomplish with her stenosis as no back extension is required. Foot work reps can be repeated 2 or 3 times.

  1. Foot work parallel Closed Heels, x 8-10 reps
  2. Foot work- Parallel Closed Toes, 8-10 rep
  3. Foot work-position open Toes, heels touching 8-10 rep
  4. Foot work-Open 2nd Position parallel Toes 8-10 rep
  5. Heel lowers for hamstring stretch 8-10 rep
  6. Running in place for hamstring stretch 8-10 rep
  7. Sitting modified Mermaid. Both sides of body. For Mary we will be concentrating on the spinal lift aspect of this exercise and not lifting up her hip as she pushes down and through. Her pushing through and up motion is likely to be constricted in terms of range of motion, but will increase gradually over time. 5 reps each side
  8. Sideways sitting (carriage joint between legs, hands on each end of metal fixed bar, push down and through, and over and up. Good for spinal lift and increasing arm range of motion. Core and underarm muscles engaged throughout. 5 reps each side.
  9. McGill Crunch. This targets the abdominals while still supporting the back. 5-10 reps and hold for 5-10.


Pre-Mat: These are always good to prepare a client for exercises on the Reformer so that they can perform the Reformer exercises more fluidly and powerfully.The fact that these exercises are supine is particularly helpful to Mary and she should be encouraged to also do them at home which should help keep the symptoms of her stenosis at bay. As Mary is a beginner, these exercises will give her a faster sense of accomplishment.

  1. Pelvic Clock – Supine. Legs bent to loosen base of spine while keeping glutes and legs inactive. X5 reps
  2. Knee sways – for upper thigh stretch and modest gluteal stretch X5 reps
  3. Knee Folds. Supine, knees bent, feet flat. Clasp one leg at a time, moving closer to chest. Alternate legs. Engage the core but do not move the Pelvis. X5 reps
  4. Leg Slides (Supine Hip Extension) Supine, Legs Bent feet on floor, to lengthen leg out from thigh, and feel hamstring stretch. Stretch out one leg at a time. Add variation of ankle rotation and toes wiggling.X5 reps
  5. Knee Folds – Supine Legs bent. X5 reps each leg
  6. Stretch Supine, knees bent and feet flat. One leg crossed over the other. Take knee in opposite hand, pull stretch over for 3 inhalations/ exhale, outer thighs and gluteal and periformis stretch. Twice each side.
  7. Supine One leg/knee bent. Other Leg straight up vertical in air for small circles, 5 in each direction (clockwise and anti clockwise). Loosens the hips and works adductors.X5 reps

Reformer: It is very likely that Mary will not be able to do the exercises listed below at first, especially with her extra weight, but a good place for her progression. All exercises require the core to be engaged in the abdominal area as well as muscles underneath the arms.

  1. Frog. Feet in straps. Core engaged. This works on hip flexors and adductors. X 5 reps
  2. Leg circles. Feet in straps and legs out straight, doing circles 5 clockwise and then counterclockwise.
  3. Hamstring Stretch feet in straps. Core engaged and keep control of the movement with straight legs as the raise and lower. As Mary becomes stronger we can add an extra challenge of a small softish tennis sized rubber ball between her knees, so that Mary becomes even more aware of her adductors.X5 reps
  4. Eve’s Lunge but only when Mary’s core is much stronger otherwise with her extra weight she will tend to collapse her back and not keep it straight and stable. We do not want her back to go into extension. So a modified version of this exercise after Mary has built up some core strength where one foot is on the foot plate and keeps her back flat when she pushes out is an excellent modification for her. X 8-10 reps.
  5. Bridging up with a stationary bar, keeping core on and back straight, strengthens the abdominal muscles, and promotes stability. Articulation of the spine as Mary bridges up and back down. X5 reps hold for 10.

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