How the Modern Pilates Instructor Is Expanding the Way We Understand Human Movement
The Pilates and Movement industry is changing. Not because the foundations of Pilates are disappearing, but because the people walking into our studios are changing, and the profession itself is evolving alongside them.
Pilates instructors today possess greater access to research, continuing education, interdisciplinary collaboration, and movement science than at any other point in the history of the profession. Pilates is increasingly becoming a trusted presence within healthcare, rehabilitation, performance training, and wellness settings around the world.
When I started out 40 years ago, Pilates was viewed primarily as a niche exercise method. Now it is regularly discussed in clinics, integrated into recovery programs, referenced by healthcare providers, and sought out by clients navigating increasingly complex physical and neurological experiences.
As the visibility and credibility of Pilates continue to grow, so does the opportunity, and responsibility, for movement professionals to deepen the way they observe, understand, communicate about, and influence human movement.
Today’s Pilates instructors are working with so many diverse bodies:
- persistent pain
- hypermobility
- pelvic floor dysfunction
- post-surgical recovery
- nervous system dysregulation
- fatigue syndromes
- trauma histories
- autoimmune conditions
- complex movement behaviors
- metabolic disorders
- cancers/neoplasms
Clients are also arriving more informed, more medically aware, and often carrying language they have heard from physicians, physical therapists, psychologists, podcasts, social media, and healthcare systems.
And as movement professionals, we are being asked to evolve alongside them! This evolution is not about abandoning the art of teaching movement. It is about deepening our understanding of why movement changes, how pathology influences movement, and how movement itself can influence physiology, perception, behavior, and healing.
This is the essence of Pathokinesiology. As I often say: Pathology influences movement… and movement influences pathology.
The future of the movement profession is not built upon fear or over-medicalization. It is built upon observation, critical reasoning, communication, and the ability to create positive movement experiences that improve the lives of the people we serve.
Below are three examples of how the modern, pathokinesiology-informed Pilates instructor may begin seeing common client presentations through a broader and more integrated lens.
-Dr.Brent
1. Hypermobility
From “Flexible” to Understanding Stabilization, Fatigue, and Proprioception
What Clients Often Say:
“I’ve always been really flexible.”
“My joints feel unstable.”
“I’m exhausted all the time.”
“I can do strange things with my body.”
“I was told I might be hypermobile.”
For years, many Pilates instructors viewed hypermobility primarily through the lens of flexibility, but today, the conversation is evolving rapidly.
Through recent discussions in the Pilates community, including conversations with experts such as Dr. Marcia Perretto on Pilates Hour and Live Aligned , movement professionals are beginning to recognize that hypermobility is often far more complex than excessive range of motion alone.
A pathokinesiology-informed instructor may begin thinking about:
- proprioception
- force transfer
- connective tissue behavior
- fatigue patterns
- autonomic nervous system involvement
- stabilization strategies
- movement variability
The question becomes less: “How flexible is this client?”
And more: “How efficiently is this person creating stability?”
What the Science Is Showing
My Live Aligned Episode “The Hypermobility Puzzle” discusses just this! ( Watch Here)
Proprioception may be altered: Research suggests many hypermobile individuals demonstrate altered joint position awareness and sensory feedback, meaning the nervous system may work harder to determine where the body is in space.
Stability is metabolically demanding: Many hypermobile clients expend tremendous muscular energy creating stabilization throughout the day, which may contribute to chronic fatigue patterns.
Hypermobility is often systemic: Conditions such as hypermobile Ehlers-Danlos Syndrome (hEDS) may involve cardiovascular, autonomic, gastrointestinal, and sensory system involvement, not simply joint laxity.
This changes the movement conversation dramatically, the modern movement professional increasingly understands: flexibility does not always equal resilience.
2. Pelvic Floor Dysfunction
From “Engage Your Core” to Understanding Pressure, Breath, and Coordination
What Clients Often Say:
“I leak when I sneeze.”
“My core feels disconnected.”
“I don’t know how to activate my pelvic floor.”
“I’ve had back pain since pregnancy.”
“I feel pressure in my pelvis.”
Traditionally, many movement conversations around the pelvic floor centered around strengthening, but modern movement science is revealing something much deeper:
the pelvic floor does not function in isolation.
It functions as part of an integrated pressure-management and stabilization system involving:
- the diaphragm
- abdominal wall
- spine
- rib cage
- breath mechanics
- posture
- and autonomic regulation
In many ways, the modern Pilates instructor is shifting from cueing isolated muscular contraction toward facilitating coordinated movement strategies.
The question is no longer simply: “Can this client activate their core?”
But rather: “How is this person managing pressure, breath, coordination, and load throughout the system?”
What the Science Is Showing
The diaphragm and pelvic floor work together: Research increasingly supports the relationship between respiration and pelvic floor mechanics. Breath strategy directly influences pressure regulation throughout the trunk.
More tension is not always better: Some clients with pelvic floor dysfunction may not demonstrate weakness at all but rather excessive resting tone, poor coordination, breath-holding strategies, or inefficient pressure management.
Stress physiology influences pelvic floor behavior: The autonomic nervous system influences muscle tone, guarding patterns, respiratory behavior, and pelvic floor function.
This is why movement professionals are increasingly studying:
- respiration
- nervous system regulation
- variability
- and movement efficiency
Not merely muscular activation, because sometimes the solution is not “more contraction”, sometimes the solution is “better coordination.”
3. Chronic Pain
From “Tight Muscles” to Understanding the Protective Nervous System
What Clients Often Say
“My shoulders are always tight.”
“I’ve tried everything.”
“My MRI looked terrible.”
“I’m afraid to move.”
“I feel fragile.”
“My pain keeps moving around.”
Perhaps no area of movement science has evolved more dramatically in recent years than our understanding of pain. In our conversations on Live Aligned with pain science experts such as Dr. Adriaan Louw, one concept continually emerges: Pain is often protective and the body is not simply a mechanical machine.
Human movement is influenced by:
- perception
- stress
- threat assessment
- previous experiences
- sleep
- inflammation
- emotion
- behavior
- and nervous system sensitization
A pathokinesiology-informed Pilates instructor begins understanding that persistent pain is often not explained entirely by tissue damage alone.
The question becomes: “What is the nervous system trying to protect?”
What the Science Is Showing
Pain and tissue damage are not always strongly correlated: Research repeatedly demonstrates that imaging findings do not consistently predict pain severity or movement capacity.
The nervous system adapts: Persistent pain may involve sensitization, where the nervous system becomes increasingly efficient at producing protective responses.
Fear changes movement behavior: Anticipation, fear, and perceived threat can alter breathing patterns, muscle guarding, balance strategies, motor coordination, and movement variability. This understanding profoundly changes movement prescription. As movement professionals, we are no longer simply stretching tissues – we are influencing human experience.
And as I often teach: Distribution of movement equals distribution of force. When movement becomes more adaptable, efficient, and variable, the body often becomes more resilient as well.
The Future of the Movement Profession
The Pilates instructor of the future may not look entirely different from the Pilates instructor of the past, but the lens through which they observe movement is evolving.
The modern movement professional increasingly understands:
- biomechanics and neuroscience
- movement and physiology
- stabilization and variability
- anatomy and perception
- pathology and human behavior
This does not mean Pilates instructors must become physicians, it means they are becoming more sophisticated observers of human movement.
More skilled communicators. More collaborative professionals. More capable of creating positive movement experiences that change the lives of the people they serve. This is the evolution of the profession, and this is the work of Pathokinesiology.
For more information about Dr.Brent’s Pathokinesiology 2026 Fall Cohort click here.
