How Pilates Teachers Can Confidently Respond to Client Questions About Medical Conditions

Amy Sasso
Aug 14
4 min read

One of the most intimidating parts of being a Pilates teacher is when someone reaches out asking whether your classes are appropriate for their injury, diagnosis, or medical condition.

These conversations can make even experienced teachers feel uncertain.

The good news? You do not need to know everything.

As Pilates instructors, our job is not to diagnose or act as doctors or physiotherapists. Our role is to understand enough to teach safely, communicate clearly, and know how to find reliable information.

This is one of the biggest skills we work on inside my Pilates instructor mentorship and a huge part of modern Pilates continuing education.

teacher helps client with shoulder alignment exercise — teacher helps a client with shoulder alignment during exercise

A Real Example: Spina Bifida and Pilates

A teacher in my community recently shared a message from a woman asking whether Pilates would be appropriate for her. She mentioned:

Spina bifida
Degenerative disc disease
Lower back pain during yoga
Pain with boat pose
Being newly diagnosed later in life

This is exactly the type of message that can make Pilates teachers panic a little.

But instead of feeling pressured to immediately know the answer, we can approach it step-by-step.

Step 1: Start With a Simple Google Search

The very first thing I would do is a quick Google search on the term spina bifida.

Here’s a basic definition:

“Spina bifida is a congenital neural tube defect where a baby's spine and spinal cord do not develop properly in the womb, often leaving an opening in the spine. It ranges from mild (occulta) to severe (myelomeningocele), potentially causing physical and neurological disabilities.”

Now, obviously a quick Google search is not the end of the process. But it gives us a starting point and helps us understand what the client may be dealing with.

This alone can help Pilates teachers feel calmer and more confident during these conversations.

Step 2: Look for Clues in the Client’s Message

The client mentioned being diagnosed later in life and described “some lower back issues.”

That would make me wonder whether this may be a milder presentation of the condition, although I would still want follow-up questions to better understand how it affects her personally.

She also teaches yoga, which gives another clue that the condition may not be severe.

This is an important mindset shift in teaching Pilates for injuries. We gather information without jumping to conclusions or catastrophizing.

Step 3: Avoid Fear Around Common Diagnoses

The client also mentioned degenerative disc disease.

This is something many Pilates teachers become nervous about, but degenerative disc changes are actually a normal part of aging and are incredibly common.

That does not automatically mean someone is fragile or unable to exercise.

This is one of the reasons I’m so passionate about evidence-based Clinical Pilates course education — helping teachers move away from fear-based thinking and toward confident, practical decision-making.

Step 4: Investigate Specific Movements

The client mentioned pain during boat pose in yoga.

Boat pose is essentially very similar to a teaser position in Pilates, so it makes sense that it may aggravate symptoms if someone already has lower back pain.

But the more important question becomes:

Are these movements actually contraindicated for someone with spina bifida?

That’s where further research comes in.

I would search:

“spina bifida exercise guidelines”
“spina bifida exercise contraindications”

Google Scholar can also be incredibly useful for Pilates teachers wanting higher quality information and I have a workshop on exactly how to do this inside the Pilates Teachers Community Mentorship Program.

What the Research Shows

Here’s what comes up regarding exercise guidelines:

Exercise guidelines for spina bifida focus on improving cardiovascular health, building strength, and maintaining mobility through a mix of aerobic activity and resistance training.

In other words: very similar to general exercise recommendations.

And regarding contraindications:

Key restrictions include avoiding high-impact contact sports, extreme back/neck extension, and activities risking head trauma.

Interestingly, that lines up with what the client herself was already noticing in her body.

This is where modern, evidence-based, Strength-based Pilates can be incredibly valuable. Instead of avoiding movement entirely, we can help clients become stronger, more capable, and more confident while respecting their unique limitations.

What I Would Say to the Client

After doing some initial research, my response would probably sound something like this:

“I’m sorry to hear you’re having back pain with some yoga poses and movements. What has your healthcare provider said about those movements? Did they advise you to stop doing them? Strength training is incredibly important for people of all ages, and getting stronger can support both your yoga teaching and your everyday life. I’d be happy to work with you. I use Pilates blended with strength training for a whole-body approach, and since you already have so much experience with yoga, I think you’d probably really enjoy it.”

One Important Final Point

Quick Google searches are simply helping us answer the immediate question and develop a general understanding of what may be going on.

If I do end up working with someone like this, I always recommend getting a doctor’s note or contact information for their healthcare provider so I can ask directly about that client’s specific indications and contraindications.

Every person is different.

As Pilates teachers, we are not diagnosing or making medical decisions. We are learning how to teach safely, communicate clearly, and collaborate appropriately with healthcare professionals when needed.

And honestly? That’s a huge part of becoming a confident Pilates teacher.

Ready to Feel More Confident Teaching Clients With Injuries and Medical Conditions?

If you’re a Pilates teacher who wants to feel more confident answering client questions, understanding pain and injuries, and blending evidence-based movement with real-world teaching skills, you’re exactly who I created this community for.

Inside the mentorship, we cover: