By Zacharias Sifakis & Charalampos Bolis

Clinical Pilates is a specialized form of therapeutic exercise performed under the supervision of a physiotherapist.
It is based on the principles of classical Pilates, adapted to meet the needs of each individual patient, with the goal of rehabilitation, injury prevention, and improvement of overall body function.

This method focuses on activating the deep stabilizing muscles of the core, ensuring correct spinal alignment, and coordinating breathing with movement. Through slow and controlled exercises, patients learn to move with greater precision and safety, improving their posture and spinal stability.

Clinical Pilates is used both for patients undergoing physiotherapy and for individuals who wish to exercise safely and efficiently. It is particularly effective in cases of low back or neck pain, scoliosis, musculoskeletal dysfunctions, orthopaedic surgeries, and sports injuries, as well as in neurological conditions such as Parkinson’s disease and multiple sclerosis.

It is also an excellent choice during the perinatal period, helping women strengthen the pelvic floor and prepare the body for childbirth and recovery.

The benefits of this method are multiple and well-documented. According to international research, Clinical Pilates contributes to reducing chronic pain (Huang & Park, 2023), improving spinal posture and mobility (Li et al., 2024), enhancing balance and proprioception (Pereira et al., 2022), and improving quality of life in people with chronic conditions (Barnet-Hepples et al., 2025). It also promotes psychological well-being, reducing stress and enhancing the sense of control and confidence (Domingues de Freitas et al., 2020).

Before starting the program, the physiotherapist performs a clinical assessment to understand the patient’s history and specific needs.
An individualized exercise plan is then designed and can be carried out individually or in small groups (up to four participants). Sessions use specialized Pilates equipment such as the Reformer, Tower, Cadillac, Wunda Chair, and resistance bands, allowing safe and adaptable exercise for every fitness level.

At Chania Physiotherapy Clinic, Clinical Pilates is an integral part of our rehabilitation programs. Each session is designed with scientific precision, aiming to enhance movement, stability, and function in a safe and progressive way.
Our goal is to help every patient regain the strength, balance, and freedom of movement they deserve.

📚 Selected References

1. Huang J., Park H.Y. (2023). Effect of Pilates training on pain and disability in patients with chronic low back pain: A systematic review and meta-analysis. Phys Act Nutr, 27(1):16–29.
2. Barnet-Hepples T. et al. (2025). Pilates lessens pain and improves quality of life in people with musculoskeletal conditions. Ann Phys Rehabil Med, 68(6):101973.
3. Li F. et al. (2024). Effects of Pilates exercises on spine deformities and posture: A systematic review. BMC Sports Sci Med Rehabil, 16(1):55.
4. Pereira M.J. et al. (2022). Benefits of Pilates in the elderly population: A systematic review and meta-analysis. Eur J Investig Health Psychol Educ, 12:236–268.
5. Domingues de Freitas C. et al. (2020). Effects of the Pilates Method on kinesiophobia associated with chronic low back pain. J Bodyw Mov Ther.

Authors:
Charalampos Bolis, MSc, BSc, MT — Physiotherapist specialized in Sports Physiotherapy, Pilates Instructor
Zacharias Sifakis, BSc, OMT, MHCPC, MAACP, MMACP, CGIMS — Specialist Physiotherapist in Musculoskeletal and Sports Rehabilitation

Chania Physiotherapy Clinic
Chania – Kalyves – Palaiochora
🌐 www.chpc.gr | 📞 +30 28210 58711

Orthopaedic Manipulative Physical Therapy (OMPT) is a specialized area of physiotherapy for the management of neuro-musculoskeletal conditions, based on clinical reasoning and by using highly specific treatment approaches, including manual techniques (manipulations, mobilizations, etc) and therapeutic exercises.

OMPT also encompasses, and is driven by, the available scientific and clinical evidence and the biopsychosocial framework of each individual patient. OMPT certified therapists have undertaken extensive postgraduate courses of study, many of which are at a Master of Science level, and have attained a recognized standard of excellence in neuro-musculoskeletal physiotherapy.

Their knowledge and practical skills ensure that they are able to provide an excellent standard of care in the examination, treatment, and management of people with neuro-musculoskeletal problems.

Our therapists' educational background, & clinical standards certification, is accredited by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT), & registered with the Musculoskeletal Association of Chartered Physiotherapists (MACP). In the UK the MACP is recognized as the specialist group of manipulative physical therapists by the IFOMPT.

Myofascial or myogenic pain means pain coming from the muscles (Myo- comes from the Greek mўs, meaning “muscle”) and the fascia (the thin tissue that is covering the muscles). Myofascial pain is probably one of the least understood and most frequently misdiagnosed types of pain. It is also one of the most common sources of pain and results in a huge number of GP consultations, days lost from work, and missed sports activities.

The symptoms of myofascial pain can vary depending on the location and the severity of the problem. People suffering from myofascial pain often report deep aching pain which can be either constant or intermittent. Usually, it is triggered by the use of the affected muscle or muscle group. This can be accompanied by a burning sensation or stabbing pain, weakness, tingling, increased or decreased sweating, stiffness, sleep difficulties, or dizziness.

Myofascial pain can also be irritated by sustained sitting or standing positions, repetitive activities such as typing or working a press, cold or damp weather, exposure to a cold draught, or psychological stress.

About Trigger points

There are over 600 skeletal muscles in the human body, and any one of these can develop, what is called according to the corresponding theory, a myofascial trigger point (TrP). Trigger points are “nervous hot spots” that cause muscles to become abnormally sensitive. This nervous excitability results in the development of tight bands of muscle or fascia that, when pressed, cause local pain, as well as referral pain to somewhere else in the body.

This referred pain is very important and if the physician is familiar with trigger points, he will very quickly be able to diagnose the problem, as each muscle group has its own pattern. If the physician knows these patterns, he will be able to discover very rapidly the nature of the problem and offer solutions.

There are some fundamental and important features of TrPs, these are:

• Trigger points are tender when pressed firmly.
• The muscle in which the TrP is active will be weaker compared to the normal one on the opposite side. 
• Trigger points in a muscle will make the muscle shorter than normal and will have contributed to a restricted range of movement.
• The muscle will have tight bands which can be felt in the body of the muscle. 
• When these tight bands are “plucked” or pressed firmly they usually cause a muscle twitch, and the person may make a “jump” response i.e. an involuntary cry of pain or reflex movement away from the pain.
• Trigger points have a typical pattern of pain referral.
• TrPs are very common indeed.

Trigger points are essentially areas of nervous excitability within the muscle and they may exist in two different states:

-Latent

A latent trigger point does not cause pain at rest but may restrict movement or cause muscle weakness. The patient presenting with muscle restrictions or weakness may become aware of pain originating from a latent trigger point only when pressure is applied directly over the point.

-Active

An active trigger point does cause pain at rest. It is tender to palpation with a referred pain pattern that is similar to the patient’s pain complaint. This referred pain is felt not at the site of the trigger-point origin, but remote from it. The pain is often described as spreading or radiating.

Causes of trigger points

The TrPs of myofascial pain may occur for many different reasons, however, the most common reasons are injury or trauma to the muscle, and acute or chronic overuse causing muscle damage or dysfunction. Overload occurs when a muscle is being used improperly, causing overstress on the muscle fibers. The muscle will often respond to the stress that is not prepared to deal with, by developing TrPs.

If this state is reoccurring, without any efficient recovery, compensation strategies in multiple areas of the body may be developed, making the problem more widespread and complicated. This clinical presentation is often referred to as myofascial pain syndrome.

Treatment of trigger points

The most important way of treating trigger points is stimulation!

Trigger points need to be stimulated through neurophysiological mechanisms to be cured. This stimulation may be in one of many different ways, however the most important is by stretching the affected muscle group.

The stretching of the muscle may be very painful indeed, and in fact, it is often too painful to be able to stretch the muscle to any meaningful degree. At this state, acupuncture may be vital in the rehabilitation of trigger point problems.

The needle causes immediate relaxation, of the affected muscle, due to the effect of the micro-trauma on the release of the neurophysiological effects suppressing the overstimulation of the muscle. This relaxation will then reduce, to a certain degree, the muscle spasm and consequently increase the flexibility of the affected muscle group.

Acupuncture for the treatment of myofascial pain has been used for at least 50 years in the Western Medical setting. In skilled hands, it is safe, effective and frequently provides long-lasting relief of pain. This has been predominantly applied by members of the Acupuncture Association of Chartered Physiotherapists – a society of British Physiotherapists who have an interest in acupuncture. The society now includes around 6,000 members, most of whom practice Western Medical Acupuncture.

Acupuncture has several local effects and general effects, many of which have been studied in great detail.

“Acupuncture is not the treatment, it is only part of the treatment”.

Specific stretching exercises are required for long-term rehabilitation of myofascial pain, however, the treatment course can be accelerated by the incorporation of acupuncture in the rehabilitation plan. There are also many other ways of treating trigger points, other methods of trigger point stimulation include;

• Deep tissue massage using firm hand pressure
• Injection with a local anesthetic (such as lignocaine also known as lidocaine) 
• Stretch and spray, a technique where the muscle is stretched to its full extent and then sprayed with a coolant 
• Simple stretching of the affected muscle group 
• Application of hot and cold packs to the muscles (ideally at the same time as the muscle is being stretched) 
• Laser

This is not a complete list as there are a number of other techniques that can be applied.

Treatment of MTrP leads to:

• Improvement of symptoms behavior
• Decreased tenderness
• Increased range of motion
• Improvement of quality of life

Further clinical research is being conducted in the field of pain, both in terms of investigating the mechanisms by which pain is experienced, and in examining different treatment options. This makes the area of pain research an exciting scientific topic with the potential to understand and, ease many people’s suffering.

Read more about current scientific evidence on myofascial pain…

Physical manipulation which is interconnected with every massage type improves blood circulation and the movement of lymph. Therapeutic massage relaxes muscle tissue and reduces painful contractions and spasms. In addition, applying pressure tends to decrease the hyperactivation (tightness) of the muscles and stiffness perception. In this way, flexibility and the range of motion are improved and peripheral nerve compression is reduced.

Sports massage aims to enhance performance or/and assist the overworked muscles to recover faster. Our therapists take into account many variables such as the athlete's training stage, history, possible injuries e.t.c., which lead them to the best selection of the technique.

Relaxing massage is used in order to promote general relaxation and address anxiety. Massage is considered to release endorphins, the natural chemical in the body that makes us feel happy and energized, promoting feelings of well-being.

In conclusion, massage can be a powerful tool to manage daily requirements and activities. So no matter if you book a session for a specific health condition or just for your well-being, massage can be beneficial for you without-beyond any doubt.

Within our services, we can provide acupuncture sessions in Chania as per the standards of the British Medical Acupuncture Society, and our therapist is an accredited member of the Acupuncture Association of Chartered Physiotherapists (AACP) in the United Kingdom.

Medical Acupuncture within modern physiotherapy is used against the background of clinical and research evidence but derives from Traditional Chinese Medicine. It is believed to have been developed a long time before the first known written reference in 300 BC in China, around the time “The Yellow Emperor’s Classic of Internal Medicine” (Huangdi Neijing) was published.

Traditional Chinese Medicine

The concept of Traditional Chinese Medicine [TCM] is an ancient system of written scripts as far back as 1000BC, founded on the holistic concept of treatment and an acknowledgment of the body’s ability to return to its balanced state of health, given the correct stimulus to do so.

There are many forces within the body that require balance in order to achieve health and fitness; two forces that are commonly referred to, are YIN [negative] and YANG [positive]. Treatment with Acupuncture is applied with the aim of restoring all the body systems to a state of balance (homeostasis). This is achieved by an in-depth physiotherapy assessment to determine the source of the imbalance and the correct acupuncture points required to address this imbalance and facilitate the body’s return to a state of health both physically and mentally.

The acupuncture needle will stimulate the flow of QI [pronounced ‘chee’], which circulates in channels or meridians within the body. The QI circulates within the deeper organs of the body but connects to the superficial skin. In the state of a normal healthy body,  balance is maintained between these systems. Both the superficial energy and the deeper energy can be influenced by the stimulation of specific acupuncture points. In case of injury, disease, emotional trauma, or infection, the natural flow of QI within the meridians and organs may well be affected and the result would be an altered flow, either a slowing or stagnation of QI causing pain and inflammation, or a deficit of QI, which may cause weakness, exhaustion, and longer debilitating disease. The stimulation of relevant acupuncture points may free stagnation, reduce excess or indeed, increase QI to the specific area or organ and thus help to restore normal QI flow and balance.

Acupuncture on Western Medicine

Physiotherapists apply their treatments based on scientific research and clinical evidence that Acupuncture can reduce pain. There is an increasing number of research publications worldwide proving the treatment effectiveness of acupuncture when compared to (chemical) medication for example. Read more about current research on Acupuncture…

Acupuncture is used by Physiotherapists as a means of enhancing pain modulation via the stimulation of the brain and spinal cord to produce natural pain-relieving chemicals, such as endorphins; melatonin to promote sleep, serotonin to promote well being, to name but a few. These assist the body’s healing process and offer pain relief as a precursor for other manual or exercise therapy.

Acupuncture is also used by advanced AACP members as a means of addressing some systemic and long-term illnesses, but always with the aim of enhancing physiotherapy treatment and improving the quality of life. It is particularly useful in chronic and persistent pain problems and sits against a background of research to support its use.

Acupuncture Techniques

There are several techniques in applying Acupuncture that is described below:

• Conventional Acupuncture

Conventional Acupuncture involves the use of single-use, pre-sterilised, disposable needles of varying widths, lengths, and materials that pierce the skin at the Acupuncture points. The Physiotherapist will determine the locations of the Acupuncture points, based on the assessment of the cause of the imbalance. A number of needles may be used at each therapy session and these are typically left in position for approximately 20-30 minutes before being removed.

• Acupressure

Acupressure uses the Physiotherapist’s hands over Acupuncture or trigger points in order to relieve muscle tightness or to stimulate QI flow and balance the body. It is a healing art that uses the fingers of the Physiotherapist on the key Acupuncture points. The amount of pressure used varies according to the condition being treated and requires trained & sensitive hands. It is often used in sensitive patients, patients with a needle phobia or with contraindications for needle use, children, & frail patients.

• Laser Acupuncture

“Laser” is the acronym for Light Amplification by Stimulated Emission of Radiation and the use of Lasers to effect treatment is known as low-level laser therapy [LLT] [Baxter 1994]. Laser stimulation may be used for any acupuncture treatment, substituting the use of a needle. It is particularly suitable for nervous patients, children, sports injuries, sensitive areas, and ears. Laser Acupuncture may be practiced by Physiotherapists who are fully trained in the correct application and contra-indications of laser therapy.

• Electro-Acupuncture

Following the detailed physiotherapy assessment, inserted needles can be coupled to the electrodes of an electro-acupuncture apparatus. These units are designed to deliver variable amplitudes and frequencies of electrical impulses. Low-frequency electro-acupuncture is intended to contribute to the mechanism of pain reduction, especially stimulating chemicals from the brain which will aid analgesia, relaxation, and sleep.

The body has the ability to “self-repair” and the use of Acupuncture, Acupressure or Electro-Acupuncture enhances the repair mechanism and facilitates an improved recovery time. This allows other physiotherapy interventions such as exercise, muscle strengthening, and rehabilitation techniques to achieve more effective results.

Manual Therapy is generally defined as a hands-on clinical examination/evaluation, intervention & rehabilitation of cases with orthopaedic problems.

Manual Therapy as a therapeutic approach is based on the application of methodical clinical reasoning, and science-based evidenced informed practice. The goal is for the patient to fully return to function and independence in their daily activities through the stimulation of different mechanisms of the human body (physiology, neurophysiology, biomechanics, etc.).

Each patient’s psychosocial background and personal needs & goals are always the main targets in the approach of every certified therapist on Manual Therapy. A shared decision-making process is required to form a therapeutic/rehabilitation plan tailored to the individual needs of each person.

The evaluation procedure followed on the first day is the fundamental basis for the overall course of each patient.

At the beginning of the clinical evaluation the steps are:

• Detailed history to identify all the contributing factors to the current clinical case, as well as associated health problems.
• A complete recording of the limited daily activities, as the patient perceives and experiences them himself.
• Recognition and prioritization of patient’s personal goals in the short and long term.

Following the subjective evaluation is the clinical examination, where the procedure requires:

• Assessment of active and passive mobility, in the structure where the malfunction is detected.
• Differential diagnosis of movement patterns of daily activities.
• Assessment of neural tissue mobility & clinical neurological examination where required.
• Evaluation of the muscle strength, kinetic control, and neuromuscular coordination to identify any weaknesses, deficits, or imbalances.

Once the assessment is completed, the therapeutic plan is then formulated by selecting and adapting the appropriate techniques, therapeutic approaches, or exercise prescription to each patient’s capabilities, needs, and goals. The therapeutic approach is constantly adapted according to the response of the symptoms and/or the body, so as to achieve optimal recovery.

There is an established misconception that manual therapy is exclusively about interventions that apply intense and violent movements. In fact, certified health professionals practicing Orthopaedic Manipulative Physical Therapy meet the requirements of a wide range of scientific knowledge and interventions in order to ensure that they provide the highest quality of service for their patient’s health.

The contribution of specialized physiotherapists to the timely and effective treatment of the orthopedic patient has been proven in various countries such as Canada, Australia, and the United Kingdom. In this way, the patient avoids unnecessary radiological tests or medications that only contribute to the additional discomfort and financial burden of the patient and/or the health care system.

In general, Manual Therapy is recognized worldwide as an effective, safe, and mild way of evaluating and treating orthopedic cases for pain management, reducing inflammation, restoring movement and function.