Pilates for spondylolisthesis: toward trust in movement
No two people with spondylolisthesis present in exactly the same way. As a Pilates instructor, my job is to understand how each person's symptoms, goals, work, and daily life shape the way I programme movement.
When Elena first contacted me, she was in deep lower back pain.
She had recently moved to Amsterdam for a high-level international executive role that required constant travel, long meetings, and extended periods of sitting. Her schedule was dense, structured down to the hour, and physically demanding in ways that are often overlooked.
A diagnosis is only one part of the picture
She had been diagnosed with grade 1 spondylolisthesis at L5-S1 - a condition in which one vertebra slightly shifts relative to another, often causing pain, stiffness, and increased sensitivity around certain movements or positions. During periods of acute pain, people are frequently advised to approach exercise cautiously, particularly movements involving spinal extension. Her doctor prescribed a corset and advised her to exercise only in supine positions - lying on her back.
But a diagnosis is only one part of the picture. No two people with spondylolisthesis present in exactly the same way, As a Pilates instructor, my job is to understand how each person's symptoms, goals, work, and daily life shape the way I programme movement.
The language we hear around pain and diagnosis can shape us deeply. Even now, I can still see traces of hesitation around certain movements, particularly spinal extension, which is generally contraindicated in spondylolisthesis and often avoided in exercise programming. But what stood out immediately was that Elena did not approach her diagnosis as a catastrophe. She was curious, intelligent, and motivated to understand what movement could still offer her.
During our first phone call, I remember telling her that her diagnosis was not a death sentence. Much later, she repeated that phrase back to me. I had almost forgotten saying it, but she had not.
That moment reminded me how much language matters.
When caution begins to shape movement
People living with spinal conditions and complex back injuries are often surrounded by messages of fragility, caution, and limitation. Sometimes this is medically necessary. Sometimes it becomes broader than intended, slowly shaping the way someone relates to movement, effort, and uncertainty. Elena was still carrying luggage into overhead compartments on airplanes, walking extensively through airports and cities, and managing enormous professional responsibilities — yet certain exercises felt threatening in a way that everyday movement did not.
This paradox became important in our work.
Private Pilates for spondylolisthesis: building continuity before complexity
Rather than trying to expose her to as many new movements as possible, I became more interested in creating a consistent and predictable movement environment where she could build confidence without fear of how her body would respond the next day. This way of thinking shapes how I approach private Pilates at Pilates Incorporated in Amsterdam West for people living with spinal conditions such as spondylolisthesis.
At first, I wanted to progress more extensively. I considered introducing some standing work, seated work, and more variation early on. But I quickly realised that what Elena needed most was not novelty. She needed a sense of continuity and trust.
Over time, our sessions developed into what I began thinking of as a kind of movement “playlist.” We returned to familiar exercises while gradually introducing small variations, changes in resistance, and new coordinative demands. The structure stayed recognizable, but the work kept evolving.
Reformer Pilates: support without avoiding challenge
“I often describe this to clients as behaving like a spring themselves.”
Most of our work initially happened on the Reformer and other classical Pilates apparatus. Reformer Pilates became an ideal starting point because of possibility do do most of the work in supine. This was not about avoiding challenge. In many ways, it allowed us to challenge her more effectively.
Pilates springs became an important part of this process. One reason I chose the Reformer early on was that its springs provide continuous feedback. The body has to organize force gradually, follow the recoil of the spring, and stay attentive throughout the entire movement — not only during the exertion, but also during the return.
I often describe this to clients as behaving like a spring themselves.
In Elena’s case, this created an opportunity to work on force matching, attention, and movement confidence in a highly supported environment. The goal was not simply strengthening isolated muscles around the spine, but improving how her whole system prepared for and responded to movement.
We used progressively increased resistance, hand weights, wedges, rollers, and targeted proprioceptive feedback to help her notice small shifts in orientation and loading. Sometimes the challenge was subtle: sensing whether her pelvis tilted anteriorly against a small support under her sacrum. Even within these more precise and attentive tasks, the work remained physically demanding, often intense enough that she shook from sustained effort and fatigue.
What surprised me was how willing she was to stay with difficulty.
Many people stop the moment effort becomes uncertain. Elena often continued even after I suggested stopping. There was determination in the way she approached the work, but also increasing sensitivity and awareness.
Flare-ups, effort, and learning to trust the body
Importantly, we were never trying to create perfect movement or eliminate all discomfort. Flare-ups still happened occasionally, and part of the process was understanding that temporary increases in pain were not necessarily signs of damage. This mattered because her professional responsibilities left very little room for physical unpredictability. A difficult pain day did not simply mean discomfort — it could affect concentration, decision-making, travel, and leadership.
That reality shaped my programming decisions constantly.
Consistency became more important than intensity.
Although twice-weekly sessions may have been beneficial physically, maintaining a sustainable once-a-week rhythm turned out to be more valuable. The goal was to create a reliable practice that could exist within the realities of her life, not outside them. Over time, we also introduced occasional online sessions to support continuity while she travelled.
From protection toward trust in movement
What changed was not only her physical capacity, but her relationship to movement itself.
She rarely wears the corset. She skis with her family during holidays. She tolerates more load, more variation, and more effort. But perhaps most importantly, movement no longer seems governed primarily by fear and anticipation.
There is more trust.
Not because her spine became “perfect,” but because her body became less defined by protection and more capable of responding, adapting, and participating in movement again.
That process doesn't end after a few weeks or months. Like any meaningful movement practice, it continues to evolve.
Is Pilates safe for spondylolisthesis?
I wrote about Elena because I am often asked: Is Pilates safe for spondylolisthesis? Can I do Pilates with spondylolisthesis?
Her story illustrates why, at Pilates Incorporated in Amsterdam West, I don't think the most useful answer begins with a simple yes or no. A diagnosis such as spondylopathy—or other forms of spinal instability, degenerative change, or persistent back pain—is only one part of the picture. What matters is the person living with it: their symptoms, movement history, daily demands, goals, fears, capacities, and how these change over time.
With Elena, the goal was never simply to strengthen isolated muscles around the spine or focus on core strengthening for spinal instability. We used Pilates and the possibilities offered by the classical Pilates apparatus, particularly the Reformer, to create a supported and progressively challenging environment in which she could develop strength, coordination, movement options, and trust in her own responses.
The aim is not to use Pilates to “fix” a diagnosis. It is to help the person become more capable, curious, and autonomous in their own body—and increasingly confident in what it can do.
