Can Pilates-Based Physical Therapy Actually Build Muscle? Yes—Here’s How

Pilates often gets labeled as a “gentle” or “low-impact” exercise method, but anyone who has experienced a strength-focused session on the reformer knows that’s not the full story.

One of my patients recently exclaimed, “I didn’t think exercises could be that hard on this thing!” after completing a set of controlled, high-resistance movements. This is a common misconception—Pilates isn’t just about small movements and stretching; it can also be an incredibly effective way to build muscle, especially when integrated into physical therapy.

When we apply principles of resistance training to the reformer—using heavier springs, lower repetitions, and controlled eccentric loading—we create a muscle-building stimulus similar to traditional weight training. The difference? Pilates-based physical therapy is designed to strengthen muscles while focusing on precision, local stabilizer activation, improving neuromuscular control, and addressing imbalances that often lead to pain or injury. This makes it an excellent approach for women who need strength training but may not thrive in a conventional gym setting.

For patients recovering from injury, struggling with chronic pain, or dealing with the natural changes that come with aging, working with a local physical therapist can eliminate some of the barriers holding them back from thriving.

Pilates-based physical therapy offers a structured, adaptable approach to building strength in a way that feels safe yet effective. The ability to fine-tune resistance, modify movement patterns, and work in a supportive, 1-on-1 environment means that even those with limitations can progressively build muscle and stability, allowing them re-engage in the activities they thought were no longer on the table for them.

Additionally, Pilates-based physical therapy enhances proprioception (your body’s awareness of movement and positioning), which is crucial for injury prevention. Strength is more than just muscle size—it’s about how well those muscles function together to support movement. By incorporating controlled resistance training into a Pilates framework, we help patients develop not just strength, but also coordination, balance, and mobility—all essential for long-term health and wellness.

So, if you’ve ever wondered whether Pilates can truly build muscle, the answer is a resounding yes—when done with the right approach.

If you're looking for a way to strengthen your body, recover from injury, or simply move better, consider trying a Pilates-based physical therapy session. You might be surprised at just how strong you can become.