Posted by: seattledizzygroup | May 18, 2013

Vestibular Rehabilitation from a Pilates Point of View

Pilates Presentation 3

Vestibular Rehab with a Pilates Spin

by Brett Lezamiz, PT, DPT, OCS

(Presented to Seattle Dizzy Group 5/11/13)

Pilates isn’t just about core strength or cranking out The Hundred.  It is a discipline with six core tenets: centering, concentration, control, precision (quality vs. quantity), breath, and flow that can add depth and variety as well as improved balance and stability to a vestibular rehabilitation program.

Core Principles of Pilates


The main focus of Pilates is to center the body, “The Powerhouse.”

All movement begins and is sustained through this center.


Joseph Pilates believed that “it is the mind that guides the body.”

We center the mind with the body in actions to bring the 5 aspects of the mind into the workout:  Intelligence, Intuition, Imagination, Will, and Memory.


Joseph Pilates didn’t call it Pilates, he called it the “Art of Controlology.”

When working from the center and with full concentration, we are able to maintain control of every movement, not allowing bad habits or gravity to take over.


“The benefits of Pilates depend solely on your performing the exercises exactly according to the instructions,” Joseph Pilates.

Work with Quality instead of Quantity.


The full workout is a flowing succession of exercises performed with vigorous dynamics.

Principles of Vestibular Rehabilitation


– Small increase in symptoms

– Slow progression

– Step forward, step back

– Worse before better

– Must produce an “error signal”

– Movements and exposure to stimuli that challenge the vestibular system


– Reduce symptoms

– Improve quality of life

– Increase postural/gait stability

– Improve visual acuity

What techniques as clinicians do we use in vestibular rehabilitation to achieve these goals?

1.  Compensation: when there is damage to the vestibular system

2.  Habituation: with repeated exposure, builds tolerance to the stimulus

3.  Adaptation: long-term changes of the vestibular system that occur in response to the stimulus

4.  Substitution: use of alternative strategies to replace lost or compromised function

Sample exercise progression:

1.  Standing Wall Exercises

A. Quiet standing in Pilates stance

B. Target practice, smooth pursuit or x1 viewing exercise standing against wall in Pilates stance

C.  Coordination exercise (breathing with head movement)

D. Arm circles 5x each way – no head movement

E. ¼ squat with target practice or x1 viewing

F. What other variables could you change? (move away from wall!)

2.  Sitting Postural Exercises (TV exercises)

A. Quiet sitting with Powerhouse engaged

B. Quiet sitting with target practice, x1 viewing smooth pursuit, etc.

C. Sitting with arms folded at shoulder level

D. Just arms with target practice or x1 viewing

E. No arms with alternating knee bending, straightening

F. Arms with alt. knee bending straightening

G. No arms with alternating leg lifting, lowering

H. Arms with alt leg lifting, lowering

Other Pre-Pilates Exercises:

Look over shoulder

Look up/down

Shoulder circles

Lift up on toes

Press up on arms

Leg lifts Iying down

***Any time we combine vestibular exercises with any other exercises (whether Pilates or just walking) the exercise becomes exceptionally HARDER!!!



BUT, it’s more like real life so you’ll get BETTER, FASTER!!!***


The Pilates Body: the ultimate at-home guide to strengthening, lengthening, and toning your body – without machines, Brooke Siler 2000; 1st edition

Vestibular Rehabilitation: A Competency Based Course. Lectures from May 2010

Brett Lezamiz, PT, DPT, OCS

BrettBrett Lezamiz is a manually trained therapist delivering individualized, hands-on treatment to her patients.  She is a certified Orthopedic Clinical Specialist (OCS) and has taken over a dozen continuing education courses to augment her knowledge and clinical skills.  She continues to take courses and she joined Pilates Seattle International in order to become a certified Pilates instructor to further satisfy her desire to provide the best care.

Through her years of practice, Brett has developed a treatment style that uses her manual skills to improve soft tissue, fascial and joint mobility.  She strongly believes one must compliment manual/hands-on work with patient-specific movement reeducation, strengthening and stabilization exercises.  This step is crucial or patients cannot return to their prior activities, or when they do, they get reinjured.

In 2010, Brett successfully completed the highest physical therapy certification for vestibular rehabilitation at Emory University (Susan Herdman course).  Since that time, she has been effectively treating patients with dizziness and/or loss of balance due to vestibular, or inner ear, conditions.

Brett attended the University of Southern California for her graduate work in physical therapy where she earned a doctorate of Physical Therapy (DPT) in 2004.  She moved back to the Pacific Northwest during her final clinical residency and has resided here and worked in several outpatient clinical settings since. Brett is active enjoying running, biking, hiking, and skiing and anything with her Golden Retriever.


Presentation information is not meant to be taken as medical advice.

Presentations posted online may include discussion notes, links, and other information added by Seattle Dizzy Group.

Download Presentation Handout PDF (original without notes):

(Join the Seattle Dizzy Group closed/secret Facebook group to download the presentation.  Send us your email address for invitation to join our Facebook group).


For more information about Vestibular Rehabilitation Therapy (VRT):


  1. […] Vestibular Rehabilitation from a Pilates Point of View […]

  2. Pilates Seattle International offers FREE Pilates mat classes every Friday! (Intermediate/Advanced Class at 12:15 pm and Basic Class at 4:15 pm).

  3. […] Vestibular Rehabilitation from a Pilates Point of View […]

  4. […] 2013, we had guest speakers on the topics of Pilates, Vestibular Rehabilitation Therapy (VRT)/Compensation, and Chiropractic […]

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Seattle Dizzy Group

Providing support & community for people living with chronic dizziness & imbalance -- in Seattle & beyond

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