Ep 27: The history of Clinical Pilates

Michael Dermansky:

Hi everyone, and welcome to the show that helps you become more confident in your body so you can keep doing the things that you love. My name is Michael Dermansky, I’m the senior physiotherapist here at MD Health and I’ve got a special guest today, Craig Phillips. I’ve known Craig for probably around 20 years now. He’s the founder of Clinical Pilates and we’re going to be talking about that today because if it wasn’t for Craig we probably wouldn’t have Pilates in Australia. So that’s the beginning introduction for you, Craig. Welcome to the show. 

Craig Phillips:

Thanks Michael, you’ve got me up an ungodly hour in the morning but I’ll be able to do this.

Michael Dermansky:

Well, tell us a little bit more about yourself. I mean, what’s your background, when you started training when you did physio and really how you introduced to Pilates to your world.

Craig Phillips:

There was another career before physio. In fact, I’m a recycled ballet dancer. I was with the Australian Ballet in the 70s. I’m getting old. So I went through the Australian Ballet through training the ballet school and the Australian Ballet Company. Spent 10 years with them. And during that time, you know, became aware and again, it was a dance year. A, pretty fit, B, working pretty hard. It’s like sports medicine on steroids. You’ve got… seven games a week plus traveling so it was a pretty intense lifestyle but it was during that period you know how do you keep yourself fit how do you keep self-function that’s when i started seeing Pilates using Pilates in the 70s in the US in London and it was just part of our training regime back then which kept us going that was the sort of the background so when i’d finish the company Bell company in about 83, went back to university and started physio. So I spent five years there. I failed a year. 

It was the neuro physios, but I’ve coming back to get them now, asked him any questions, but it was, um, it was during that period that, you know, well I was studying and then at the end of that, there’s a chap called Jim Garrick, who was an orthopedic surgeon. from San Francisco, San Francisco’s hospital. And he was out here talking to sports medicine. I was working at Pran Sports Medicine Center. He was talking about dance injuries. I said, yep, that was part of my background. He said, oh, we’ve just set up. And when sports medicine was starting to gain traction, this is at Victoria House in Melbourne, he said, oh, we’ve put this Pilates stuff into the hospital setup. And he said, I reckon, if part of, if these athletes, no looking after you know, athletes like the San Francisco 49ers and what have you. He said, God, if those athletes could do half what those dancers can do, they’d be less injured. I said, okay, I know this stuff. We used to do it. 

Cut a long story short. He said, well, why don’t you come and see what we’re doing? And I did. So I got funding from the government to go across there. And we started this relationship with some Francis hospital in San Francisco and set up a sister clinic here, which was the first Pilates clinic. Australia and that was late 80s

Michael Dermansky:

Wow.

Craig Phillips:

and that’s where it kicked off and I keep going back to the states working with some of the surviving Pilates masters from that worked with Joseph Pilates himself and it was that relationship backwards and forwards for many years back over to the UK catching with people there and that was sort of the start of it here and people said what is this stuff? We used to get a lot of footballers and the surgeons and the doctors and the physios coming through, mainly because there was lots of ballet dancers that they liked to watch. I came on this equipment because I was still fairly heavily involved in the performing arts industry back then. Yeah.

Michael Dermansky:

So when, so you brought, so where was your first studio anyway? I mean, was it the one in South Yara?

Craig Phillips:

Sorry the first.

Michael Dermansky:

First place that you opened in terms of Palladio when you brought it to Australia.

Craig Phillips:

Oh that was in Paran. So that was in Malvern Road, Paran. It was Paran Sports Medicine Centre. And that was where I was working. I started up there. So built a relationship and said, I’m going to bring this strange looking equipment in. I’ll put it over in the corner there and we’ll have a look and see what it’s going, what it’s doing. And then eventually built, actually built another section. I made an arrangement with them. We built another section at Victoria House. And we put Pilates clinic in there and then it sort of just grew, we outgrew that. It was very handy because there’s a lot of sports medicine doctors and the surgeons and the other physio sports med physios there. 

So it created a real buzz, you know, with AFL particularly, you know, a lot of Olympic athletes, what have you, wanted to get on this strange equipment because they’d been hearing about it. And then we sort of moved from there to locally around the corner to a bigger. set up and then we’ve just been for 20 years now the one at South Yarra which we literally have just closed as we speak because I’m relocating to Montalbot which is near Box Hill Hospital. There’s another project going on there going with another large clinic as well so yeah the future continues.

Michael Dermansky:

Well, speaking of the future, I mean, you, you learned this stuff in America. I mean, I’m American London as well. It went to San Francisco back and forth as well. But I know that you looked at the thing, you know, some great stuff here, but it needs to be modified and changed a lot. What, what was different from what you learned in Pilates and how you develop clinical blood is because that’s your development, you develop that.

Craig Phillips:

Yeah, it was, I mean, Pilates itself was sort of from that and Joseph Pilates was around that culture physique area, era, the beginning of the 20th century. Now a lot of focus on fitness, but again, it was that, you know, if you, if you go back, you look at Tai Chi, you look at yoga, you look at gymnastics from the Greeks, you know, exercise is nothing new. And this was sort of another version of exercise working on pretty simple spring loaded equipment. And that was where it began. You know, he was looking at keeping prisoners of war fit and things like that. It was, um, it was part of a thing of focus on health, which has always been around and exercise has always been a big part of health, health management. 

That was where it sort of came from as we sort of started doing what we’d been doing as ballet dancers on the equipment. We found a lot of high level, strong athletes. struggled and I still struggle with the concept of strength. When I say to people, I’ve been working in sports medicine for 35 years with strong injured athletes. This is nothing new and we’ve seen it before, the more strength they have, the more injuries they have. So it came down to this area of control and again going back to Jim Garrick, highly paid elite level athletes with… don’t even ask, millions of dollars. And yet they can’t actually control their movement terribly well. 

And you see this all the way through sports. It’s not your strong athletes that last. It’s your people who got the better control. The Fedors, the Agassiz, the Sampras, less injuries, longer careers. So that was where we sort of started putting the process together and finding strong guys who couldn’t actually control their bodies and move. started getting interesting and at the same time the ballet dancers were there. So it sort of encouraged them to come in. And we found the same thing in San Francisco. Now the 49ers would come in. It was that relationship. Like, how do you guys do this? And the dancers are like, that’s just what we do. Yeah.

Michael Dermansky:

But I mean, you change it as well. You said, look, you know, there’s a lot of exercise. There’s really good exercises, but they don’t work for everybody. And how do we, how did you change it to be specific to you put your physiotherapy hat on and say, look, how does, how do the two come together? And I know you’ve modified a lot of things and said, look, these will work really well for these people, but this won’t work very well for other people as well. So what was your thinking process behind that? And how do you, how did you do that?

Craig Phillips:

I guess it came down to, you know, the idea of exercise is good. And everybody sort of comes up with the prospect says, you know, Every patient is different, but they never tell you what that difference is. Yeah. You go to a great big long spiel. There’s about three words. They differ in their response to load and the response to the direction of that load. That’s the big one.

Michael Dermansky:

Yeah.

Craig Phillips:

Now, which direction does that load come from? We were seeing this with exercises. Some people respond well to exercise, but it’d be worse. And this was the concept of, well, if you’re loading somebody in flexion, it had a flexion trauma, a flexion injury, it’s not going to help them. So you can’t homogenize it’s heterogenizing their prospect. You know, you can.

Michael Dermansky:

For all the listeners as well, they might not know what flexion is. So bending forward, so flexion is bringing the movement forwards, and then extension is gonna be moving the movement backwards on the lateral flexion, which is sideways as well. So I think what Craig’s saying as well is that some people, no matter how much we do forward stuff, they’re just not gonna like it, and they’ll get worse from it rather than better from it. So we’re going.

Craig Phillips:

Yeah, and that was a big component. You know, you could correlate this then to, you know, if they’ve had a disc injury, or they’ve had a PAS defect or a spondylitis thesis or a femoral encroachment, depending on what the structure may be at fault, assumingly, you know, you’re not going to put somebody with a disc injury or the disc prolapse into a lot of flexion. Yet we were seeing exercise programs where that was exactly what was happening. They were lying on their back in supine. We started seeing the transversus work coming out and I was a big fan of that originally. That was again, the late 80s, early 90s. And we sort of correlated a lot of that work into the Pilates work. And that sort of held us in good stead for quite a few years but this direction load kept on popping up as we, you know hang on a sec, even with radiology. And this is where we’ve got more interesting because nobody tests radiological findings.

You know, you talk to any radiologist, it’s a huge. body of literature now saying what you see on radiology can’t be taken as gospel. You know you can see a big disc bulge on radiology that’s got nothing to do with the patient’s presentation. People walk around the street with disc bulges. Even on the same day, you know, radiology can change. We don’t do serial radiology. We’ve got Charles April, radiologist in the US, who’s a very loud advocate for don’t trust radiologists. Him as a radiologist. Unfortunately passed away.

So we found ourselves testing radiological findings going, well, if this is a PAS defect, it’s a fracture, it won’t like loading an extension. Let’s see what happens. And this is, of course, with your chronic population, not your subacute. And we did a lot of this with the cricket teams, finding that PAS defect on radiology wasn’t relevant. Nothing new here to see, but actually we could test these radiological findings and say, well, that’s an artifact, that’s interesting, but it’s not important. and get these people back. So this sort of then carries through to your normal population. We can work out whether they need surgery or not. And this is probably one of the biggest ones we’re following at the moment, which I’ll talk about more later.

Michael Dermansky:

Mm-hmm.

Craig Phillips:

The number one cost to the health system in this country is musculoskeletal injuries. Number one, you know, Australian Institute of Health and Welfare. more than mental health, more than cardiac, more than stroke put together. Musculoskeletal is number one. Dicky backs, D’s, hips, shoulders, you know, the grumbly joints. Billion dollar industry. multi-billion dollar.

Michael Dermansky:

So you know, you said this, that you know, you see the quicker as a little past defect as well. And they, you know, on the radiological findings, you find this as well. And you know, you know that you, that’s not exactly what you’ll see in the clinic as well. There’s a really interesting podcast that came out recently on, um, from JOSPT insights to talked about exactly that when you’ve seen the positive effect on a scan already, it’s too late. That’s a fracture that won’t heal. And it may not be hot, it may not be the cause of their injury. So just cause you see it on a scan doesn’t mean it’s the major cause of their problems. So it’s really important to test properly. So, I mean, I guess that’s the biggest difference between clinical Pilates and what you originally saw that Pilates was an exercise regime based on stability and control. But the specifics of what does that person’s body actually like? How do we put our hats on as health professionals and decide.

We know all this injury based stuff and we know this stuff about stability, but they need to meet together for the person and that’s where the big difference was with your clinical blood E program that you wrote that. Okay, we can put the two together and I’ll work even better rather than just having, you know, the stability and all this treatment like, oh, why can’t we put the two together? They actually work beautifully together.

Craig Phillips:

Hmm. I guess that’s the, you know, it comes down to a simple model. I mean, this is where looking at a lot of the treatment programs that have survived over the years have involved this direction loading Mackenzie. I’ve got a huge respect for the Mackenzie approach. Robin Mackenzie died not that long ago now, but looking at disc model, but he was looking at directional modeling back then. So he sort of took that concept going, well, that actually has got level one evidence to support it. And we can take it that next step further and apply this to what we were doing. We’re going, yes, it does work.

Michael Dermansky:

Yeah.

Craig Phillips:

You agree with this model or not? I don’t disagree. I think it’s something you can tell patients. They’ve seen her on Dr. Google and yes, you look like a disc, sound like a disc, behaves like a disc. We can, we can treat it like a disc. People want the diagnosis. They want a structure. But we know they know heart of hearts. Um, there’s less and less support for structural diagnoses. And you can’t say that, you know, I’ve just found out Michael is about 200 tests for the shoulder joint. Did you know that?

Michael Dermansky:

I know there’s a lot and I know not all of them are relevant and there’s a lot of tests with jaw joint and every other joint that we may or may not use.

Craig Phillips:

I was teaching a course about six or eight months ago and they said I was about 200. I said what? And I spoke to orthopedic surgeon Ian Harris, people may have heard of him. He was doing a study on sham versus rotator cuff surgery with shoulders at the moment. That’s an interesting one. Fantastic, fantastic guy. And I said Ian, how many shoulder tests are there? I was told 200. He said yeah, it could be. I said do you know them? He said no. Hahaha

Michael Dermansky:

I mean, it’s just like every, every practitioner as well will have a battery test they’re used to and they’re happy. So it doesn’t matter if there’s 200 tests or there’s five, as long as you get the information out of, I mean, why do we do testing of anything? We do something to get more information about decision for the client or the patient. And if we’re not getting information with decision making, well, it’s lovely to do a test, but it’s not useful.

Craig Phillips:

And the thing, the only reason I like tests, pre and post intervention. And that’s the biggest thing for getting buy in with a patient. If you’ve done a test, lower limb, upper limb, and you can show them that you’ve made a change to that test within session, then people are listening. Um, we have this huge thing on educating patients. Uh, I say, unless you’ve demonstrated, there’s no point trying to educate. You got to demonstrate first, then educate. Don’t just give them a spiel. and then nothing happens.

Michael Dermansky:

Yeah, that’s right. I mean, they have to, if they feel a belief rather than you need to try to convince them that this is what they need to do. You know, well, show them, believe them, show them you can make a change and then people believe we’ll see this clinical blood as you wrote a long time ago. I mean, I trained in this A long time ago as well. So

Craig Phillips:

We’ve changed it’s like a Nokia 3310, Michael.

Michael Dermansky:

What’s Nokia? Who owns Nokia now? Is it existing? That’s another story. 

Michael Dermansky:

But I mean, have you seen this program? What difference have you seen clinical pilates made over the last 20 years? Or no, 80s. So almost 40 years you’ve been running this program

Craig Phillips:

Yeah.

Michael Dermansky:

for. How has it made it? Have you seen it make a change in people’s lives compared to what you previously saw as pilates?

Craig Phillips:

I guess the thing that made the difference, and this is where we started doing this with athletes, physios started getting interested, so we sort of started as an information sharing process, and we were the first ones to do this with physios. No one has done this anywhere else in the world. So we brought this into the physios, started sharing the information saying, look, here’s what we’re seeing. Tell me if I’m wrong. Tell me what you’re seeing or just making this up. And that’s sort of where it evolved. We sort of developed it into a training program because the interest was growing. We went in with the Australian Physio Association, spent 20 years working with them, fine tuning it to say, look at how much stuff do we need? What do we get rid of? Taking all the fat out and cutting into the, making sure we were keeping in line with the research that was occurring at the time. 

From there, we’ve also then supported research. had doctoral programs, masters programs, PhD programs, we’ve still got those going. I’ve just been up in Singapore, we’ve got a PhD running up there at the moment through Changi General. And it’s this case of bringing in research, testing it, letting somebody go away, pull it apart, come back, going, yes, it’s got inter-rater reliability, you know, it’s got a 0.87 kappa, yes, we can do an RCT, we can do all these different things, it should be doing scientifically, and coming back. positive result and that was where separating it out from just homogenous exercise from a gym industry that we can actually use this as a treatment tool that was where the treatment we’ve done what we do normally as physios hasn’t worked so we start looking then at the chronic population and standing back so the development became how you simplify I’ve written read a lot of books over time. Malcolm Gladwell is one you may have heard of him, but some of the work that he’s done, making things simple, blink, rapid decision making. The less you do, the more you know what Steve Jobs did. Keep it simple, stupid. 

And we found this with clinical Pilates. You’ve got this idea of directions, I said flexion extension. You’ve also got a left and a right. You’ll hear it. I have students in, let alone normal physios and what have you. And they say, how many times do you hear a patient say, I’ve got my dicky hip and then I’ve got my dicky knee, I’ve got my shoulders playing up, my ankles, oh, it’s all on the right side. It’s one side. And this seems to be a thread right throughout. Sports medicine, we’ve gone through sporting teams, Olympic squads, and this asymmetry, that their next injury is on the same side as every other injury. You know, it’s just one sidedness. And this is where exercise, generally given on both sides we found no just do one side just do one side and do one direction and that showed under scrutiny inter-rater reliability of 0.87 kappa highly robust highly reliable if you treat one side in one direction you’ve got a much better prediction for a good outcome. 

We tested this with the British Olympic squad British rowing team and was leading up to the 2012 Olympics we took their strength and conditioning program this was done as a masters by Royal Navy physio Abbie Turner and we took their training programs found if they had a directional bias as we call it and changed their strength and conditioning program to just doing one side in one direction and then of course it was tested on the ergos and the ergometers were showing PB’s and of course that came across on the water in performance at 2012 Olympics, 2016 Olympics. We won’t mention 2020, because it all turned into a bit of a mess with COVID, but we’ve got it back on the radar to sort these guys out. 

So, you know, research like that, which hasn’t been published, the good stuff’s not getting published because it’s worth money, you know, huge potential. And they get massive research dollars, which is brilliant. So this is where we took that one and said, if we can do it with Olympic squads, why can’t we do it with… just the general public. And again, this simplification of treatment. So right, we treated the structure and that was probably the big thing where, structure-based classification and treatment up to a point, six weeks, 12 weeks, 15 weeks maybe, but by six months, you can’t really rely on the structure as being the cause of their problem, which is constantly in the literature. So we had to come up with something else and this was the movement-based classification and treatment. So using movement to differentiate between structure and something else. 

So this has been probably the big change, taking all the research, the literature that’s around and consolidating it down. How you translate this saying, well, if we can’t rely on structure, what can we rely on everybody’s where’s my mobile phone? It’s must be 10 feet away from me. Everyone’s got one video function on it. I video everything on their own phones. Um, but if you can video something and show the difference, pre and post intervention with a function test, lower limb or upper limb, patients go, whoa, that’s a big difference. I’ve seen this to surgeons, other physios have referred. Rather than writing big long reports, you can actually show a video, you can upload it, you can do whatever. But that movement and that video analysis is gold. Absolutely gold, yeah.

Michael Dermansky:

So I mean, you took this concept in this, I mean, I know you fly to US and London as well, and you took this concept from, you know, training just these interest of physios here in Australia. And I mean, you’ve done this worldwide as well. When did it cross the shores to other places as well from the concept that you had here in Australia?

Craig Phillips:

I racked up a lot of frequent flyer miles. I actually got involved with an association called I Adams, International Association of Dance, Medicine and Science, it was in the 1990s. You know I wasn’t the only physio who, or the only ex ballet dancer who’d become a physio, I was finding there was more, you know the Royal Ballet, the head physio there was Maura McCormick, was a former ballet dancer, so we’d get on like house on fire and there’s a lot of us had gone into this physio field from you know the US from Sweden, Canada, oh name a few, UK of course, now France and this sort of brought together a lot of people interested in the performing arts and from sports medicine Jim Garrick, James Garrick still does a lot of work with iAdams you know I’m still in contact with them but it brought this connection between performing arts and sports medicine. 

So we’d had a conference every year and it would be in the US, you know, it would be in Israel, it would be in Sweden, it would be in the UK, in the States. We even got one into Australia. We held it at the Australian Institute of Sport. Trying to think when I organized that, 2007-ish. But there was, it was this dance medicine process that sort of brought this together. So they’d say, well, you know, come up to Sweden. let’s do some training up there, do some lectures, come back to the UK, come across to France, Israel I’m trying to think, Hong Kong, Singapore, huge interest up there. So it was that, that was really the real connection with a lot of the international side. It was through sports medicine and performing arts medicine. And we’re finding a lot of sports medicine people. We did a lot of work with Liverpool Football Club. Now Leeds, that head physio has now gone to Leeds, who in fact have just been bought by the San Francisco 49ers. I said, fine if Jim Garrick is still working with them. Big circle.

Michael Dermansky:

circle. Yeah.

Craig Phillips:

So, yeah, that was the interest. So I’d be doing a conference, doing lectures, I’d be invited to speak at conferences and sort of tied it all together with teaching at the same time. Yeah. And that was, that was probably the biggest thing. And the correlation with sports medicine was the turnaround, you know, performing arts medicine, which is where we developed this as well. It’s like sports medicine on steroids. You’ve got seven games a week,

Michael Dermansky:

I mean even

Craig Phillips:

you know,

Michael Dermansky:

the NBA players what play four or five games a week and that’s enormous load And you’re talking about performers that have to do seven shows. That’s there’s no downtime. That’s just you have to perform

Craig Phillips:

And you’ve got to decide quickly, you know, whether you can get them on tomorrow and they’ll be on tomorrow Is it safe to put them on? What do you modify? And we were seeing this with Cats was probably one of them that woke me up to this whole thing. Yeah the show cats Firstly it’s inflection ever seen humans try to be cats There they’ve been over for two and a half hours So their inflection their entire performance and the other thing too is all choreographed on one side and this was because the choreographer Gillian Lynn had a buggered hip I think it was a right hip so she’d choreographed everything on the left side. We have a problem Houston we’ve got people doing everything in flexion and everything on the left and guess what

Michael Dermansky:

Welcome.

Craig Phillips:

they’re falling apart so

Michael Dermansky:

Yeah.

Craig Phillips:

we had to do things that correlated to that doing the opposite basically to get them on stage and offset it, we even changed choreography. And it took them weeks to notice, and they went, hang on a sec, he’s doing that on the other side. And I said, yes, who changed that? And I said, I did. I said, you can’t change the choreography. I said, well, I can, and I did. And I said, if we just get him doing everything as he had been doing, we’ve lost him, he’ll be off. 

So that was the show Kat started me, and I started looking at other performances, other shows. where they’re doing the same thing, you know, day after day after day saying, right, we’ve got to offset the effect of that choreography. The set of what they were doing. We did a lot of work with Cirque du Soleil over the years as well. Um, that was interesting. And yeah, it was, it was sort of seeing how could you keep a show running. Riverdance. Now there was a show, um, huge, became absolutely huge. Multi Brazilian dollar box office thing.

But if you’re looking at Irish dancing, it’s all vertical compression. Added to which they weren’t professional athletes, they were lawyers, they were accountants, some of them were doctors, some of them were students, they’d all been competition dancers but not professional, working at the level. And they were doing I think about nine or 10 shows a week. And we had to sort of keep that. And they arrived in Australia with the, well, can you just come on tour with us for three months? And I went, that’s not going to be easy. just organize everything. 

So that was where trying to pull them into being a professional dance organization, treat them their injuries. Half the cast were already broken when they came to Australia and they had to meet millions, 20, 30, $40 million in advanced box office sales. It was a challenge. It was a challenge, but we put them together and at the end of it, I said, you have to get a traveling physio with you. no matter what is your next priority, every sporting team has a physio or two and a doctor, and these guys just picked up as they went along. So yeah, that continued for many years as well. So I was going across to Ireland, helping them sort out things over there. And it sort of became this thing of being traveled around and paid for. Yeah, can you come to Dumblin and help us sort out this thing, we need some physios. I said, right, who have you got? So yeah, it was

Michael Dermansky:

Very good.

Craig Phillips:

an interesting lifestyle.

Michael Dermansky:

One last question to go. Where do you see the direction of clinical pilates, strength training, physio, and going forward in the future? From here. Where would you like it to go?

Craig Phillips:

How much time have we got?

Michael Dermansky:

We’ve got about three minutes left over.

Craig Phillips:

Exercise. Exercise is critical. We’re seeing that everywhere. It’s been publicized. Medicine, exercise is medicine. Everybody says no matter what your condition, exercise. There was a thing on SBS the other night talking about getting older and living older. Every single person on that program is talking about the importance of exercise. The big thing that we’ve got is correlating exercise to our health system. We know that health systems, not just here, but worldwide, are crumbling under pressure. And it’s people being in hospital that don’t need to be there.

Craig Phillips:

I can say hand on heart, 50% of the people on hospital waiting lists in Australia alone do not need to be there.

Michael Dermansky:

They don’t need to be there. It’s so preventable. It’s just insane

Craig Phillips:

It’s hospital. Yeah, I can go into lots of stats and figures, but we hospitalise 11 million people. There’s 11 million hospitalisations per annum in our country. We’ve got more hospital beds per head of population. Deloitte reported last year that we have to build one 375 bed hospital a month for the next 15 years to meet current demand. Can’t be. The NHS in Britain, the biggest health system in the world. fifth largest employer in the world has now officially collapsed. We’ve got far too much surgery going on, we’ve got way too much focus on hospitalisation, yet there’s no focus on keeping people out of hospital, even though it’s legislated. 

So we’re working a lot with adequacy with insurers, with private health insurers, I have been called a serial pest, good, don’t remember me. But keeping people out of hospitals that aren’t necessary, which orthopaedic waiting lists, which is one of the heaviest. And during last year alone on the back end of COVID, 67,000 people pulled themselves off of their waiting list for surgery. 67,000 just in Australia. Question, how many physios were involved in that? Number two, how many physios documented that? Three, what was it worth? About two and a half billion dollars showing that the surgeries weren’t needed. And this is where we’ve got the huge impact to show and demonstrate. And this is where everyone talks about outcome based medicine, actually using exercise to say, these persons don’t need joint replacement, don’t need back surgery, spinal surgery. 

The work Ian Harris is doing as a professor of orthopedics, doing surgery on people to show they don’t need surgery is anti-excessive surgery. You know, do stitch up a rotator cuff or just do a scope and close it up. No surgery. He said, there won’t be any difference. He knows. So it’s this. Hospitalization, the focus on hospitalization, we talk about strengthening Medicare. They’ve got to start looking at hospital waiting list, orthopedic waiting list is a big one. Do one thing, do it well, you’ll save billions right there. 

So it’s taking this thing of, can we actually classify these patients? If we can’t make a change to them in a set period of time, good, you need surgery. But if we can cut those waiting lists even by 10%, 20%, that’s a massive saving. We’ve now got the clinics out there. We’ve got thousands of clinics, Michael.

Michael Dermansky:

Yes.

Craig Phillips:

Nearly 20,000 physios we’ve trained. This has been picked up a lot in Asia, Singapore, Hong Kong. We’re doing a lot of work up there. I can’t keep up with it. But yeah, you know, we can do this in Australia. As I said, it’s been taken elsewhere, but that’s the one thing of where this is going to go and where it’s going right now is healthcare systems. You know, taking been talked about, put it into practice at the coalface, get the universities to listen to clinicians. That’s a big one. I’m a, what am I, a reluctant academic, I’ll finish my PhD one day. But this is where actually making a change out there and documenting it is huge.

Michael Dermansky:

Yeah, and it is really big. We’ve seen in our clinic for the last 20 years as well that where things can be preventable, people have better lives. It’s just sitting there waiting for this magical surgery will may or may not fix. And there’s a group, interesting studies have shown as well where people’s lives aren’t any better after a joint replacement they were beforehand. Like why? Well, because they didn’t change anything. So you may have got changed the joint, but if nothing else has changed around it too, nothing’s gonna change. And this is just… Preventable tragedy is just crazy.

Craig Phillips:

The Australian Orthopaedic Association, the National Joint Registry, which is a brilliant initiative here in Australia for 20 years, the last decade thereabouts, there was about a 36% rise in hip and knee replacements, 2010 to 2020. On the current trends, and this is documented, listed, published, between 2020 and 2030, they’re predicting as opposed to 36% increase, there’ll be a 208% increase in hip and knee replacements. hip replacements and a 276% increase in knee replacements. The ageing population is not advancing at 270%, nowhere near that, it’s single figures. Over 65 is the baby boomers. 

So this is where it’s a runaway train, we’re just watching a car crash at the moment and government just throwing money at hospitalisation. So the waiting lists are now at record levels. over 100 000 Victoria alone on hospital waiting lists the majority of orthopedics and they don’t need to be there but no one seems interested. Governments insurers I just sit here saying what is the problem so physios we’re going to get noisy very noisy

Michael Dermansky:

Well at least it’s not been making us stronger. People, you know, keep moving, you know, we have solutions to these things. We just need to be confident enough to actually do it.

Craig Phillips:

Yeah, now we’ve been awarded by the government. You know, Pilates was attacked in 2017 amongst natural therapies saying Pilates has no evidence to support it. Fortunately, I knew where the health minister lived down the road from me here. We presented the literature, said, you know, here’s literature, your defense forces for one. We’ve got it right through the defense forces in Australia and UK, football clubs, universities in Australia and overseas. I said, this is the published research. So April 1st, 2019, they said Pilates was of no value. April 7th, 2019, they overturned that decision, said, right, yes, okay, we’ve made a mistake, let’s have a look at this and put a group together. That was meant to say something, but that was three years ago, we’ve never heard from them. 

Again, NetReap, Natural Therapies Review, Expert Advisory Panel. So you know you’re doing something when people wanna shut you down. which was great. So I thought April Fool’s Day was the best day to put that into place. It was true, April 1, 2019. People said, clinical exercise. I said, no, this is clinical pilates. Use the name, there is absolutely no reason you can’t do it. So yes, yeah.

Michael Dermansky:

Well, that’s excellent. Thank you very much for your time, Greg. It’s been great insights as well. And it’s great to hear where you came from and where you’re going forward with your clinical pilates research as well. I mean, or direction anyway. So thanks very much for your time. We’ll talk to you soon.

Craig Phillips:

Thank you. It’s a great profession and I’m still excited by it. Yeah.

Michael Dermansky:

Yes, yes, I want.

Craig Phillips:

Okay. All right. We shall talk.

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