The Truth About Chronic Pain and Why It Keeps Returning | Ariel Lehaitre, MSPT

I knew within the first few minutes of speaking with Arielle that this was not going to be a conversation about Pilates as a trend or physical therapy as a short-term fix.

Arielle talks about the body like someone who has spent her entire life negotiating between performance and injury, between structure and adaptation. Before she became a physical therapist and opened Pilates Santé in Los Gatos, she was a serious ballet dancer. Movement was not recreation for her, it was identity. By the time she was twelve, she was already dealing with tendon injuries and being introduced to Pilates inside a traditional outpatient physical therapy clinic. What stood out was not just recovery, but continuity. She could still train, still move, still be in her body without making things worse.

That idea never left her.

Years later, after physical therapy school and nearly a decade in outpatient orthopedics, she opened her studio in 2008. What she built was not a Pilates studio that sits next to rehab culture, but one that merges directly with it. In her world, rehabilitation is not something that ends before training begins. It is all part of the same process of learning how to move in a body over time.

When Rehabilitation and Training Become the Same Thing

One of the clearest tensions in our conversation was how differently the healthcare system and the body actually operate. Traditional physical therapy is often structured in short, defined episodes of care. A knee gets a plan, a back gets a protocol, and once symptoms improve, patients are discharged. But bodies do not resolve themselves in tidy timelines.

In Arielle’s practice, recovery and performance happen simultaneously. Someone recovering from surgery is still working on balance, breath, core control, and full-body strength. Someone with chronic pain is not just treating a painful area, but retraining how they move, respond, and stabilize under load. What stood out in how she described this is how often she sees patients arrive believing movement is dangerous. They have been told about degeneration or structural damage and begin to interpret every sensation as harm.

Her first job is often not physical progression but re-education. Movement is safe. Pain is not always damage. The nervous system can become overprotective after injury or stress. That shift alone changes what becomes possible in rehab.

There is also a clear belief in her work that walking and general activity are not enough on their own. Movement is beneficial, but it is not the same as strength training. Without resistance and progressive loading, the body maintains capacity rather than rebuilding it. That distinction becomes especially important in the populations she sees most often now, including perimenopausal and postmenopausal women who have often been told that staying active is sufficient.

For Arielle, the missing piece is load. The body needs challenge to adapt.

The Core Is Not What People Think It Is

That idea connects directly to how she thinks about the core, which she does not describe as a single muscle group but as an integrated system. It includes the deep abdominal muscles, the back, the glutes, the hips, and the scapular stabilizers working together with breath and posture control. The goal is not isolated abdominal work, but coordination across the entire trunk.

In Pilates sessions, nothing is truly isolated. Even simple movements like lifting an arm become exercises in spinal control and pelvic stability. Breath is layered into this system not only for relaxation, but for timing, coordination, and nervous system regulation. What she described aligns closely with what I see clinically: when the nervous system becomes less guarded, pain often shifts before structural change ever occurs.

A large part of her work is also centered on fear. Many patients arrive with imaging that has already shaped how they see their bodies. Degeneration, disc changes, arthritis. By the time they reach her, movement often feels risky.

So the first stage of treatment is rebuilding trust. Trust that movement is not inherently harmful. Trust that pain is not always proportional to damage. Trust that the nervous system can be sensitized and still recalibrated. From there, load is introduced gradually through Pilates equipment, resistance bands, or very basic functional tasks like sit-to-stand work.

What she is ultimately building is tolerance. Tolerance to load, tolerance to sensation, and tolerance to movement without fear.

Movement That Has to Work in Real Life

That same philosophy shows up in how she works with aging populations. The goal is not abstract flexibility or fitness metrics. It is functional capacity. Can someone get off the floor. Can they navigate stairs. Can they recover from a stumble. Can they live independently without fear becoming a limitation.

In those cases, Pilates becomes less about form and more about life. She even described practicing getting up and down from the floor with patients as a deliberate part of therapy. It is not symbolic. It is practical.

What ties all of this together is her view that rehabilitation is not a phase that ends. It is an ongoing process of adaptation. Strength, mobility, breath, and confidence are not separate goals. They are interconnected systems that must be developed together over time.

By the end of the conversation, what stayed with me was not a single method or technique, but the underlying philosophy: the body is not something to fix and return to normal. It is something to keep learning how to live in.

Connect

You can learn more about Arielle through Pilates Sante, where she blends physical therapy and Pilates to support movement, strength, and long-term rehabilitation. She also leads the Clinical Instructor Academy, focused on educating Pilates instructors on working with clients with injuries and more complex conditions. For more conversations like this one, subscribe to The Resilience Factor wherever you get your podcasts, and find me @dr.pamelamehta on social media.