Lymph Flow, Pilates, and the Spanish Flu

Published on:  March 29, 2020
Last updated on:  June 27, 2021

Pilates and Health

Joseph Pilates, the German born creator of Pilates, was quite sickly as a child and started developing a group of exercises he referred to as “Contrology” (and that we now know as Pilates) at an early age believing fully that poor health was the result of three things:

  • bad posture
  • insufficient breathing
  • not using the full range of motion

While interned by the British on the Isle of Mann during World War I, he worked with other internees, including prisoners of war, some of whom were confined to hospital beds when the Spanish flu broke out in 1918. 

(If you’ve ever wondered why some of the Pilates equipment looks so strange, legend holds it’s because the original equipment was a hospital bed that Joe rigged to help bedridden patients perform some of the Pilates (Contrology) exercises.)

The Spanish Flu

The Spanish flu wasn’t your annual run of the mill flu.  It killed about 2.5% of the people infected compared with the typical flu mortality rate of 0.1%.

And, unlike normal strains of flu virus, it killed young adults (between the ages of 20 and 40) at alarming rates.

the Spanish flu mortality rate by age from Wikipedia

One more major difference between the Spanish flu and “normal” flu.  In the Northern Hemisphere, the Spanish flu spread like wildfire during the summer and fall compared with flu’s typical notoriety for spreading during the winter.

And, what likely made the Spanish flu so deadly was the war. 

This insidious virus didn’t stop in a single season either.  It mutated into an even more deadly strain and trekked the world a second time. 

Several virologists have mapped the outbreak of the Spanish flu and show three waves of this illness with the deadliest month on record, October 2018, claiming the lives of 25 people per 1,000 infected (2.5% mortality rate).

Wikipedia graph Spanish flu in 3 waves

WWI and the Spanish Flu

Let’s talk dates here.  The Spanish flu ravaged humanity from January 1918 to December 1920.  But, it’s suspected that one wave washed through US military camps in the fall of 1917. 

We all know the First World War ended in November 1918 well before the Spanish flu pandemic was over.  However, even though the war was over, Joe Pilates remained interned on the Isle of Mann until he was repatriated in March 1919.  So, he worked with internees during the deadliest part of the outbreak.

Although the Spanish flu infected half a billion people (just over 25% of the entire world population at the time) and killed between 20 and 50 million people (some estimates are as high as 100 million deaths), not a single one of the half-starved internees that Joseph Pilates worked with at the internment camp (including those who were bedridden) died during the pandemic.  In an interview published in Sports Illustrated on February 12, 1962, Joseph Pilates boasted of the internees loyal to his Contrology exercises:

“They ended the war in better shape than when it started, and when the great influenza epidemic came sweeping over all the countries that had fought in the war, not one of them came down with it.”

Now, that’s an incredibly bold statement, and I really think Joe was using some hyperbole here.  It’s nigh on impossible to find concrete information on whether the Spanish flu visited the Isle of Man or not, and in fact, the most trustworthy data I could find is from a book that’s decidedly biased against Joe’s claim.

If you happen across any solid data about the Spanish flu on the Isle of Man, please leave a comment with a link because I’d love to get more sources on this.

In the meantime, here’s what Javier Perez Pont and Esperanza Aparicio Romero share in their book Joseph Hubertus Pilates The Biography

It appears the Isle of Man was spared the brunt of the pandemic but did not wholly escape.  Documented cases of the Spanish flu were recorded in October 1918 on the little island, the deadliest month on record for the Spanish flu.  By January 1919, the island’s government enforced preventive measures to try to abate the spread of the disease.  In total, 125 people on the Isle of Man died from the Spanish flu between its outbreak on the island in October 1918 and the end of 1919. 

1918 influenza ward at a US army base in France digitally enhanced with color

Joseph was on the island for about 6 of those 15 months.  I’d imagine the influenza spread to his internment camp, Knockaloe, on the island during that time, but I cannot say for sure, and I am inclined to believe Joe probably didn’t reveal the whole story during his interview with Sports Illustrated, and his camp was probably quite protected from the pandemic.

Regardless of this historical tidbit, I am inclined to believe there’s substantial health benefits from Pilates that likely go beyond “regular” exercise (of course, I’m a 20-year student of this exercise modality, and I know all the great benefits it’s offered me, so I’m also decidedly biased).

Pilates and Lymph Drainage

Although Joe’s attribution of the health of the internees in his ward to Pilates might be a bit (or a lot) of hyperbole, it’s worth looking at the benefits of Pilates beyond just strengthening our core and increasing our flexibility.

I think Joe knew his exercises very well, and he was a devout student of anatomy.  Both of these understandings are reflected in his quote:

“Contrology is specifically designed and conducted to arouse sluggish blood, distend every capillary, force lymph through every interstice: by stretching every muscle and sinew and wringing out the body all under the strict control of the awakened brain in each of its ten billions of nerve cells.”

-Joseph H. Pilates

Most Pilates exercises are intended to do one or more of the following:

  • stretching: creating space within the body rather than focusing on building muscle
  • moving the core: deep within our bodies, situated near the navel is a central collection point for lymph known as the cysterna chyli
  • Pilates exercises are largely conducted lying down and inversions are frequent poses throughout the series – this removes gravity from the equation from a lymphatic flow perspective
  • breathing DEEPLY: believe it or not, deep breaths stimulate our parasympathetic nervous system taking us out of the stressful “fight-or-flight” state most of us reside in from the moment we wake up until the moment our head hits the pillow again at night

Pilates inversion mat exercise

Of course, Pilates isn’t the only exercise that’s beneficial for moving lymph and encouraging breathwork.  Yoga leaps to mind and even the action of walking, the rhythmic movement of your arms by your sides and your joints moving, encourages lymph flow.  Another great way to encourage lymph flow is by jumping on a trampoline.

But, Pilates is unique of all these other types of exercises.  I truly believe based on personal experience that Pilates targeting of the core perhaps works the internal lymph collection point (cysterna chyli I mentioned above) more so than these other types of exercises.  I also believe the distinct breath work associated with Pilates is nothing to sneeze at.

I'm not saying Pilates, exercise, breath work, or promoting lymph drainage will keep you from getting any other illness.  I think these things can help support your overall well being enabling your body to fight off communicable diseases or lessen the severity of any communicable disease you catch.

If you enjoyed this article, be sure to check out the post:  "How to Improve Lymph Flow Naturally" written by acupuncturist and holistic health practitioner, Leslie Deems, DACM, L. Ac.

And, be sure to check back in for our next post in this series that discusses the science behind our lymph system and explains why it's just so important for our health.

Finally, if you're interested in a step-by-step guide for stimulating superficial lymph movement in the body by dry brushing, then be sure to sign up for our newsletter to get the guide delivered straight to your inbox. 

Staying in (Lymph) Flow


Disclaimer:  This article is not intended to treat, diagnose, prevent, or cure any disease.

Brandy Searcy founder Rain Organica

About the Author

Brandy's a formulation scientist and self-proclaimed health geek who loves hiking, gardening, bird-watching, and body boarding. 

Her struggle with acne during her teens and 20s led to a holistic and healthy approach to skincare, embracing skin as an organ to be loved and cared for rather than a canvas to wage war on. 

Since 2008, she's been developing all-in-one products for a simple routine at home, & Rain Organica started when her backpacking friends asked for a portable skincare routine to keep their skin healthy & happy on and off the trails.

You can try Rain Organica for yourself with The Essentials Kit, a complete skincare routine in just 3 steps.

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