Pilates is safe for most people; hip problems from it are rarely countedEmerging evidence
No country collects injury statistics for Pilates, and no survey has counted hip or groin pain in Pilates clients or instructors (the one instructor survey reports only neck and low back pain). An Australian association of Pilates instructors says the usual problems are muscle strain, flares of existing conditions and occasional falls from equipment. Two hip-region cases are published: a 66-year-old woman with osteoporosis, on long-term treatment for it, broke her thigh bone when "The ball rolled forward and pulled her leg with it" during a Pilates exercise, and a 60-year-old woman had severe buttock pain after three yoga and Pilates sessions in a row, taken up after nearly a year of inactivity. For hip pain after yoga poses, see our hip pain after yoga guide.
Most hip pain after a class is a muscle or tendon meeting more work than it is used to. The NHS lists "Sprain or strain, or tendonitis" as a likely cause of pain after intense or repetitive exercise, and outer hip pain alone affects about one in four women over 50.
Sources 1, 2, 3, 4, 5, 6
What Pilates asks of the hipEmerging evidence
Much of the mat repertoire holds the legs off the floor while your trunk keeps the pelvis still: the hundred, the double-leg and straight-leg stretches, the lower lift, scissors, the teaser and the corkscrew. In a lab study of 8 healthy adults, the deep hip flexor (psoas) worked hardest in maximal hip flexion efforts and much less in a curl-up; linking that to front-of-hip pain in Pilates leg work is our reading, as it wasn't measured in Pilates or in people with pain. A review of 87 ab exercise studies lists avoiding active hip flexion with fixed feet among its safety rules.
The single-leg circle moves the thigh around the socket; the side kick series is done lying on one side with the top leg swinging; the roll-up, rolling like a ball, the seal and the spine stretch forward bend the hip deeply. On the reformer, footwork bends and straightens the hips against springs, and work with your feet in the straps (leg circles, frogs, openings) moves the hip through big ranges with the springs helping or resisting. In a lab study of 14 people on Pilates equipment, the spring set-up changed where in the range the hip worked hardest. No study has measured the hip in leg circles, the side kicks, footwork or the straps; the only other Pilates hip lab study is of the clam.
Sources 7, 8, 9, 10
Clicks are common and usually harmlessEmerging evidence
In 87 elite ballet dancers (another group), 91% reported a snapping hip; 58% had some pain with the snap, but only 7% had taken time off dance for it, and on ultrasound the snap was the hip flexor tendon at the front in 59% of hips. About 5% to 10% of people have a painless snapping hip, and it is called a problem only when it hurts. When it does, care without surgery comes first, and a review says most cases resolve within 6 to 12 months.
Sources 11, 12, 13
The side of the hip: gluteal tendons and lying on themStrong evidence
Pain on the bony point at the side of the hip is now thought to come mainly from the gluteal tendons rather than the bursa, and it is common from mid-life: one-sided in 15.0% of women and 6.6% of men aged 50 to 79. A review names the thigh drawn across the body as a key factor, and the outer hip trial's protocol explains that this squeezes the tendons against the bone, that many people can't lie on the sore side, and that common buttock and iliotibial band stretches hold the hip in that squeezed position. An NHS trust leaflet adds that it often starts after a sudden rise in load.
So the side kick series lying on the sore side, the top leg dropping across the body, the inner thigh lift and figure-four or crossed-leg stretches can flare it, while lying on the other side with a pillow between your knees doesn't press on it (our reading of the trial's rules for Pilates side-lying work).
Sources 14, 15, 16, 17, 18
A groin pinch in deep bends: the hip jointEmerging evidence
A deep pinch in the groin when the knee comes to the chest and turns in points to the hip joint: impingement or a labral problem in younger active adults, arthritis from mid-life. An international group uses bending with the knee across and turned in as a test, and in one trial, people with impingement were asked to avoid "extremes of hip flexion, abduction, internal rotation". The NHS says "Do not try to diagnose the cause of the pain yourself", and a scan isn't a diagnosis on its own: impingement needs symptoms, examination findings and imaging together, and labral and cartilage changes are common on scans of hips that don't hurt.
Sources 19, 20, 21, 5
Rare but important: infection, fractures and herniasEmerging evidence
A hip that is suddenly very painful, hot or swollen, especially if you feel unwell, can be a joint infection, which needs treating as soon as possible; the NHS says a high temperature is common, although not everyone has one. With thin bones, a minor slip can break the thigh bone, as in the case above, and a lump in the groin can be a hernia. These are rare, and the warning signs say what to do.
Sources 22, 3
How it usually goesEmerging evidence
Hip flexor soreness and a mild strain usually settle over days to weeks, and NHS inform says new hip problems or flare-ups should begin to settle within 6 weeks. Outer hip pain is slower: in 164 people seen in Dutch general practice, at least 36% still had it after a year, but in the outer hip trial, 78.6% of people given education and exercise rated themselves a success at a year. For impingement and labral pain, a meta-analysis of 26 studies (1,153 people) found 54% responded to treatment without surgery (moderate certainty). No one can promise a date.
Sources 23, 24, 6, 25
