Pilates after a concussion or head injury: the first days, a symptom-guided return, dizziness, the neck, the moves to change, and a class

If in doubt, sit them out, and get checked within 24 hours

The UK concussion guidelines: "All those suspected of sustaining a concussion should be assessed by an appropriate onsite Healthcare Professional or by accessing the NHS by calling 111 within 24 hours of the injury." Call 999 for any of the red flags below.

Source 1

Rest for 24 to 48 hours, then start moving

Strict rest until every symptom has gone doesn't help: the international consensus says it "is not beneficial", and across 7 studies early activity or exercise shortened recovery by about 4.6 days.

Sources 2, 3

No study has tested Pilates after a concussion

The only one is a 30-person US trial of gentle clinical Pilates moves added to the usual return to activity from day 7, registered in 2026 and not yet recruiting. Pilates goes alongside the graduated return, never instead of it.

Sources 4, 5

Walking or a static bike comes first

In the trials that sped recovery, light aerobic exercise was compared with gentle stretching, and the stretching group was slower (a median of 17 days against 13). Pilates goes beside walking or cycling, not in place of it (our reading).

Sources 6, 7

Where Pilates fits the UK stages (our reading)

A few minutes of breathing in stage 1; seated Pilates in stage 2; head-up, bodyweight Pilates in stage 3, where the UK guidelines allow "low intensity, body weight resistance training"; harder trunk work, reformer springs and head-down moves once you're free of symptoms at rest; anything you could fall or be knocked in after 14 days free of symptoms at rest.

Source 1

The 2-point rule, and getting up slowly

A rise of no more than 2 points out of 10, settling within an hour, is fine; more than that, stop and try again tomorrow at an easier level. Getting up from the mat is when dizziness often flares: 37% of teenagers felt light-headed or dizzy on standing up from lying down after a concussion, against 4% without one.

Sources 2, 8

Red flags

The UK guidelines call these red flags. They need urgent assessment, by ambulance if necessary. If a neck injury is suspected, only a trained healthcare professional should move the person.

• Any loss of consciousness, or getting drowsier
• No memory of events before or after the injury
• Increasing confusion or irritability, or unusual behaviour
• New problems understanding, speaking, reading or writing, less feeling, loss of balance, weakness or double vision
• A seizure, twitching limbs, or lying rigid or motionless
• A severe or worsening headache, repeated vomiting or severe neck pain
• A suspected skull fracture: a cut, bruise, swelling or severe pain where they were hit
• Previous brain surgery, a bleeding disorder, blood-thinning medicine, or being drunk or on drugs at the time

Sources 1, 9

Any time, during or after Pilates

Any red flag at any time, such as a severe or worsening headache, repeated vomiting, getting drowsier, or new weakness or double vision, means 999.

Source 1

What concussion is

The NHS (National Health Service): "Most head injuries are not serious, but it's important to get medical help for any symptoms. You might have concussion (a temporary brain injury) that can last a few weeks." You don't have to be knocked out: Headway says "only around 10% of reported concussions involve a loss of consciousness". Symptoms can be physical (headache, dizziness, feeling sick, sensitivity to light and noise), or in mood, thinking and sleep.

Sources 9, 10, 1

How long it lasts

The UK guidelines: "Most symptoms of a concussion resolve by two to four weeks, but some can take longer." and "Although symptoms may resolve following a concussion, it takes longer for the brain to recover." In 278 studies of mostly North American athletes, symptoms lasted 14 days on average and return to sport took about 20. People seen at hospital after a head injury of any cause recover more slowly: in 1,154 people at US trauma centres, 53% still had some limitation at 12 months.

Sources 1, 11, 12

What a Pilates class asks

Lying down and getting up again, often several times; rolling (rolling like a ball, the seal, the open-leg rocker); legs-overhead and upside-down moves (the roll-over, the jack knife, control balance); head-down folds (spine stretch forward, roll-downs); curls that lift and hold the head (the hundred, the chest lift); balance on one leg; a moving reformer carriage with springs; counted breathing; and often music, mirrors and screens. In the early weeks each of these can bring on a headache, dizziness or overload, and while your balance is off a fall is a risk (our reading).

Sources 1, 8

Dizziness on standing and on changing position

In 297 teenagers seen within 10 days, 37% felt light-headed or dizzy on standing up from lying down, against 4% without a concussion. In 597 adults at concussion clinics, 58% had symptoms on a tilt test. Benign paroxysmal positional vertigo (BPPV), spinning set off by head position, was found in 29% of 102 young people with lasting dizziness at one clinic.

Sources 8, 13, 14

The neck

"New or worsened neck pain was reported with 47.0% of injuries" in 2,163 US college sport concussions, and symptoms lasted longer with it. The UK guidelines say of headaches that last: "Sometimes they are from a neck injury."

Sources 15, 1

Concussion or a more serious brain injury

This page is for concussion (a mild traumatic brain injury). After a longer loss of consciousness, a scan showing damage or brain surgery, our exercise after a brain injury guide applies; NICE (the National Institute for Health and Care Excellence) asks that people whose problems persist are referred "to a clinician trained in assessing and managing the consequences of traumatic brain injury".

Source 16

Relative restStrong evidence

The international consensus: "Relative (not strict) rest, which includes activities of daily living and reduced screen time, is indicated immediately and for up to the first 2 days after injury." The UK guidelines: "It is best to minimise any activity to 10 to 15-minute slots." Easy daily activities and short walks are fine if symptoms rise no more than mildly.

Sources 2, 1

Keep screens to a minimumEmerging evidence

The UK guidelines: "Phone or computer screen time should be kept to the absolute minimum to help recovery." In a trial of 125 people aged 12 to 25, those told to use screens in the first 48 hours took longer to recover (a median of 8 days against 3.5). That includes follow-along Pilates videos (our reading, as on our yoga page).

Sources 1, 17

Where Pilates fits now

Not a class. A minute or two of slow, easy breathing sitting up, with your eyes open, is an easy activity (our reading).

Source 1

Moving between stages

"Progression through the stages below is dependent upon the activity not more than mildly exacerbating symptoms." If an activity makes symptoms more than mildly worse, rest until the next day. Get advice from NHS 111 if symptoms get worse or haven't improved by 14 days, and see a GP if they last beyond 28 days.

Source 1

Stage 1, the first 24 to 48 hours: relative rest

Slow, easy breathing sitting up, for a minute or two. No class.

Source 1

Stage 2: daily activities and short walks

Seated Pilates breathing, shoulder circles and gentle spine movements, a few minutes at a time: the first half of our class.

Source 1

Stage 3: light exercise, body weight only

The UK guidelines: "Brisk walks and low intensity, body weight resistance training are fine but no high intensity exercise or added weight resistance training." Our 15-minute head-up class fits here, alongside walking or a static bike. Mat work on your back and side can start once lying down and getting up don't bring symptoms on.

Source 1

Stage 4: once you're free of symptoms at rest

"Start training activities in chosen sport once not experiencing symptoms at rest from the recent concussion. It is important to avoid any training activities involving head impacts or where there may be a risk of head injury." The guidelines add: "Now increase the intensity of exercise and resistance training." This is when curls with your head lifted, harder trunk work and head-down moves can come back, building up gradually. Reformer springs count as added resistance, so they fit here too (our reading of the guidelines).

Source 1

Stages 5 and 6: full training, then competition

"When free of symptoms at rest from the recent concussion for 14 days can consider commencing training activities involving head impacts or where there may be a risk of head injury." Then rolling, upside-down moves and standing or jumping work on a moving reformer carriage can come back (our reading). Competition waits until day 21 at the earliest; if symptoms continue beyond 28 days, stay out of sport and see a GP.

Source 1

A mild, brief rise is fine; more than that, stopStrong evidence

Before you start, score your worst symptom from 0 (none) to 10. A rise of no more than 2 points, settling within an hour, is acceptable, the international consensus says.

Stop and rest if your symptoms rise by more than 2 points out of 10, a new symptom starts, or the rise lasts more than an hour. Try again the next day at an easier level.

In the later stages, if symptoms come back, drop back to training with no risk of a knock to the head, and stop at once if they come back after a knock in training.

Sources 2, 1

No study of Pilates after a concussionStrong evidence

Our searches of PubMed, Europe PMC and ClinicalTrials.gov in November 2026 found no published trial, pilot or case report. One trial is registered: 30 college athletes, gentle clinical Pilates moves ("pelvic tilts, bridging, seated spinal twists, bent-knee fallouts, supine toe taps, clamshells, side-lying leg lifts, supine side-to-sides, quadruped arm and leg reach, and standing roll downs") added to the usual return from day 7. It isn't recruiting yet, and results are expected in 2030.

Sources 4, 5

Light activity helps; strict rest doesn'tStrong evidence

In a meta-analysis of 7 studies, activity and prescribed exercise shortened recovery by 4.6 days on average. In 88 young people, 5 days of strict rest gave more symptoms than usual care; in 107 adults, 6 days of bed rest did no better than none; and returning to activity from 72 hours was safe in 456 children. Most of the evidence is in sport-related concussion.

Sources 3, 18, 19, 20, 2

Aerobic exercise recovered faster than stretchingEmerging evidence

In 103 teenagers, those who did light aerobic exercise recovered in a median of 13 days, against 17 with "a gentle, whole-body, progressive stretching program". In 118 teenagers, aerobic exercise about halved the risk of symptoms lasting beyond 28 days, with no adverse events. A review of 9 trials agreed. The stretching group is the nearest tested thing to a gentle floor routine, which is why Pilates goes beside walking or cycling (our reading).

Sources 6, 7, 21

Light strength work in the stagesStrong evidence

The UK guidelines allow "low intensity, body weight resistance training" in stage 3, and the international consensus says people "May start light resistance training that does not result in more than mild and brief exacerbation" of symptoms. Neither names Pilates; placing head-up, bodyweight Pilates there is our reading.

Sources 1, 2

Dizziness on changing position is commonEmerging evidence

37% of teenagers against 4% without a concussion felt light-headed on standing up from lying down; 58% of adults at concussion clinics had symptoms on a tilt test; and BPPV was found in 29% of young people with lasting dizziness at one clinic, often "not diagnosed and treated until many weeks after the injury". No study has tested rolling or head-down Pilates moves after a concussion.

Sources 8, 13, 14

Neck and balance physiotherapy for lasting symptomsEmerging evidence

"If dizziness, neck pain and/or headaches persist for more than 10 days, cervicovestibular rehabilitation is recommended." In a trial of 31 people, 73% of those given neck and balance physiotherapy were cleared within 8 weeks, against 7% without. In 60 adults with lasting symptoms, adding it to aerobic exercise improved neck and balance measures but not symptoms.

Sources 2, 22, 23, 24

Pilates for neck pain and balance, in other groupsEmerging evidence

In 8 trials (439 people) with long-term neck pain, Pilates was no better than other exercise for pain (low-certainty evidence). Pilates improved balance in older adults in about half the trial groups pooled. Neither was tested after a concussion.

Sources 25, 26

Yoga and mindfulness after brain injuryMixed evidence

A 2021 meta-analysis of 20 small studies (539 people) with lasting symptoms after a mild brain injury found a small to moderate benefit, with "lack of randomisation, blinding, and recording of adverse events". It doesn't include Pilates.

Source 27

Rolling moves

Rolling like a ball, the open-leg rocker and the seal: fast changes of head position, which bring on dizziness in many people after a concussion and spinning in BPPV.

Sources 8, 14

Upside-down and legs-overhead moves

The roll-over, jack knife, boomerang, control balance and the advanced corkscrew put your head below your heart and weight on your neck, with a risk of a fall. They wait until you've been free of symptoms at rest for 14 days.

Source 1

Head-down moves and lying back fast

Roll-downs, spine stretch forward, the saw, and rolling down fast in the roll-up: they come back in stage 4, slowly.

Sources 1, 8

Balance away from support, and standing on a moving carriage

Standing on one leg without a counter, and standing work on a moving reformer carriage, a jumpboard or a Wunda chair: a fall risk. The international consensus recommends early activity "while avoiding the risk of contact, collision or fall", so these wait until you've been free of symptoms at rest for 14 days.

Sources 1, 2

Hot rooms, loud music, mirrors and screens

Wait until symptoms have settled, and keep screens to a minimum in the first 48 hours, follow-along videos included.

Sources 1, 17

Hands-on adjustments

Ask your teacher for no hands-on adjustments to your head or neck, a spot near a wall, and to be able to skip moves (our suggestion, as on our yoga page).

After 10 days, ask about physiotherapyEmerging evidence

If dizziness, neck pain or headaches last more than 10 days, physiotherapy for the neck and balance system is recommended, and helped people back to sport sooner in a small trial. More Pilates isn't a substitute.

Sources 2, 22

Spinning when you lie down, roll over or look up

It can be BPPV, which a GP can test and treat. Leave rolling and head-down moves out until it's been checked; our Pilates for vertigo guide has a head-up class.

Source 14

Dizziness or a racing heart on standing

Common after a concussion. See a GP if it doesn't settle; our Pilates for PoTS (postural tachycardia syndrome) guide covers exercise with it.

Sources 8, 13

Headaches

Headaches can last months: in 2,291 people in Europe, more than a quarter still had headaches 12 months after a brain injury of any severity. The UK guidelines: "Sometimes they are from a neck injury." Our Pilates for headaches guide covers tension-type headaches and migraine.

Sources 1, 28

The reformer

Lying footwork and arm work on light springs once you're free of symptoms at rest, when the UK guidelines say to increase resistance training; springs count as added resistance (our reading). Standing, kneeling or jumping on the moving carriage waits until 14 days free of symptoms at rest, because of the fall risk (our suggestion).

Source 1

Your usual class

Fuller classes with head-down moves once you're free of symptoms at rest; rolling, upside-down and fall-risk work after 14 days free of symptoms at rest. If symptoms come back, drop back a stage. Hot classes, loud music and mirrors can wait until symptoms have settled (our suggestion).

Source 1

Children and teenagers

The same stages, with school first and no competition before day 21. The UK guidelines say children and teenagers may take longer to recover than adults.

Source 1

The NHS also says call 999 if someone has hit their head and

If you're told to go to A&E, don't drive yourself there after a head injury.

• Has fallen from a height of more than 1 metre or 5 stairs.
• Has problems with their vision or hearing.
• Has a black eye without hitting their eye.
• Has clear fluid coming from their ears or nose, or is bleeding from their ears or has bruising behind their ears.
• Has new numbness or weakness in any part of their body, or problems with walking, balance, understanding, speaking or writing.
• Hit their head at high speed, such as in a road accident.
• Has a head wound with something inside it, or a dent in their head.
• Is a baby under 1 with a bruise, swelling or large cut on their head.
• Has changed in behaviour, for example is more irritable or distracted, or has lost interest in things around them.

Source 9

Get help from NHS 111

Within 24 hours for any suspected concussion, and if, after a head injury, you:

• Are being sick.
• Feel dizzy.
• Take medicine that thins your blood, or have a condition that does.
• Were drinking alcohol or taking drugs at the time.
• Have symptoms that are getting worse, or haven't improved by 14 days.
• Have any other symptoms you're worried about. For a child under 5, call 111 for advice.

Sources 9, 1

See a GP

• Symptoms of a head injury last more than 2 weeks, or any concussion symptoms remain after 28 days.
• You're not sure if it's safe to drive or to go back to work, school or sport.
• You're stuck at a stage, with symptoms getting much worse as you do more.
• Dizziness, neck pain or headaches have lasted more than 10 days: ask about physiotherapy.
• Low mood, anxiety or poor sleep isn't settling.

Sources 9, 1, 2

During or after Pilates

Stop and rest if your symptoms rise by more than 2 points out of 10, a new symptom starts, or the rise lasts more than an hour. Try again the next day at an easier level.

In the later stages, if symptoms come back, drop back to training with no risk of a knock to the head, and stop at once if they come back after a knock in training.

Any red flag at any time, such as a severe or worsening headache, repeated vomiting, getting drowsier, or new weakness or double vision, means 999.

Sources 2, 1

Chest pain or fainting: call 999

Call 999 if:

• You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
• You have chest pain and feel sweaty, sick, light-headed or short of breath.
• Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.

Sources 29, 30, 31

If you need help now

Concussion can affect your mood. If you are thinking about suicide or can't keep yourself safe, call 999 or go to A&E. For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988. Headway, the brain injury charity, runs a nurse-led helpline on 0808 800 2244, Monday to Friday, 9am to 5pm.

Source 10

Before you start

The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.

Source 32

"Rest in a dark room until every symptom has gone"Strong evidence

Strict rest until symptoms resolve isn't beneficial; in a trial of 88 young people, 5 days of strict rest gave more symptoms than usual care. Rest for 24 to 48 hours, then build up.

Sources 2, 18, 3

"Pilates heals the brain faster"Strong evidence

No study has tested Pilates after a concussion, and the first trial isn't recruiting yet. Light aerobic exercise has the evidence.

Sources 4, 5, 6

"Gentle stretching or Pilates is all the exercise I need"Emerging evidence

In two trials, gentle stretching was the slower group against light aerobic exercise. Do Pilates beside walking or a static bike.

Sources 6, 7

"Any headache in class means I'm doing damage"Strong evidence

A rise of no more than 2 points, settling within an hour, is acceptable; more than that, stop and try again tomorrow at an easier level.

Sources 2, 1

"Once I feel fine, I can go back to any class"Strong evidence

"Although symptoms may resolve following a concussion, it takes longer for the brain to recover." Anything with a fall or knock risk waits until you've had 14 days free of symptoms at rest.

Source 1

"Rolling and upside-down moves get blood to the brain and speed recovery"Strong evidence

No study supports it. Dizziness on changing position and BPPV are common after a concussion; leave rolling and upside-down moves until you're free of symptoms at rest (our suggestion).

Sources 4, 8, 14

"Strengthening my neck with Pilates will fix my headaches"Emerging evidence

For headaches, dizziness or neck pain lasting more than 10 days, neck and balance physiotherapy is what's recommended; Pilates for long-term neck pain was no better than other exercise.

Sources 2, 22, 25

"You have to be knocked out to have a concussion"Strong evidence

Headway: "only around 10% of reported concussions involve a loss of consciousness". A headache, dizziness or feeling foggy after a knock counts.

Sources 10, 1