Pilates guide

Pilates for CrossFit: bracing and breathing, shoulders overhead, the lower back, hips and recovery, what the evidence shows, and a routine

CrossFit and other functional fitness classes mix lifting, gymnastics moves and conditioning against the clock. Most injuries are to the shoulders, lower back and knees, and previous injuries, switching between scaled and full loads and more training hours go with more of them. Pilates can add what a hard workout doesn't: trunk control while you breathe, shoulder-blade and upper-back work for overhead and hanging positions, hips and a steady single leg, and a genuinely lighter session. Only one small study has looked at Pilates in people who do CrossFit, and it lasted one session.

So Pilates sits beside your coach, scaled and progressive training and your strength work, never in place of them, and it isn't a recovery treatment or a substitute for rehabilitating an injury. We're not connected with CrossFit or any brand, gym or governing body.

This guide covers Pilates breathing against bracing, the shoulders overhead, the lower back, hips and landings, leaking with jumps, rest days and rhabdomyolysis, Pilates vs CrossFit, a 25-minute class and the warning signs.

The short version

One study, and it lasted one session

The only Pilates study in people who do CrossFit-style training tested a single session, with no comparison group described, and we could read only its abstract. No trial has tested Pilates, or core training, for CrossFit performance or injuries.

Sources 1, 2

Shoulders, backs and knees

About a third of people who do this kind of training have been injured at some point, at about 4 injuries per 1,000 hours, similar to weightlifting. Shoulder injuries come mostly in gymnastics moves and back injuries in heavy lifts.

Sources 3, 4, 5

Breathing and bracing are different tools

Bracing raised the pressure inside the abdomen far more than drawing the belly in, and a held breath raised blood pressure far more than breathing out. Pilates breathing suits conditioning work and a Pilates class; a brief braced breath belongs to heavy lifts.

Sources 6, 7

Leaking is common and treatable

In surveys, about a third to nearly a half of women who do CrossFit reported leaking, mostly with jumps, and in a trial, daily pelvic floor training improved it for 64% against 8%.

Sources 8, 9

Rhabdomyolysis is rare but serious

Muscle breakdown with dark urine was seen mostly in beginners, but not only. After a single episode, NHS Scotland's pathway puts stretching-based exercise such as Pilates first, before gym work and running.

Sources 10, 11

Time it, and count it

Do Pilates after a session or on a rest day, not in the hour before heavy lifts, and count a hard reformer class as training, not rest.

Sources 12, 13

What CrossFit asks of your body, and where Pilates fits

Each note keeps its own measure; most studies are surveys that rely on memory.

The method, in one paragraphEmerging evidence

Researchers call the wider method high-intensity functional training (HIFT), which "emphasizes functional, multi-joint movements that can be modified to any fitness level". Workouts are hard: after a short benchmark workout, jump height was 8% and plank endurance 46% down in 20 trained athletes, and the authors say recovery can take more than 24 hours; heart rates of 90% of predicted maximum or more were measured across three workouts. In the Compendium of Physical Activities, kettlebell swings are 9.8 METs (multiples of resting energy use), against 2.8 for Pilates in general.

Sources 14, 15, 16, 17

How often people get hurtEmerging evidence

Across 28 studies of 11,089 adults, 36% had been injured, at 4.3 injuries per 1,000 hours, and 9.9 in the five prospective studies. Injuries were to the shoulder (26%), back and spine (26%), knee (14%), wrist, hand and fingers (12%), arm and elbow (10%) and ankle and foot (6%). A second review found 8.7% of injuries needed surgery, and a third judged every study at high risk of bias. Weightlifting has 2.4 to 3.3 and powerlifting 1.0 to 4.4 injuries per 1,000 hours, and a review of three cohorts found CrossFit's risk comparable to weightlifting, running and other sports.

Sources 3, 18, 19, 4, 20

Which movesEmerging evidence

In 386 US participants, shoulder injuries came most often in gymnastics moves and lower back injuries in powerlifting moves, and having a trainer involved went with a lower injury rate. In 288 Portuguese practitioners, injuries came mainly in gymnastics exercises and 46.1% were to the shoulder. In 308 German athletes, the snatch and clean caused 36.3% of injuries and the box jump the highest single share (14.3%).

Sources 5, 21, 22

Who gets hurtEmerging evidence

Switching between the prescribed and a scaled load went with 3.5 times the odds of injury, and a previous injury with 3.2 times. 168 novices in an 8-week start-up programme had 9.5 injuries per 1,000 hours, and in 3,049 people a short time in the sport went with 1.82 times the odds. A 2011 military consensus warned of a disproportionate injury risk from these programmes, particularly for novices, but newer surveys disagree on beginners: in Libya, experienced athletes were at higher risk, and in Czechia younger, higher-volume athletes and competitors.

Sources 23, 24, 25, 26, 27, 28, 29

What Pilates offers, and what it doesn't

Pilates can train trunk endurance and control while you breathe, the shoulder blades, rotator cuff and upper back for overhead and hanging positions at low load, wrist strength, hip strength and one-leg control, and the pelvic floor, in a session that is genuinely lighter (our reading). It can't replace coached, scaled training and steady progression, strength work, the lifting brace for heavy lifts, or rehabilitation of an injury, and it isn't a recovery treatment. Across 11 trials, Pilates built strength no better or worse than other exercise, at very low to low certainty.

Source 30

What the evidence says

Pilates for CrossFit is untested apart from one single-session study. Core training improves trunk endurance in athletes, and almost nothing that prevents CrossFit injuries has been tested.

One single-session Pilates studyMixed evidence

In Brazil, people taking part in an extreme conditioning programme did one Pilates session; its abstract reports that a sit-and-reach test and a wall-ball test improved straight afterwards and perceived effort fell. The abstract describes an observational study, gives no numbers of people or results and describes no comparison group, and we couldn't open the full text. Our searches on 1 November 2026 found no other Pilates study, and no randomised core training trial, in CrossFit or functional fitness athletes.

Sources 1, 2

Comparisons of people who chose Pilates or CrossFitMixed evidence

In 148 recreational adults from Greek gyms, the CrossFit and mixed-training groups had higher aerobic fitness (maximal oxygen uptake, or VO2max, of 44.97 and 44.03 mL/kg/min) than the Pilates group (33.90) and less fat; flexibility didn't differ. In 60 Turkish adults, people doing CrossFit had better trunk endurance than gym-goers and inactive people, and in Brazil CrossFit athletes had stronger trunk extensors than sedentary people. In 103 young women, pelvic floor symptoms didn't differ by main type of exercise. People chose their own exercise, so none of this shows what either does.

Sources 31, 32, 33, 34

Does Pilates build the deep trunk muscles?Emerging evidence

In 34 gym members, 8 weeks of unsupervised mat Pilates thickened the deepest tummy muscle only during a Pilates move, not at rest, sitting or standing, and strength training thickened the muscle above it more. Pilates instructors had a thicker deep muscle than resistance exercise instructors in a small snapshot. In lab models, bracing the whole trunk, not the deepest muscle, gives the spine its stiffness.

Sources 35, 36, 37

Core training in athletesEmerging evidence

Across 31 studies, trunk training improved trunk muscle endurance most, with smaller effects on strength, power and sport performance. In 29 trials, core training improved core endurance and balance but not sport performance overall, and in 22 studies it improved jumping but not throwing or hitting speed. An older review called the benefits to performance marginal.

Sources 38, 39, 40, 41

Pilates and strengthMixed evidence

Across 11 trials, Pilates built strength no better or worse than other exercise, at very low to low certainty. Keep your strength training.

Source 30

Pilates and back pain in generalEmerging evidence

A Cochrane review of 10 trials (510 people) found "low to moderate quality evidence that Pilates is more effective than minimal intervention for pain and disability", but no better than other exercise for disability. In 118 trials (9,710 people), Pilates ranked among the most effective exercise for chronic low back pain, alongside strength, core-based and mind-body exercise. That is back pain in general, not in CrossFit athletes.

Sources 42, 43

What prevents CrossFit injuriesMixed evidence

Almost nothing has been tested. The one prevention trial, mobility and stability exercises in the warm-up for 10 weeks in 32 recreational athletes, found no difference, with far too few injuries to show anything; in 502 Israeli athletes, those who warmed up reported more injuries, probably because people with pain warm up more. The links point to coaching, steady scaling, rehabilitating old injuries and building up gradually. Across sports, strength training cut injuries to about a third.

Sources 44, 45, 5, 23, 46, 47

Breathing and bracing

Two ways to use your trunkEmerging evidence

Bracing raised the pressure inside the abdomen by 116.4 mmHg against 9.9 for drawing the belly in, and in a lab model bracing stiffened the spine by 32%, while the deepest tummy muscle alone added 0.14%. In 24 CrossFit athletes, drawing in thickened the deep trunk muscles more and bracing activated the surface muscles more. A review of 22 trials found both improve trunk stability measures, with few direct comparisons.

Sources 6, 37, 48, 49

Holding your breathEmerging evidence

A held breath raised blood pressure to 311/284 mmHg at a maximal leg press in 10 athletes, against 198/175 breathing out; a review says "The health risks associated with the VM during resistance exercise remain unconfirmed." (VM is the Valsalva manoeuvre, a breath held against a closed throat).

Sources 7, 50

Which to use when

Pilates breathing (out on the effort, at low load) suits conditioning work and a Pilates class; a brief braced breath belongs to heavy lifts (our reading). Our Pilates for weightlifters guide and our guide to breathing when lifting set out bracing, belts and who shouldn't hold their breath.

Shoulders overhead and hanging

Where shoulders get hurtEmerging evidence

Shoulder injuries come most often in gymnastics moves. In 187 surveyed athletes there were 1.94 shoulder injuries per 1,000 hours, and 38.6% were flare-ups of injuries from before CrossFit. In 68 uninjured South African athletes, 76% reported some shoulder pain, mostly mild, with function preserved.

Sources 5, 51, 52

KippingEmerging evidence

In 11 athletes, kipping added hip and knee swing and more abdominal and hip flexor work to a pull-up compared with strict pull-ups: a whole-body, trunk-heavy movement.

Source 53

Shoulder studies in CrossFit athletesMixed evidence

Soft tissue work plus a cross-body stretch for 4 weeks improved shoulder rotation in 21 athletes, and the stretch added nothing. Athletes with shoulder pain had less rotation, poorer upper-body balance reach and less lower trapezius activity, which are links, not causes. A trial comparing two shoulder programmes is registered with no results, and its protocol says "no consensus exists on the most effective exercise intervention".

Sources 54, 55, 56, 57

Where Pilates fits

Shoulder-blade, rotator cuff and upper-back work at low load: scapular push-ups, outward rotation with a band, the open book and thoracic extension (our reading). Strict pull-up and handstand strength are built in coached training, as our CrossFit guide says, and a sore shoulder needs the shoulder hub's lines below.

The lower back

Backs and heavy liftsEmerging evidence

The back and spine take about a quarter of injuries in this kind of training, and back injuries come mostly in heavy lifts.

Sources 3, 5

Fatigue and formEmerging evidence

In 15 volunteers doing 100 lifts, the back muscles tired, the spine bent further and the estimated bending load on the lower back rose by 36%. In 40 men squatting heavy loads to failure, trunk muscle activity rose through the set, more in novices. These are lab studies of lifting, not CrossFit, but form fades late in a workout done for time, which is a reason for scaling and coaching, not something a Pilates class fixes (our reading).

Sources 58, 59

Where Pilates fits

Trunk endurance against bending, arching and turning while you breathe (the dead bug, side plank, Pallof press and bird dog), and hip hinge practice. For back pain from deadlifts or burpees, our pain guides have the stages.

Sources 38, 42

Hips, knees and landings

Knees and box jumpsEmerging evidence

The knee takes about 1 in 7 injuries, and in one survey the box jump caused the largest single share of injuries.

Sources 3, 22

Where Pilates fits

Hip strength and one-leg control for landing, at low load: the clamshell, side-lying leg circles, hip airplane and one-leg stands. In team-sport athletes, core training improved balance moderately and jump height a little, at low to very low certainty. Jump and landing training belong to your coach.

Source 60

Leaking with jumps and lifts

How common it isEmerging evidence

Across 13 surveys of 4,823 women who do CrossFit, 44.5% reported leaking urine, mostly stress leaking, and "Exercises based on jumps were commonly associated with urine leakage." (poor to fair quality studies); a second review gave 32.1%. Double-unders (47.7%), skipping and box jumps were the commonest triggers among 105 CrossFit women.

Sources 8, 61, 62

What helpsEmerging evidence

In the only trial (47 women in functional fitness with stress leaking, in Norway), 16 weeks of home pelvic floor training, "3 sets of 8-12 maximum pelvic floor muscle (PFM) contractions daily" with weekly reminders by phone, improved leaking for 64% against 8%. Across 19 studies of leaking during exercise, only pelvic floor training has trial evidence.

Sources 9, 63

Pilates and the pelvic floor

No study has tested Pilates for leaking in CrossFit athletes. A Pilates class can include pelvic floor training, but it's the training, not the class, that has the evidence (our reading). Our Pilates for the pelvic floor guide has the squeezes, and a pelvic health physiotherapist can assess you.

Rest days, recovery and rhabdomyolysis

Pilates isn't a recovery treatmentMixed evidence

In 10 active women, 4 weeks of gentle mat Pilates didn't change lactate in a running test, and in 34 people, daily slow breathing added nothing to recovery after 4 weeks of sprint intervals, although slow breathing raises heart rate variability in the moment. After a hard benchmark workout, recovery can take more than 24 hours whatever you do. A Pilates class can feel good on a rest day; it is a lighter session, not a treatment.

Sources 64, 65, 66, 15

Count it as trainingStrong evidence

The International Olympic Committee's consensus says "Emerging evidence indicates that poor load management is a major risk factor for injury", so a hard reformer class counts as a session, not a rest day.

Source 13

RhabdomyolysisEmerging evidence

At one US hospital, 11 of 523 people treated for CrossFit injuries (2.1%) had rhabdomyolysis; more than half were beginners, and "The most common presenting symptom was dark urine (90.9%)". It follows "unaccustomed exercise (especially with eccentric/muscle-lengthening contractions)", and across 772 athletes most cases followed running or weightlifting. Fewer than 1 in 10 people with it have all three classic signs (pain, weakness and dark urine), and an experienced coach aged 45 developed it after a routine workout.

Sources 10, 67, 68, 69, 70

Pilates after rhabdomyolysisStrong evidence

After a single episode with a clear trigger, NHS Scotland's pathway says activity "should be phased in gradually, first with stretching based exercise, e.g. pilates, before returning to gym-work and running". Our rhabdomyolysis guide has the stages; do Pilates only within them, and with your doctor's agreement.

Source 11

Pilates vs CrossFit, and doing both

They do different jobsMixed evidence

CrossFit-style training builds fitness, strength and power: a 2025 review of 19 studies found this kind of training improved strength, power, speed, endurance and agility in healthy people, but not flexibility. In one comparison of gym-goers, those doing CrossFit had much higher aerobic fitness than those doing Pilates, though people chose their own exercise. Pilates adds control, mobility and trunk endurance at low load: 2.8 METs for Pilates in general against 7.5 to 9.8 for kettlebell circuits and swings.

Sources 31, 71, 17

Doing bothEmerging evidence

Do Pilates on a rest day or after a lighter session, not in the hour before heavy lifts or a hard workout. Long static holds just before hard efforts cost a little performance (3.7% on average, more with holds of 60 seconds or longer), and an expert panel advises against long static stretching before maximal efforts. Count a hard reformer class as training.

Sources 72, 12, 13

Bodies and weight loss

Neither promises a particular body shape, and we don't compare bodies. Our Pilates for weight loss guide covers weight loss.

Pilates core exercises for CrossFit

The Pilates version

The double-leg stretch (close to a hollow body), single-leg stretch and criss-cross for trunk control while you breathe, the leg pull front for a long plank, and the dead bug, side plank and Pallof press against bending, arching and turning. Trunk training improves trunk endurance most. The workouts themselves, and core work under load, stay in your CrossFit sessions.

Sources 38, 48

Breathe out on the effort, and the pelvic floor

Lateral breathing, 5 to 8 breaths at the start of every session (the move page's dose); pelvic floor training, 8 slow holds of up to 10 seconds and 8 quick squeezes, three times a day (from the move page's dose); pelvic floor relaxation, 5 to 10 slow breaths, 1 to 3 times a day (the move page's dose), if your pelvic floor feels tight or sore rather than weak.

Trunk control while you breathe

Double-leg stretch, 6 to 10 reps (the move page's dose), arms forward if overhead bothers your shoulders; criss-cross, 6 each side, slowly (the move page's dose); leg pull front, 3 to 5 each side (the move page's dose), on fists or forearms if your wrists complain, as its page says; dead bug, 2 sets of 8 each side (our Pilates for weightlifters class); side plank, 2 sets of 20 to 30 seconds each side (our Pilates for weightlifters class); Pallof press, 2 sets of 8 each side (our Pilates for weightlifters class).

Shoulders for hanging and overhead

Scapular push-up, 10, pausing at the top (our Pilates for climbers class), against a wall with a sore shoulder; outward rotation with a band, 10 each arm (our Pilates for tennis players class); side-lying open book, 8 to 10 slow openings each side, pausing 2 seconds at the end (the move page's dose); foam roller thoracic extension, 5 to 8 slow breaths at each of 3 or 4 spots along the upper back (the move page's dose); Y-T-W raises, 5 of each shape (our Pilates for weightlifters class); wall angel, 8 slow slides (our Pilates for weightlifters class).

Wrists, for front racks, handstands and burpees

Wrist and forearm flow, 60 seconds (the CrossFit warm-up and mobility routine); wrist curls, 12 slow reps with a light weight (our Pilates for wrist pain class).

The squat and the hinge

These agree with our Pilates for weightlifters guide, which has mobility for the lifts in full. Knee-to-wall ankle rock, 10 slow rocks per side, daily (the move page's dose); 90/90 switch, 10 slow switches, pause at the ends (the move page's dose); hip hinge practice, 8 (our Pilates for weightlifters class); cat-cow, 8 waves, slower than feels natural (the move page's dose).

Hips and one leg, for jumping and landing

Clamshell, 10 each side (our Pilates for athletes class); side-lying leg circles, 8 each direction, each side (the move page's dose), kept small; hip airplane, 2 sets of 5 slow turns each leg (the move page's dose), holding a rack or wall; single-leg stand, 2 sets of 30 seconds each leg (our Pilates for weightlifters class), eyes closed once it's easy.

What to change or leave out

The hour before a hard workout or heavy lifts

No long holds or hard trunk session: long static holds just before maximal efforts cost a few per cent of force. Use the CrossFit warm-up instead.

Sources 72, 12

A sore shoulder, or one that slips overhead or hanging

Leave out the leg pull back, whose page says to skip it if your wrists or the front of your shoulders hurt, and do push-ups against a wall, as the Pilates push-up's page suggests. Keep wall angels small and leave out the Y of the Y-T-W raises, as our weightlifters class says, and see our Pilates for shoulder pain guide.

Source 73

Sore wrists from front racks, push-ups or handstands

Use forearm planks, fists for the leg pull front, and our Pilates for wrist pain guide. In one survey, 29.1% of wrist injuries came back, so let a sore wrist settle before loading it again (our suggestion).

Source 74

Leaking

Swap the teaser and roll-up for head-down moves such as the knee fold, as the teaser's page suggests, do the pelvic floor squeezes daily, and see a pelvic health physiotherapist if it continues.

Source 9

Back pain that's worse arching

Keep swimming and the swan small, or use the bird dog, as their pages say, and see our pain guides for back pain from deadlifts or burpees.

Holding your breath

Pilates moves are done breathing. Save the braced breath for heavy lifts, and leave it out altogether with high blood pressure, heart disease, glaucoma, a hernia, recent surgery or in pregnancy, as our weightlifters guide and breathing guide say.

Sources 7, 50

After rhabdomyolysis

Only within our rhabdomyolysis guide's stages, and with your doctor's agreement; NHS Scotland's pathway puts stretching-based exercise such as Pilates first, before gym work and running.

Source 11

Heat

No hot Pilates or other hot classes after a hard session in a hot gym; drink and cool down first (our suggestion).

Classes to follow

Our 25-minute off-day class covers what CrossFit adds to lifting: the pelvic floor, trunk control while you breathe, the shoulders for hanging and overhead, wrists, and hips for landing. Our rest-day class for lifters is the one for the squat, the hinge and trunk endurance, so alternate the two. Before a workout, use the CrossFit warm-up; the pelvic floor, wrist pain and shoulder pain classes are for those problems, and the rhabdomyolysis session for the return after an episode, at its stages.

Off-day Pilates for CrossFit: a 25-minute class for the pelvic floor, trunk control while you breathe, shoulders for hanging and overhead, wrists and hips for landing

A 25-minute off-day Pilates class for CrossFit: the pelvic floor, trunk control while you breathe, shoulders for hanging and overhead, wrists, and hips for landing.

25 minIntermediate18 movesBand, anchor point

Rest-day Pilates for lifters: a 25-minute class for trunk endurance, the hinge, hips, ankles and the upper back, breathing out on every effort

A 25-minute rest-day Pilates class for lifters: trunk endurance, the hinge, ankles and hips, the upper back and overhead position, breathing on every effort.

25 minIntermediate18 movesWall, band

CrossFit warm-up and mobility routine: shoulders, wrists, hips and ankles

A 15-minute warm-up and mobility routine for CrossFit-style training: easy rowing, shoulder, wrist, hip and ankle mobility, shoulder-blade work and squats.

15 minBeginner14 movesCardio machine, wall

CrossFit-style workout for beginners: learn the lifts, then a short scaled workout

A 45-minute beginner session in the shape of a CrossFit class: a warm-up, goblet squats, deadlifts, push-ups and rows, a 10-minute EMOM, then core work.

45 minBeginner15 movesCardio machine, wall

Both-sides Pilates for athletes: a 30-minute class for trunk endurance, hips, the back of the body and one-leg balance

A 30-minute Pilates class for athletes in any sport: trunk endurance, hips, the back of the body, rotation and one-leg balance, done equally on both sides.

30 minIntermediate18 movesWall

Pilates strength workout: a 30-minute class with weights or a band

A 30-minute Pilates strength class with dumbbells or a band: Pilates trunk work plus squats, lunges, rows and push-ups, each set taken until it is hard.

30 minIntermediate15 movesDumbbell, band

Pilates for your pelvic floor: squeeze, move, release

A 20-minute Pilates workout for your pelvic floor, built on UK pelvic health physiotherapists' booklet: squeeze as you breathe out, move, then fully release.

20 minBeginner18 movesWall, bench or box

Wrist-kind Pilates: a 25-minute class on your forearms, with a wrist strength block and steps back onto your hands

A 25-minute Pilates class for sore wrists: hands-free mat work, moves on your forearms, a short wrist strength block, then steps back onto your hands.

25 minBeginner19 movesWall, dumbbell

Step-by-step Pilates for a sore shoulder: a 20-minute class

A 20-minute Pilates class for a sore shoulder: gentle range first, then shoulder-blade and rotator cuff strength, then light weight on the arms, in steps.

20 minBeginner15 movesBench or box, other / check instructions

Exercise after rhabdomyolysis: a light session for the first weeks back

A 30-minute light session for the first weeks back after rhabdomyolysis: easy cycling or walking, Pilates-style moves and light strength, never to failure.

30 minBeginner15 movesCardio machine, bench or box

New to Pilates?

The beginner Pilates plan builds the basics over 4 weeks, 3 days a week; fit it around your training, on rest days.

When to stop and get help

This is general information, not a diagnosis. A&E means accident and emergency; in the US, call 911 for 999, and use your doctor's urgent line or urgent care for NHS 111.

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 75, 76

Dark urine and very sore muscles: get help the same day

Dark, red or cola-coloured urine, much less urine than usual, or very painful, weak or swollen muscles in the days after a session: get medical help the same day. Dark pee isn't always there, so muscles far sorer, more swollen or weaker than the session explains still need the same-day check.

The signs to act on, from our rhabdomyolysis guide:

  • Dark pee: red, brown, tea or cola coloured, especially with very sore, swollen or weak muscles, in the hours or days after exercise.
  • Muscle pain, cramps or aches far worse than the session explains, or muscles that are swollen.
  • Feeling too weak or tired to finish a workout, or everyday tasks you could do before.
  • Peeing much less than usual, feeling very thirsty, being sick, swollen feet or legs, or feeling very tired, dizzy, confused or sleepy: these can be signs of kidney injury.
  • A high temperature along with the muscle pain.

Sources 77, 78, 10

Call 999 or go to A&E: a swollen, tight muscle or heatstroke

Don't drive yourself to A&E.

  • Sudden, severe pain in a muscle, especially if it's very swollen and tight, or numb, weak or tingling: this can be compartment syndrome, which needs surgery as soon as possible.
  • Signs of heatstroke: still unwell after 30 minutes of resting somewhere cool, being cooled and drinking; a very high temperature; hot skin that isn't sweating and might look red (harder to see on brown or black skin); a fast heartbeat; fast breathing or breathlessness; confusion and loss of coordination; a fit; or loss of consciousness.

Source 79

Back pain with numbness or bladder problems

Call 999 or go to A&E: loss of feeling or numbness around the genitals or bottom, new trouble peeing or controlling your bladder or bowels, changes in genital sensation during sex or problems with erections or orgasm, or pain, tingling, weakness or numbness in both legs. These are signs of cauda equina syndrome, which needs treating in hospital urgently. Don't drive yourself.

Source 80

The shoulder

Call 999 or go to A&E: after a fall or injury, your shoulder looks out of place or has changed shape, you cannot move your arm, or your shoulder is painful, bruised or swollen. Do not drive yourself, and do not try to put it back in yourself.

Same day (GP or NHS 111): sudden or very bad shoulder pain; you cannot move your arm; the arm or shoulder is badly swollen or has changed shape; pins and needles that do not go away; no feeling in the arm; the arm is hot or cold to the touch; pain that started after an injury such as a fall; or severe pain in both shoulders.

Same day (GP or NHS 111): sudden weakness lifting the arm after an injury or fall. A rotator cuff tear caused by an injury needs urgent referral to a shoulder specialist. After a dislocation in anyone over 40, the rotator cuff should be checked: about 40% have a tear.

See a GP or physiotherapist if:

  • Your shoulder has partly or fully come out of joint, or you worry it might.

Sources 73, 81

A joint that slips, locks or swells

A shoulder that slips out or looks out of place, a knee that gives way, locks or swells within hours, or a wrist that's swollen and can't take weight needs checking before you train it again. Our pain guides say what to do.

Sources 81, 82, 83

Leaking, pregnancy and after a baby

Don't start CrossFit new in pregnancy; if you already train, talk to your midwife, and see our pregnancy guide. After having a baby, or with leaking or a feeling of heaviness, our postpartum and pelvic floor guides help, and a pelvic health physiotherapist can assess you.

Source 84

Very flexible joints

Build strength and control before high-impact and gymnastics work, as our hypermobility guide explains.

If you're hypermobile, don't use mobility work to push further: the NHS says "do not overextend your joints just because you can". See a GP if you think you have joint hypermobility syndrome: for example, your joints keep dislocating, or you keep getting sprains, strains, pain or stiffness.

Sources 85, 86

Before the hardest sessions

The PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone) asks about a heart condition or high blood pressure, chest pain, dizziness or losing consciousness, other long-term conditions and their medicines, a bone or joint problem that activity could make worse, and being told to exercise only under supervision. If you answer yes to any, check with your GP or a qualified exercise professional first. If you're over 45 and not used to hard exercise, ask a qualified exercise professional before the hardest sessions, and delay if you're ill.

Source 87

Unusual breathlessness

Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.

Source 88

During a session

A joint pain that is sharp, gets worse during a session, lingers into the next day or changes how you move is a reason to use an easier version, and to see a GP or physiotherapist if it keeps happening (the rule in our plans).

Source 89

Stop the session if

You feel any pain or become unwell, as the NHS advises for its Pilates videos, and especially for chest pain or pressure, unusual breathlessness, dizziness or fainting. If you have a health problem, an injury or any symptoms, get advice from a healthcare professional, such as a GP, before you start.

Source 90

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 90

Myths

"Pilates is too easy for CrossFit athletes"Mixed evidence

Pilates is light on the heart and lungs (2.8 METs in general, against 7.5 to 9.8 for kettlebell circuits and swings), but slow trunk-endurance work is hard for many strong people, and trunk training improves trunk endurance most. It's a different job, not an easier version of the same one.

Sources 17, 38

"Pilates and CrossFit can't mix"Mixed evidence

Nothing suggests they clash if Pilates is timed away from hard sessions and counted as training load. The one study of a Pilates session in conditioning athletes reported no harm, with no comparison group.

Sources 72, 13, 1

"Pilates builds a natural weightlifting belt"Mixed evidence

Unsupervised mat Pilates thickened the deepest tummy muscle only during a Pilates move, and in lab models bracing the whole trunk, not the deepest muscle, stiffens the spine.

Sources 35, 37

"Pilates flushes out the soreness from a hard workout"Mixed evidence

The claim appears on a Pilates body's own blog, but gentle mat Pilates didn't change lactate, slow breathing added nothing to recovery after hard intervals, and recovery from a hard benchmark workout can take more than 24 hours whatever you do.

Sources 91, 64, 65, 15

"Rhabdo only happens to beginners"Emerging evidence

More than half the hospital cases were beginners, but an experienced coach developed it after a routine workout, and it follows unaccustomed exercise at any level, especially lowering work.

Sources 10, 70, 67

"Leaking during double-unders is normal, so ignore it"Emerging evidence

It's common, about a third to nearly a half of women in surveys, but treatable: daily pelvic floor training improved it for 64% of women in a trial, against 8%.

Sources 8, 61, 9

"A strong core prevents all injuries"Strong evidence

Firm evidence that a weak core causes injuries is lacking; the programmes that cut injuries trained strength and balance, and stretching didn't help.

Sources 92, 46

"You need a reformer for real Pilates"Mixed evidence

In the one trial that compared them in athletes (footballers), both mat and reformer Pilates improved tests, the reformer slightly more on three. Use what you can get to.

Source 93

Questions people ask

Is Pilates good for CrossFit?

It can add trunk control while you breathe, shoulder-blade and upper-back work for overhead and hanging positions, hip strength and a genuinely lighter day. Only one study has looked at Pilates in people who do CrossFit, and it lasted one session, so treat it as a supplement, not a performance tool. Our yoga for CrossFit guide covers yoga.

Pilates vs CrossFit: which is better?

They do different jobs. CrossFit-style training builds fitness, strength and power, and in one comparison of gym-goers, those doing CrossFit had much higher aerobic fitness than those doing Pilates, though people chose their own exercise. Pilates adds control, mobility and trunk endurance at low load.

Can you do Pilates and CrossFit together?

Yes. Do Pilates on a rest day or after a lighter session, not in the hour before heavy lifts or a hard workout, and count a hard reformer class as training.

Should I do Pilates before or after CrossFit?

After, or on a separate day. Before a workout, the CrossFit warm-up does the job; long static holds just before maximal efforts cost a little force.

Is Pilates breathing the same as bracing?

No. Pilates breathes out through the effort at low load; bracing tightens the whole trunk around a breath for heavy lifts and raised abdominal pressure far more in lab studies. A held breath raises blood pressure much more than breathing out, so our breathing guide lists who shouldn't hold it.

Will Pilates help my shoulders for kipping and handstands?

It can train the shoulder blades, rotator cuff and upper back at low load, but no study has tested a shoulder programme in CrossFit athletes. Build strict pull-ups and handstand strength in coached training, as our CrossFit guide says.

Can Pilates help my lower back in CrossFit?

For back pain in general, Pilates helps about as much as other exercise. In CrossFit, back injuries come mostly in heavy lifts, so coaching, steady scaling and the matching pain guide come first.

Is reformer Pilates good for CrossFit athletes?

It can add spring resistance and controlled range; in one small trial in footballers the reformer did slightly better than the mat on a few tests. It isn't a substitute for loading, and a hard reformer class counts as training.

Is Pilates too easy for CrossFit athletes?

It's lighter on the heart and lungs (about 2.8 METs, against 7.5 or more for a kettlebell circuit), but long holds and slow trunk work are hard for many strong people. It's a different kind of hard.

Does Pilates help with leaking during double-unders?

Pelvic floor training does: 16 weeks of daily training improved leaking for 64% of women in functional fitness, against 8%. A Pilates class can include the squeezes; see a pelvic health physiotherapist if it continues.

Can I do Pilates after rhabdomyolysis?

Only at the right stage and with your doctor's agreement: NHS Scotland's pathway puts stretching-based exercise such as Pilates first, before gym work and running. Our rhabdomyolysis guide has the stages.

Will Pilates make me weaker for CrossFit?

No trial shows it. In trials, Pilates built strength no better or worse than other exercise, so keep your strength work and time Pilates away from heavy sessions.

Sources

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  32. Yentür 2025 · Core endurance in 60 adults doing CrossFit, gym training or neither (comparison study, J Bodyw Mov Ther)
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  36. Moon 2015 · Abdominal muscle activity in Pilates instructors, resistance exercise instructors and controls (cross-sectional study, J Exerc Rehabil; read in full)
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  41. Reed 2012 · Core stability training and athletic performance (systematic review, Sports Med)
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  61. Álvarez-García 2022 · Urinary leaking in women who do CrossFit (systematic review and meta-analysis, Arch Esp Urol)
  62. Yang 2019 · High-impact CrossFit exercises and stress leaking in 105 active women (survey, Neurourol Urodyn)
  63. Petter Rodrigues 2024 · Treatments for exercise-induced leaking in women: 19 studies (systematic review, BJU Int)
  64. Moon 2022 · Low-intensity mat Pilates, aerobic capacity and recovery in 10 active women (study, Phys Act Nutr)
  65. Raidl 2026 · Slow breathing as recovery after sprint interval training (randomised trial, Int J Sports Physiol Perform)
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  68. Bäcker 2023 · Exertional rhabdomyolysis in 772 athletes (systematic review, Clin J Sport Med)
  69. Murawska-Ciałowicz 2026 · Rhabdomyolysis and kidney injury after intensive exercise (narrative review, J Hum Kinet; read in full)
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  71. Wang 2025 · High-intensity functional training and fitness in healthy people (systematic review and meta-analysis, BMC Public Health; read in full)
  72. Behm 2016 · Stretching, performance, range of movement and injury (systematic review, Appl Physiol Nutr Metab)
  73. NHS · Shoulder pain (past its review date: reviewed May 2023, review due May 2026)
  74. Tawfik 2021 · Hand and wrist injuries in 270 CrossFit athletes (survey, Cureus; read in full)
  75. NHS · Chest pain (past its review date: reviewed August 2023, review due August 2026)
  76. NHS · Fainting
  77. NHS · Blood in urine
  78. NHS · Acute kidney injury
  79. NHS · Heat exhaustion and heatstroke
  80. NHS · Back pain
  81. NHS · Dislocated shoulder
  82. NHS · Knee pain
  83. NHS · Wrist pain
  84. NHS · Urinary incontinence (past its review date: reviewed June 2023, review due June 2026)
  85. Liaghat 2021 · Joint hypermobility and shoulder injuries in athletes: 6 studies, 2,335 athletes (systematic review and meta-analysis, BMC Musculoskelet Disord; read in full)
  86. NHS · Joint hypermobility syndrome (past its review date: reviewed August 2023, review due August 2026)
  87. PAR-Q+ Collaboration · The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+), 2025 version (read in full)
  88. NHS · Shortness of breath
  89. NHS · How to warm up before exercising (with the NHS exercise video safety information)
  90. NHS · Pilates for beginners (exercise video, with safety information)
  91. Pilates Method Alliance · Why athletes love Pilates (blog; an example of untested claims; read in full)
  92. Huxel Bliven 2013 · Core stability training for injury prevention (review, Sports Health; read in full)
  93. Yılmaz 2025 · Mat or reformer Pilates in 30 football players (randomised trial, PLoS One; read in full)

Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.