Pilates guide
You can keep doing Pilates with a frozen shoulder, if you change the arm work. In the very painful stage, move the shoulder gently and only as far as is pain-free, and keep the rest of you strong with your arms low: in a study, exercise within pain limits did better than intensive stretching through pain. As the pain settles, gentle holds to mild discomfort and shoulder-blade work help bring the movement back.
No trial has tested Pilates for frozen shoulder, so it sits beside your GP's and physiotherapist's care, including any injection, never in place of it.
This guide covers what frozen shoulder (adhesive capsulitis) is and how long it lasts, how to choose moves by how sore it is, what to skip on the mat and the reformer, what the trials show, diabetes, the warning signs, and a 20-minute class with a 10-minute shoulder block for the painful stage.
Keep your arms low, lie on your good side, and keep the rest of you strong. The NHS says to keep moving your shoulder, because keeping it still "will make the pain worse", and not to make up your own strenuous exercises.
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The stages overlap, so UK shoulder specialists say they're of limited use for choosing treatment. A clinical guideline matches stretching to how irritable the shoulder is right now.
Gentle exercise within pain limits left 89% with normal or near-normal shoulders at 2 years, against 63% after intensive stretching through pain, in a study of 77 people that wasn't randomised.
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No trial has tested Pilates for frozen shoulder. Use it to keep moving and stay strong, not as a treatment.
A steroid injection speeds early improvement and home exercise adds to it. In the largest trial, physiotherapy with an injection did about as well at a year as manipulation or keyhole surgery. Ask your GP.
A shoulder out of place after a fall, or shoulder or arm pain with chest pain, needs 999; a hot, red, swollen shoulder or fever needs help the same day. The full list is below.
"Frozen shoulder means your shoulder is painful and stiff for months, sometimes years", the NHS says: the tissue around the joint becomes inflamed, then gets tighter and shrinks. Doctors call it adhesive capsulitis. Turning the arm outwards goes first, and pain is often worse at night. It's diagnosed from your history and an examination.
About 2% to 5% of people, typically women aged 45 to 60, with a peak at 56; 6% to 17% get it in the other shoulder within 5 years. People with diabetes are about 5 times more likely to have it, and thyroid disease roughly doubles the odds.
The NHS says months or years, and UK sources say typically 1 to 3 years. In 223 people followed for an average of 4.4 years, 59% had normal or near-normal shoulders and 41% some symptoms, almost all mild; 6% had severe symptoms. A review found no evidence of neat phases to full recovery: most improvement comes early.
A US guideline describes a painful "freezing" stage of about 3 to 9 months, a "frozen" stage of about 9 to 15 months and a "thawing" stage from about 15 to 24 months. UK sources describe overlapping phases, or just "pain-predominant" and "stiffness-predominant". The 2025 UK care pathway says the overlap limits their use for choosing treatment, so this guide goes by how sore your shoulder is now.
As the gentle, pain-free movement the NHS asks for in the painful stage, as strength for the rest of you with your arms low, and later as graded stretching and shoulder-blade work. It isn't a treatment for the capsule.
The levels and the pain rule are from our frozen shoulder guide, word for word; the three groups of moves below follow them.
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The guideline says exercises "should be performed without significant pain", with the intensity matched to how irritable the shoulder is.
So: in the very painful stage, stay pain-free. Later, stretch to mild discomfort and hold. A stretch should not leave a lasting flare afterwards; if it does, go gentler next time.
Pendulum swings, table slides and a stick to help the arm turn out, a few minutes 2 or 3 times a day, never into pain. Do Pilates for the rest of you with your arms low.
Hold the table slide and the turn-out a little longer, then add a finger climb up a wall, a cross-body stretch and light band work. The UK FROST home programme progressed "from gentle pendular exercises to firm stretching exercises according to stage".
Once night pain has gone, longer holds into the stiff directions and shoulder-blade strength help bring the range back. In trials, firmer end-of-range mobilisation by a therapist did slightly better than staying pain-free in long-standing stiffness, at very low certainty; no trial has tested firmer stretching on your own.
Our searches in October 2026 found no trial of Pilates for frozen shoulder, completed or registered. The only Pilates trial in shoulder pain, in 33 people whose diagnosis wasn't given, ran for 2 weeks with no follow-up.
In 77 people, explanation, pendulum swings and active exercise within the pain-free range ("supervised neglect") left 89% with normal or near-normal shoulders at 2 years, and 64% within a year, against 63% at 2 years after intensive stretching and mobilisation beyond the pain threshold. It wasn't described as randomised.
In 100 people stiff for 3 months or more, firm end-range mobilisation by a therapist did slightly better than gentle mobilisation, "the overall differences between the 2 interventions being small". Across 10 trials (424 people), end-range techniques helped at very low certainty.
The UK care pathway strongly recommends an injection into the joint, which improves symptoms faster than waiting, with no long-term benefit shown after about 3 months. Across 65 studies (4,097 people), it was the only treatment clinically better in the short term, and adding a home exercise programme gave extra benefit later. Exercise and manual therapy did less well than an injection at 7 weeks, with little difference by 6 to 12 months.
The UK pathway suggests offering physiotherapy after an injection, and found no trial comparing physiotherapy alone with waiting. The Chartered Society of Physiotherapy: "A steroid injection followed by gentle stretching and strengthening exercises is effective for the majority".
In UK FROST, 503 adults in hospital care (30% with diabetes) had early physiotherapy with an injection, manipulation under anaesthetic, or keyhole surgery to release the capsule. At 12 months none was clinically better (Oxford Shoulder Score 37.2, 38.3 and 40.3), keyhole release had more serious complications (8 against 2), and physiotherapy started much sooner.
In 75 people, a hospital exercise class did better than one-to-one physiotherapy or home exercise alone. The UK pathway rates this low certainty, and the class wasn't Pilates, but it suggests a regular, guided class can help.
"There are no clinical trials assessing the role of dosage" for exercise in frozen shoulder, a review says, and a 2026 review of 31 studies found a small benefit of exercise, at very low certainty. Every dose on this page is our editorial starting point or another site page's.
Pendulum, about 1 minute (10 small circles each way), 2 to 3 times a day; table slide, 10 slow repetitions, 1 to 3 times a day; stick-assisted turning out, for a very irritable shoulder, 10 slow repetitions, pain-free, twice a day; thoracic rotation with your arms crossed, 6 rotations per side, moving with the breath; lateral breathing, 5 to 8 breaths at the start of every session (the moves' pages). Shoulder rolls, 10 slow circles each way, small if it's sore (our yoga for frozen shoulder class).
3D demoPendulum exercise (Codman's pendulum)Beginner · A bench or box
3D demoTable slide (seated forward reach)Beginner · A bench or box
3D demoStick-assisted external rotation (lying)Beginner · Other / check instructions
3D demoShoulder rollsBeginner · No equipment
3D demoThoracic rotationBeginner · No equipment
3D demoLateral breathing (Pilates breathing)Beginner · No equipmentArms resting on the mat or by your sides; lie on your good side, with your head on a pillow. Knee fold, 2 sets of 5 to 10 each side, every other day; heel slide, 10 slow repetitions each side, once or twice a day; single-leg circle, 5 circles each direction, each leg; side kick, 8 to 10 each side; wall side leg lift, 10 to 12 each side (the moves' pages). Pelvic tilts then 2 sets of 8 bridges, 10 clamshells each side and 2 sets of 8 sit-to-stands with your arms crossed (our editorial starting point).
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoGlute bridgeBeginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wall
3D demoSit to stand from a chairBeginner · A bench or boxTable slide, 5 to 10 with a 10 to 20 second hold at the end, and stick-assisted turning out, 3 to 5 holds of 20 to 30 seconds (the moves' pages for this stage). Wall finger climb, 5 climbs holding the top for a count of 10; cross-body stretch, 3 holds of 20 to 30 seconds; doorway chest opener, 2 to 3 holds of 20 to 30 seconds, elbow below shoulder height at first; band rotation out and in, 2 sets of 10 to 15 in a small range; band row, 2 sets of 12 to 15; wall push-up, 2 sets of 10 (our frozen shoulder and yoga for frozen shoulder guides, editorial).
3D demoTable slide (seated forward reach)Beginner · A bench or box3D demoStick-assisted external rotation (lying)Beginner · Other / check instructions
3D demoWall climb (finger walk up the wall)Beginner · A wall
3D demoCross-body shoulder stretchBeginner · No equipment
3D demoDoorway chest openerBeginner · A wall
3D demoStanding band external rotationBeginner · A band + An anchor point
3D demoBand internal rotationBeginner · A band + An anchor point
3D demoBand rowBeginner · A band + An anchor point
3D demoWall push-upBeginner · A wallOverhead stretch at a bench, 3 holds of 30 to 45 seconds; sleeper stretch, 3 holds of 30 seconds on the stiff side, gently, only if turning the arm inwards stays stiff; shoulder circles, 3 slow circles each way; wall angel, 2 sets of 8 (our frozen shoulder guide, editorial). Mermaid, reaching only as high as is comfortable, 3 each direction, each side; swimming with your arms by your sides at first, 2 to 3 sets of 20 to 30 seconds (the moves' pages).
3D demoOverhead lat stretch at a bench (elbows on the bench)Intermediate · A bench or box
3D demoSleeper stretchIntermediate · No equipment
3D demoShoulder CARs (controlled articular rotations)Beginner · No equipment
3D demoWall angelBeginner · A wall
3D demoMermaid (Pilates seated side bend)Beginner · No equipment
3D demoSwimming (Pilates)Intermediate · No equipmentThese follow the moves' own cautions and our Pilates for shoulder pain guide.
Leave out the leg pull front and back, the side bend, push-ups, the kneeling side kick, control balance and the crab while the shoulder is painful or stiff. Bring weight back in steps, starting at the wall, as our Pilates for shoulder pain guide sets out.
In the roll-up, reach your arms forward rather than overhead; keep the double leg stretch's overhead reach pain-free; leave out the teaser for now.
Rocking (holding your ankles) and the double leg kick (hands clasped behind your back): leave them out, or hold a towel.
Do side-lying moves on your good side only, and leave the sleeper stretch until the stiff but settled stage.
Gentle did better than forceful in the painful stage, and the guideline says exercises should be done without significant pain.
Leave hanging from a bar and heavy overhead pressing until the shoulder moves freely: they load the end of a range you don't yet have (our editorial view).
Footwork, bridging and side-lying leg work are fine. Straps, arm circles, pulling straps and rowing on the long box work the shoulder against springs: leave them until the shoulder is stiff rather than painful (our suggestion). No study has tested the reformer for frozen shoulder.
Once it's settled, light springs with your arms below shoulder height can help you move it, within the same pain rule: mild discomfort only, and no lasting flare afterwards.
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Tell your teacher before class about a frozen shoulder, an injection, or surgery, so they can change the arm work.
In 18 studies, people with diabetes were about 5 times more likely to have frozen shoulder, about 13% of people with diabetes had it, and about 30% of people with frozen shoulder had diabetes. Newer studies, including UK health records, agree.
The 2015 UK care pathway says people with diabetes "tend not to respond as well to treatment". The 2025 pathway lists injections for people with diabetes as a gap in the research.
Thyroid disease, especially an underactive thyroid, roughly doubles the odds. Whether hormone therapy protects against frozen shoulder isn't known: a 2026 pilot of 1,952 women found no significant difference.
If you haven't been checked for diabetes, ask your GP whether you should be: about 3 in 10 people with frozen shoulder have diabetes (our suggestion). A meta-analysis says "Screening for DM should be considered in patients presenting with AC", and the NHS says "it's important to have your regular diabetes check-ups".
Painkillers and gentle movement first, then a steroid injection, and physiotherapy, which the NHS says "usually lasts at least 6 weeks". A home exercise programme alongside an injection gave extra benefit later.
A shoulder specialist may suggest a large-volume injection (hydrodilatation), manipulation under anaesthetic or keyhole surgery to release the capsule. In UK FROST, none was clinically better than early physiotherapy with an injection at a year.
Follow your clinician's timing before stretching harder; the gentle moves can carry on. After a procedure, follow your team's physiotherapy first: in UK FROST everyone had up to 12 sessions, and the programmes discouraged keeping the arm still.
The British Elbow and Shoulder Society says to contact your health care provider "if you feel that you are not making progress within 6-12 weeks or your shoulder pain is getting worse".
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Our 20-minute class: the shoulder block every day in the very painful stage (about 10 minutes), the arms-low Pilates block 2 or 3 times a week, and the gentle holds only once the pain is mostly 6 out of 10 or less. When it's stiff but settled, move on to the Pilates for shoulder pain class and the push-up progression.
A 20-minute Pilates class for a frozen shoulder: a pain-free shoulder block, arms-low Pilates for the rest of you, and gentle holds once the pain has settled.
20 minBeginner14 movesA bench or box, Other / check instructionsTwenty minutes of gentle yoga for a frozen shoulder: pain-free assisted movement, standing poses with the arms low, and gentle holds once it's less sore.
20 minBeginner14 movesA bench or box, Other / check instructionsA 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 movesA bench or box, Other / check instructionsA 25-minute band routine for healthy shoulders: move the shoulder and upper back through their range, then strengthen the rotator cuff and shoulder blades.
25 minBeginner12 movesA wall, A bandA 15-minute chair Pilates class done entirely sitting down, in a chair or wheelchair: breathing, spine moves, and leg and arm strength with water bottles.
15 minBeginner13 movesA bench or box, Something with weightWork up to full push-ups: wall, incline and knee push-ups, then the floor push-up and harder variations.
15 minBeginner8 movesA wall, A bench or boxThese are the same warning signs as our shoulder pain guides, word for word. 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.
Get help from NHS 111: pain or tightness in your chest, neck, shoulders, jaw or arms that comes and goes, often brought on by exercise, stress, emotion or cold and easing after a few minutes' rest. It can be angina, a sign of a heart problem. If you've been diagnosed with angina, get help from NHS 111 too if it feels worse than before, is happening more often, lasts longer or happens when you're resting.
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Contact a GP immediately, go to 111.nhs.uk or call NHS 111: a new or frequent headache that usually comes on suddenly (your scalp may also feel sore or tender), pain in the jaw muscles or tongue when eating or talking, or problems with your sight, such as double vision or loss of vision in 1 or both eyes. With pain and stiffness around the shoulders, these can be signs of temporal arteritis (giant cell arteritis), which up to 1 in 5 people with polymyalgia rheumatica develop. If you suddenly can't see from 1 or both eyes, call 999 or go to A&E.
Stop for sharp pain, a feeling that the shoulder is slipping, pins and needles or numbness down the arm, or pain that is still worse by your next session after strengthening.
Call 999 if:
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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.
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.
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.
Gentle exercise within pain limits did better than intensive stretching through pain (89% against 63% near-normal at 2 years), and the NHS says to avoid movements that cause you pain. Firmer work helps a little only once the shoulder is stiff rather than painful.
The NHS says keeping it still "will make the pain worse", and the UK FROST physiotherapy discouraged keeping the arm still.
Most people get much better, but 41% still had some symptoms an average of 4.4 years after it started, mostly mild, and a review found no evidence of neat phases to full recovery.
In UK FROST, keyhole release was no better at a year than physiotherapy with an injection, and had more serious complications.
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No trial has tested it. Pilates helps you keep moving and stay strong while the shoulder recovers.
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It hasn't been tested: no Pilates trial exists for frozen shoulder. Gentle, pain-free movement suits the painful stage, and gentle exercise within pain limits did better than forceful stretching in a study. Use Pilates to keep moving and stay strong, alongside your GP's or physiotherapist's care.
Yes, if you change the arm work: keep your arms low or resting, lie on your good side, and skip anything that takes weight on your arms or reaches overhead or behind you while it's painful. Tell your teacher first. In class, "Stop for sharp pain, a feeling that the shoulder is slipping, pins and needles or numbness down the arm, or pain that is still worse by your next session after strengthening."
The footwork, bridging and side-lying leg work are fine; keep your arms out of the straps while the shoulder is painful. Once it's stiff rather than painful, light springs with your arms below shoulder height can help, within the same pain rule. No study has tested the reformer for frozen shoulder.
In the very painful stage, pendulum swings, table slides and assisted turning out, pain-free, a few times a day. As it settles, gentle holds to mild discomfort, then shoulder-blade and band work. Bridges, knee folds, leg circles and side-lying work can carry on throughout with your arms low.
While it's painful or stiff: planks, push-ups and the leg pull, the roll-up with your arms overhead, rocking (holding your ankles), lying on the sore side, and reformer strap work. Bring them back one at a time once the shoulder has settled.
The NHS says months or years, and UK trial teams say typically 1 to 3 years. Most people get much better, but years later about 4 in 10 still have some symptoms, almost all mild. Treatment aims to get you better faster.
Guidelines describe a painful freezing stage, a stiff frozen stage and a thawing stage, but they overlap, so UK specialists say they're of limited use for choosing treatment. Go by how sore it is now: very painful, less sore, or stiff but settled.
No. Exercises should be done without significant pain, and gentle exercise did better at 2 years than intensive stretching through pain. Later, stretch to mild discomfort only, with no lasting flare afterwards.
Physiotherapy after a steroid injection is recommended, and an injection plus physiotherapy improved function more than physiotherapy alone in the short term. Whether physiotherapy alone beats waiting hasn't been tested properly. In many areas you can refer yourself.
Ask your GP: a steroid injection speeds early improvement, and adding home exercise brings extra benefit later. Follow your clinician's timing before stretching harder; the gentle moves can carry on.
It's much more common with diabetes and can be slower to get better, but the same gentle approach applies. If you haven't been checked for diabetes, ask your GP whether you should be.
Follow your surgical team's physiotherapy first: in the largest trial, everyone had up to 12 physiotherapy sessions after a procedure. Pilates can keep the rest of you strong, and add shoulder work once your physiotherapist agrees.
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.
