Pilates guide
Pilates can help with a groin strain, because the exercises that worked in trials are ones a Pilates class already does: squeezing a cushion or ring between your knees, side-lying inner thigh lifts, bridges and side planks. In a Lancet trial, strength and coordination training around the pelvis got 23 of 34 athletes with long-standing groin pain back to sport without pain, against 4 of 34 with treatment that didn't include active training. No trial has tested Pilates itself for a groin (adductor) strain, so Pilates fits around the rehab plan in our groin strain guide, not instead of it.
Not every groin pain is a strain. A lump in the groin, a hot hip with a fever, or a child or teenager with hip, thigh or knee pain and a limp needs checking first.
This guide covers what a groin strain is and the groin pain that isn't one, when to start, the Pilates moves for each stage, the wide-legged moves to leave for later, the Copenhagen plank, getting back to sport and the warning signs, with a 25-minute class.
No trial has tested Pilates in a groin strain. What worked in trials was active strengthening around the pelvis, and the Cochrane review says the evidence is too thin to back any one treatment. Pilates is a reasonable way to do the early and middle stages of the plan in our groin strain guide; it doesn't replace it, or a physiotherapist's advice.
In 81 male athletes on a structured programme of active exercises, most were pain-free in a median of 13 days and back in full team training in 18. Complete tears took about 11 weeks.
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Squeezing a cushion, soft ball or Pilates ring between your knees is the groin strain guide's first exercise, and side-lying hip adduction (the Pilates inner thigh lift) is the easiest level of the Copenhagen adduction programme, as a later trial copied it. Keep pain at 3 out of 10 or less at first.
In athletes with an acute adductor strain, flexibility returned to normal early in rehab while strength kept improving throughout. No trial has tested stretching for groin pain, so the wide-legged Pilates moves wait.
One adductor exercise, built up over 3 levels, lowered groin problems by 41% in 652 semi-professional men and helped in Japanese school players, though an amateur trial didn't repeat it. A football programme that included core exercises didn't significantly reduce groin pain.
Doctors sort groin pain into adductor, hip flexor, inguinal and pubic bone types, plus the hip joint. A lump in the groin, a hot hip with a fever or a hip you can't put weight on needs checking before exercise.
The adductors are the inner thigh muscles that pull your legs together, and a groin strain usually means a strain of one of them, most often adductor longus. An NHS community service describes pain on the inside of the thigh, pain when you bring your legs together, and sometimes minor swelling or bruising, more often in sports with twisting, turning, changing direction and kicking. Kicking caused 40% of acute groin injuries in football in one study. The NHS has no groin strain page; its sprains and strains advice applies.
An expert agreement sorts groin pain in athletes into adductor-related pain ("Adductor tenderness AND pain on resisted adduction testing."), iliopsoas-related pain (the hip flexor), inguinal-related pain (often called a sports hernia, with no hernia you can feel) and pubic-related pain, plus the hip joint and other causes. Hip flexor groin pain is usually treated without surgery, in low-quality studies; inguinal-related pain is 5% to 20% of groin problems in male athletes, rarely a true hernia, and physiotherapy-led rehab comes first.
In elite European football, hip and groin injuries were 14% of all injuries over 15 seasons, and adductor-related pain was the commonest kind (63%). A previous groin injury almost doubled the risk of groin pain in a Danish trial, and weaker adductors and less hip rotation are risk factors too.
On a criteria-based programme, most acute adductor strains in male athletes were back in full team training in a median of 18 days, and complete tears in 78 days. A review of 30 studies gives 1 to 7 weeks for partial tears. An NHS community service says minor strains may take a couple of weeks and that even the most severe are usually back to normal within 6 months with physiotherapy.
The Pilates ring (the "Magic Circle") is one of Joseph Pilates' own inventions, and the teaching body describes it as "used in various exercises to target the inner thighs, upper arms, and chest". The side-lying inner thigh lift is part of the classical side kick series. Wide-legged moves (the open-leg rocker, the saw with wide legs, high scissors) and the reformer's feet-in-straps frogs and circles stretch the adductors under load, so they wait (our reading of the moves; no study has measured them in a groin strain).
Footballers, ice hockey players and others who kick or change direction need the full return-to-play plan, including the Copenhagen progression. Gradual groin pain may come from somewhere else, so see a physiotherapist or GP if it isn't clearly a strain. In pregnancy, groin pain is usually pelvic girdle pain. Children and teenagers with hip, thigh or knee pain and a limp need checking the same day.
No trial of Pilates in an adductor strain. Active strengthening carries the evidence, from small trials and cohorts.
Our searches of PubMed, Europe PMC and ClinicalTrials.gov found one Pilates trial in groin pain, in a different condition, and none in an adductor strain.
Source 1
In 88 men in Egypt with a sports hernia (pain where the groin meets the lower tummy, without a true hernia), adding 6 weeks of Pilates to laser and ultrasound treatment improved leg function and a hip score, but eased pain by under 1 point out of 10, which the authors say is less than people notice. The comparison group did no exercise at all, so it compares Pilates with no exercise, not with other exercise. We could read only the abstract, and a sports hernia isn't an adductor strain.
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In a Danish Lancet trial of 68 athletes with adductor-related groin pain for a median of 40 weeks, 8 to 12 weeks of active training to improve the strength and coordination of the muscles around the pelvis returned 23 of 34 to sport without pain, against 4 of 34 after physiotherapy without active training (stretching, electrotherapy and massage). The benefit was still there 8 to 12 years later. It was one centre, with a blinded assessor.
Two trials, 122 people, both at high risk of bias: exercise therapy succeeded more often than passive physiotherapy (74% against 29%), but the evidence was too thin to recommend any one treatment. A new Cochrane review is under way, and a 2023 review rated the evidence very low certainty.
In 81 male athletes in Qatar with an acute adductor injury, a programme of active exercises (leg swings, hip circles, band work, a one-leg coordination exercise and the Copenhagen adduction) 3 times a week, loaded so that pain stayed around 2 out of 10, returned most to full team training in 18 days. Those who met pain-free criteria before going back had fewer re-injuries (5% against 21%). Flexibility came back early by itself while strength kept improving. There was no comparison group.
A 2021 review found no trial of stretching on its own for recovery from groin pain or injury in athletes.
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In one pilot of 20 footballers with groin pain, reported in two papers, 12 weeks of core stability training improved groin scores, balance and trunk endurance against usual training, but not agility. In 42 elite youth players, adductor and core exercises halved groin pain, but not significantly (3 of 21 against 6 of 21). A trial of core training in young gymnasts with an adductor strain is registered as completed, with no results yet. Small and early.
In 652 semi-professional Norwegian men, one adductor exercise (the Copenhagen adduction, built up over 3 levels, 3 times a week in pre-season and then weekly) lowered the share with groin problems from 21.3% to 13.5%; in 202 Japanese high school players it lowered groin pain too. In 502 amateur men and women, with low compliance, it made no difference. Eight weeks of it raised adductor strength by about 36%, with little soreness. A Danish programme with core stability exercises cut groin pain by 31%, which wasn't significant, and groin prevention programmes overall weren't significant.
Small trials of mat or reformer Pilates improved agility, strength and hop tests in footballers; none counted groin injuries, and a 2025 review called the research limited and mixed.
For the first 2 to 3 days the NHS advises protection, rest, ice, compression and raising the injured area, and to avoid heat, alcohol and massage for the first couple of days. "When you can move the injured area without pain stopping you, try to keep moving it". An NHS community service suggests starting gentle exercises once pain is improving after about 48 hours.
In the first stage, our groin strain guide's goal: "Keep pain at 3 out of 10 or less." In the strengthening stages, the hip guides' rule: "During the exercise, pain up to about 5 out of 10 is acceptable. It should settle within an hour or so, and your hip should be no worse that night or the next morning. If it is, do less next time (fewer repetitions, a smaller range, a lighter load), not nothing."
An NHS community service adds: "As a rule of thumb if your symptoms are aggravated for more than 15 minutes after performing exercises, you are doing too many or pushing too hard."
An NHS community service builds its groin strain exercises from 3 sets of 10 towards 3 sets of 20, about 4 times a week. Our class below suits 3 times a week (our editorial starting point).
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Breathing, squeezes, bridges and the knee side plank within a few days, keeping pain at 3 out of 10 or less. Standing, side-to-side work and side kicks once the squeeze is pain-free at a firm effort. The Copenhagen plank, then gentle range and wide-legged moves, last. These start times are our editorial guidance, from the NHS advice and the active, criteria-based programme in the trials, not trial rules.
The steps follow the move's own page; the dose is our groin strain guide's.
See the movement on the 3D figure: Lying adductor ball squeeze
Keep pain at 3 out of 10 or less. Lateral breathing: "5 to 8 breaths at the start of every session", from the move page's dose. Heel slides: "10 slow repetitions each side, once or twice a day", from the move page's dose, knees in line. Squeeze: as in the steps above. Bridges: 2 sets of 10, with the cushion squeezed between your knees at the top once the plain squeeze is easy; knee side plank: 3 holds of 15 to 20 seconds each side (our groin strain guide). Inner thigh lift: "10 to 12 each side", from the move page's dose; its page says: "With a groin strain, start with a small lift." Knee folds: "2 sets of 5 to 10 each side, every other day", from the move page's dose. Dead bug heel taps, 2 sets of 6 each side, and clams and side-lying leg raises, 2 sets of 10 each side, for the outer hip (our editorial starting point).
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoLying adductor ball squeezeBeginner · Other / check instructions
3D demoGlute bridgeBeginner · No equipment
3D demoKnee side plankBeginner · No equipment
3D demoSide-lying inner thigh lift (Pilates side kick series)Beginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoDead bug heel tapsBeginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSide-lying leg raiseBeginner · No equipmentOnce the squeeze is pain-free at a firm effort, 3 times a week. Band hip adduction and band hip abduction: 3 sets of 10 to 12 each side; split squat: 3 sets of 8 each side (our groin strain guide). Side kick, small kicks with no pulse: "8 to 10 each side"; side-leg circles, small: "8 each direction, each side"; shoulder bridge: "3 to 5 kicks each leg (the classical sequence uses 3)"; side-stepping: "10 steps each way, next to a counter (the NHS balance exercises)", each from the move page's dose. Side plank, 2 holds of 20 to 30 seconds each side, and single-leg stand, 2 holds of 30 seconds each leg (our editorial starting point). 90/90 lift-off: "3 holds of 5 to 8 seconds each way, each side (our editorial starting point)", the move page's dose; its page: "Sharp groin pain is not, so back off if it appears."
3D demoStanding band hip adductionBeginner · A band + An anchor point
3D demoStanding band hip abductionBeginner · A band + An anchor point
3D demoSplit squatIntermediate · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSide-lying leg circles (Pilates side kick series)Beginner · No equipment
3D demoShoulder bridge (Pilates)Intermediate · No equipment
3D demoSide-stepping (sideways walking)Beginner · A wall
3D demoSide plankIntermediate · No equipment
3D demoSingle-leg standBeginner · A wall
3D demo90/90 hip lift-offIntermediate · No equipmentCopenhagen work 3 times a week, then once a week to keep the benefit, short lever (knee on the bench) first, in small sets (our groin strain guide). Its page: "Avoid during acute groin pain. Soreness was mild in the trials that built up gradually, so start with 3 to 5 slow reps a side and build up over the weeks." Side plank with leg lift, 2 sets of 10 each side (our editorial starting point). Kneeling side kick: "4 each side (the classical sequence uses 4)", from the move page's dose. Cossack squat: "6 slow shifts per side, hold the last one", the move page's dose, only as deep as is comfortable; its page says to leave it out while a groin strain is painful. Leg pull front: "3 to 5 each side (the classical sequence uses 3)", from the move page's dose.
Once squeezing your knees together and side-to-side work are pain-free. Leg circles, small: "5 circles each direction, each leg (the classical sequence uses 5)", from the move page's dose; its page says to stop if you feel groin pain. Lying inner thigh stretch: "Hold 20 to 30 seconds, 2 to 4 times each side (our editorial starting point)", from the move page's dose, to a mild pull only; its page says to skip it after a recent groin strain, so it comes back last.
Leave the open-leg rocker, the saw with wide legs, high scissors, frog positions and the pancake until squeezing and side-to-side work are pain-free, then widen slowly (our suggestion: strength, not flexibility, is what needs rebuilding).
Keep side kicks and leg circles small, with no pulses, until the groin is settled (our suggestion, from the move pages' cautions).
The reformer's adjustable springs can make work easier or harder, but the feet-in-straps frogs and circles and any side-splits work open the hips wide, so they wait. Tell the teacher about the strain.
Say no to anyone pressing your knees apart or widening your legs for you (our suggestion).
Groin pain in pregnancy is usually pelvic girdle pain, and standing on one leg and moving the legs apart can provoke it: see our Pilates in pregnancy guide. After a hip replacement, wide, turned-out positions wait for your surgeon's go-ahead.
Keep stretches mild and in the middle of your range, and favour the strengthening moves: the NHS says not to overextend your joints just because you can.
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Meeting pain-free criteria before going back went with fewer re-injuries (5% against 21%). Sprinting, cutting and kicking should be pain-free at full effort, as our groin strain guide says.
Source 4
In the trial that worked, the Copenhagen adduction continued once a week through the season. Built up gradually, soreness was mild.
Once you're back, a Pilates class once or twice a week can keep up adductor, hip and trunk work (our suggestion). Our Pilates for footballers guide covers training around football.
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Our 25-minute class follows the first two stages of our groin strain guide: squeezes, side-lying work and side planks, then short standing work, with no wide-legged stretching. Its structure is our editorial choice. Do it 3 times a week, from the first week if squeezing stays within 3 out of 10. The prevention workout has the Copenhagen progression for the last stage, the inner thigh and adductor workouts add strength, and the footballers and hip flexor classes come after you're back. If you prefer yoga, try the yoga class for a groin strain.
A 25-minute Pilates class after a groin strain: ring or cushion squeezes, bridges, side-lying inner thigh lifts and side planks, then short standing work.
25 minBeginner15 movesOther / check instructions, wallA 25-minute yoga class after a groin strain: squeezes, bridges and side planks, then short-stance standing poses and side steps, with no wide-legged stretches.
25 minBeginner15 movesOther / check instructions, wallThe Nordic hamstring and Copenhagen adduction programmes from the football trials: a 10-week build, three adductor levels, then once a week in season.
15 minIntermediate6 movesWall, anchor pointA 25-minute inner thigh workout at home: sumo squats with a dumbbell or kettlebell, Cossack squats, ball squeezes and Copenhagen planks, with bridges and hip mobility.
25 minIntermediate10 movesDumbbell, kettlebellA 35-minute gym adductor workout: dumbbell sumo squats, the hip adduction machine, cable adduction and Copenhagen planks, with sets, reps and groin advice.
35 minBeginner10 movesCardio machine, wallA 25-minute Pilates class for footballers: trunk control, the groin and outer hips, hamstrings with the hip extended, and balance, for recovery days.
25 minBeginner17 movesOther / check instructions, wallA 25-minute Pilates class for the hip flexors: pelvic control, hip flexor strength, the glutes and back of the hip, and a gentle pelvis-tucked stretch.
25 minBeginner16 movesBand, anchor pointA 20-minute Pilates ring workout for beginners: squeeze, press and balance with a magic circle, or a cushion and a belt if you don't have one.
20 minBeginner11 movesOther / check instructions, bandThese are the warning signs from our groin strain, hip and hernia 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.
Call 999 or go to A&E now if you have a femoral hernia (a small lump at the top of your thigh, in your groin) and very bad tummy pain, you feel sick or you're being sick, you cannot fart or poo, you have a high temperature or you feel hot, cold or shivery, or you've suddenly become confused. Do not drive to A&E. With any other hernia and pain in or around it, a bloated tummy, feeling or being sick, vomiting blood or vomit that looks like coffee grounds, constipation, a high temperature or feeling hot, cold or shivery, or sudden confusion, get help from NHS 111.
A lump in the groin, upper thigh or tummy, especially one that appears when you cough or strain and goes when you lie down: see a GP, as it may be a true hernia. A femoral hernia (a small lump at the top of the thigh, mainly in women over 50, though it can happen to anyone) needs treating in hospital.
A pop high on the inner thigh, then a large bruise, a dent or a gap you can feel, and weakness squeezing the legs together, can be a complete tear of the adductor longus tendon: get it checked within days, as our inner thigh pain guide says.
Call 999 or go to A&E: severe hip pain after a fall or injury, or you cannot stand, walk or put weight on the leg. In an older adult this can be a broken hip; the leg may be at an odd angle or look shorter. Don't drive yourself.
Call 999 or go to A&E: tingling or loss of feeling in the hip or leg after an injury.
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Ask for an urgent GP appointment or get help from NHS 111 if you have severe hip pain that started suddenly but you've not had a fall or injured your hip, your hip is swollen and feels hot, the skin around your hip has changed colour, or you have hip pain, feel generally unwell and have a high temperature (or feel hot, cold or shivery). A hot, swollen hip with a high temperature can be a joint infection.
Call 999 or go to A&E if your child gets sudden pain in their hip, knee or thigh (hip problems can sometimes be felt in the thigh or knee) or cannot put any weight on their leg. If your child is limping, ask for an urgent GP appointment or get help from NHS 111 the same day. This applies to teenagers too, and in some children knee pain is the only sign.
Call 999 or go to A&E if you have sciatica on both sides, weakness or numbness in both legs that's severe or getting worse, or numbness around or under your genitals, or around your bottom (anus); if you find it hard to start peeing, cannot pee or cannot control when you pee; or if you do not notice when you need to poo or cannot control when you poo, and this is not normal for you. These could be symptoms of a serious back problem that needs to be treated in hospital as soon as possible.
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Call 999 if:
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.
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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.
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The NHS advises protecting and resting it for 2 to 3 days, then keeping it moving once pain allows. Active, criteria-based rehab got most acute adductor strains back to full training in about 18 days, and active training beat passive care in long-standing groin pain.
No trial has tested stretching on its own for groin pain, flexibility came back early by itself while strength took longer, and the treatment that lost in the Lancet trial was built on stretching, electrotherapy and massage.
No trial has tested it in an adductor strain. The one Pilates trial in groin pain was in a sports hernia, and it compared Pilates with no exercise.
A football programme with core stability exercises didn't significantly reduce groin pain, and groin prevention programmes overall weren't significant. The prevention trials that worked used a single adductor exercise, the Copenhagen adduction.
Built up gradually, soreness was mild (a median of 0 to 2 out of 10) and adductor strength rose by about 36% in 8 weeks. It isn't for the painful early stage, as its page says.
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The squeezes, side-lying lifts and side planks that match the evidence need a mat and a cushion or ring. The reformer's springs can tailor the load, but its feet-in-straps frogs and circles open the hips wide, which waits. No trial has tested the reformer in a groin strain.
It can be a good way to do the early and middle stages of rehab: squeezes, side-lying inner thigh lifts, bridges and side planks are the moves the groin strain plan starts with. No trial has tested Pilates in an adductor strain, though, and the evidence is for active strengthening in general. Our groin strain guide has the full plan.
Start with a cushion or Pilates ring squeeze between your knees, bridges, the knee side plank and a small side-lying inner thigh lift. Then add side kicks, side-leg circles and standing band work. The Copenhagen plank comes last, for strength and prevention.
Not hard, and not early. No trial has tested stretching for groin pain, and in athletes with a strain, flexibility came back early by itself while strength took longer. Keep inner thigh stretches to a mild pull until squeezing your knees together is pain-free.
At first, wide-legged moves (the open-leg rocker, the saw with wide legs, high scissors), big side kicks and circles, frog positions, and the reformer's feet-in-straps frogs and circles. Bring them back once squeezing and side-to-side work are comfortable.
In the first stage, keep pain at 3 out of 10 or less; later, up to about 5 out of 10 that settles within an hour or so. An NHS community service says symptoms aggravated for more than 15 minutes afterwards mean you're doing too much.
Usually, once a lump, a fever, a hip you can't put weight on and the other warning signs are ruled out. Groin pain has several sources, from the adductors to the hip flexor, the pubic bone and the hip joint, so if it isn't clearly a strain, see a physiotherapist or GP and read our groin pain guide.
A ring or cushion squeeze between the knees is the groin strain guide's first exercise. Squeeze gently at first and build to a firm effort over days, keeping pain at 3 out of 10 or less.
Most acute adductor strains in male athletes on active rehab were pain-free in about 2 weeks and back in full training in about 18 days, while complete tears took about 11 weeks. An NHS community service says even severe strains are usually back to normal within 6 months with physiotherapy.
Not on current evidence. A prevention programme with core stability exercises didn't significantly reduce groin pain. The exercise that did, in semi-professional men and in Japanese school players, was the Copenhagen adduction, built up gradually, and an amateur trial didn't repeat it.
Footwork with your legs parallel, bridging and side-lying work can suit the early stages with a teacher who knows about it. The feet-in-straps frogs and circles and side splits open the hips wide, so they wait. No reformer trial exists.
A strain hurts on the inner thigh when you squeeze your legs together. A lump in the groin, especially one that appears when you cough and goes when you lie down, may be a hernia: see a GP, and get urgent help for a femoral hernia with very bad tummy pain or sickness.
That's pain where the groin meets the lower tummy, without a true hernia; doctors now call it inguinal-related groin pain, and physiotherapy-led rehab comes first. One trial added Pilates to laser and ultrasound in 88 men and found better function but only a small change in pain, against no exercise. Our sports hernia guide covers it.
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.
