Pilates for a herniated disc: slipped and bulging discs, the nerve and your leg, bending or arching, the moves to change, and a class

A disc on a scan is common, and often harmless

In 3,110 people with no back pain, scans showed disc bulges in 30% of 20-year-olds and 84% of 80-year-olds. Nothing actually slips: the soft centre bulges out, and it hurts when it irritates a nerve.

Sources 1, 2

Most get better, and many discs shrink

The NHS says a slipped disc "usually gets better slowly with rest, gentle exercise and painkillers", and sciatica usually gets better in a few weeks to a few months. In scan studies, the biggest herniations shrank most often.

Sources 2, 3, 4

Keep moving, gently

The NHS says the type of exercise isn't important as long as it doesn't cause pain or make your back pain worse. The National Institute for Health and Care Excellence (NICE) suggests a group exercise programme for back pain with or without sciatica; it doesn't name Pilates, though its full guideline counts Pilates as one kind of exercise it means.

Sources 2, 5, 6

The Pilates trials are small and short

Four small trials (30 to 54 people each) found less pain and disability after 4 to 8 weeks than no exercise or usual care. None followed people up afterwards, and two are reported only as abstracts in local journals with unclear randomisation.

Sources 7, 8, 9, 10

Let your leg guide you

Keep moves that ease your leg or leave it the same, and shrink or drop moves that send pain further down it. Many people have a direction, arching back or bending forward, that eases their pain.

Sources 11, 12, 13

Know the 999 signs

Numbness around your genitals or bottom, new trouble peeing or pooing, or weakness or numbness in both legs needs 999 or A&E (accident and emergency), not a class.

Sources 14, 3

The disc and the nerve

Between each pair of vertebrae is a disc with a tough outer ring and a softer centre. The NHS: "A slipped disc, also called a prolapsed or herniated disc, is when a soft cushion of tissue between the bones in your spine bulges outwards. It's painful if it presses on nerves." When it irritates a nerve root, pain runs into the buttock and down the leg, often below the knee, sometimes with pins and needles, numbness or weakness: sciatica. The NHS calls a slipped disc the most common cause of sciatica.

Sources 2, 3, 15

What your scan does and doesn't meanStrong evidence

In a review of 3,110 people without back pain, disc bulges were found in 30% at age 20, 50% at 40, 69% at 60 and 84% at 80, and disc protrusions in 29% at 20 and 43% at 80. Many of these changes are "likely part of normal aging and unassociated with pain". NHS inform says scans are generally not advised for sciatica.

Sources 1, 15

Bulge, protrusion, extrusion

Scan reports use a sliding scale: a broad bulge, then a protrusion, an extrusion, and a sequestration, where a fragment has separated. The words describe the shape on the scan, not how much it should hurt.

Source 4

L4 L5 or L5 S1

No study has compared Pilates for discs at different levels. The largest Pilates trial included discs from L3 L4 to L5 S1, and the advice in this guide is the same at any level: your leg's response, not the level on the scan, guides the moves.

Source 7

How it usually goesEmerging evidence

Sciatica "usually gets better in a few weeks to a few months but can last longer", the NHS says, and NHS inform that it usually improves within 12 weeks, though for some people it takes up to a year. A North American Spine Society guideline expects most people to improve whatever the treatment. In scan studies of people treated without surgery, herniations shrank in 96% of sequestrations, 70% of extrusions, 41% of protrusions and 13% of bulges. Shrinking on a scan and feeling better don't always go together.

Sources 3, 15, 16, 4

Why straight legs can pull on a sore nerve

Doctors test for an irritated nerve root by raising your straight leg while you lie on your back. In people having surgery for a disc, this test was positive in about 9 in 10. Pilates moves that fold forward over straight legs, or lift a straight leg high, put the nerve in a similar position, which is why this guide bends the knees for now. No trial has tested that change.

Source 17

Guidelines: stay active and exercise, of any kindStrong evidence

NICE recommends advice that encourages you to carry on with normal activities, and in recommendation 1.2.2 says to consider a group exercise programme for back pain with or without sciatica, choosing the type to suit you; it doesn't name Pilates. Its full guideline counts Pilates as biomechanical exercise, alongside core stability work. The World Health Organization (WHO) found too little evidence to say any type of exercise is better than another for long-lasting back pain, with or without leg pain. The NHS says walking, swimming, yoga and Pilates may help back pain.

Sources 5, 6, 18, 2, 14

Four small Pilates trials in disc herniationMixed evidence

In 54 people with a disc bulge or protrusion and back and leg pain, physiotherapist-led Pilates 3 times a week for 6 weeks cut a disability score from about 29 to 15, against about 26 to 23 with no exercise. But people were put into groups in the order they arrived, the groups differed at the start, and nobody was followed up after 6 weeks. In 45 women, adding Pilates to water exercise 3 times a week for 8 weeks improved mobility and disability more than water exercise alone.

Two more trials, of 34 and 30 people, found less pain after 4 and 6 weeks of Pilates, but they are reported only as abstracts in local journals and don't say clearly how people were randomised. No trial compared Pilates with the same amount of other exercise, and none measured leg pain on its own, so the certainty is very low.

Sources 7, 8, 9, 10, 19

Exercise eases leg pain a little, at firstMixed evidence

Across 5 trials, structured exercise eased leg pain by about 11 points out of 100 more than advice to stay active in the short term (low-quality evidence), with no difference in disability and no difference in the long term. Across 18 trials of physiotherapy for sciatica (2,699 people), none clearly beat control treatments, and all were at high or unclear risk of bias. Stabilisation exercise beat no treatment in single trials, and a 2026 review of 13 trials found exercise eased disc pain, with results that varied a lot between trials.

Sources 20, 21, 22, 23

Core and motor control work: no better than other exerciseStrong evidence

Motor control exercise, which shares Pilates' focus on the deep trunk muscles, helped long-lasting back pain more than doing little but no more than other exercise, in 29 trials of 2,431 people. In a disc trial of 74 people, stabilisation exercise did no better than general exercise. It did beat a TENS machine (transcutaneous electrical nerve stimulation) in 40 people, but that compares exercise with a passive treatment.

Sources 24, 25, 26

What carries over from Pilates for back painEmerging evidence

In a Cochrane review of 10 trials (510 people) with long-lasting back pain from no single cause, Pilates eased pain by about 14 points out of 100 in the short term compared with minimal care, but did no better than other exercise. In 296 people, twice a week beat once a week. In 64 people, Pilates-based exercise beat cycling at 8 weeks but not at 6 months. None of these trials was in disc herniation.

Sources 27, 28, 29, 30

Surgery: faster, not better in the long runEmerging evidence

For sciatica from a disc, surgery gave faster relief than physical activity in a review of 12 trials, but the difference faded in the long term. The NHS says surgery is not usually needed; NICE suggests considering spinal decompression when other treatment hasn't helped and the scan matches the symptoms.

Sources 31, 2, 5

The rule

Some discomfort during exercise is fine, and it does not mean you are doing damage: the WHO counts "hurt does not necessarily mean harm" among the messages people with back pain need. Aim for pain you would call mild to moderate, no more than about 5 out of 10. It should settle within an hour or so, and your back should be no worse the next morning. If it is worse, do less next time (fewer reps, a smaller range, a lighter load), not nothing.

Leg symptoms are the exception: stop or shrink any movement that sends pain, pins and needles or numbness further down your leg. If leg symptoms move back towards your spine, that is a good sign, even if your back aches a little more for a while.

Sources 18, 32, 3

Find the direction that eases itEmerging evidence

About 7 in 10 people with back pain have a direction of movement that eases it, and pain moving back towards the spine is a good sign. In 312 people with back pain with or without sciatica, exercise matched to that direction did better than unmatched exercise. In 181 people with severe sciatica, exercises chosen by how symptoms responded beat sham exercises. As a full method, McKenzie therapy was no better than guideline advice at 2 years in 66 people with disc-related sciatica.

Try a gentle back bend (the sphinx) and a gentle knee hug, and keep whichever eases your leg or draws the pain up towards your back. You don't need both.

Sources 11, 12, 13, 33

No direction is banned

The largest Pilates disc trial used rounding moves (the roll-down, saw and spine stretch) and arching moves (the swan and swimming), progressed after 3 weeks, and reported no harms, though it didn't formally record them. So bring moves back one at a time and keep each one if your leg doesn't mind.

Source 7

No need to braceEmerging evidence

In 152 people with long-lasting back pain, being taught to keep the tummy relaxed and move smoothly during Pilates gave slightly better disability results than being taught to hold the core tight. Breathe and move; you don't need to brace all the time.

Source 34

In the first days and weeks

Walk little and often: 5 to 15 minutes several times a day (our herniated disc guide's plan). The NHS says if the pain is very bad you may need to rest at first, but you'll get better more quickly if you gradually start gentle exercise as soon as you can, and not to sit or lie down for long periods.

Sources 2, 3

Adding Pilates

The largest disc trial used physiotherapist-led sessions of 45 to 60 minutes, 3 times a week for 6 weeks, starting with a one-to-one session. Our editorial starting point: the 20-minute class below twice a week, once walking doesn't spread your leg pain, alongside your walks.

Sources 7, 29

Classes, and the reformer

A physiotherapist-led (clinical) Pilates class is closest to the trials. Tell the teacher about your disc and which direction eases your leg. No trial has compared reformer and mat Pilates for a disc: knees-bent footwork, bridging and side-lying work on light springs are usually fine, and long-lever, straight-legged and rolling work can wait (our suggestion).

Sources 5, 7, 19

Forward folds over straight legs

The spine stretch forward and the saw: bend your knees or sit on a block. The single and double straight-leg stretches: use knee folds instead. The teaser: leave it for now.

Source 17

The roll-up, neck pull and rolling moves

Our move pages already say to use the half roll back or skip the roll-up during a disc-related flare, and to avoid the neck pull then. Leave out the roll-over, jack knife, rolling like a ball, open-leg rocker, corkscrew, boomerang, control balance, crab and rocking until your back has settled. The NHS says the type of exercise matters less than whether it causes pain or makes it worse.

Source 2

Tummy work with the legs out long

Do the hundred and the double leg stretch with your knees bent and your head down, or use knee folds and dead bug heel taps instead.

Source 34

Leg circles

Bend the other knee and keep the circles small, or leave them out if they pull down your leg.

Source 17

Exercise from about 4 to 6 weeks helpsEmerging evidence

In a Cochrane review of 22 trials (2,503 people), exercise programmes starting 4 to 6 weeks after disc surgery reduced pain and disability faster than no treatment, though not in the long term, and none of the trials found more repeat operations. Programmes started straight after surgery did no better, and a trial of early rehabilitation found no benefit over no referral. A review of 55 trials found limits on activity after surgery added nothing.

Sources 35, 36, 37

One trial of Pilates after surgeryMixed evidence

A 2024 review of rehabilitation in the first 3 months after disc surgery describes one trial (Zuo 2021) in people afraid of movement: adding supervised Pilates, twice a day for 6 weeks, to routine care and talking therapy improved function at 6 weeks. It is a single trial, and no study in the review looked at side effects. Follow your surgical team's timetable; our guide to exercise after back surgery has the stages.

Source 38

Call 999 or go to A&E

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.

Call 999 or go to A&E: back pain with chest pain, or back pain that started after a serious accident, such as a car crash.

Sources 14, 3

With sciatica, the NHS says go to A&E or call 999 if you

• have sciatica on both sides
• have weakness or numbness in both legs that's severe or getting worse
• have numbness around or under your genitals, or around your bottom (anus)
• find it hard to start peeing, can't pee or can't control when you pee, and this isn't normal for you
• don't notice when you need to poo or can't control when you poo, and this isn't normal for you
• have changes in how your penis or vagina feels during sex, can't get or keep an erection, or can't orgasm

Source 3

The same day

Same day: leg weakness that is getting worse.

Same day (urgent GP appointment or NHS 111): new difficulty lifting the front of your foot or toes (foot drop), or a foot that slaps down or catches as you walk, especially if it is getting worse. Weakness in both legs, or with numbness around the genitals or bottom or bladder or bowel changes, is the 999 emergency above.

Same day (GP or NHS 111): back pain and you feel hot, cold, shivery or generally unwell, or severe pain that starts suddenly or is getting worse quickly.

Same day: you have or have had cancer, and new back pain that is severe and doesn't let up, is getting steadily worse, is worse at night and disturbs your sleep, is worse when you cough, sneeze or strain, or comes with tenderness over the spine. Contact your cancer team or GP urgently. With cancer, new weakness, difficulty walking, numbness or bladder or bowel problems are an emergency.

Source 14

After a fall

Sudden mid or lower back pain after a minor fall, lift, cough or sneeze, especially from 50 or with long-term steroid tablets.

Often worse moving or changing position and eased by lying down. It can be an osteoporotic spinal fracture, so see a GP; height loss or a new curve in the upper back are other signs.

See a GP

If your sciatica hasn't improved after a few weeks of looking after it at home, is getting worse, or is stopping you doing your normal activities. In many areas you can refer yourself to NHS physiotherapy for back problems.

Back pain that hasn't improved after a few weeks of looking after it at home, stops you doing day-to-day activities, worries you, or you're struggling to cope.

Unexplained weight loss, or a lump, swelling or change in the shape of your back.

Pain that doesn't improve with rest or is worse at night, or pain that is worse when you sneeze, cough or poo.

Sources 3, 14

Chest pain or fainting while exercising: 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 39, 40

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 41

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 42

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.

"A herniated disc needs bed rest"Strong evidence

You may need to rest at first if the pain is very bad, but the NHS says you'll get better more quickly if you gradually start gentle exercise as soon as you can, and not to sit or lie down for long periods. NICE encourages carrying on with normal activities.

Sources 2, 3, 5

"Pilates pushes the disc back in place"Strong evidence

No exercise has been shown to move a disc. Herniations often shrink on their own over weeks to months, and most people improve whatever the treatment. Pilates helps, if it does, by keeping you moving and stronger.

Sources 4, 16

"Pilates cures a slipped disc"Mixed evidence

Four small, short trials found less pain and disability than no exercise, with no follow-up after the programme. That's promising, not proof.

Sources 7, 8, 9, 10

"Never bend forward again"Emerging evidence

No trial shows a move harms a disc, and the main Pilates disc trial used roll-downs and forward stretches. Some legs prefer bending forward, others arching back; let your leg decide, then bring bending back gradually.

Sources 7, 11, 12

"You must brace your core all the time"Emerging evidence

Pilates with a relaxed tummy did slightly better for disability than with the core held tight, and core-focused exercise is no better than other exercise.

Sources 34, 24

"Your scan shows how bad it is"Strong evidence

Disc bulges and protrusions are common in people with no pain, and become more common with age.

Source 1