Pilates for hip pain: arthritis, outer hip pain, impingement and hip replacements

No Pilates trial yet

We found no published trial of Pilates for hip arthritis, outer hip pain, hip impingement or after a hip replacement. One trial in hip arthritis finished in 2025 but hasn't posted its results.

Sources 1, 2

Exercise helps hip arthritis a little

In a 2026 Cochrane review, exercise eased hip arthritis pain and improved function slightly compared with no treatment. Every guideline still puts exercise first, and Pilates is one way to do it.

Sources 3, 4

Outer hip pain: don't squeeze the tendons

In a trial of 204 people, education plus exercise that avoided squeezing the outer hip tendons beat a steroid injection. In Pilates terms, that means no clams, no lying on the sore side and no crossed or dropped top leg.

Sources 5, 6

Impingement: work short of the pinch

At least 3 months of exercise is the first step. Keep deep hip bends above any pinch, keep leg circles small, and skip big circles with your feet in straps.

Sources 7, 8

After a hip replacement, your team's precautions come first

Precautions differ between operations and hospitals. A surgeon's case series used modified Pilates from 2 weeks after leaving hospital, within each person's precautions, and reported no problems.

Sources 9, 10, 11

A child with a limp needs checking the same day

Sudden hip, thigh or knee pain, a limp, or not putting weight on a leg needs an urgent GP appointment or NHS 111 the same day. Hip problems in children can be felt in the thigh or knee.

Source 12

Hip pain in plain words

"Hip pain is common, especially as you get older", the NHS says. Common causes include osteoarthritis (over 45, pain worse when walking and stiffness after moving), bursitis on the outside of the hip (pain that can spread to the thigh and is worse when moving or lying on your side), and strains after exercise; severe pain after a fall can be a broken hip. Our hip pain guide helps you work out the likely cause.

Source 13

Outer hip pain is usually the tendons

Pain over the bony point on the side of the hip is usually the gluteal tendons rather than just a bursa, a condition also called greater trochanteric pain syndrome. A review by tendon researchers says the combination of compression and high tension is thought to harm tendons most, and that excessive hip adduction (the thigh drifting across the body) is a key factor. That's why the advice is to avoid positions that squeeze the tendons.

Sources 14, 6

Side-lying work and the clamMixed evidence

Side-lying moves mean lying on the bottom hip, and if the top knee drops, the top hip moves across the body. A hip physiotherapist and researcher advises removing clams for people with outer hip pain, because "As the knees come together the ITB is wrapped firmly around the greater trochanter, compressing the gluteal tendons" (the ITB, or IT band, is the tough band down the outside of the thigh, and the greater trochanter the bony point of the hip), and for pain at the front of the hip or after hip keyhole surgery. In healthy adults, clams worked the main side-hip muscle (gluteus medius) about half as hard as side-lying leg lifts, and a review of 56 studies found weight-bearing exercises worked it best. That's expert advice and lab studies, not treatment trials.

Sources 15, 16, 17

Deep bends, circles and crossing the middle

Rolling moves, the roll-up, the teaser and spine stretch forward bend the hip past a right angle, which matters after some hip replacements and with impingement. The same physiotherapist says long-lever leg circles with the feet in straps can provoke hip joint pain and pain at the sitting bone. Crossing your legs, or moves that take the thigh across the middle of your body, matter after a hip replacement and with outer hip pain.

Sources 8, 9

No published Pilates trialMixed evidence

Our search found no published trial of Pilates for hip arthritis. One trial randomised 52 people with hip arthritis to clinical Pilates or standard exercise, both supervised by a physiotherapist for 45 minutes twice a week for 12 weeks. It was completed in June 2025, and no results have been posted.

Sources 1, 2

Exercise helps a littleStrong evidence

A 2026 Cochrane review (18 studies, 1,368 people) found that, compared with no treatment, exercise "probably reduces pain slightly", by about 7 points on a 0 to 100 scale, and improves function slightly, by about 9 points, at moderate certainty: changes the authors judged unlikely to be clinically meaningful on average. Against a placebo or attention control, there was little or no difference in pain (low certainty).

Source 3

Guidelines put exercise firstStrong evidence

The National Institute for Health and Care Excellence (NICE) recommends exercise tailored to you for everyone with osteoarthritis. The American College of Rheumatology and Arthritis Foundation strongly recommend exercise and tai chi for hip arthritis, and OARSI, an international osteoarthritis research society, lists structured exercise as a core treatment. None names Pilates.

Sources 4, 18, 19

Claims that run ahead of the evidenceMixed evidence

A teacher-training school's guide for instructors says research suggests Pilates "can significantly improve pain, function, and quality of life" in hip arthritis. We found no published trial that shows this. Its practical advice (modified moves, a pain-free range and checking with your doctor) is sensible.

Sources 20, 2

Education plus exercise beat an injectionEmerging evidence

In the LEAP trial, 204 people aged 35 to 70 with outer hip pain for more than 3 months had 14 physiotherapy sessions of education and exercise over 8 weeks, one steroid injection, or wait and see. At 8 weeks, 77% of the education and exercise group reported success, against 59% after the injection and 29% with wait and see. At a year, education and exercise still did better than the injection on overall improvement, though pain didn't differ. No major side effects were reported.

Source 5

The advice may matter as much as the exercisesEmerging evidence

The education taught people to avoid postures and movements that squeeze the tendons against the bone, and to build up load gradually; the authors say it "could plausibly contribute" to the benefit. The programme left out the usual stretches for the outer hip and buttock, because they hold the thigh across the body, and limited that movement in the exercises.

Sources 5, 6

The trial's starting doses

In the first week of the LEAP programme:

• Pressing your knees out against a belt, lying on your back: 3 to 5 holds of 5 to 10 seconds, twice a day
• The same press standing: holds of 5 to 15 seconds
• Bridges, squats and side-stepping: 10 of each
• No extra outer hip pain during these. Heavier, slower strengthening could go up to 5 out of 10 if the pain eased afterwards and wasn't worse that night or the next morning

Source 6

Which Pilates moves to changeMixed evidence

No clams. Lie on your good side with a pillow between your knees so the top leg stays level, and don't let the top leg drop to touch the other ankle each time; if it still hurts, do the standing version at a wall. Leave out the inner thigh lift (its top leg crosses over), outer hip stretches and crossed legs, and never lie on the sore side (our suggestion, from the trial programme and a hip physiotherapist's advice).

Sources 8, 15, 6

Exercise first, for at least 3 monthsEmerging evidence

An international consensus of 38 researchers and clinicians (Zurich 2018) recommends exercise-based treatment for at least 3 months for young and middle-aged active adults with hip-related pain, along with physical activity, including sport, and education and shared decisions. It notes that strong trial evidence for physiotherapist-led treatment is lacking.

Source 7

Work short of the pinchMixed evidence

Keep deep hip bends above any pinch at the front of the hip (rolling moves, the roll-up, the teaser, spine stretch forward and knees hugged to your chest), keep leg circles small, skip long-lever circles with your feet in straps, and stop clams if they pinch at the front of the hip. That's expert advice: no trial has tested Pilates for impingement. Our hip impingement guide has a staged plan.

Sources 8, 15

A case seriesMixed evidence

A surgeon's case series of 22 hip replacements in 21 people (average age 46) used modified mat Pilates from within 2 weeks of leaving hospital, adapted to back-approach precautions: no bending the hip past 90 degrees, no crossing the middle of the body and limited inward turning, with pillows and balls for support. The precautions eased from 6 weeks, and no adverse events were reported. As reported in that paper (Levine 2009), most US hip surgeons in a survey allowed Pilates after a hip replacement: 58%, and another 24% for people who already did it.

Source 11

Precautions differ between operationsStrong evidence

The NHS lists examples: don't sit with your legs crossed, don't bend your hip more than 90 degrees (a right angle), don't bend down to touch your feet, avoid low chairs and chairs without arms, and avoid jumping and sudden turns while you recover. AAOS (the American Academy of Orthopaedic Surgeons) says the precautions, and how long you follow them, depend on the surgical technique, and that most people can do most of the "don'ts" after 6 to 8 weeks.

An NHS specialist orthopaedic hospital tells most people with a normally shaped hip to carry on guided by pain, and keeps precautions, for up to 12 weeks, for higher-risk hips. After a front (anterior) approach, one US surgeons' sheet says not to turn your knee or foot outward, not to pivot on the operated leg and not to take the hip back beyond straight, typically for 6 weeks.

Sources 9, 10, 21, 22

In Pilates terms

Follow your own team's precautions (our suggestion, from the NHS, the case series and the precaution sheets). Moves that bend the hip past a right angle, such as the roll-up, rolling moves, the teaser and knees hugged in, often wait until you're cleared after a back approach; moves that turn the leg out (the clam, the bent-knee fall-out) or lift it behind you (the leg lifts in swimming) often wait after a front approach. Moves lying on your back and standing at a wall usually come first.

Sources 9, 22, 11

In the long runStrong evidence

AAOS lists "unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports" as realistic after a hip replacement, and says most surgeons advise against high-impact activities such as running and jumping. Mat Pilates is low-impact (our reading).

Source 23

Our starting point

Two or three Pilates sessions a week, with walking or cycling on other days (our editorial starting point). With outer hip pain, the LEAP programme added daily home exercises to 14 physiotherapy sessions over 8 weeks. The NHS also has a 32-minute Pilates video class for arthritis, which needs a cushion or pillow.

Sources 5, 24

The 5 out of 10 ruleEmerging evidence

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.

Pain can go up a little when you start a new exercise programme; guidelines for arthritis say so and still recommend keeping going. If pain climbs week after week, or a warning sign appears, stop and get it checked.

Sources 4, 6

With outer hip pain

There should be no extra outer hip pain in squats, bridges and side-steps, as in the LEAP programme.

Source 6

Get urgent medical help if

These are the same warning signs as our hip pain guides. 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: 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 look shorter or turned outward. Don't drive yourself.
• Tingling or loss of feeling in the hip or leg after an injury.
• Buttock or leg pain with numbness around the genitals or bottom, new trouble controlling your bladder or bowels, or weakness or numbness in both legs.
• A hot, swollen hip, or hip pain with a fever or feeling generally unwell (a possible joint infection).
• A child or teenager with sudden hip, thigh or knee pain, a limp, or who will not put weight on a leg. Hip problems in children can sometimes be felt in the thigh or knee, and in some children knee pain is the only sign.

Sources 13, 12

See a doctor or physiotherapist if

• Hip pain that stops normal activities or disturbs sleep, keeps getting worse, or has not improved after 2 weeks of looking after it at home.
• Stiffness lasting more than 30 minutes after waking.
• Bone pain that is constant or worse at night, especially with a lump, unexplained weight loss, fever or tiredness, or a past history of cancer.

Source 13

After a hip replacement

The warning signs in our hip replacement guide, which gives their sources:

• Pain and swelling in your hip or leg with breathlessness or chest pain: call 999 or go to A&E, and do not drive yourself. It can be a blood clot that has reached the lungs.
• Signs of a dislocated hip: severe hip pain, a leg that looks shorter or is turned unusually far in or out, a new bulge at the side of the hip, unusual hip movement or a change in its shape, or walking that is suddenly difficult or painful. Don't walk on it; go to A&E straight away.
• Throbbing or cramping pain in your hip or leg: ask for an urgent GP appointment or get help from NHS 111. It could be a blood clot.
• A high temperature, or feeling hot, cold or shivery; oozing or pus from the wound; or redness, tenderness, swelling or pain in your hip or leg that is not getting better or is getting worse: ask for an urgent GP appointment or get help from NHS 111. These can be signs of an infection. If you feel unwell or feverish and the wound looks infected, go to A&E.
• Cold, pale or blue toes, or new pins and needles, numbness or weakness in the leg or foot: get medical help straight away.

Your precautions

Always follow the precautions your team gives you. They depend on the surgical approach, how stable your hip was in the operation and your own risk; some teams give several for up to 12 weeks, others few or none. Ask before you start Pilates, and ask which moves to leave out and for how long.

Sources 9, 10, 21

During Pilates

Stop the move for a sharp pinch at the front of the hip in deep bends or circles, a catching or locking feeling, or outer hip pain that builds during side-lying work, and swap to the versions on this page (our suggestion).

Tell the teacher

Tell the teacher about hip pain, arthritis or a replacement before a class. The NHS advises getting advice from a GP or other health professional before following its exercise videos if you have a health problem, an injury or any symptoms, or have recently had an operation.

Source 25

"Pilates is too risky after a hip replacement"Mixed evidence

A surgeon's case series used modified mat Pilates from 2 weeks after leaving hospital, within each person's precautions, with no adverse events reported, and most surgeons in a survey reported in that paper allowed Pilates. Follow your own team's precautions, which vary between operations.

Sources 11, 9, 10

"Research shows Pilates significantly improves hip arthritis"Mixed evidence

No trial has been published; the one registered trial finished in 2025 without posting results. The evidence is for exercise in general, which helps a little and is recommended first by every guideline.

Sources 1, 2, 20, 3

"Clams are the best exercise for the hip"Mixed evidence

In healthy adults, clams worked the main side-hip muscle about half as hard as side-lying leg lifts, and weight-bearing exercises did best. A hip physiotherapist advises against clams for outer hip pain and hip joint pain, and the outer hip pain trial used belt presses, standing holds, bridges, squats and side-steps instead.

Sources 16, 17, 15, 6

"Stretch your IT band and outer hip to fix bursitis"Emerging evidence

The LEAP programme left those stretches out, because the stretch position squeezes the tendons, and education plus exercise without them beat a steroid injection.

Sources 6, 5

"Hip precautions are the same for everyone and last for months"Strong evidence

They depend on the surgical technique and your risk, and some hospitals give few or none to people at ordinary risk. AAOS says most people can do most of the "don'ts" after 6 to 8 weeks. Follow what your team gives you.

Sources 10, 21

"Rest a sore, arthritic hip"Strong evidence

The NHS says it's best to keep moving if you can, without overdoing it, and NICE offers exercise to everyone with osteoarthritis.

Sources 13, 4