Pilates guide
Pilates can be a good way back to regular exercise after a hip replacement: it strengthens the muscles around the hip and trunk with little impact, and almost every move can be adapted. No trial has tested it, and it doesn't replace the exercises your physiotherapist gives you, but a surgeon's case series used modified mat Pilates from the first weeks without problems, and surveys suggest most hip surgeons allow it.
What changes is which moves you do, and when. Hip precautions, the movements to avoid while your hip heals, depend on your operation: after some, you won't bend your hip past a right angle or cross your legs; after others, you won't turn your leg out or take it behind you; some hospitals give few or none. Your surgical team's advice comes first.
This guide covers when to start, how your precautions translate into Pilates moves, the reformer, what to keep moderate even years later and the warning signs that need help, with a 25-minute class for when your team eases your precautions. Our hip replacement guide covers the rehabilitation stages.
NICE (the National Institute for Health and Care Excellence) wants rehabilitation, including a home exercise programme, to start on the day of surgery or within 24 hours, and the NHS says doing your exercises early on helps your hip's long-term strength and movement. Pilates is an addition your team agrees to, not a replacement.
We found no trial of Pilates after a hip replacement. One surgeon's case series of 22 hips used modified mat Pilates within each person's precautions and reported no adverse events, and a survey of US hip surgeons suggests most allow Pilates, as reported by the case series' authors and a 2018 paper.
They depend on your operation. After a back (posterior) approach, teams often say not to bend the hip past a right angle, cross your legs or turn the leg in; after a front (anterior) approach, not to turn the leg out, pivot on it or take it behind you. Some hospitals give few or none, and most last about 6 weeks, up to 12.
While they last, moves that bend the hip past a right angle, cross the body or turn the leg wait or change, such as the roll-up, rolling like a ball, the teaser and knees hugged to the chest. Moves on your back and standing at a counter usually come first.
Our synthesis of NHS trust leaflets, AAOS (American Academy of Orthopaedic Surgeons) advice, the case series and the surgeon surveys: a class from about 6 to 12 weeks, fuller classes and the reformer from about 3 months, most of the repertoire by 6 months. No study has tested this, and your own team's advice comes first.
Two people dislocated a replaced hip during yoga, 9 and 17 years after surgery, one moving into a shoulder stand and one in a deep standing forward fold. Ask your surgeon before legs-overhead Pilates moves such as the roll-over and jack knife.
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A hip replacement swaps the worn ball and socket of the hip for metal, ceramic or plastic parts. The surgeon reaches the joint from the back (a posterior approach), the side or the front (an anterior approach), and NICE recommends considering a back or side approach. Modern hip replacements are designed to last at least 15 years.
A physiotherapist or occupational therapist should start your rehabilitation on the day of surgery if possible, and within 24 hours, with a home exercise programme, clear goals and someone to contact. Most people go home 1 to 3 days after the operation and have a check 6 to 12 weeks after it.
Pilates is a system of controlled exercises on a mat or on equipment such as the reformer, a bed-like frame with a sliding carriage, springs, ropes and a footbar. Its basic moves on your back, side and front work the buttock and side-hip muscles and the trunk with little impact, which is why one surgeon built a modified programme around them.
Nothing in Pilates is special to a new hip. What matters is choosing moves that respect your precautions, and building up gradually.
Bending the hip (the knee coming towards your chest), crossing the middle of your body (the knee or foot moving across) and turning the leg in or out. Back-approach precautions usually limit bending past a right angle, crossing and turning in; front-approach precautions limit turning out and taking the leg behind you.
One teacher-training school also advises avoiding two combinations early on: turning in while crossing, and bending while opening the knees and turning out, as in the frog.
We found no trial of Pilates after a hip replacement. The only Pilates study is one surgeon's case series: 21 people (22 hips, average age 46) chose modified mat Pilates, starting within 2 weeks of leaving hospital, 3 or 4 times a week with a certified instructor, within each person's precautions and using pillows and balls. All were satisfied, there were no adverse events, and 73% of the women in the series, which also included knee replacements, were still doing Pilates a year later.
It has big limits: it looked back at notes, had no comparison group, and the people were young, motivated and chose Pilates themselves. It shows a supervised, modified start can work; it doesn't show Pilates beats the usual home programme.
A 2007 survey of US hip surgeons suggests most allow Pilates after a hip replacement, and more allow it for people who did Pilates before, as reported by the case series' authors and a 2018 paper (the survey's own summary gives no figures). European hip surgeons agreed on more activities the longer it had been since surgery, and Dutch surgeons put yoga and tai chi at "allowed with experience".
This is expert opinion: in a survey of 139 US surgeons about activity after hip and knee replacements, none claimed strong evidence for their advice.
Across 37 studies, people got back on average to the level of sport they managed before the operation, at 16 to 28 weeks. Walking, cycling, swimming and golf were the commonest activities in a survey of 2,366 people after hip or knee replacements, 90% of golfers went back to golf, and one NHS trust allows golf and dancing from 3 to 6 months.
This is our synthesis of NHS trust leaflets, AAOS advice, the case series and the surgeon surveys. No study has tested it, and your own team's advice comes first.
One NHS trust's rule: "A moderate ache that settles quickly is acceptable, severe pain that takes hours to settle is not", and pain at night means you've overdone things. Add one new move, or a few more repetitions, at a time (our suggestion).
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In trials, exercise before a hip replacement improved quality of life and the strength of the side-hip muscles, at moderate certainty, and the case series' authors encouraged starting Pilates before the operation. Our Pilates for hip pain guide has a class that spares a painful hip.
Precautions are movements to avoid while the tissues heal, to lower the risk of the hip dislocating. Which ones, and for how long, depend on the approach, how stable the hip was during surgery and your own risk.
One specialist NHS orthopaedic hospital tells most people with a normally shaped hip to be guided by pain, and keeps precautions for up to 12 weeks for higher-risk hips, such as after a revision or a past dislocation, or with hypermobility. One NHS trust asks only that you don't cross your legs for 6 weeks.
After a back approach, 4 trials of 1,616 people found early dislocation in 1.2% with precautions and 0.6% without, a difference that could be chance (low certainty), and about a quarter of people (22% to 28%) didn't follow their precautions anyway. In one trial, people without precautions found daily activities easier and drove sooner; in a 2026 trial of 1,133 people, there were 4 dislocations without restrictions against 6 with them. Other reviews, and a 2026 study of 10,357 people, found no clear difference in dislocation either way.
That's why many teams now give fewer precautions to people at ordinary risk. It isn't a reason to drop yours: dislocations are rare, and the trials couldn't rule out a small difference.
While your precautions last, these usually wait or change:
While your precautions last, these usually wait or change:
Lie on your back, sit, and stand at a counter first. Lie on your side only when your team allows: hospitals differ, and one advises sleeping on your back for the first month, then on the operated side if it isn't tender, while a teacher-training school advises avoiding lying on the replaced side in class. A pillow between your knees helps.
No jumping while your hip recovers, and use chairs high enough that your knees stay below your hips.
AAOS says most people can do most of the "don'ts" after 6 to 8 weeks without any impact on the implant, and one NHS trust lifts its leg-crossing rule at 6 to 8 weeks. Most of the Pilates mat repertoire comes back with them.
Two case reports describe dislocations during yoga: one 17 years after a back-approach replacement, moving from the plough into a shoulder stand, in a woman whose hip had been abnormally shaped since birth (hip dysplasia); and one 9 years after front-approach replacements, in a 90-year-old, in a standing forward fold. The authors warn that this risk "may not cease with time". In healthy people, many yoga poses reach the limits of hip movement.
Fourteen yoga teachers who had front-approach replacements with no precautions all went back to practising and teaching, at 2 months on average. About a third found one pose hard, such as pigeon or a seated twist, and used an easier version; none had complications at about 5 years.
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Once your team says your precautions are over, do most of Pilates as usual, but keep the extreme combined positions moderate: legs over your head (the roll-over, jack knife, control balance and boomerang) and deep folds with the knees together and turned in. Ask your surgeon before the legs-overhead moves, even years later (our editorial advice, from these reports).
No study has tested the reformer after a hip replacement. These points are our editorial advice, reasoned from the precaution lists and one teacher-training school's guidance:
In 55 adults aged 65 to 95 at risk of falls, a weekly reformer class for 10 weeks improved balance. That trial didn't include people after a hip replacement, so it is indirect.
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Keep every hip bend at or below a right angle and your knees apart, and use your leaflet's doses (one NHS trust starts with 5 of each, building to 10) or the move pages' doses for the breathing, heel slide, belt press, knee fold and hundred.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoSupine isometric hip abduction (belt press)Beginner · A band
3D demoKnee foldBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoHundred (Pilates)Intermediate · No equipmentHold a counter, keep your knees no higher than your hips, turn with small steps rather than pivoting, and use your leaflet's doses (one NHS trust gives 5 to 10 of each and builds single-leg balance to 30 seconds).
3D demoSeated marchBeginner · A bench or box
3D demoBreath reachBeginner · No equipment
3D demoStanding marchBeginner · No equipment
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wall
3D demoStanding wall-press hip abductionBeginner · A wall
3D demoSit squat (partial squat)Beginner · No equipment
3D demoSide-stepping (sideways walking)Beginner · A wall
3D demoSingle-leg standBeginner · A wall
3D demoSlow calf raiseBeginner · A wall
3D demoSit to stand from a chairBeginner · A bench or boxTypically from about 6 to 12 weeks (our synthesis), add these one at a time: lie on your side only once you're allowed, keep leg circles small, and after a front approach leave out clams and the swimming legs while turning out and taking the leg behind you are restricted.
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSide-lying leg raiseBeginner · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoSwimming (Pilates)Intermediate · No equipment
3D demoBird dogBeginner · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demoChest lift (Pilates curl-up)Beginner · No equipment
3D demoSingle-leg stretch (Pilates one leg stretch)Intermediate · No equipment
3D demoClamshellBeginner · No equipmentThe roll-up, rolling like a ball, the seal, the open-leg rocker, the teaser, spine stretch forward, the saw, the double-leg stretch and the criss-cross take the hip past a right angle. Use the chest lift, a pelvic tilt or the spine twist sitting on a high cushion instead. The case series brought the roll-up and rolling like a ball back between 6 weeks and 6 months.
The inner-thigh lift, hip twist, corkscrew, windscreen wipers, lying twists with the knees across, and side-sitting for the mermaid. Sit on a chair for the mermaid.
Clams, bent-knee fall-outs, the frog, butterfly and figure-four stretches, happy baby, standing kickbacks, lunges and kneeling hip flexor stretches on the operated side.
The roll-over, jack knife, control balance and boomerang take the hip to its limit. Ask your surgeon before these, even years later.
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Hip airplanes and standing hip circles pivot on the standing leg: wait until your team lifts your precautions. Skip jumps and the reformer jump board while your hip recovers.
NICE recommends a home programme with support for most people, and supervised rehabilitation for people who struggle; in 7 trials, home exercise worked about as well as supervised sessions. Keep doing your physiotherapy exercises: Pilates is a way to keep going once that programme ends, or a different way to do parts of it.
The NHS advises getting advice from a healthcare professional before following its Pilates videos if you've recently had an operation. Tell your Pilates teacher which approach you had, your precautions and how long they last; the case series' authors advise close supervision by a certified instructor.
Our hip replacement guide sets out the stages from the hospital bed onwards, with the doses NHS leaflets use, and when golf, swimming and driving usually come back.
The 25-minute return class is for after your surgical team or physiotherapist has eased your precautions: check with them first. In the early weeks, use the hip pain or chair classes within your precautions; check the over-50 class's spine twist, mermaid and clams against them, and leave the strength and balance workout until about 3 months.
A 25-minute Pilates class for after a hip replacement: hip, trunk and balance work that keeps your hip bend at a right angle and your knees apart.
25 minBeginner18 movesA band, A wallA 20-minute Pilates class for hip pain: bridges, outer-hip holds, standing leg work and balance, without deep bends, crossed legs or lying on the sore side.
20 minBeginner14 movesA band, A wallA 20-minute chair Pilates workout for beginners and older adults: breathing, sitting tall, gentle spine and leg moves, and a standing finish at the chair.
20 minBeginner14 movesA bench or box, Something with weightA 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 weightA 20-minute beginner mat Pilates session for over-50s with no deep or repeated rounding of the spine, plus back strengthening and standing balance.
20 minBeginner13 movesA wallStrength and balance in one session: squats, Romanian deadlifts, push-ups, rows, step-ups, back extensions, carries and single-leg balance.
45 minBeginner14 movesA wall, A dumbbellOnce your precautions are over and everyday activity is back, usually after about 3 months, a week of strength, balance and walking.
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.
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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.
Some people also hear clicking or popping. If it happens during exercise or after a fall and you can't get to A&E safely, call 999 (our addition). Severe hip pain after a fall or injury, or not being able to stand, walk or put weight on the leg, also needs A&E.
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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.
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Stop the move for a sharp pain in the groin or hip, a clunk, or a feeling that the hip is giving way. One NHS trust: "If you experience a sharp pain, stop activity immediately. If symptoms persist, contact your GP for advice." A numb patch on the outer thigh after a front approach is usually a skin nerve; our meralgia paresthetica guide explains it.
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Not for most people. One NHS trust lifts the leg-crossing rule at 6 to 8 weeks, and AAOS says most people can do most of the "don'ts" after 6 to 8 weeks. Some higher-risk hips keep precautions for up to 12 weeks. Follow your team.
No trial exists, but a case series used modified mat Pilates from within 2 weeks of leaving hospital without adverse events, and surveys suggest most hip surgeons allow Pilates. The risk lies in a few extreme positions, not in Pilates.
They depend on the approach, how stable the hip was and your own risk. Back-approach and front-approach examples are nearly opposite, and some hospitals give few or none.
Your rehabilitation starts on day 1, and Pilates basics on your back and standing are the same movements; the case series started modified mat work within 2 weeks. When you join a class is your team's call.
It depends on your operation. The case series used small, modified leg circles in the first 6 weeks, and one NHS trust adds clams at 6 to 8 weeks; after a front approach, clams turn the leg out, which is often restricted for a while.
Most moves come back, but dislocations have happened years later in extreme positions, including moving through the plough into a shoulder stand. Ask your surgeon before legs-overhead moves.
Usually yes, once your surgical team or physiotherapist agrees and within the precautions you've been given. There are no trials, but a surgeon's case series used modified mat Pilates without adverse events, and surveys suggest most hip surgeons allow it. Your physiotherapy exercises come first.
It depends on your team. Pilates moves that match your rehabilitation exercises, such as heel slides and bridges, can start alongside them, and a surgeon's case series started modified mat Pilates within 2 weeks of leaving hospital, with an instructor. Many people join a class from about 6 to 12 weeks, but that's our synthesis of hospital advice, not a tested rule.
It depends on your operation. After a back (posterior) approach, teams often restrict bending the hip past a right angle, crossing the middle of your body and turning the leg in, which rules out the roll-up, rolling moves, the teaser and knees pulled to your chest for a while. After a front (anterior) approach, they often restrict turning the leg out and taking it behind you, so clams, frog positions and the swimming legs wait.
It can be, with changes, though no study has tested it. Our editorial advice: use parallel feet rather than heels together, skip the frog and the jump board, keep strap work small, and get on and off the low carriage carefully within your bending limit. Tell the teacher which operation you had.
Follow the ones your team gave you, for as long as they say. In trials, routine precautions after a back approach didn't clearly reduce dislocation, which is why many teams now give fewer, but that's their decision to make for your hip.
Not while your precautions rule it out. One NHS trust lifts the leg-crossing rule at 6 to 8 weeks, and the American Academy of Orthopaedic Surgeons says most people can do most of the "don'ts" after 6 to 8 weeks. Until then, keep a cushion or small ball between your knees.
Ask your team, as hospitals differ. One advises sleeping on your back for the first month, then on the operated side if it isn't tender, while a teacher-training school advises avoiding lying on the replaced side in class. A pillow between your knees helps.
They haven't been compared. NICE recommends a home programme with support, and home exercise worked about as well as supervised sessions in trials. Pilates is a way to keep going once that programme ends.
Exercise before surgery improved hip strength and quality of life in trials, and the case series' authors encouraged starting Pilates before the operation. Our Pilates for hip pain guide has a class that spares a painful hip.
Most of it, once your team has lifted your precautions. But dislocations have happened years later in extreme positions, including moving into a shoulder stand, so ask your surgeon before legs-overhead moves like the roll-over and jack knife.
Severe hip pain, a leg that looks shorter or is turned unusually far in or out, a bulge at the side of the hip, or walking that is suddenly difficult or painful; some people hear clicking or popping. Don't walk on it: go to A&E straight away, or call 999 if you can't get there safely.
Yes: which approach you had, your precautions and how long they last. The NHS advises getting advice from a healthcare professional before following its exercise videos if you've recently had an operation.
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.
