Pilates guide
Pilates is a low-impact way to move your joints through their range and strengthen the muscles around them, which is what guidelines recommend for joint pain. The National Institute for Health and Care Excellence (NICE) offers exercise to everyone with osteoarthritis and says it isn't harmful to the joints. In knee osteoarthritis, small trials found Pilates eased pain more than doing nothing and about as much as other exercise.
It isn't better than other exercise, and it's light, so it works best alongside walking or cycling and some strength work with weights or bands. It doesn't cure arthritis or rebuild cartilage, and it doesn't replace a diagnosis, medicines for inflammatory arthritis or gout, physiotherapy or surgery.
This guide answers whether Pilates is good or bad for your joints, what to do about stiffness, how much ache is all right, what to do in a flare (and why gout is different), the moves to start with and the ones to change for sore knees, hands, hips, very flexible joints and thin bones, and the warning signs that need a doctor the same day. It ends with joint-friendly classes to follow.
NICE offers tailored exercise to everyone with osteoarthritis and says exercise "is not harmful to osteoarthritic joints". In 49 studies of exercise lasting up to 30 months in people with painful knees, joints didn't wear faster.
A traditional mat class uses about 1.8 METs (multiples of the energy you use at rest), and Pilates in general 2.8, below the 3 where moderate activity starts. So it trains control, range and endurance rather than your heart or heavy strength.
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Small trials found Pilates eased knee osteoarthritis pain more than doing nothing and about as much as other exercise. The evidence is thin: the comparison with no exercise rests on 3 trials of 66 people.
Choose what you'll keep doing, and add walking or cycling and some strength work with load: Pilates is no better than other exercise for strength.
Pain up to about 5 out of 10 that has settled by the next morning is all right. In trials, exercising into some pain did no worse than pain-free exercise.
Stiffness that eases within half an hour fits osteoarthritis. Stiffness for longer after waking, swelling in several joints, or a hot, swollen joint needs a GP, and sometimes the same day (warning signs below).
NICE's committee "wanted to reassure people with osteoarthritis and healthcare professionals that exercise is not harmful to osteoarthritic joints". Across 49 studies (48 of them randomised trials) of exercise lasting 3 to 30 months in adults over 45 with knee pain, there were no serious harms, no increase in pain, no faster damage on scans and no more knee replacements. The National Rheumatoid Arthritis Society (NRAS): "There is no evidence to suggest that regular, even intensive exercise will harm your joints."
A review of 9 trials that scanned knee cartilage with MRI (magnetic resonance imaging) found knee-loading exercise "seems to not be harmful" for cartilage in people with, or at risk of, knee osteoarthritis. The quality of the evidence was low.
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Our searches found no study of injury rates among people who do Pilates. In the knee trials, only 2 of 11 reported side effects at all (none serious), and reviewers noted that "active monitoring was limited". So the answer to "is Pilates bad for my joints" leans on the evidence for exercise in general.
In the 2024 Cochrane review of exercise for knee osteoarthritis, exercise may have caused more side effects than usual care (low certainty), with no serious harms in the long-term studies. NICE asks clinicians to explain that joint pain may increase when you start, and that regular exercise still helps.
Mat Pilates is done lying, side-lying, sitting, kneeling and standing, slowly and with the breath, and a mat class has no jumping (the reformer's jump board is the exception). The parts that can bother sore joints are kneeling (knees), weight on your hands (wrists and fingers), deep hip bending (hips, and new hip replacements), rounding and legs-overhead moves (the spine and neck), and pushing very flexible joints to the end of their range. Each has a swap, below. The NHS has a free 32-minute Pilates class for arthritis that needs only a mat and a cushion.
The NHS: "Joint pain is common, especially as you get older." It can come from a sprain or strain, osteoarthritis, bursitis, rheumatoid arthritis, gout or, rarely, a joint infection, and "Perimenopause and menopause can also cause aching and painful joints due to lowered levels of oestrogen". Our joint pain in the menopause guide covers that. "Do not self-diagnose, see a GP if you're worried."
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Worldwide, about 595 million people had osteoarthritis in 2020, and the knee is the commonest joint. The NHS calls it the most common type of arthritis, usually starting in the late 40s, with pain and stiffness that are worse when you haven't moved for a while and sometimes a grating or crackling sound in the joint.
NICE diagnoses osteoarthritis without scans in people aged 45 or over with joint pain on activity and either no morning stiffness or stiffness that lasts no longer than 30 minutes. The NHS asks you to see a GP if your joints are stiff for more than 30 minutes after waking up. For suspected inflammatory arthritis, such as rheumatoid arthritis, NICE asks GPs to refer urgently when the small joints of the hands or feet, or more than one joint, are swollen.
A flare is a temporary worsening of pain, swelling and stiffness, worse than your normal, and the NHS says flare-ups can last several days. In 67 people with knee pain who kept a daily diary, flares lasted a median of 8 days and were about twice as likely in the 2 days after kneeling, squatting, climbing stairs or heavy lifting.
With joint hypermobility syndrome, "The main treatment is improving muscle strength and fitness so your joints are better protected", and the NHS says "do not overextend your joints just because you can". Our Pilates for hypermobility guide covers it.
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NICE: "For all people with osteoarthritis, offer therapeutic exercise tailored to their needs (for example, local muscle strengthening, general aerobic fitness)." European (EULAR), international (OARSI) and American College of Rheumatology guidelines agree, and EULAR's 2025 update keeps physical activity as standard care in inflammatory arthritis and osteoarthritis.
In the 2024 Cochrane review (139 trials, 12,468 people), exercise improved knee pain by about 9 points out of 100 against placebo or attention control (low certainty) and about 13 points against no treatment or usual care (low certainty), and function by about 11 to 13 points (moderate certainty). Most trials were at unclear or high risk of bias.
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The 2026 Cochrane review of hip osteoarthritis (18 trials, 1,368 people) found exercise "probably reduces pain slightly", by about 7 points out of 100, an amount "unlikely to be clinically meaningful". In hand osteoarthritis, exercise eased pain by about half a point out of 10, from low-quality evidence.
A 2025 review of 11 trials (476 people) found Pilates eased pain more than no exercise (3 trials, 66 people, low-quality evidence) but not more than conventional exercise (5 trials, 210 people, very low quality), and knee range of movement improved more with Pilates (2 trials, 70 people). A second review of 8 trials (322 people) found the same pattern, with signs that small trials with disappointing results may be missing.
One analysis of 38 trials ranked Pilates and tai chi best among mind-body exercise for knee pain and function, but noted few large or low-bias trials. Another, of 29 trials, gave Pilates the highest chance of improving function but no clear effect on pain, at low or very low certainty. The largest, of 217 trials of all kinds of exercise, ranked aerobic exercise best overall. Rankings like these don't show that Pilates is best.
A review of 7 studies (397 people, 73% women) found Pilates eased back pain, neck pain and knee osteoarthritis, and "Overall Pilates was as effective as other exercise". No serious side effects were reported.
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In long-lasting low back pain, the Cochrane review (10 trials, 510 people) found Pilates eased pain more than minimal treatment (low-quality evidence) and was no better than other exercise for disability. Network analyses rank Pilates near the top, but no type of exercise is clearly better. Our Pilates for back pain guide has the detail.
Against no exercise, Pilates improved balance, strength, flexibility and function scores in 39 studies of adults over 60, mostly at low certainty, and sit-and-reach flexibility in adult women. Against other exercise, it did no better for strength in 24 trials of adults over 60.
Our searches found Pilates trials only in knee osteoarthritis, none in hip, hand or shoulder osteoarthritis; the Cochrane hip review includes none. For those joints, the case rests on exercise in general. Our rheumatoid arthritis and ankylosing spondylitis guides cover the small Pilates trials in inflammatory arthritis.
No trial shows that Pilates rebuilds cartilage, reverses osteoarthritis or reduces inflammation in it. In inflammatory arthritis and gout, medicines control the inflammation; Pilates is a way to stay active alongside them.
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Arthritis UK suggests strengthening on at least two days a week and balance work on two days. The knee trials used 2 or 3 sessions a week for 6 to 10 weeks. NICE's committee thought supervised exercise likely to help more than exercising alone. Our editorial starting point: two Pilates sessions a week, with walking, cycling or swimming on other days towards the NHS's 150 minutes a week.
Some pain is all right. Our arthritis guide counts pain of 0 to 2 out of 10 as safe and up to 5 as acceptable if it has settled by the next morning. The 0 to 2 and up to 5 bands come from a training programme for severe hip and knee osteoarthritis, where 93% of sessions stayed at acceptable pain or below; across long-term muscle and joint pain, exercising into some pain did no worse than pain-free exercise.
Arthritis UK: "If your joints are hot or swollen because of your condition, it's sometimes a good idea to focus on stretching exercises and avoid strengthening exercises until they settle down." A hot, swollen joint with a high temperature needs help the same day (warning signs below).
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The knee trials mostly used mat classes, and the NHS arthritis class needs only a mat and a cushion. No trial has compared mat and reformer Pilates for osteoarthritis or general joint pain. Chair Pilates suits days when the floor is hard.
Because Pilates is light and no better than other exercise for strength, treat it as the control, range and confidence part of your week, alongside walking or cycling (aerobic exercise ranked best for knee osteoarthritis) and some strength work with load (our reading).
Lateral breathing: 5 to 8 breaths; heel slide: 10 slow repetitions each side; ankle circles: 5 slow circles each way with each ankle; hip windshield wipers: 10 slow passes side to side, 2 rounds; shoulder rolls: 10 to 15 slow circles each way; tendon glides: 4 to 6 of each position, holding each for 5 seconds (from the move pages' doses). These also make a flare-day set.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoAnkle CARs (controlled articular rotations)Beginner · No equipment
3D demoHip windshield wipersBeginner · No equipment
3D demoShoulder rollsBeginner · No equipment
3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipmentPelvic tilt into bridge: 8 slow reps, lifting only as high as is comfortable; clamshell: 10 each side; sit to stand: 5 slow reps, hands on your thighs if you need them (our Pilates for arthritis class); side kick: 8 to 10 each side, on a folded towel if the bottom hip is sore; single-leg circle: 5 circles each direction, each leg, kept small; seated knee extension: 3 sets of 10 to 15 each leg, in the bent-knee half if the full range hurts; wall side leg lift: 10 to 12 each side (from the move pages' doses).
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoSit to stand from a chairBeginner · A bench or box
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wallCat-cow: 8 waves, slower than feels natural, and thoracic rotation: 6 rotations per side, moving with the breath (the move pages' doses); open book: 8 to 10 slow openings each side; swan: 5 to 6 reps, kept small if arching pinches; mermaid: 3 each direction, each side, on a chair if side-sitting bothers your knees or hips (from the move pages' doses).
Single-leg stand: up to 30 s each side, a hand near the wall (our Pilates for arthritis class); side-stepping: 10 steps each way next to a counter (from the move page's dose); slow calf raise and wall push-up: 10 to 15 reps each, stepping closer to the wall if your wrists or shoulders complain (our joint care workout).
Pad or skip kneeling moves such as the knee hover, bird dog and kneeling side kick, and do the mermaid on a chair, as our Pilates for arthritis guide suggests. Kneeling and squatting came before knee flares in the diary study. Leave out the reformer's jump board while your knees are sore (our suggestion; no study has tested it).
Make fists or use your forearms, or swap planks, leg pulls, the side bend and push-ups for lying or chair moves (our suggestion, as in our Pilates for arthritis and wrist pain guides). Tendon glides keep the fingers moving.
Follow your surgical team's limits on bending and kneeling. Our Pilates after hip replacement and knee replacement guides list the moves to leave out while a new joint recovers.
Work in the middle of your range and keep knees and elbows soft; the saw and spine stretch forward pages already say "stop the reach before the end of your range rather than hanging into it". Strength and control matter more than stretch.
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Avoid deep or repeated rounding of your back, especially with a weight, and rolling moves; our Pilates for osteoporosis guide has the swaps.
A flare is a temporary worsening of pain, swelling and stiffness, worse than your normal, that can disturb sleep and activity. The NHS says flares can last several days.
The National Rheumatoid Arthritis Society's steps: relative rest, doing less than usual; ice or heat for 15 to 20 minutes; keep the joints moving; return gently, with only a few repetitions; then gradually work back. Arthritis UK suggests slow, gentle movement rather than stopping, cutting the load first and then the number of sets, and never forcing a movement.
Arthritis UK: "The general advice is to focus on slow and gentle movement during a flare up, rather than stopping altogether." The NHS: "do not completely stop moving the affected joint".
Leave strengthening until hot or swollen joints settle, and keep to breathing and gentle range, such as heel slides, ankle circles and hand glides. High-intensity, high-impact or high-volume exercise is the most likely to aggravate symptoms. A flare can last several days; if an activity always brings one on, avoid it.
In a gout attack, the NHS says to "rest and raise the limb" and "do not put pressure on the joint". Leave Pilates for the hot joint until the pain and swelling have gone down; gentle work for the rest of you is reasonable if you feel well (our suggestion). Our Pilates for gout guide covers it.
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Start with the 25-minute Pilates for arthritis class twice a week: it has no kneeling, no weight on your hands and a flare-day stop point. The joint care workout adds load and moves every joint; the mobility class suits stiff joints without arthritis; chair Pilates suits days when the floor is hard; the knee, hip and hypermobility classes each focus on one need; and the flare-up routine is for bad days.
A gentle 25-minute Pilates class for arthritis and stiff joints: lying, chair and standing moves, with no kneeling or weight on your hands, and flare-day options.
25 minBeginner16 movesBench or box, something with weightA 25-minute session for healthy joints: slow circles to take every joint through its range, then a strength circuit for hips, knees, ankles, shoulders and grip.
25 minBeginner13 movesWall, bench or boxA 25-minute Pilates mobility class: standing joint circles, spine and hip work on the mat, strength at the end of your range, then sit-to-stands and balance.
25 minBeginner18 movesWall, bench or boxA 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 movesBench 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 movesBench or box, something with weightA 25-minute Pilates class for sore knees and knee arthritis: lying and side-lying leg work, shallow squats and balance, with no kneeling at all.
25 minBeginner15 movesBench or box, something with weightA 25-minute Pilates class for hip arthritis: hip movement in every direction, lying and standing strength, and balance, with no deep bends and a flare-day stop.
25 minBeginner19 movesBand, wallA 20-minute Pilates class for hypermobile joints, HSD and hEDS: supported positions first, mid-range control, slow changes and steady breathing.
20 minBeginner17 movesOther / check instructions, bandA 10-minute routine for a pain flare-up: slow breathing, small gentle moves lying and sitting, a short stroll if you can, then rest. Repeat later in the day.
10 minBeginner10 movesBand, bench or boxThe beginner Pilates plan builds a habit of 3 short classes a week; the seniors plan adds strength, balance and walking; the walking plan builds to 150 minutes a week.
A free 4-week, 3-day Pilates plan for complete beginners. Two mat days and one wall day, with clear rules for when to move each exercise to its harder version.
3 training days25 minBeginner3 days a weekA 12-week exercise plan for over-65s: strength and balance three times a week, short balance sessions and daily walks, based on falls-prevention trials.
3 training days40 minBeginner6 days a weekA free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginnerThese are the warning signs of our joints, arthritis and gout guides, word for word, with the chest pain and stop lines our other Pilates guides use. 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.
If you have very bad joint pain after a fall or injury, you can't walk or put weight on a joint, a joint has moved out of place, or you have tingling or no feeling around the joint after an injury.
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If you have joint pain and the skin around it is swollen and feels hot, or joint pain and you feel generally unwell, have a high temperature or feel hot, cold or shivery. A joint infection (septic arthritis) usually develops quickly over a few days and needs checking straight away. In the US, contact your doctor or urgent care.
Ask for an urgent GP appointment or get help from NHS 111. In the US, use your doctor's urgent line or urgent care.
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Same day: a sudden, very painful, hot, swollen, red joint, often the big toe but sometimes the middle of the foot (the midfoot) or the ankle, especially with a high temperature, feeling shivery or being unable to eat. It may be gout, but it could be a joint infection (septic arthritis), which is urgent.
If you have sudden pain and swelling in a joint and:
These can be signs of an infection inside the joint (septic arthritis), which usually needs treatment in hospital.
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Pain and stiffness on both sides of the body that is worse after not moving, such as when you wake up, can be rheumatoid arthritis, and the NHS advises seeing a GP if your joints are stiff for more than 30 minutes after waking. Our rheumatoid arthritis guide covers exercise for it.
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If joint pain is stopping you doing normal activities or affecting your sleep, the pain or swelling is getting worse or keeps coming back, it hasn't improved after 2 weeks of treating it at home, your joints are stiff for more than 30 minutes after waking up, or your child has joint problems. In many areas you can refer yourself to NHS physiotherapy through community musculoskeletal (MSK) services.
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See a GP if you think you or your child have joint hypermobility syndrome: for example, you keep getting pain and stiffness in your joints, sprains and strains, or joints that pop out, or you often feel tired even after rest.
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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 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.
If you have a heart, lung or joint condition, are pregnant or have recently been unwell, start gently and read our guide for your condition. Muscle soreness for a day or two after a new exercise is common and fades as you repeat it.
Breathe out as you lift, and don't hold your breath.
Start where you're comfortable: chair, wall and standing versions all count. Our Pilates for plus-size bodies guide covers getting up and down from the floor and the equipment that helps.
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NICE says exercise isn't harmful to osteoarthritic joints, long-term exercise didn't speed joint damage in 49 studies, and knee-loading exercise didn't harm cartilage (low-quality evidence). Recreational runners even had less hip and knee arthritis than people who didn't run, in observational studies that can't prove cause.
In small trials, Pilates eased knee osteoarthritis pain more than no exercise and about as much as other exercise. Kneeling and the jump board are the parts to change.
It's light activity and no better than other exercise for strength. NICE pairs muscle strengthening with general aerobic fitness, so add walking or cycling and some strength work with load.
The NHS says not to stop moving a painful joint completely, and in an arthritis flare, slow, gentle movement beats stopping. Gout is the exception: rest the hot joint during an attack.
Some pain when you start is expected, and exercising into some pain did no worse than pain-free exercise. Pain above 5 out of 10, pain that lingers into the next day, or a hot, swollen joint are different.
With very flexible joints, the NHS says not to overextend them just because you can: strength and control come first. Long stiffness after waking can be inflammatory arthritis and needs a GP, not a deeper stretch.
We found no trial showing it does in osteoarthritis. Inflammatory arthritis and gout need medical treatment; Pilates sits alongside it.
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No trial has compared them for joint pain, and the knee trials mostly used mat classes. Choose what you'll keep doing.
For most people, yes: it's a low-impact way to move your joints through their range and strengthen the muscles around them, which is what guidelines recommend. In knee osteoarthritis, small trials found it eased pain more than doing nothing and about as much as other exercise. It isn't better than other exercise, so choose it if you'll keep it up.
Not for healthy or arthritic joints: NICE says exercise isn't harmful to osteoarthritic joints, and long-term exercise didn't speed joint damage in 49 studies. No study has counted injuries in Pilates classes, so this rests on the evidence for exercise in general. The parts that can bother sore joints are kneeling, weight on your hands, deep hip bending after a hip replacement and pushing very flexible joints too far, and each has a swap.
Gentle Pilates moves each joint through its range, and in older adults it improved flexibility and balance scores against no exercise. Everyday stiffness that eases within half an hour of moving is common. Stiffness that lasts more than 30 minutes after waking, or swollen joints, needs a GP.
It can help as part of regular exercise, which eases knee osteoarthritis pain a little and improves function. Some aching when you start is normal and usually settles. A hot, swollen joint needs help the same day.
Yes: a mat class has no jumping, and you can do it lying, sitting and standing. With sore knees, pad or skip kneeling moves and leave out the reformer's jump board.
Some ache is fine, up to about 5 out of 10, if it has settled by the next morning. Sharp pain, pain that gets worse during a session or lingers into the next day, or a joint that swells means doing less next time. See a GP or physiotherapist if it keeps happening.
Usually from doing more than you're used to, kneeling on sore knees or putting weight on sore wrists; make the move smaller or use the swap. Our knee, hip, wrist and shoulder pain after Pilates guides cover each joint. A hot, swollen joint with a temperature needs help the same day.
Keep moving gently: do less, cut the load, and keep to breathing and gentle range until it settles. Gout is different: rest the hot joint during an attack and come back once the pain and swelling have gone down.
Yes, if it works on strength and control in the middle of your range rather than stretching further. Our Pilates for hypermobility guide has the details and a class.
Not in osteoarthritis, as far as trials show. Inflammatory arthritis and gout need medical treatment, and Pilates is a way to stay active alongside it.
No trial has compared them for joint pain. The knee trials mostly used mat classes, and the NHS arthritis class needs only a mat and a cushion; choose what you'll keep doing.
Two or three sessions a week is what the knee trials used. Add walking, cycling or swimming, and some strength work with weights or bands on at least two days a week.
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.
