Pilates for knee pain: arthritis, kneecap pain, surgery and knee-safe moves

Knee arthritis: it helps more than no exercise

In 11 small trials (476 people), Pilates eased knee arthritis pain compared with no exercise, at low certainty. The classes ran for 6 to 10 weeks, 2 or 3 times a week.

Source 1

It isn't better than other exercise

Against conventional exercise there was no clear difference. The National Institute for Health and Care Excellence (NICE) recommends exercise tailored to you for everyone with osteoarthritis, without naming a type, so Pilates is one good way to do it.

Sources 1, 2, 3

The NHS has a Pilates class for knee problems

Its 33-minute video class focuses on strengthening the knees and knee mobility. The NHS calls exercise one of the most important treatments for osteoarthritis.

Sources 4, 5

After surgery, your rehabilitation plan comes first

After a knee replacement, adding Pilates-based exercise to standard rehabilitation helped balance in one small trial, and the NHS says not to kneel on the new knee until your doctor says you can. We found no trial of Pilates after ACL reconstruction.

Sources 6, 7, 8

Kneecap pain: one small trial, in teenagers

In 34 teenagers, adding Pilates-based core exercise to physiotherapy helped. For adults, strengthening weak muscles and stretching tight ones has the strongest evidence.

Sources 9, 10

Protect your knees in class

Pad or swap kneeling moves, keep deep knee bends small, and keep squats shallow at first. Get a knee that locks, gives way or swells checked.

Sources 11, 12

Knee pain in plain words

The NHS says knee pain can often be treated at home, and you should start to feel better in a few days; see a GP if it doesn't improve within a few weeks. Knee arthritis (osteoarthritis) is diagnosed from your symptoms, without an X-ray: NICE says if you're 45 or over, with joint pain when you're active and no morning stiffness, or stiffness that lasts no longer than 30 minutes. Our knee pain guide helps you work out the likely cause.

Sources 12, 3

Kneecap pain

Pain behind or around the kneecap, often called runner's knee, typically comes on with stairs, kneeling, squatting and long spells of sitting. NHS inform says it's often down to how the kneecap is loaded, with weak buttock and thigh muscles, tight hamstrings and calves, and sudden changes in activity among the main factors.

Source 10

Strength without weight through the kneeEmerging evidence

Most mat Pilates is done lying or on your side, so the thigh and hip muscles work without your body weight on the knee. In 32 women in their 60s, 12 weeks of Pilates twice a week made the muscles that straighten and bend the knee stronger than stretching did.

Sources 13, 1

What the arthritis classes looked like

Classes ran for 6 to 10 weeks, 2 or 3 times a week, often for an hour. The most common moves were the hundred, the single- and double-leg stretch, the clam and the shoulder bridge, with side kicks, leg circles, squats and bridges in some, at 5 to 10 repetitions.

Sources 1, 14, 15

Knee arthritis: better than no exerciseEmerging evidence

A 2025 review of 11 trials (476 people aged 43 to 68) found Pilates eased pain more than no exercise (a standardised effect of −1.09, which is large but with a wide margin of uncertainty, from 3 trials and 66 people, low certainty), and helped the knee bend further. The trials were small, and most were at high risk of bias.

Source 1

Not better than conventional exerciseMixed evidence

Against conventional exercise, pain (5 trials, 210 people) and function didn't clearly differ, at very low certainty. A second review of 8 trials found the same, and signs that small trials with disappointing results may be missing from the published record.

Sources 1, 2

Rankings put Pilates high, at low certaintyMixed evidence

A network analysis of 38 trials of mind-body exercise ranked Pilates and tai chi best for pain and function against usual care, which it rated moderate certainty. A 2026 analysis of 29 trials found Pilates most likely to improve function, while tai chi and a Chinese exercise called Wuqinxi looked best for pain, with low or very low certainty for several comparisons. Rankings like these rest on indirect comparisons.

Sources 16, 17

Single trialsMixed evidence

In 41 women, mat Pilates twice a week improved arthritis scores while a control group didn't change. In 40 women, Pilates 3 times a week for 8 weeks beat isometric exercise for pain and function, and in 41 people it beat conventional exercise. Adding pain education to 8 weeks of Pilates eased fear and worry about pain, but not the pain itself. All were small.

Sources 14, 15, 18, 19

Guidelines: exercise, not a particular kindStrong evidence

NICE: "For all people with osteoarthritis, offer therapeutic exercise tailored to their needs (for example, local muscle strengthening, general aerobic fitness)", and consider supervised sessions. The American College of Rheumatology and Arthritis Foundation strongly recommend exercise for knee arthritis, found too little evidence to rate mind-body practices other than tai chi and yoga, and rank no exercise above another. OARSI, an international osteoarthritis research society, lists structured exercise as a core treatment.

Sources 3, 20, 21, 5

Side effects weren't measured wellMixed evidence

Only 2 of the 11 trials reported side effects (none, or none serious), and the second review says active monitoring was limited, so we can't say how often Pilates upsets a sore knee.

Sources 1, 2

Knees that cave inMixed evidence

In 36 young adults whose knees cave inwards when they land, 6 weeks of supervised Pilates improved the knee's angle in a jump test, and balance. In 34 novice runners, 12 weeks of home Pilates didn't significantly change how far the knees caved in while running. In 30 young volleyball players, Pilates reduced landing errors.

Sources 22, 23, 24

After a knee replacement: little evidence, but promisingMixed evidence

In 34 people after a knee replacement, adding 6 weeks of Pilates-based exercise to the standard programme improved balance and physical quality of life more than the standard programme alone. A surgeon's case series used modified mat Pilates from within 2 weeks of leaving hospital, within each person's restrictions, after 17 knee and 22 hip replacements, and reported no adverse events. That's little evidence, so your surgical team and physiotherapist decide when to start.

Sources 6, 25

The NHS advice while you recoverStrong evidence

After a knee replacement, the NHS says:

• Avoid twisting your knee, bending down and reaching up as much as possible
• Do not sit with your legs crossed for the first 6 weeks
• Do not kneel on your new knee until your doctor says you can
• Follow the exercises your physiotherapist has recommended

Source 7

Rehabilitation comes firstStrong evidence

NICE recommends advice on exercises before and after a joint replacement, starting rehabilitation on the day of surgery or the day after, and supervised outpatient rehabilitation if you're having difficulties. Pilates is a later addition, not a replacement for that plan.

Source 26

In Pilates terms

Once your team agrees, start with lying and sitting moves, keep knee bends within the range you've got back, and leave kneeling and deep knee bends until you're cleared (our suggestion, from the NHS advice and the case series).

Sources 7, 25

After ACL surgery: no trialsMixed evidence

We found no trial of Pilates after ACL reconstruction. Across ACL injuries, a review of 18 trials found no type of exercise better than another (moderate certainty), and single studies of tai chi and Pilates showed very uncertain benefit over no treatment. Follow your rehabilitation plan; Pilates can add strength and control once your physiotherapist agrees.

Sources 8, 27

Partial ACL tears without surgeryEmerging evidence

In 50 adults with a partial ACL tear managed without surgery, 12 weeks of mat Pilates 3 times a week made the thigh muscles stronger than no treatment, and people felt their knee was more stable. A review found only this trial and one of tai chi.

Sources 28, 29

One small trial, in teenagersEmerging evidence

In one small trial of 34 teenagers aged 14 to 17 with kneecap pain, adding Pilates-based core exercises to physiotherapy 3 times a week for 3 months eased pain and improved hip and thigh strength, function and quality of life more than physiotherapy alone. We found no trial in adults.

Sources 9, 30

What helps kneecap painStrong evidence

NHS inform: "The strongest evidence suggests that strengthening any weak or underactive muscles and stretching any short or tight muscles is very important." It also suggests kneeling less and taking regular breaks from activities that bring the pain on. Pilates side-lying work and bridges train the hip muscles involved; our runner's knee guide has a staged plan.

Source 10

A torn meniscus: no trialsMixed evidence

We found no trial of Pilates for a torn meniscus. Our meniscus tear guide covers the exercise plan; in class, avoid deep knee bends and twisting on a bent knee while it's sore (our suggestion).

Source 31

What the trials used

Two or three sessions a week for 6 to 10 weeks.

Source 1

Some ache is expectedStrong evidence

NICE advises telling people with osteoarthritis that "joint pain may increase when they start therapeutic exercise", that regular exercise will still be good for their joints, and that keeping it up long term brings the benefits.

Source 3

How much pain is OK

Our knee pain guides use a simple rule: during and after exercise, 0 to 2 out of 10 is safe and up to 5 is acceptable, and your knee should be back to its usual level by the next morning. If it isn't, drop back one step next time (a shallower bend, fewer repetitions), not to nothing.

Our starting point

Two or three sessions a week, such as our 25-minute class, the NHS's 33-minute class or a beginners' class with the kneeling swaps below, for at least 6 weeks (our editorial starting point). Add walking or cycling on other days for general fitness, which NICE also suggests.

Sources 1, 4, 3

Kneeling

Moves on all fours, the knee hover and the kneeling side kick put weight through the front of the knee, and a Pilates teaching platform says "Those with knee problems should avoid" the kneeling side kick. Pad your knees with a folded mat or swap to a lying or standing version. In 600 people at risk of knee arthritis, kneeling for 30 minutes or more on 6 or more days a week was linked with worsening cartilage behind the kneecap: far more kneeling than a class, but a reason not to kneel for long on a sore knee. After a knee replacement, don't kneel on the new knee until your doctor says you can.

Sources 11, 32, 7

Deep bends and side-sitting

Rocking ("Avoid this exercise if you have back or knee injuries", the same platform says), the single-leg kick (heel towards your bottom), rolling moves and hugging a knee in during leg stretches all bend the knee deeply. Keep the bend small, hold behind your thigh rather than your shin, or leave them out while your knee is sore. If side-sitting in the mermaid bothers your knees, its move page suggests sitting cross-legged, on a block or on a chair.

Source 11

Squats and wall sits

Squatting and kneeling are typical triggers for kneecap pain. Keep squats and wall sits shallow at first, knees over your toes, and go deeper as your knee allows (our suggestion; our knee guides start at about 45 degrees of knee bend).

Source 10

The reformerMixed evidence

In leg presses on a reformer, 15 people used two different muscle patterns depending on the direction they pushed the footbar, so the teacher's cues change which muscles work. Spring settings didn't predict the force on the footbar accurately, so a lighter spring isn't a precise lighter load. Keep the knee bend comfortable and let the teacher cue the direction (our suggestion).

Sources 33, 34

Jumping

Leave reformer jumpboard work until your knee has settled and your strength is back (our suggestion; no study has tested it in knee pain).

Get urgent medical help if

These are the same warning signs as our knee pain guides. In the US, call 911 for 999, and use your doctor's urgent line or urgent care for NHS 111.

• Leg pain or swelling 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.
• Back or leg symptoms with numbness around the genitals or bottom, new trouble controlling your bladder or bowels, or severe or worsening weakness or numbness in both legs.
• Get advice from NHS 111 now: a hot, red or swollen knee with sudden severe pain, a very high temperature, or feeling hot, cold or shivery. This can be a joint infection.
• You cannot move the knee or put any weight on it, or it is very painful, badly swollen or has changed shape.
• You hurt your knee and cannot take 4 steps, or you are 55 or over and hurt it in a fall: get it checked the same day for a broken bone.
• Throbbing pain and swelling in one calf or thigh with red, blue or darkened skin or swollen veins, or sudden worse pain and swelling around a lump at the back of the knee (a possible clot or a burst Baker's cyst).
• The knee locks, gives way or clicks painfully. Painless clicking is normal.

Source 12

See a doctor or physiotherapist if

• Knee pain that has not improved within a few weeks of looking after it at home. Many areas offer NHS physiotherapy without a GP referral.
• Numbness, tingling or weakness that travels down the leg from the back. That points to a nerve (sciatica) rather than the knee.

Source 12

During Pilates

Sharp, catching or giving-way pain, or new swelling, is a reason to stop and get it checked. Stop the move straight away for a sharp pain inside the knee when you bend deeply or twist, a kneecap that feels as if it slips, or numbness in your lower leg while kneeling or side-sitting (our suggestion).

After a knee replacement

Follow your surgical team's advice and the NHS: "do not kneel on your new knee until your doctor says you can", and don't sit with your legs crossed for the first 6 weeks. Our knee replacement guide lists the signs of an infection or a clot that need urgent help.

Source 7

Tell the teacher

The NHS advises speaking to a GP before following its Pilates classes if you have knee problems, are recovering from an injury or have a health condition. Tell the teacher about knee arthritis, a replacement or a meniscus problem, so they can suggest swaps.

Source 4

"With knee arthritis, avoid exercise classes: you'll wear the joint out"Strong evidence

NICE says regular exercise will be good for the joints even if pain rises at first, and the NHS calls exercise "one of the most important treatments for people with osteoarthritis". Our knee arthritis guide explains that no exercise has been shown to damage the joint.

Sources 3, 5

"Pilates is better than other exercise for knee arthritis"Mixed evidence

It beats no exercise in small trials but not conventional exercise, and rankings that put it near the top rest on indirect comparisons. Guidelines recommend exercise you'll stick to, not one type.

Sources 1, 2, 16

"Never kneel again after a knee replacement"Mixed evidence

The NHS says not to kneel on a new knee until your doctor says you can; our knee replacement guide adds that one NHS trust says kneeling does the replacement no harm, though some people never find it comfortable. Frequent daily kneeling was linked with cartilage wear behind the kneecap in one observational study, which is far more kneeling than a class.

Sources 7, 32

"Your knee hurts because it's out of line, and Pilates will realign it"Mixed evidence

Strengthening the muscles is what helps kneecap pain. Home Pilates didn't change how far runners' knees caved in, and while supervised Pilates improved knee angles in a jump test, a better angle in a test isn't the same as less pain.

Sources 10, 23, 22

"Squats are bad for your knees"Emerging evidence

Squats were part of the trial programmes, and knee programmes start with shallow squats and build up. Adjust the depth, not the squat itself.

Sources 1, 10

"Pilates is proven after ACL surgery"Mixed evidence

We found no trial after ACL reconstruction. One trial in partial tears managed without surgery found stronger thighs, and reviews find no exercise type better than another, so your rehabilitation plan comes first.

Sources 8, 28, 27