Pilates guide
Pilates can help after a knee replacement, alongside the exercises your physiotherapist gives you. Many Pilates basics, such as heel slides, bridges and side-lying leg lifts, are the same moves as your rehabilitation, and in two small trials, adding Pilates-based or core exercises to standard rehabilitation improved balance, function and quality of life.
The main changes are about kneeling and deep bending. Kneeling hasn't been shown to harm a new knee, but it's what people find hardest, and the NHS says to wait until your doctor says you can. Your surgical team's advice comes first.
This guide covers when to start, getting the bend and the straightening back, kneeling in class, building strength and balance, the reformer and the warning signs that need help. Our knee replacement guide covers the rehabilitation stages.
NICE (the National Institute for Health and Care Excellence) wants rehabilitation from the day of surgery or within 24 hours, and a 2026 US physical therapy guideline recommends progressive strength training from the early weeks, plus balance training. Pilates is one way to keep doing that once your team agrees.
Adding 6 weeks of Pilates-based exercise to standard rehabilitation improved balance and physical quality of life in 34 people, and adding core stability exercises by video call improved function, pain and strength in 42. A surgeon's case series used modified mat Pilates in 17 knees without problems.
Stairs and chairs need about 90° to 120° of knee bend. One NHS trust warns that scar tissue tightens over the first 6 weeks and that after 3 months flexibility is very hard to improve, so keep up your daily bending and straightening exercises, and don't sleep with a pillow under the knee.
The NHS says don't kneel on the new knee until your doctor says you can. After that, studies haven't shown kneeling harms it, though it's often uncomfortable: start on something soft and keep it short. Many people who think they can't kneel can when tested or taught.
Our synthesis of an NHS trust leaflet, a Pilates professional body's advice, the case series and a survey of European knee surgeons: lying and seated Pilates moves that match your exercises once you're home, a class from about 6 weeks, and the reformer with moderate springs. No study has tested this, and your own team's advice comes first.
The NHS says avoid twisting your knee, a Pilates professional body says no standing on wobble cushions early, and one NHS trust discourages jumping for the long term. Its pain rule: "A moderate ache that settles quickly is acceptable, severe pain that takes hours to settle is not".
A knee replacement swaps the worn ends of the thigh and shin bones, and sometimes the back of the kneecap, for metal and plastic parts; a partial replacement replaces only one side and usually recovers faster. Most people go home 1 to 4 days after the operation, have a check at about 6 weeks and try walking without an aid from about then.
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Get the knee straight, get it bending, and rebuild the strength and balance that arthritis and surgery took away. Stairs and chairs need about 90° to 120° of bend, and getting out of a bath about 135°.
Many Pilates basics are the same movements as the leaflet exercises: heel slides, bridges, side-lying leg work and tightening the thigh with the knee straight. The two small trials added Pilates-based or core exercises to standard rehabilitation, not in place of it.
Kneeling is the activity people find hardest after a knee replacement: 60% to 80% report difficulty, often because of pain, numbness around the scar or fear of harming the implant. Many Pilates classes kneel: all fours, the knee hover, kneeling side kicks and the reformer's knee stretches.
In Turkey, 46 people were randomised after a knee replacement and 34 analysed: 6 weeks of Pilates-based exercise added to a standard programme improved balance (13.6 points more on the 56-point Berg balance scale) and physical quality of life more than the standard programme alone. The summary doesn't describe the Pilates exercises, and a quarter of the people weren't analysed.
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In 42 people, core stability exercises by video call for 8 weeks and by phone for 4 more, added to standard exercises, improved function, pain, straightening, quality of life, chair-stand strength and stair climbing more than standard exercises alone. Knee bend didn't differ. This was core stability work rather than Pilates by name, in one small trial.
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A surgeon's case series included 17 knee replacements (average age 55) using modified mat Pilates from within 2 weeks of leaving hospital, with deep-bend moves such as rolling like a ball left until 6 months or later; there were no adverse events. A 2019 review judged that Pilates needs more study before it joins standard programmes.
The 2026 US guideline recommends progressive strength training from the early weeks after surgery to improve function, strength and range, and balance training. NICE wants a home programme with support. Pilates moves map onto these jobs, which is our reading rather than something the trials tested.
Across 45 studies, 85% went back to physical activity or sport, after a median of about 4 months (very low certainty). European knee surgeons recommended yoga from 6 to 12 weeks after the operation, and in a survey of 257 Australians, yoga was among the activities people most often went back to.
This is our synthesis of an NHS trust leaflet, a Pilates professional body's advice for instructors, the case series and a survey of European knee surgeons. No study has tested it, and your own team's advice comes first.
One NHS trust: "A moderate ache that settles quickly is acceptable, severe pain that takes hours to settle is not". Swelling can last 3 months or more, so raise your leg after a session if it puffs up, and drop back a step if it swells more than usual (our suggestion).
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In 20 older adults, walking and slopes needed less than 90° of knee bend, stairs and chairs 90° to 120°, and getting out of a bath about 135°. The researchers suggested 110° as a rehabilitation goal.
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One NHS trust asks you to hold the bend for 8 to 10 seconds, 5 to 10 times, because "the scar tissue will tighten up in the first 6 weeks" and "After 3 months it becomes very difficult to improve flexibility".
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Don't sleep with a pillow under your knee, as the NHS advises. Quad sets with a small towel under the heel, not the knee, and a hamstring stretch help the knee straighten.
Choose moves that use the bend you have, such as heel slides and the single-leg kick lying face down, and don't force a kneeling or deep-squat position to get the bend back (our suggestion). If your knee isn't bending to about 90°, or isn't getting straight, by around 6 weeks, tell your physiotherapist or surgical team now: stiffness is easier to treat early (our threshold, from NHS trust leaflets).
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The NHS says don't kneel on your new knee until your doctor says you can.
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A review found "no evidence that there is any clinical reason why patients should not kneel on their replaced knee", and one NHS trust tells patients that kneeling won't harm the replacement. It is often uncomfortable, though, and some people never find it comfortable.
In 122 people, 81% could kneel when observed, though only 37% thought they could; in 307 knees, everyone who completed a simple kneeling programme could then kneel, though many of those eligible didn't take part; and in a trial after partial replacement, teaching kneeling improved it a year later.
Even so, across 36 studies only about 37% could kneel at a year and 48% at 3 years or more, and in 888 knees in Singapore, 64% couldn't kneel at a year.
Once the scar is comfortable and your team agrees, one NHS trust suggests kneeling on something soft, such as the bed, then on a firmer surface with a cushion or pad. In a study of 60 people, a thick pad that spreads the pressure meant no one found kneeling impossible or extremely difficult. In class, use a folded mat or cushion and keep kneeling short, as a Pilates professional body advises padding or limiting kneeling.
Pilates Association Australia, a professional body for instructors, gives this advice for clients after a knee replacement. It hasn't been tested:
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In a lab study, reformer leg pushes could be done with two different patterns of muscle use, depending on how people pushed the footbar. Ask your teacher to watch how you push.
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Use your leaflet's doses (one NHS trust holds quad sets and straight-leg raises for a slow count of 5 to 10, 5 to 10 times), keep nothing under the knee, and kick through a smaller range if deep bending hurts.
3D demoQuad set (static quads)Beginner · No equipment
3D demoStraight-leg raiseBeginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoSingle-leg kick (Pilates one leg kick)Beginner · No equipment
3D demoLateral breathing (Pilates breathing)Beginner · No equipmentStart with 8 slow repetitions of each (our editorial starting point; the hundred's page starts at 50 beats), build sit-to-stands towards 3 sets of 8 to 10 (editorial), and keep your knees in line with your toes without twisting.
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoHundred (Pilates)Intermediate · No equipment
3D demoSingle-leg circle (Pilates one leg circle)Beginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSide-lying leg raiseBeginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSit squat (partial squat)Beginner · No equipment
3D demoSit to stand from a chairBeginner · A bench or boxOn a firm floor, holding a counter or banister: one NHS trust builds single-leg balance to 20 to 30 seconds and step-ups to 5 to 10, and holding the hamstring stretch for 30 seconds is our editorial starting point.
The knee hover, kneeling side kick, bird dog, cat-cow and other all-fours work: wait until your doctor says you can kneel, then use a folded mat or cushion and keep it short. Meanwhile, do the side kick lying down, the dead bug in place of the bird dog, and cat-cow sitting on a chair.
Rolling like a ball, the seal, rocking and child's pose need a deep knee bend, and the case series kept rolling like a ball for 6 months or later. Leave them until bending and kneeling are comfortable.
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Side-sitting for the mermaid bends and twists the knee: sit on a chair instead, as the move's page suggests.
Avoid twisting on a planted foot, as in hip airplanes and standing hip circles, and standing on wobble cushions, early on.
One NHS trust discourages jogging, jumping and contact sport after a knee replacement: skip jump squats and the reformer jump board.
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NICE recommends a home programme with support for most people, and supervised rehabilitation for people who struggle; the US guideline adds progressive strength and balance training. Keep doing your physiotherapy exercises every day, and use Pilates to add to them once your team agrees.
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 about your knee and whether you've been cleared to kneel; one NHS trust suggests going back to the gym with "a personalised programme developed by someone who understands the limitations of your new knee".
Our knee replacement guide sets out the stages from the hospital bed to golf, with the doses NHS leaflets use, and our kneeling guide covers kneeling in everyday life.
Our suggested pairing: your physiotherapy exercises daily, and the knee pain class, which has no kneeling, 2 or 3 times a week once your physiotherapist agrees, adding heel slides and the single-leg kick for bend; walk or use a static bike on other days.
A 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 movesA bench or box, Something with weightA gentle 25-minute Pilates class for arthritis: lying, side-lying, chair and standing moves, with no kneeling or weight on your hands, and flare-day options.
25 minBeginner16 movesA bench or box, Something with weightA 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 gentle leg strength routine with no jumping: sit-to-stands, step-ups, wall sits, bridges and calf raises.
20 minBeginner7 movesA bench or box, A stepStrength 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 everyday activity is back, usually after about 3 months, a week of strength, balance and walking.
Call 999 or go to A&E if breathing suddenly becomes difficult, if pain in your chest or upper back comes on suddenly with breathlessness or a very fast heartbeat, or if someone passes out. Do not drive yourself. It can be a blood clot that has reached the lungs.
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One NHS trust: "If you experience sharp pain, stop the activity immediately, and if symptoms persist contact your GP for advice." If the knee swells more after a session, drop back a step (our suggestion), and avoid twisting on it.
A review found no clinical reason not to kneel on a replaced knee, and most people tested or taught could kneel. Wait for your team's go-ahead, then start on something soft.
It hasn't been shown to. Discomfort, numbness around the scar and fear are the usual reasons people don't kneel, and a thick pad that spreads the pressure helped in one study.
An ache that settles quickly is expected; severe pain that takes hours to settle means do less next time. The US guideline builds exercise up while avoiding too much swelling, pain or lingering soreness.
The case series used mat Pilates, and the core stability trial was done at home by video call. The reformer helps by letting you set springs and range, but it isn't needed.
One NHS trust warns that flexibility becomes "very difficult to improve" after 3 months. A knee that isn't bending to about 90° by around 6 weeks needs your team, not a class.
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Yes, alongside your physiotherapy, once your team agrees. In two small trials, adding Pilates-based or core stability exercises to standard rehabilitation improved balance, function and quality of life more than standard exercise alone. The exercises your physiotherapist gives you come first.
Your rehabilitation starts on day 1, and many Pilates basics, such as heel slides, bridges and side-lying leg lifts, are the same moves. A Pilates instructors' professional body suggests classes after medical clearance, usually once about 6 weeks of outpatient physiotherapy is done. Your own team's advice comes first.
Wait until your doctor says you can, as the NHS advises. Kneeling hasn't been shown to harm the replacement, though it's often uncomfortable: once you're cleared, start on something soft, use a cushion or folded mat, and keep kneeling short. Many people who think they can't kneel can when taught.
It's the activity people find hardest: 60% to 80% report difficulty, often because of pain, numbness around the scar or fear of harming the implant. A thick pad that spreads the pressure let people who couldn't kneel do it comfortably in one study.
Early on, leave out kneeling moves until you're cleared, deep knee bends such as rolling like a ball and child's pose, twisting on a planted foot, standing on wobble cushions and jumping. Swap them for lying, side-lying, seated and standing versions.
It can help you keep the bend you've regained, with moves like heel slides and the single-leg kick. In the first weeks, your daily bending and straightening exercises matter most: one NHS trust warns that after 3 months flexibility is very hard to improve. Stairs and chairs need about 90° to 120° of bend.
It can be: a Pilates professional body suggests footwork with a moderate spring and the stopper set so your knee bends only as far as is comfortable, plus side-lying legwork. It says knee stretches kneeling on the carriage are often too painful, with the scooter as an alternative. This advice hasn't been tested.
Progressive strength training is recommended after a knee replacement. Pilates bridges and side-lying work help, but add sit-to-stands, step-ups and, later, light weights; our knee replacement guide has the stages.
An ache that settles quickly is fine; severe pain that takes hours to settle means do less next time. Swelling can last 3 months or more, so raise your leg after a session if it puffs up.
Usually yes, often sooner: recovery from a partial replacement is usually shorter, and kneeling tends to come back more easily. Follow your own team's timeline.
European knee surgeons recommended yoga from 6 to 12 weeks after a knee replacement. The same care with kneeling and deep knee bends applies.
Sudden difficulty breathing, or chest or upper back pain with breathlessness, is a 999 call. Throbbing or cramping leg pain, a high temperature, an oozing wound, or knee redness, swelling or pain that's getting worse needs an urgent GP appointment or NHS 111.
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.
