Pilates for neck pain: what the trials show, and how to protect your neck

It helps long-lasting neck pain more than doing nothing

In 8 small trials (439 adults whose neck pain had lasted more than 3 months), Pilates eased pain by about 1.5 points on a 0 to 10 scale straight after a course, and eased disability too, compared with no exercise or minimal care.

Source 1

It isn't better than other exercise

Other exercise eased pain slightly more straight after treatment, with no difference in disability. Strengthening the neck, shoulder blades and arms has the best support, so a Pilates class for neck pain should include upper-back and shoulder-blade work.

Sources 1, 2, 3

Keep your head supported

Most neck strain in Pilates comes from holding the head up for a long time, in moves like the hundred, or from pulling on it. Rest your head down when your neck tires, and put a folded towel behind your head.

Sources 4, 5

Leave out moves that put weight on your neck

The roll-over, jack knife, boomerang, control balance and the crab put weight on the neck or upper back. Leave them out while your neck hurts or you have arm symptoms.

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Use the 5 out of 10 rule

Pain up to 5 out of 10 during exercise is acceptable, and your neck should be no worse the next morning. Most new neck problems improve within 8 weeks.

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Some signs need help first

Arm weakness, numbness or clumsiness that's getting worse, new problems with balance or walking, or neck pain with a severe headache need same-day advice. The full list is under "When to get help".

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Neck pain in plain words

"Most neck pain only lasts a few weeks", the NHS says. The common causes are the neck getting locked in an awkward position while you sleep, sitting at a desk for a long time, a pinched nerve, and injuries such as whiplash. NHS inform adds that neck problems are rarely caused by serious disease or damage, that many people get them for no obvious reason, and that most improve within 8 weeks. Both advise keeping your neck moving rather than wearing a collar.

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Who the trials studied

Adults aged 18 to 65 whose neck pain had lasted more than 3 months, mostly described as non-specific or mechanical neck pain, with no single cause found. None of the trials was in whiplash, a trapped nerve or neck arthritis, so the results apply to everyday long-lasting neck pain.

Source 1

What the trial classes looked like

Classes of 30 to 60 minutes, once to three times a week, for 4 to 12 weeks, on a mat or on Pilates equipment, starting with the easiest (level 1) versions and building up. Typical moves were breathing, the shoulder bridge, arm openings, breaststroke preparation and the swan, swimming, side-lying work, and the hundred and leg stretches in their easiest form; some added light resistance bands for the shoulder blades and arms.

Several trials were led by physiotherapists. One taught four mat exercises to do at home, 2 sets of 10 a day, alongside physiotherapy.

Sources 1, 10, 11, 12

Clinical Pilates

When a physiotherapist assesses you and adapts the exercises, it's often called clinical Pilates, and several of the trials used it. Our clinical Pilates guide explains what that involves and how to find a class.

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Posture is a weaker cause than people thinkMixed evidence

In 46 people with a forward head, clinical Pilates improved head and neck angles more than home exercise, but pain and disability improved by the same amount. In Pilates and yoga classes for neck pain, pain and disability eased while posture didn't change. Our posture guides cover forward head posture and the "neck hump".

Sources 14, 11

Better than no exerciseEmerging evidence

A 2025 review of 8 trials (439 adults) found that, compared with no exercise or minimal care, Pilates lowered pain by about 1.5 points out of 10 straight after a course (very low certainty) and eased disability (low certainty). Between 8 weeks and 3 months later, pain was about 2.5 points lower: the review rates this "moderate certainty", but it rests on just 2 trials and 98 people.

Only one of the 8 trials was at low risk of bias, the trials had 36 to 88 people each, and most followed people for only about a month after the course.

Source 1

Not better than other exerciseMixed evidence

Against other exercise (yoga, stabilisation, isometric and strengthening programmes), other exercise eased pain slightly more straight after treatment, by about half a point out of 10 (low certainty), and disability didn't differ. A review of 5 trials found Pilates no better than other treatments at 3 months (low certainty), and an overview of 25 reviews of exercise for neck pain found that was the only Pilates review it could include.

Sources 1, 2, 15

No single best exerciseMixed evidence

A network meta-analysis (a review comparing many trials at once) of 40 trials found that motor control exercise, strengthening, and yoga, Pilates, tai chi and qigong as a group all eased pain more than no treatment, and "not one superior type" (very low quality evidence). A 2026 overview of 52 reviews found yoga, Pilates and tai chi helped with no clear winner, and suggests matching the exercise to what each person prefers.

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Strengthening has the best supportEmerging evidence

A Cochrane review found moderate-quality evidence that strengthening the neck, shoulder blades and arms eases long-lasting neck pain, while stretching alone, breathing exercises or general fitness training may not help (low quality). That's why our class adds upper-back and shoulder-blade work to the Pilates.

Source 3

Pilates and yoga: about equalMixed evidence

In two trials of 56 people each, Pilates and yoga helped about equally. Network analyses that rank yoga or stability exercise first are indirect and low certainty; one ranked Pilates best for mental quality of life. Our yoga for neck pain guide covers the yoga side.

Sources 12, 11, 19, 20

Single trialsMixed evidence

Pilates on a mat and equipment twice a week for 12 weeks beat usual medicines alone in 64 adults, and cut painkiller use. Clinical Pilates beat posture education in 50 adults over 6 weeks. Neck stabilisation exercise eased pain more than Pilates in 45 adults, and did at least as well for "text neck" in 75. Reformer Pilates twice a week for 6 weeks eased pain, fear of movement and poor sleep compared with no exercise in 54 women with back or neck pain. All of these trials were small.

Sources 10, 13, 21, 22, 23

At workMixed evidence

In 30 office workers, both groups did 8 weeks of supervised Pilates, one with kinesiology tape added, and both improved; with no group that skipped Pilates, it shows improvement over time rather than a Pilates effect. A 2026 review of 23 workplace studies concluded that Pilates may reduce pain and disability in workers with back or neck pain.

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Heat and electrical treatments add littleMixed evidence

In 50 women, adding hot packs, TENS (a small electrical device) and ultrasound to clinical Pilates helped more than Pilates alone. But a multidisciplinary guideline (OPTIMa) advises against clinic-based heat and electrical treatments for neck pain, so exercise stays the main treatment.

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Headaches that start in the neckMixed evidence

In 37 people with headaches from the neck (cervicogenic headache), clinical Pilates helped, but hands-on mobilisation by a physiotherapist reduced how often and how badly headaches came, and painkiller use, more. In a second trial of 25 people, mobilisation plus Pilates beat mobilisation alone for headache intensity. Our cervicogenic headache guide has more.

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Whiplash, a trapped nerve and neck arthritis: no trialsMixed evidence

Our search found no trial of Pilates for whiplash, a trapped nerve (cervical radiculopathy) or neck arthritis (cervical spondylosis). Pilates may still suit as general exercise once the warning signs below are ruled out, but follow your condition's guide first.

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Adults over 50Emerging evidence

In a review of mat Pilates in adults over 50 with long-term muscle and joint problems, including neck pain, Pilates helped about as much as other exercise. People kept up group classes well but home practice poorly.

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What the trials used

Two or three sessions a week of 30 to 60 minutes, for 6 to 12 weeks, starting with the easiest versions of each move.

Sources 1, 10, 13

Our starting point

Twice a week for at least 6 weeks, plus a few gentle neck movements most days (our editorial starting point). For the neck movements, NHS inform suggests starting with 2 to 3 repetitions, little and often through the day, and building up to about 10.

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A class helps you keep goingEmerging evidence

People keep up group classes better than exercise on their own at home, so a class or a follow-along routine is worth it.

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If it isn't helping

NHS inform says to talk to a healthcare professional if your neck problem hasn't improved within 8 weeks, or if neck exercises haven't helped within 6 weeks. In many areas you can refer yourself to NHS physiotherapy.

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Why ab work strains the neck

A Pilates teacher-training textbook explains that the head weighs about 5 kilograms, and when you don't curl your upper body far enough, "the head lies farther from the body's center of gravity, creating a longer lever. The result is often neck strain and tension." Pulling on the neck with the hands, or pushing the chin to the chest, strains it too. A classical teaching platform says neck strain is "extremely common, especially when you're getting started", mostly in moves where you hold your head up for a long time, like the hundred or single-leg stretch.

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Simple fixes

Teachers suggest:

• Put your head down when your neck starts to tire, and lift it again only if it settles. You still work your abs.
• Place folded towels or a firm pillow behind your head, not under your neck.
• Curl from your chest so your head stays in line with your spine, within the "shadow" of your shoulders.
• Don't pull on your head with your hands or jam your chin into your chest.

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Moves that put weight on the neck

A Pilates teaching platform advises avoiding the jack knife, the boomerang and the crab (which rolls onto the top of the head) with neck or spine injuries, not rolling past your shoulder blades in the roll-over, never rolling onto your neck in the seal or rolling like a ball, and never yanking on your neck in the neck pull. Control balance also takes weight on the upper back and neck. No trial has tested these moves either way, so leave them out while your neck hurts.

Source 6

Back bends and equipment

In the swan, swimming and breaststroke preparation, look down at the mat and keep your neck long, as teachers cue. On a reformer, keep your head on the headrest in lying work, and skip overhead and upside-down work while your neck hurts (our suggestion).

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One case reportMixed evidence

A 42-year-old woman felt a "pop" in her neck during a reformer move, then a headache that eased when she lay flat. Weeks later, scans showed a spinal fluid leak, and she recovered with rest. It's a single case, so no rate can be given, but a pop followed by a new headache needs checking the same day.

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Get urgent medical help if

These are the same warning signs as our neck pain guides. In the US, call 911 for 999, and use your doctor's urgent line or urgent care for NHS 111. A fall from equipment, or rolling hard onto your neck, counts as a neck injury.

• Call 999 or go to A&E after a neck injury if the person is unresponsive, has severe neck pain or cannot move their head, or fell from a height such as 5 or more stairs. Do not drive yourself. Being 65 or over, a dangerous fall or crash (from more than 1 metre or 5 steps, diving, a high-speed or rollover crash, being thrown from a vehicle, or a bike or horse-riding accident), or tingling in the arms or legs after an injury puts you at high risk of a broken neck: get checked.
• Call 999 or go to A&E: a stiff neck with a fever, especially if bright light hurts your eyes, you have a rash that does not fade when you press a glass on it, or a very high or very low temperature with shivering. These can be signs of meningitis.
• Call 999 or go to A&E: a headache that came on suddenly and is extremely painful; numbness or weakness in the face or body; a drooping face, or being unable to lift both arms and keep them up; difficulty speaking, swallowing, balancing, walking or remembering; double vision or loss of vision; drowsiness or confusion. A torn neck artery often starts with headache and neck pain, sometimes with dizziness or tingling, so head or neck pain unlike any you have had before needs checking.
• Call 999 or go to A&E: new problems walking, loss of bladder or bowel control, or a sudden loss of coordination, such as difficulty doing up buttons. These can be signs of pressure on the spinal cord.
• Call 999: chest pain that spreads to your arm, neck or jaw, especially with breathlessness, sweating or feeling sick. It could be a heart attack.
• Same day (urgent GP appointment or NHS 111): severe neck pain that starts suddenly or gets worse quickly; heaviness or weakness in the arms or legs; pins and needles in an arm along with neck or arm pain; or pain between the shoulder blades.
• Same day: clumsiness, numbness, pins and needles or weakness in one or both arms that is getting worse; problems with balance or walking since the neck pain started; or neck pain with a severe headache.

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See a doctor or physiotherapist if

• Neck pain or stiffness that has not eased after a few weeks, or after 8 weeks of looking after it yourself; painkillers are not helping; or you are worried. In many areas you can refer yourself to NHS physiotherapy.
• Neck pain with feeling generally unwell, or that started while you were ill with another condition such as rheumatoid arthritis or cancer; or neck pain with blurred vision, ringing in the ears or dizziness.
• Severe pain that is constant or disturbs your sleep, a fever or unexplained weight loss, or a history of cancer, inflammatory arthritis, TB, a weakened immune system, neck surgery or a violent injury. Serious causes are very rare, but these need checking.
• You are over 50 and your shoulders and neck stay stiff for more than 45 minutes each morning (possible polymyalgia rheumatica).

Sources 9, 8

During Pilates: the 5 out of 10 rule

NHS inform's neck exercise advice: rate your pain from 0 to 10. During exercise, 0 to 3 is minimal and 4 to 5 is acceptable; 6 or more is too much. If it goes higher, do fewer repetitions, move more slowly or rest longer between movements.

Exercise should not make your neck worse overall. Soreness from a new exercise should ease quickly, and your neck should be no worse the next morning. Stop any exercise that makes your symptoms worse or causes new pain.

Arm symptoms are the exception, as in our neck pain guides. If a move sends pain, tingling or numbness further down your arm, or the extra symptoms last more than an hour afterwards, make the movement smaller or leave it out.

Stop and get checked for dizziness, double vision, slurred speech, trouble swallowing or any of the warning signs above.

Source 7

A pop in your neck

If you feel a pop or a sudden sharp pain in your neck during a move, stop. If a new headache follows, especially one that eases when you lie down, get advice the same day, and call 999 for any of the urgent headache or brain signs above (our suggestion, from a case report). Don't go back to rolling or upside-down moves until it's been checked.

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Tell the teacher

Before a class, tell the teacher about neck pain, arm symptoms, or a past neck injury or operation. 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, and stopping straight away if you feel pain or become unwell.

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"Pilates fixes your posture, and that cures neck pain"Mixed evidence

Posture and pain change separately: clinical Pilates improved head and neck angles without easing pain more than home exercise, and Pilates classes eased pain without changing posture. Pilates helps neck pain about as much as other exercise.

Sources 14, 11, 1

"Pilates is the best exercise for neck pain"Mixed evidence

Other exercise eased pain slightly more straight after treatment, and reviews find no single best type. The best exercise is one you'll keep doing.

Sources 1, 16, 18

"Pilates ab work always strains your neck, so avoid it"Emerging evidence

Neck strain is common and fixable: rest your head down when it tires, support it with a folded towel, and curl from your chest. Several trial programmes included the hundred or leg stretches at level 1, and no harms were reported.

Sources 4, 5, 1

"Stretch your neck every day to fix it"Emerging evidence

Stretching alone may not help long-lasting neck pain; strengthening does. Gentle movement still helps: NHS inform's neck exercises are small turns, tilts and nods within comfort.

Sources 3, 7

"Rest your neck, or wear a collar, until it's better"Strong evidence

The NHS says don't wear a neck collar, because "it's better to keep your neck moving", and NHS inform advises moving your neck for short periods every hour and staying active.

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"The reformer is safer for a sore neck"Mixed evidence

No trial has compared mat and reformer Pilates for neck pain. Reformer classes helped back and neck pain compared with no exercise in one trial, and the one reported serious neck problem happened on a reformer. Choose the setting where a teacher can adapt the moves for you.

Sources 1, 23, 32