Pilates for rugby players: the neck, back, hips and hamstrings, trunk control and recovery, what the evidence shows, and a routine

Where rugby players get hurt

In elite men's rugby union there are about 91 injuries per 1,000 match hours, most often to the head, knee, shoulder, ankle and back of the thigh, and nearly half in the tackle. Concussion has been the most common match injury in the English Premiership for 14 seasons running. Community rugby has fewer injuries, but they keep players out for weeks.

Sources 1, 2, 3

What prevents injuries is already known

The Activate warm-up cut match injuries and concussions in teams that did it regularly, and prevention programmes only work when they're kept up. Strength training prevents sports injuries, and the Nordic hamstring exercise roughly halved hamstring injuries across sports, though that's less certain in randomised trials alone.

Sources 4, 5, 6, 7, 8, 9

No trial has tested Pilates in rugby players

Small Pilates trials in football players improved agility, hops and leg strength, and none counted injuries. Core training in 16 professional rugby players improved trunk endurance, but not sprint speed, power or agility.

Sources 10, 11, 12, 13

Use Pilates on the other days

Our reading: Activate before training and matches, the gym and the Nordic for strength, and Pilates on recovery days for trunk control, the neck and shoulder blades, the hips and the back of the thighs, mobility and one-leg balance.

Source 14

The neck: train it, but don't expect it to stop concussion

Activate includes neck holds, and neck training builds strength. One professional squad with stronger necks had fewer concussions, but pooled studies are very uncertain.

Sources 14, 15, 16, 17

Concussion: if in doubt, sit them out

No competition before day 21 in community rugby, with a staged return. Pilates waits too: breathing and gentle mobility fit the early stages.

Sources 18, 19

Elite men's rugby unionStrong evidence

Across 19 studies, there were 91 injuries per 1,000 match hours and about 3 per 1,000 training hours, with 27 days missed on average. By site, the head made up 17% of match injuries, the knee 13%, the shoulder 12%, the ankle 9%, the back of the thigh 7%, the neck 3% and the lower back 2%. Tackling and being tackled caused nearly half. Forwards and backs were injured about equally often, but forwards missed more days.

Source 1

The English Premiership, 2024-25Strong evidence

The match injury rate was the lowest on record, at 59 per 1,000 hours. Concussion was "the most common match injury for the fourteenth season in a row", 26% of match injuries, and 45% happened in the tackle. For the first time in 14 years, hamstring injuries weren't the most common diagnosis: calf injuries led in training, though hamstring injuries still cost the most training days.

Source 2

Community and amateur rugbyStrong evidence

In English community rugby there were 26 match injuries per 1,000 hours for men and 27 for women, most in the tackle. In amateur men's rugby, the tackler was injured more often than the ball carrier. Across all formats, sevens had the highest injury rate.

Sources 3, 20, 21

ConcussionEmerging evidence

Across 98 studies, there were about 10 concussions per 1,000 player hours in rugby union and 9 in rugby league, almost all in matches. Studies that used the elite Head Injury Assessment reported about twice as many.

Source 22

Women's rugbyEmerging evidence

In women's 15s there were about 20 match injuries per 1,000 hours, with the head and face the most common site. In Premiership Women's Rugby, knee ligament injuries cost the most time. In 396 female players, 63% to 88% leaked urine with effort, and 43% while playing rugby.

Sources 23, 24, 25

The neck and backEmerging evidence

In professional players, neck injuries happened mostly in matches and lower back disc injuries mostly in training, often in the gym. In 569 young players, about 1 in 5 had a stinger (a burning, dead arm after contact) in a season, and over a third of them had another. In 185 teenage players, a stress fracture of the lower spine (spondylolysis) went with less hip rotation and a rounder upper back.

Sources 26, 27, 28

Shoulders and kneesEmerging evidence

Shoulder injuries ran at about 11 per 1,000 match hours, more often to the tackler. Teenage contact-sport players often dislocated again after keyhole repair (15% of those followed for a year, 31% of those followed for 4 years), mostly while playing rugby. Over 20 Premiership seasons, ACL (anterior cruciate ligament) injuries were the costliest knee injury.

Sources 29, 30, 31

What Pilates offers, and what it doesn't

Pilates trains trunk control and endurance, hip and back-of-thigh strength, shoulder-blade and neck endurance, mobility of the hips and upper back, and one-leg balance, on a mat or on spring-loaded equipment such as the reformer. It doesn't replace heavy strength work, the Nordic, the Activate warm-up or tackle coaching (our reading).

Source 32

No Pilates trial in rugbyMixed evidence

We found no trial of Pilates in rugby players, and none that counted injuries after Pilates in any contact sport. In the only contact-sport trial that mentions Pilates, elite Australian footballers given deep trunk muscle training missed fewer games, and Pilates was what they did while waiting their turn, not the treatment being tested.

Sources 10, 33

Core training in rugby: endurance, not speedMixed evidence

In 16 professional rugby players, 6 weeks of core stability training improved trunk endurance, but not sprint speed, power or agility. In a professional club, tailored hip and pelvis programmes halved the days lost to lower back, pelvis and hip injuries, though the number of injuries didn't change.

Sources 13, 34

Pilates in football: performance, not injuriesMixed evidence

In 30 amateur football players, 8 weeks of mat or reformer Pilates on top of team training improved agility, hops, sprints and passing, the reformer a little more on three tests. In 15 young players, 5 weeks of mat Pilates raised leg strength. None measured injuries.

Sources 11, 12

Strength training prevents injuriesEmerging evidence

In 6 trials of 7,738 people, strength training cut sports injuries to about a third.

Source 7

Activate comes firstEmerging evidence

In schoolboy rugby (3,188 players), the 20-minute Activate warm-up had an unclear effect overall, but teams that did it 3 or more times a week had about 72% fewer match injuries and 59% fewer concussions. In men's community clubs, concussions fell by about 60%, with no clear change in injuries overall, and only half the clubs returned complete data. Its balance, landing, strength and neck work runs in phases set out by the RFU.

Sources 4, 5, 14

Only if you keep it upEmerging evidence

Across 52 trials of prevention programmes, teams that did them most consistently halved their injuries, while teams that did them least saw no clear benefit.

Source 6

Pilates on the other days

Our suggested week: Activate before every training session and match, strength work in the gym, and our 25-minute recovery-day Pilates class once or twice a week in season, the day or two after a match, or 2 or 3 times a week in the off-season (our editorial starting point).

Sources 35, 14

Neck strength and concussion: unsettledMixed evidence

In 225 professional players, each 10% more neck extension strength went with 13% fewer concussions. But in another professional squad, neck strength didn't predict concussion, and across 8 studies of 7,625 team-sport athletes the link was small, with very low certainty.

Sources 15, 36, 16

Neck training builds strengthMixed evidence

In 28 under-18 players, 8 weeks of self-resisted neck holds, 3 times a week, raised neck strength a lot. Activate includes static neck holds in every direction. Pilates adds chin tucks and head-supported endurance work.

Sources 17, 14

Stingers

A burning, dead arm after a tackle is usually a stinger, and most settle within minutes. Symptoms in both arms, the legs or with neck pain are an emergency (see the warning signs). Our stinger guide covers returning to play.

Source 27

Hamstrings: the Nordic has the evidenceMixed evidence

In professional rugby union, hamstring injuries happened mostly while running, and players who did Nordic exercises had fewer and less severe injuries. Across 15 studies in many sports, programmes including the Nordic roughly halved hamstring injuries, but a re-analysis of the randomised trials alone found the effect uncertain.

Sources 37, 8, 9

Pilates for the back of the thigh

Bridges, the single-leg kick and the saw train the hamstrings and glutes in control and stretch them gently. That's our reading of what they offer; no trial has tested them for hamstring injuries. Keep the Nordic in your gym work.

Groin: the adductor programmeEmerging evidence

In 652 football players, the Copenhagen adductor exercise cut groin problems by 41%. Rugby has no trial of its own. The adductor squeeze and the Pilates inner thigh lift are easier first steps.

Source 38

Shoulders

Most shoulder injuries happen in the tackle. One small study linked a stiffer upper back and less shoulder-blade movement with dislocation, which the review calls a hypothesis. Upper-back rotation and shoulder-blade work fit, but no exercise programme has been shown to prevent shoulder injuries in rugby.

Sources 29, 30

The lower back in young players

Back pain that's worse arching in a young player needs checking for a stress fracture before any back-extension moves. Hip rotation and upper-back mobility work may help, but that's our reading of one cohort study.

Source 28

Two to three days to recoverEmerging evidence

After a match, most signs of muscle damage and stress returned to normal within 48 to 72 hours. In 25 professional players, sleeping longer improved sleep time and lowered a stress hormone. Pilates is low-load control and mobility work, which suits the day or two after a game.

Sources 35, 39

Your pelvic floor

Leaking urine with effort is common in female rugby players, more so in forwards and after childbirth. Pelvic floor training belongs in the week; our Pilates for the pelvic floor guide has the exercises, and a pelvic health physiotherapist can help.

Source 25

Knees

Knee ligament injuries cost Premiership Women's Rugby players the most time, so keep Activate's landing and balance work, and add one-leg balance in Pilates.

Source 24

After a concussion, stinger or neck injury

Only do the stages you've been cleared for. Leave out moves that put weight on the neck (the roll-over, jack knife, control balance, boomerang and neck pull) and rolling moves until you're back in full-contact training, and leave the neck holds until you're cleared.

Back pain that's worse arching

Back pain that is worse arching back and has lasted more than a couple of weeks can be a stress fracture of the spine (spondylolysis): get it checked.

Until it's checked, leave out the swan, rocking, double-leg kick and swimming, and use the bird dog and dead bug.

An unstable shoulder or a recent repair

Leave out the leg pull back, push-up and side bend, which put weight on the arm near the end of its range, until your physiotherapist clears them. In swimming, keep your arms by your sides.

A recent hamstring strain or groin pain

Keep the reach small in the saw and spine stretch forward, and follow our hamstring strain guide before adding Nordics. Skip the Copenhagen plank during acute groin pain.

A head injury: call 999

Call 999 if someone has hit their head and has been knocked out and hasn't woken up, can't stay awake or keep their eyes open, has a fit, has fallen from a height of more than 1 metre or 5 stairs, has problems with their vision or hearing, has clear fluid coming from their ears or nose, has new numbness or weakness, has problems with walking, balance, understanding, speaking or writing, hit their head at high speed, or their behaviour has changed. Get help from NHS 111 if they're being sick, feel dizzy or take medicine that thins the blood. If you're told to go to A&E (accident and emergency), don't drive yourself there if you have hit your head.

Source 40

Concussion red flags

The UK guidelines call these red flags, needing urgent assessment by a healthcare professional or at A&E (accident and emergency), by ambulance if necessary. World Rugby adds numbness, tingling, burning or weakness in the arms or legs, and slurred speech. If a neck injury is suspected, only trained healthcare professionals should move the player.

• Any loss of consciousness, or getting drowsier
• No memory of events before or after the injury
• Increasing confusion or irritability, or unusual behaviour
• New problems understanding, speaking, reading or writing, less feeling, loss of balance, weakness or double vision
• A seizure, twitching limbs, or lying rigid or motionless
• A severe or worsening headache, repeated vomiting or severe neck pain
• A suspected skull fracture: a cut, bruise, swelling or severe pain where they were hit
• Previous brain surgery, a bleeding disorder, blood-thinning medicine, or being drunk or on drugs at the time

Sources 18, 41, 40

Signs that mean a player comes off

World Rugby lists signs any one of which may suggest a concussion. The player comes off, and doesn't return that day.

• A seizure, or a known or suspected loss of consciousness
• Unsteady on their feet, or poor coordination
• Confusion, a dazed, blank or vacant look, or a change in behaviour
• Lying motionless, slow to get up, or clutching their head

Source 41

If in doubt, sit them out

With a suspected concussion, if in doubt, sit them out. The UK's grassroots guidelines say no sport for at least 24 hours, get checked by a healthcare professional or NHS 111 within 24 hours, follow a staged return, and no competition before day 21; if symptoms last beyond 28 days, stay out of sport and see a doctor. Pilates waits too: gentle breathing and mobility fit the early, light-activity stages, and trunk and strength work come later (our reading). Our concussion guide has the stages.

The NHS says to get help from NHS 111 if, after a head injury, you're being sick, feel dizzy, take medicine that thins your blood, were drinking alcohol or taking drugs at the time, or have any other symptoms you're worried about. See a GP if symptoms last more than 2 weeks, and don't play contact sports for at least 3 weeks.

The Rugby Football Union's (RFU) graduated return to activity and sport runs in 6 stages: relative rest for 24 to 48 hours; daily activities and light activity such as short walks; easy aerobic exercise and light bodyweight training, using Activate exercises; non-contact rugby drills and weight training, no earlier than day 8 and only once free of symptoms at rest; full-contact training, no earlier than day 15 and only after 14 days free of symptoms at rest, building from walk-throughs to tackle bags; and a return to play no earlier than day 21. The 21-day minimum is the same for adults and children.

Sources 18, 19, 40

Neck and spinal cord

• At the pitch: neck pain or tenderness after a collision, or severe neck pain. Keep the player still and call 999. Only trained healthcare professionals should move a player with a suspected neck injury.
• Numbness, tingling, burning or weakness in both arms, in more than one limb, or in the legs: keep the player still and call 999. It can be an injury to the spinal cord, even if it passes in minutes.
• Weakness in the arm that doesn't settle within minutes: the player doesn't go back on, and needs urgent medical assessment, by ambulance if necessary.
• Same day: arm weakness, numbness or burning that is still there after the game, or that keeps coming back. Go to an urgent treatment centre or A&E, or get help from NHS 111.
• A second stinger, or stingers that keep coming back: see a sports medicine or spine specialist, usually with an MRI scan, before going back to contact sport.

Sources 41, 27

A pop at the back of the thigh

Same day: a pop near the sitting bone, a large bruise high on the back of the thigh, or you cannot put weight on the leg. The tendon may have pulled away from the bone, which needs assessing before you start these exercises.

Get help from NHS 111 if you think you've injured your hamstring and it's very painful, or the pain is getting worse; there's a large amount of swelling or bruising, or the swelling or bruising is getting worse; it hurts to walk or stand using the injured leg; your leg feels very stiff or is difficult to move; it's not feeling any better after treating it yourself; or you have a very high temperature or you feel very hot, but also cold and shivery, which could be signs of an infection.

A shoulder that looks out of place

Call 999 or go to A&E: after a fall or injury, your shoulder looks out of place or has changed shape, you cannot move your arm, or your shoulder is painful, bruised or swollen. Do not drive yourself, and do not try to put it back in yourself.

Your shoulder has partly or fully come out of joint, or you worry it might.

A knee or ankle injury

Go to A&E (accident and emergency) if you've injured your knee and it has changed shape, it becomes very swollen very quickly, you felt a pop or snap, you can see bone sticking out, or it's bleeding heavily. Don't drive yourself: ask someone to take you, or call 999 if the pain means you can't move your leg to get there.

Get advice from NHS 111 now: you cannot move the knee or put any weight on it, or it is very painful, badly swollen or has changed shape, or it locks, gives way or clicks painfully. A pop, quick swelling and a knee that gives way point to an ACL injury: our ACL injury guide says what to do.

Call 999 or go to A&E if you heard a crack, the joint has changed shape or points at an odd angle, it's numb or tingling, or the skin has turned blue or grey or is cold. Get help from NHS 111 or an urgent treatment centre if you can't put any weight on it or walk more than a few steps.

Chest pain or fainting: call 999

Call 999 if:

• You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
• You have chest pain and feel sweaty, sick, light-headed or short of breath.
• Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.

Sources 42, 43

Unusual breathlessness

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.

Source 44

Before you start

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.

Source 45

"Pilates is too gentle for rugby players"Mixed evidence

No trial has tested it either way. Loaded versions such as the leg pull, side plank and single-leg bridges are hard, and Activate uses similar balance, trunk and neck work. But Pilates doesn't replace heavy strength training, which has the injury evidence.

Sources 14, 11, 7

"A strong core prevents all injuries"Emerging evidence

Core training in rugby players improved trunk endurance, not speed or power, and no core-only programme has cut rugby injuries. The programmes that did mixed strength, balance, landing and neck work, and needed regular use.

Sources 13, 4, 6

"A strong neck stops concussion"Mixed evidence

The link between neck strength and concussion is small and uncertain. Train the neck, but follow the concussion rules.

Sources 16, 36

"Pilates prevents hamstring injuries"Mixed evidence

No study has tested it. The Nordic hamstring exercise has the injury evidence.

Sources 10, 8

"You need a reformer for real Pilates"Mixed evidence

In football players, mat and reformer Pilates both improved performance tests. Use what you can get to.

Sources 11, 32