Pilates guide
Shoulder impingement means pain on the outside of the shoulder and upper arm, worse lifting the arm out to the side or overhead, often at night. It's also called subacromial pain, shoulder bursitis or rotator cuff related shoulder pain. The old explanation, a tendon pinched under the bone, is doubtful: shaving the bone to make more room did no better than a placebo operation in two trials, one followed for 10 years. Exercise is the first treatment, and the exercise that helps strengthens the rotator cuff and the muscles around the shoulder blade, gradually, with some discomfort allowed.
No published trial has tested Pilates for impingement itself, but Pilates can carry that exercise if it's adapted: cuff and shoulder-blade work with the elbow at your side, arms kept below shoulder height at first, weight on your hands built up from a wall, and arms brought back overhead in front of you rather than in a wide sweep.
This guide covers what impingement is, the 5 out of 10 rule, how to bring your arms back overhead, the moves to change on the mat and the reformer, what the evidence shows and the class to follow. Shoulder or arm pain with chest pain can be a heart attack: call 999.
Guidelines now prefer names such as subacromial pain or rotator cuff related shoulder pain, because no single structure can be pinned down as the cause. Scan changes are common in shoulders that don't hurt.
In two trials of 313 and 210 people, one followed for 10 years, shaving bone to make more room did no better than an operation that didn't. A Cochrane review rates this high certainty.
In 102 people waiting for surgery, cuff and shoulder-blade strengthening, with pain allowed up to 5 out of 10, meant 20% chose surgery against 63% after general exercise, and 35% against 65% at 10 years. In 708 people, one advice session plus a home programme did as well as up to six physiotherapy sessions.
One 33-person trial found clinical Pilates eased shoulder pain more than conventional exercise over 10 treatment days. In a 2026 trial of 60 adults with rotator cuff tendinopathy, adding unloaded Pilates moves to physiotherapy didn't improve pain or arm function more, though turning-out strength improved more. A trial in impingement finished in 2025 and hasn't reported. So Pilates needs added cuff work with a band or light weight.
The NHS says "do not stop moving your shoulder completely", but not to carry on with activities that involve repeatedly lifting your arm above your head while it hurts. In Pilates: arms forward rather than overhead, knees down for planks, the lightest springs, and arms back overhead in steps.
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Shoulder or arm pain with chest pain needs 999. Sudden weakness lifting the arm after an injury or fall, or a hot, swollen shoulder with a fever, needs help the same day. The full list is below.
The NHS lists "pain at the top and the outside of your shoulder" and "shoulder pain that's worse when you lift your arm, especially when you lift it above your head". The Dutch orthopaedic guideline calls it subacromial pain syndrome: shoulder pain that doesn't follow an injury, around the top of the shoulder, "often worsening during or subsequent to lifting of the arm".
Impingement, subacromial pain, shoulder bursitis, rotator cuff tendinopathy and rotator cuff related shoulder pain describe much the same pain. A 2025 editorial argues for "rotator cuff-related shoulder pain" because "specific shoulder structures cannot be implicated as the definitive source of shoulder symptoms". The NHS and the US surgeons' patient pages still describe a tendon rubbing on bone; the placebo-surgery trials don't support that idea. The advice on this page applies whichever name you've been given.
A review found changes at the collarbone joint and under the shoulder's roof in shoulders without pain about as often as in painful ones: "often comparable to that in symptomatic shoulders". Full-thickness rotator cuff tears showed on ultrasound in 11% to 17% of people in two population samples. In the Holmgren trial's 10-year follow-up, cuff tears on scans rose from 28% to 55% whether or not people had surgery, and showed in 51% of their other shoulders.
The NHS says it usually gets better within a few weeks or months. It can linger: in one older group, 54% still had symptoms after 3 years. Give a programme about 12 weeks before you judge it.
Exercise carries the evidence. Pilates has two tiny trials in shoulder pain that disagree, and none published in diagnosed impingement.
In CSAW (313 people who had already tried exercise and at least one steroid injection), decompression surgery did no better than an arthroscopy alone at 6 months, and both operations beat no treatment by less than a difference patients notice. In FIMPACT (210 people), decompression gave no benefit over a placebo operation at 2, 5 or 10 years, and all three groups, including the exercise group, had improved a lot by 10 years. Cochrane rates this high certainty, a BMJ panel makes "a strong recommendation against surgery", and the 2026 Dutch guideline update keeps its recommendation against decompression.
In 102 people waiting for decompression surgery, everyone had a steroid injection, then 12 weeks of two lowering exercises for the rotator cuff, three shoulder-blade exercises and a stretch for the back of the shoulder, or general neck and shoulder movement. Pain was allowed up to 5 out of 10. At 3 months, 20% chose surgery against 63%; at 10 years, 35% (15 of 43) against 65% (26 of 40). One centre and one physiotherapist.
In GRASP, 708 adults with a new episode of rotator cuff pain did as well over 12 months with one advice session and a home programme as with up to six physiotherapy sessions of progressive exercise (turning the arm out, lifting it forwards and lifting it to the side, 5 days a week). An injection helped only in the short term.
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A review of 16 reviews makes a strong recommendation for exercise as the first treatment, but the effects are modest and the quality of evidence low to very low. In a network of 99 trials, only exercise held up for pain and function to 3 months when the weaker studies were left out. Motor control programmes were probably slightly better than general exercise for disability.
Reviews of shoulder-blade exercise find a small short-term benefit for pain and function, at low to very low certainty. It's a sensible part of a programme, not proven better than cuff strengthening.
In 33 people with shoulder pain and no specific diagnosis, clinical Pilates on 10 treatment days improved pain and a shoulder function score more than conventional exercise, with no follow-up. In 60 adults aged 40 to 60 with rotator cuff tendinopathy, split into four groups of 15 by coin flip, adding unloaded Pilates moves to physiotherapy for 8 weeks didn't improve pain or arm function more than physiotherapy alone, though external rotation strength improved more; only Pilates combined with a manual therapy for the diaphragm eased pain more, and the trial was registered after recruitment began. A Pilates trial in 34 people with impingement finished in August 2025 with no results posted, and another is recruiting. Our searches (October 2026) found no other.
All of these studies were in healthy people. No study has measured shoulder load in a Pilates move in someone with impingement.
Push-ups with the hands raised or the knees down put less force through the hands than other versions, and putting more weight on the arms in planks made the shoulder-blade muscles work harder. In a bone-pin study, the wall push-up plus put the shoulder blade "in a position potentially associated with shoulder impingement", so the authors advise caution with it early on.
In 8 healthy men, the gap between the top of the arm bone and the shoulder's roof was smallest with the arm at about shoulder height, and higher up, the narrowest point moved away from the tendon. With the arm at shoulder height, turning it out gave more room. Raising the arm needs the shoulder blade to turn upwards and tilt back with it, rather than staying pinned down.
In 22 healthy men doing seated reformer arm work, shoulder muscle activity rose with each heavier spring, and the authors warn that too heavy a spring may bring "abnormal compensation", so springs should go up carefully. Springs are load: start light.
One case report describes both shoulders dislocating during an unsupervised reformer session. No rate can be given from a single case.
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An instructors' professional body advises working "in a pain free range" and strengthening the shoulder-blade muscles. It still explains impingement as a space too small for its contents, which the placebo-surgery trials don't support.
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During shoulder strengthening, pain up to about 5 out of 10 is acceptable, and a little is expected. By your next session it should be back to where it was before. If it isn't, use a lighter band or weight or a smaller range next time, not nothing.
Stop an exercise, or shrink its range, if you get the feeling the shoulder is about to slip out (editorial).
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The trial programmes ran for about 12 weeks, with the cuff and shoulder-blade work done at home once a day (Holmgren) or 5 days a week (GRASP). Pilates classes 2 or 3 times a week around that is our editorial starting point.
Lateral breathing: 5 breaths, sitting tall with your shoulders soft (our Pilates for shoulder pain class; adapted from the move page's dose). Table slide: 10 slow reps (the class; adapted from the move page's dose). Pendulum: "About 1 minute (10 small circles each way), 2 to 3 times a day." (the move page's dose). Thoracic rotation: "6 rotations per side, moving with the breath" (the move page's dose). Open book: "8 to 10 slow openings each side, pausing 2 seconds at the end (our editorial starting point)" (the move page's dose), lying on your pain-free side and keeping it pain-free, as its page says.
Stick-assisted turning out: 10 slow reps, pain-free (our Pilates for shoulder pain class; adapted from the move page's dose). Turning out against a band: 2 to 3 sets of 15 with a light band and a slow return (our shoulder impingement guide, stage 1; 3 sets of 15 is the Holmgren trial's dose). Side-lying turning out: 2 sets of 8 (the class), building to 3 sets of 15 once a day, lowering over 3 seconds (the guide's stage 2, the Holmgren dose). Turning in against a band: 2 to 3 sets of 15 (stage 2). Scaption: 3 sets of 15, thumbs up, to shoulder height, lowering over 3 seconds (stage 2).
3D demoStick-assisted external rotation (lying)Beginner · Other / check instructions
3D demoStanding band external rotationBeginner · A band + An anchor point
3D demoSide-lying external rotationBeginner · A dumbbell
3D demoBand internal rotationBeginner · A band + An anchor point
3D demoScaption raiseBeginner · A dumbbellY-T-W raises: 5 of each shape, W and T first, adding the Y when lifting your arms overhead is comfortable (our Pilates for shoulder pain class). Swan: 5 small lifts (the class; adapted from the move page's dose). Swimming: "2 to 3 sets of 20 to 30 seconds." (the move page's dose), with your arms by your sides or bent while the shoulder is sore, as its page suggests. Band row: 2 to 3 sets of 15 (our shoulder impingement guide, stage 1; adapted from the move page's dose). Wall angel: 8 slow slides, arms only as high as is comfortable (the class). Cross-body stretch: 2 holds of 20 seconds each side (the class), only if there's no pinch at the front of the shoulder.
The steps are our suggestion, as on our Pilates for rotator cuff guide, from a push-up force study (a rough guide, measured in push-ups rather than Pilates moves), a plank study in healthy people and the moves' own pages; the caution on the push-up plus is from a bone-pin study in healthy people. The wall push-up and push-up plus doses are from our Pilates for shoulder pain class and guide; the incline push-up, knee plank and knee push-up doses and the week or two at each step are editorial; the knee hover dose is the move page's dose, "3 holds of 15 to 30 seconds."
See the movement on the 3D figure: Wall push-up
These steps are editorial: no trial has tested them. They follow the NHS advice not to keep repeatedly lifting your arm above your head while it hurts, our shoulder impingement guide's swap to scaption raises to shoulder height with thumbs up, and imaging of healthy shoulders, in which the gap under the shoulder's roof was smallest around shoulder height and the shoulder blade turned upwards as the arm rose. The breath reach's dose is the move page's dose, "5 breaths, exhale longer than inhale".
See the movement on the 3D figure: Breath reach
The moves' own cautions, and our Pilates for rotator cuff guide's list.
Leave out the leg pull front (its page: "Skip it with shoulder pain."), the leg pull back ("Skip it if your wrists or the front of your shoulders hurt."), the kneeling side kick ("Skip it with wrist or shoulder pain.") and full push-ups until the steps above get you there. For the side bend, its page says "If your wrists or shoulders hurt, use the knee side plank or a forearm side plank instead."
Rocking: "Holding your ankles pulls your shoulders back, so skip it if the front of your shoulder hurts (our suggestion)." The double-leg kick: "If the hand clasp hurts your shoulders, hold a towel between your hands." The hip twist: with tight shoulders, bend your elbows and rest on your forearms, as its page says.
The roll-over, jack knife, boomerang and control balance put weight on your shoulders and neck; control balance's page says "It may not suit a shoulder or neck injury." Leave them out for now.
The sleeper stretch is "Easy to overdo: lying on the shoulder already compresses it, and pressing hard or through a front-of-shoulder pinch can aggravate impingement." In the side kick, if propping on your elbow hurts, rest your head on your arm, as its page says.
The roll-up, teaser, double-leg stretch and mermaid reach overhead: follow the steps above. The roll-up's page says "If your shoulder is stiff or sore, reach your arms forward rather than overhead (our suggestion)."
Start with the lightest arm spring, arms below shoulder height and in front of you. Leave rowing, backstroke and arm circles in the straps for later, and the moves with your hands on the footbar (the elephant, long stretch, up stretch and knee stretches) until you've reached the plank step (our suggestion, as our Pilates for rotator cuff guide says). One reformer maker's manual lists "Neck issues, shoulder issues, weak lower back" among the reformer hundred's precautions.
Each move's own page gives its cautions; the swaps are in the notes above.
3D demoLeg pull front (Pilates leg pull down)Advanced · No equipment
3D demoLeg pull back (Pilates leg pull up)Advanced · No equipment
3D demoKneeling side kick (Pilates side kick kneeling)Advanced · No equipment
3D demoPush-up (Pilates)Intermediate · No equipment
3D demoSide bend (Pilates)Advanced · No equipment
3D demoRocking (Pilates)Advanced · No equipment
3D demoDouble-leg kick (Pilates double kick)Intermediate · No equipment
3D demoRoll-over (Pilates roll-over with legs spread)Advanced · No equipment
3D demoControl balance (Pilates)Advanced · No equipment
3D demoSleeper stretchIntermediate · No equipmentIf your shoulder has dislocated or feels as if it might slip, see our Pilates for shoulder pain guide's section on a loose shoulder. If it's stiff in every direction, even when someone else moves your arm, see our Pilates for frozen shoulder guide.
See our Pilates for rotator cuff guide, which covers tears, repairs and the cuff load of each mat and reformer move.
Pain, tingling or numbness spreading down the arm with neck pain points to the neck: see our Pilates for cervical spondylosis and Pilates for neck pain guides.
Your team's arm programme comes first: see our Pilates for shoulder pain guide.
With hypermobility, the NHS advises not overextending your joints: keep your elbows soft rather than locked, use fists if your wrists bend back too far, and push the floor away rather than sinking into your shoulders.
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In pregnancy, after the first trimester, keep time flat on your back to a few minutes: prop your upper body up, or use a side-lying or all-fours version.
Swap face-down work for all-fours versions as your bump grows.
Start with the 20-minute Pilates for shoulder pain class, built for this: gentle range, then cuff and shoulder-blade strength, then weight on your arms in steps, with your arms below shoulder height to start. The band routine adds cuff work, the posture routine works the upper back, and the swimmers' class comes once planks are comfortable. The chair class keeps your arms low on a bad day.
A 20-minute Pilates class for a sore shoulder: gentle range first, then shoulder-blade and rotator cuff strength, then light weight on the arms, in steps.
20 minBeginner15 movesA bench or box, Other / check instructionsA 25-minute band routine for healthy shoulders: move the shoulder and upper back through their range, then strengthen the rotator cuff and shoulder blades.
25 minBeginner12 movesA wall, A bandA 12-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.
12 minBeginner8 movesA foam roller, A wallA 25-minute dryland Pilates class for swimmers: shoulder-blade control, trunk endurance, back extension, hips and rotation, built for loose shoulders.
25 minBeginner16 movesA wallA 20-minute yoga sequence for shoulder pain: gentle movement, standing poses with the arms low, shoulder strength, and weight on the arms built up from the wall.
20 minBeginner16 movesA bench or box, A wallA 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 weightThese are the warning signs from our shoulder pain guides, word for word. 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.
Get help from NHS 111: pain or tightness in your chest, neck, shoulders, jaw or arms that comes and goes, often brought on by exercise, stress, emotion or cold and easing after a few minutes' rest. It can be angina, a sign of a heart problem. If you've been diagnosed with angina, get help from NHS 111 too if it feels worse than before, is happening more often, lasts longer or happens when you're resting.
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Stop and get checked if you get a sharp pain with a sudden loss of strength: a small tear can get bigger.
Sharp pain, a feeling that the shoulder is slipping or a clunk, pins and needles or numbness spreading down the arm, or pain that's worse the next morning and doesn't settle by your next session (our suggestion, from NHS inform's pain guide and the reformer case report). Tell your teacher about shoulder pain, a past dislocation, surgery or breast cancer treatment before class.
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.
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The Dutch guideline renamed it subacromial pain syndrome because the pinching explanation doesn't hold up on its own, and taking bone away to make space did no better than a placebo operation, still at 10 years. Some patient pages still describe rubbing.
In healthy shoulders, the gap under the shoulder's roof is smallest around shoulder height, not fully overhead, and gradual loading is the treatment. Arms come back overhead as strength returns, in front of you and within comfort.
The NHS says "do not stop moving your shoulder completely", and the programme that kept people off the surgery list allowed pain up to 5 out of 10.
No trial has tested this cue. Raising the arm needs the shoulder blade to turn upwards and tilt back with it, and at shoulder height, turning the arm out gave more room. Let your shoulder blades move with your arms rather than pinning them (our suggestion).
Pilates has two tiny trials in shoulder pain: one positive, and one in which adding unloaded Pilates moves to physiotherapy didn't improve pain or arm function more, though turning-out strength improved more. What helped in the larger trials was cuff and shoulder-blade work that got gradually harder.
Shoulder muscle activity rose with each heavier spring in a lab study, and too heavy a spring may bring compensation. Springs are load: start light.
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In 708 people, one advice session plus a home programme did as well as up to six sessions, and the injection's benefit didn't last.
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Our shoulder impingement guide gives the evidence: "A systematic review found no clear difference in upper-back rounding between people with and without shoulder pain." Upper-back work is still worth doing for strength.
It can be, if it includes cuff and shoulder-blade strengthening that gets gradually harder and builds up weight on your hands slowly. Pilates itself has barely been tested: one small trial found it helped shoulder pain, and in a 2026 trial adding unloaded Pilates moves to physiotherapy didn't improve pain or arm function more, though turning-out strength improved more.
Usually yes, with changes: arms below shoulder height at first, no weight on your hands until wall push-ups are easy, and pain kept to about 5 out of 10 and settled by your next session. Tell your teacher and use the lightest springs on the reformer.
While it hurts: the leg pull front and back, the kneeling side kick, control balance, rocking, the roll-over and jack knife, full push-ups and the side bend, and on the reformer, overhead strap work and the moves with your hands on the footbar. Most come back as strength returns.
No move is proven best. Turning your arm out against a band with your elbow at your side, scaption raises to shoulder height, Y-T-W raises, a small swan, swimming with your arms low, rows, wall push-ups and the knee hover follow the programme that kept people off the surgery list.
Lift them in front of you, thumbs up, only as high as is comfortable, and let your shoulder blades move with your arms rather than pinning them down. Bring the full overhead reach back in steps over weeks; the steps are our suggestion, as no trial has tested them.
The roll-up itself is fine for most shoulders, but reaching your arms overhead may hurt. Reach them forward instead, as the move's own page suggests, until overhead is comfortable.
It can be, because springs let you start very light, but heavier springs make the shoulder muscles work much harder. Start with the lightest arm spring, arms low and in front of you, and leave rowing, backstroke and the hands-on-the-footbar moves until later.
Shoulder bursitis, impingement, subacromial pain and rotator cuff tendinopathy usually describe the same picture: pain on the outside of the shoulder, worse lifting the arm. The advice on this page applies to all of them.
Usually not: surgery to make more room did no better than a placebo operation in two trials, one followed for 10 years, and a guideline panel recommends strongly against it. If you're not improving after a good 3 months of exercise, or your arm is clearly weak, ask for a specialist opinion.
Usually weeks to months. The NHS says it usually gets better within a few weeks or months; the trial programmes ran for about 12 weeks, and the benefit of the specific exercise programme lasted 10 years.
It hasn't been shown to, but weight on your hands, arms loaded overhead and heavy reformer springs can irritate a shoulder that isn't ready. Build load gradually, and go back a step if pain is still worse by your next session.
Call 999 for shoulder or arm pain with chest pain that feels tight or squeezing, or that spreads to your arms, neck or jaw. Get help the same day for sudden weakness lifting the arm after an injury or fall, or a hot, swollen shoulder with a fever. See a GP or physiotherapist if it's getting worse or hasn't improved after 2 weeks of looking after it yourself.
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.
