Pilates guide
Most shoulder pain gets better with time and the right kind of movement, and the NHS's advice is to keep using your arm. Pilates has barely been tested for shoulder pain: there's one small trial, of 33 people over 2 weeks.
What does have good evidence is strengthening the rotator cuff and the muscles around your shoulder blade, building up the load gradually. A Pilates class can do that well, as long as the arm work moves forward in steps and you change the moves that load a sore shoulder.
This guide covers the common causes, what the trials and guidelines show, how much pain is OK while you exercise, frozen shoulder, rotator cuff problems, a shoulder that slips and Pilates after breast cancer surgery, the moves to start with and the ones to change, and when to see a GP or physiotherapist. There's also a 20-minute class that builds up in steps.
The NHS advises easing shoulder pain yourself for 2 weeks, not stopping using your shoulder completely, and trying shoulder exercises for 6 to 8 weeks. The Chartered Society of Physiotherapy (CSP) says most common causes "will get better naturally over time", though it can take several months.
In 33 people with shoulder pain, 10 sessions of clinical Pilates over 2 weeks eased pain and disability more than conventional exercise. We could read only the abstract, which gives no diagnosis and no follow-up after the last session, so it's a weak signal.
Specific rotator cuff and shoulder-blade strengthening led to success in 69% of people with long-standing shoulder pain, against 24% with general movement, and far fewer chose surgery. Guidelines put exercise at the centre of treatment, with no single best programme.
Pain up to 5 out of 10 during exercise is acceptable, and it should be no worse the next morning. If it is, do fewer repetitions, go slower or rest longer, rather than stopping.
Start at the wall, then your hands and knees, then planks and push-ups. While your shoulder hurts, leave out the leg pulls, control balance and kneeling side kick, as their own cautions say.
Stay in the comfortable range: in one study, gentle exercise within pain limits left 89% with normal or near-normal shoulders at 2 years, against 63% with intensive stretching.
Pain and stiffness that lasts months or years: frozen shoulder or arthritis. Pain that's often worse when you use your arm: tendonitis, bursitis or impingement, which the CSP calls the most common cause, "especially in 30 to 70 year olds". Tingling, weakness, or a shoulder that clicks or locks: instability, sometimes with hypermobility. Sudden, very bad pain after an injury: a dislocation, a broken bone or a torn tendon. Pain felt in the shoulder can also come from the neck, NHS inform says, often as pins and needles or burning pain.
Many clinicians now group impingement, tendon problems and small wear-and-tear tears under one name, rotator cuff related shoulder pain. The 2026 Dutch guideline calls it subacromial pain syndrome: shoulder pain that's "particularly painful during arm elevation". Our shoulder pain guides explain each condition.
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The shoulder becomes painful and stiff "for months, sometimes years", but "the pain and stiffness will usually go away eventually", the NHS says. It's more common with diabetes: the British Elbow and Shoulder Society (BESS) puts it at 10.8% of people with diabetes against 2.3% without. The CSP says it typically affects people in their 50s.
Weight on your hands (the knee hover, planks, the leg pulls, the side bend and the push-up), arms overhead (the roll-up and swimming), arms behind you (rocking and the leg pull back), weight towards your neck (the roll-over and control balance), and springs on the reformer, where heavier springs and different arm angles change which shoulder-blade muscles work. In one case report, both shoulders dislocated during an unsupervised reformer session as the arms moved out to the side and turned outwards.
One trial: 33 people with shoulder pain for at least 4 weeks had 10 sessions of clinical Pilates over 2 weeks or conventional exercise. Pain and disability improved more with Pilates. We could read only the abstract, which gives no diagnosis, no programme detail and no follow-up after the last session. We found no Pilates trials in frozen shoulder, rotator cuff tears, a shoulder that slips or shoulder arthritis.
In 102 people with impingement pain for more than 6 months who had been referred for surgery, 12 weeks of specific rotator cuff and shoulder-blade strengthening led to success in 69% against 24% with general neck and shoulder movement, and 20% chose surgery against 63%. Across 89 trials, shoulder exercise on its own was "a reasonable first-line approach", though the certainty was very low, and in a Cochrane review one type of exercise was rarely better than another.
In 708 adults with a new rotator cuff problem, up to 6 physiotherapy sessions of progressive exercise did no better over a year than one session of best-practice physiotherapy advice, and a steroid injection gave no long-term benefit.
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Programmes that teach control of the shoulder blade and arm, the closest match to Pilates, reduced disability slightly more than general exercise in 7 trials, at moderate certainty, but not pain; a network analysis ranked plain strengthening first. The 2026 Dutch guideline says treatment should include exercise, but "scientific evidence is lacking on the form or protocol".
For rotator cuff related pain without a tear, home exercise did as well as supervised exercise at 12 weeks across 12 trials, though few reported how well people kept it up. Online rehabilitation did at least as well as in-person care, at very low certainty.
In lab studies of people without shoulder pain, reformer arm work drew more shoulder-blade muscle activity as the springs got heavier, until very heavy springs brought compensation; the arm's angle changed which parts of the trapezius worked most; and push-up plus variations worked the serratus anterior hardest on one leg. Twelve reformer sessions improved shoulder-blade strength in inactive women. So a Pilates class is a reasonable way to do shoulder strengthening, not a special one.
Across 10 studies, people with and without shoulder pain had similar upper-back rounding. Sitting tall lets your arm lift a little further in the moment, so it's worth doing during arm work.
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NHS inform: rate your pain from 0 to 10, where 0 to 3 is minimal, 4 to 5 acceptable and 6 to 10 excessive. "Aim to keep your pain within a rating of 0 to 5", and "your pain should be no worse the morning after you've exercised". If it climbs, do fewer repetitions, move more slowly or rest longer between movements.
In the strengthening trial, pain wasn't allowed above 5 out of 10 during the exercises, any increase had to settle before the next session, and the load came down if it didn't.
NHS inform: start with 2 to 3 repetitions little and often, add 1 or 2 every few days, then sets of 8, two or three times a day, up to "a maximum of 2 sets of 15". The NHS suggests shoulder exercises for 6 to 8 weeks to stop pain coming back. The strengthening trial ran for 12 weeks: 3 sets of 15 twice a day for the first 8, with the load increased every other week.
The NHS: "do not make up your own strenuous exercises or use heavy gym equipment", and with impingement, don't carry on with activities that caused the pain or involve repeatedly lifting your arm above your head. NHS inform: avoid sports or heavy lifting until you have less discomfort and good movement. In Pilates, that means light springs and weights, arms below shoulder height to start, and the weight-bearing classics later.
Two or three Pilates sessions a week with short daily home exercises, for at least 6 to 8 weeks: pain-free range first, then rotator cuff and shoulder-blade strength within the 5 out of 10 rule, then weight on your arms in steps.
BESS calls frozen shoulder "a self-resolving pathology". The NHS says to keep moving your shoulder, because keeping it still will make the pain worse, and not to make up your own strenuous exercises.
In 77 people, exercise within pain limits left 89% with normal or near-normal, painless shoulders at 2 years (64% within a year), against 63% with intensive stretching and manual mobilisation. The groups weren't randomised.
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BESS strongly recommends steroid injections, which improve symptoms faster than waiting, and suggests physiotherapy after an injection. In UK FROST (503 people), physiotherapy with an injection did about as well at a year as manipulation under anaesthetic or keyhole surgery to release the joint, and the surgery had more serious complications. The CSP: "A steroid injection followed by gentle stretching and strengthening exercises is effective for the majority". Talk to your GP.
No Pilates trial. While it's very painful, keep to pain-free movement (pendulum swings, table slides and assisted turning out, like the assisted exercises in the CSP's shoulder videos) and Pilates moves with your arms low. As the pain eases, add stretching to mild discomfort and shoulder-blade strength. BESS found low-certainty evidence that hospital group exercise classes may speed recovery, so a class may help you keep going (our suggestion).
The NHS says impingement usually gets better in a few weeks or months. Specific strengthening helped people whose pain had lasted more than 6 months, and for a new problem, one session of good advice did as well as six physiotherapy sessions.
In 452 people with full-thickness tears that came on without an injury, a physical therapy programme worked for about 75% at 2 years, and fewer than 25% chose surgery. In trials of mostly small wear-and-tear tears, surgery made little or no difference compared with exercise at a year. Exercise doesn't repair the tendon; it helps the shoulder work around it (our reading).
If you suddenly can't lift your arm after an injury or fall, get help the same day (an urgent GP appointment or NHS 111): an injury can tear a tendon, and that needs checking.
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From the NHS strength exercises, push-up plus studies and the moves' own pages; the order is our suggestion.
See the movement on the 3D figure: Wall push-up
Recovery usually takes 6 to 12 weeks, the NHS says, and up to 16 weeks for some sports. The CSP says exercises to strengthen the shoulder and improve balance reactions help reduce the risk of it happening again. Avoid taking your arm out to the side and turning it back, the position in the reformer case report and in some strap work and doorway stretches, and stop if it feels about to slip.
The NHS lists instability, sometimes because of hypermobility, among the causes of shoulder pain. Our Pilates for hypermobility guide covers working in the middle of your range.
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The National Institute for Health and Care Excellence (NICE) asks hospitals to give you arm and shoulder exercises before treatment and to refer you to physiotherapy if your movement stays reduced. Our breast cancer surgery guide has the timeline, including the early exercises below shoulder height.
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In small trials, Pilates improved shoulder movement, strength, arm function and pain after surgery, but not more than other exercise for movement or quality of life; across 6 trials (531 women) it eased pain. In one trial of 69 women, the gains in range and strength had faded by 6 to 12 months.
NICE says there is "no indication that physical activity causes, or worsens, lymphoedema". In 60 women with lymphoedema, clinical Pilates reduced swelling more than standard exercises, but in a small study of 15 survivors the affected arm's volume increased. Across reviews, supervised weightlifting probably reduced the risk of swelling getting worse. Get any new swelling checked; our lymphoedema guide has more.
New exercises can cause short-term muscle soreness that eases quickly; your shoulder should be no worse the morning after.
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If it hurts during weight-bearing or overhead moves, go back a step: wall push-ups instead of planks, arms low instead of overhead, lighter springs. If the pain is getting worse or hasn't improved after 2 weeks, see a GP or physiotherapist.
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Heavier springs make the shoulder muscles work harder, and very heavy ones led to compensation in a lab study. Learn the strap work with a teacher, keep springs light at first, and tell them about your shoulder: the Pilates Method Alliance strongly recommends practising with an instructor, especially on equipment.
Start with the first six if your shoulder is very sore or stiff, then add the strengthening moves within the 5 out of 10 rule, using NHS inform's sets of 8 building up to 2 sets of 15; our 20-minute class gives a starting dose for each.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoPendulum exercise (Codman's pendulum)Beginner · A bench or box
3D demoTable slide (seated forward reach)Beginner · A bench or box
3D demoStick-assisted external rotation (lying)Beginner · Other / check instructions
3D demoThoracic rotationBeginner · No equipment
3D demoSide-lying open bookBeginner · No equipment
3D demoStanding band external rotationBeginner · A band + An anchor point
3D demoSide-lying external rotationBeginner · A dumbbell
3D demoBand rowBeginner · A band + An anchor point
3D demoProne Y-T-W raisesBeginner · No equipment
3D demoWall angelBeginner · A wall
3D demoScaption raiseBeginner · A dumbbell
3D demoBand pull-apartIntermediate · A band
3D demoSwimming (Pilates)Intermediate · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipmentMove on to the next one only when the last feels easy and pain stays at 5 out of 10 or less.
Go only to mild discomfort: hold the two stretches for 15 to 30 seconds (the chest stretch page's dose), do the mermaid 3 times each way, and leave them out in the painful stage of frozen shoulder.
The leg pull front and back, control balance, the kneeling side kick and upward plank, as their own cautions say; the sleeper stretch, which you do lying on the shoulder; and, after a dislocation, the doorway chest stretch and reformer strap work with your arm out to the side and turned back.
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Do the side bend as a knee side plank, rest on your forearms in the hip twist, hold a towel in the double leg kick, do push-ups at a wall or on your knees, lower only as far as the front of your shoulder is comfortable in dips, and in the side kick, rest your head on your arm if propping on your elbow hurts (the moves' own cautions).
While the shoulder is sore, keep your arms forward in the roll-up and by your sides in swimming, reach only as high as is comfortable in the mermaid, and don't hold your ankles in rocking. With impingement, the NHS advises against activities that involve repeatedly lifting your arm above your head.
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Start with our 20-minute class twice a week, or its first block alone if your shoulder is very painful or frozen; the band routine adds more rotator cuff work.
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 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 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 20-minute Pilates class for neck pain: head-supported core work, upper-back and shoulder-blade strength, gentle neck movement and slow breathing.
20 minBeginner15 movesA wallDeep neck holds and shoulder-blade strength in under 20 minutes: one of the best-supported kinds of exercise for a stiff, sore neck.
18 minBeginner11 movesA band, An anchor pointWork up to full push-ups: wall, incline and knee push-ups, then the floor push-up and harder variations.
15 minBeginner8 movesA wall, A bench or boxThe UK breast surgery leaflet's exercises in one daily routine: a shoulder warm-up, the basic set for week 1 and the stretching set from week 2.
15 minBeginner6 movesA wall, Other / check instructionsA 30-minute workout in your wheelchair: a warm-up, seated cardio, four shoulder exercises from a trial programme, and stretches for the front of the shoulders.
30 minBeginner14 movesA bench or box, A bandThese are the same warning signs as our shoulder pain guides. In the US, call 911 for 999, and use your doctor's urgent line or urgent care for NHS 111.
In many areas you can refer yourself to NHS physiotherapy without seeing a GP first.
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.
The NHS: don't completely stop using your shoulder, because that can stop it getting better. NHS inform advises gentle movement early on, then using it more, and with frozen shoulder, keeping it still makes the pain worse.
There's no Pilates trial in rotator cuff tears, and no exercise repairs a tendon. A physical therapy programme worked for about 75% of people with tears that came on without an injury, and surgery added little over exercise at a year for mostly small wear-and-tear tears.
Across 10 studies, people with and without shoulder pain had similar upper-back rounding. Sitting tall helps the arm lift in the moment, but strengthening is what has trial evidence.
Exercise within pain limits left 89% with normal or near-normal shoulders at 2 years, against 63% with intensive stretching. Frozen shoulder gets better on its own, slowly.
Progressive strengthening has the best evidence: specific exercises led to success in 69% against 24%, and far fewer people chose surgery. NHS inform accepts pain up to 5 out of 10 during exercise.
Several classical moves put heavy load on the shoulders (the leg pulls, control balance, the push-up), and their own cautions say to skip or change them with shoulder pain. In one reported case, both shoulders dislocated during an unsupervised reformer session.
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It can be, if the arm work builds up gradually. Only one small trial has tested it: in 33 people, 10 sessions of clinical Pilates over 2 weeks eased pain and disability more than conventional exercise. What has strong evidence is progressive shoulder strengthening, which a Pilates class can provide if the load goes up in steps.
Start with pain-free movement (pendulum swings, table slides, assisted turning out), then strengthen the rotator cuff and shoulder-blade muscles (side-lying outward rotation, Y-T-W raises, a small swan), then add weight on your arms: wall push-ups first, then the knee hover. Our 20-minute class puts them in order.
While it hurts, leave out the leg pull front and back, control balance, the kneeling side kick and upward plank, swap the side bend for a knee side plank, and do push-ups at a wall or on your knees. Keep your arms below shoulder height at first and avoid heavy springs or weights; the NHS advises against making up strenuous exercises or using heavy gym equipment.
Pain up to 5 out of 10 during exercise is acceptable, and it should be no worse the next morning. If it is, do fewer repetitions, go more slowly or rest longer, rather than stopping altogether. Stop and get it checked for sharp pain, a feeling that the shoulder is slipping, or pins and needles spreading down the arm.
It hasn't been tested, but gentle exercise within pain limits suits frozen shoulder: in one study, 89% had normal or near-normal shoulders at 2 years after gentle exercise, against 63% after intensive stretching. Stay in the comfortable range while it's very painful, and add stretching and strength as it eases. A steroid injection can speed recovery, so talk to your GP.
For impingement, progressive strengthening helps: in one trial, 69% did well with specific shoulder exercises against 24% with general movement, and far fewer chose surgery. For tears that came on without an injury, a physical therapy programme worked for about 75% of people at 2 years. Pilates hasn't been tested for either, no exercise repairs a tear, and sudden weakness lifting the arm after a fall needs same-day care.
It can be, with a teacher who knows about your shoulder: springs let you start light, and in a lab study, heavier springs made the shoulder muscles work harder until very heavy ones led to compensation. Learn the strap work with a teacher: in one reported case, both shoulders dislocated during an unsupervised reformer session.
A new class can cause short-term muscle soreness that eases quickly and is no worse the next morning. If it hurts during weight-bearing or overhead moves, go back a step: wall push-ups instead of planks, and arms low instead of overhead. Pain that is getting worse, or hasn't improved after 2 weeks, needs a GP or physiotherapist.
Yes, once your team agrees: exercises to strengthen the shoulder help reduce the risk of it happening again. Avoid taking your arm out to the side and turning it back (some reformer strap work and the doorway stretch), and stop if it feels about to slip. The NHS says recovery usually takes 6 to 12 weeks.
Yes, once the early exercises your team gives you are done. In small trials, Pilates helped shoulder movement, strength and pain about as much as other exercise, and NICE says there is "no indication that physical activity causes, or worsens, lymphoedema". Get any new arm swelling checked; our breast cancer surgery guide has the timeline.
Probably not on its own: across 10 studies, people with and without shoulder pain had similar upper-back rounding. Sitting tall lets your arm lift a little further in the moment, so it's worth doing during arm work, but strengthening is what has the evidence.
Call 999 for shoulder or arm pain with chest pain that feels tight or spreads to your arms, neck or jaw; go to A&E if, after a fall, your shoulder looks out of place or you can't move your arm; get same-day help if it's hot and swollen or you have a high temperature. See a GP or physiotherapist if it isn't better after 2 weeks of looking after it yourself; in many areas you can refer 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.
