Pilates guide
No trial shows that Pilates treats tennis elbow: in the one small trial, adding Pilates-based core, posture and flexibility work to therapy didn't improve recovery significantly more than therapy alone. What the evidence supports is loading the forearm muscles that lift the wrist, with still holds, then lifting, then slow lowering, and patience: most people are much better within a year.
Pilates fits alongside that loading, never in place of it, as exercise with a light grip, once you change how you take weight on your hands. A physiotherapist can set the loading if it isn't easing.
This guide covers what tennis elbow (lateral elbow tendinopathy) is and how long it lasts, why grip and straight arms matter, the forearm exercises that treat it, which mat and reformer moves to change, the elbow pain rule, what the trials show for exercise, injections and shoulder work, golfer's elbow, the warning signs, and a 25-minute class with a 10-minute forearm block to do every day.
In the one small trial (17 people), adding Pilates-based core, posture and flexibility work to therapy didn't improve recovery significantly more than therapy alone. Our searches found no other Pilates trial, published or registered.
A US physical therapy guideline recommends resisted exercise for the muscles that lift the wrist (still holds, lifting or slow lowering), about 3 sets of 15 for 6 to 12 weeks, without making symptoms worse. A UK care pathway recommends physiotherapy.
In trials, about 89% of people given no treatment or a placebo were much better or recovered within a year. Exercise mostly speeds the early weeks, with small, short-lived effects.
Grip was 29% weaker with the elbow straight than bent, pain-free grip was best with the elbow bent and the thumb up, and palm-down gripping and lifting predicted new tennis elbow in workers. So the knee hover, leg pulls, push-ups and side bend go onto your forearms, and ring squeezes and gripped reformer straps wait.
About 3 to 4 out of 10, settling within an hour, and no worse the next morning (our elbow pain rule). Holds pushed above the pain threshold left more pain 30 minutes later.
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Arm pain with "pressure, heaviness, tightness or squeezing across your chest" needs 999, and "a swollen elbow with a very high temperature" needs help the same day. The full list is below.
"Tennis elbow is a condition that causes pain around the outside of the elbow. It usually goes away with rest but can sometimes last over a year", the NHS says. It hurts when you lift or bend your arm, grip things or move your wrist. By the time people see a clinician, a US guideline says, "the inflammatory process has often resolved, yet symptoms remain", so clinicians now call it lateral elbow tendinopathy. Our tennis elbow guide covers diagnosis and the problems that can look like it.
"Anyone can get tennis elbow but it's more common in people between 35 and 54 years of age", the NHS says, and computer work, manual tasks and playing an instrument can set it off. In 4,783 Finnish adults aged 30 to 64, 1.3% had it at the time, most often at 45 to 54, and forceful and repetitive work together raised the odds 5.6 times. In workers followed over time, a palm-down forearm combined with a power grip or lifting predicted new cases, though neither did alone.
In the no-treatment and placebo groups of 24 trials (1,085 people), half of those still affected recovered or improved greatly every 2.5 to 3 months, and 89% were much better at a year, however long it had already lasted. In one trial, 83% of people who waited and saw had recovered at a year. An NHS Lothian leaflet says "it can take between 6 and 24 months to settle".
Two caveats: more than half of people who see a clinician still report some symptoms at a year, and it came back within 2 years in 8.5% of one US population.
As grip-light, whole-body exercise while the tendon settles, as a place to do shoulder-blade and rotator cuff work, which may add a little, and alongside the forearm loading that treats the tendon. It isn't a treatment on its own.
The sore tendon steadies the wrist whenever you grip, and US surgeons say it "helps stabilize the wrist when the elbow is straight". In 81 people with tennis elbow, grip on the sore side was 29% stronger with the elbow bent than straight, and pain-free grip was best with the forearm thumb-up and the elbow bent. These are lab studies; none tested a Pilates position.
Palm-down forearm work combined with a power grip or lifting predicted new tennis elbow in workers. A US guideline advises keeping "lifting objects with the forearm rotated in a pronated position" (palm down) to a minimum, and an NHS Lothian leaflet says "Where possible lift and grip with your palm facing upwards".
Weight on straight arms with the palm flat (the knee hover, plank, leg pull front, push-up, side bend and the swan pressed up) makes the forearm muscles steady the wrist, and so does gripping: holding your ankles in rocking and the open-leg rocker, the hand clasp in the double-leg kick, squeezing a ring between your palms, and holding straps, handles and the footbar on the reformer. Most lying, side-lying and seated mat work asks little of your grip. No study has measured forearm load in Pilates positions.
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A US physical therapy guideline recommends resisted exercise for the wrist extensors: still holds (isometric), lifting (concentric) or slow lowering (eccentric), about 3 sets of 15 for 6 to 12 weeks, with loads that "should not exacerbate symptoms", moving from holds to lifting to lowering as you can manage. A UK consensus of physiotherapists suggests holds "for up to 60 s and repeated five times, once daily", then lifting and lowering, "three sets of 10 to 15 repetitions, once daily".
Some discomfort during forearm exercises is fine. Keep it mild: no more than about 3 to 4 out of 10. It should settle within an hour or so, and your elbow should be no worse the next morning.
Tingling is the exception: stop any exercise or position that brings on pins and needles or numbness in your hand, especially in the ring and little fingers, and avoid holding the elbow fully bent while it settles.
Our tennis elbow guide sets the loading out in stages: settle, build, then strengthen and return. The forearm doses on this page are that guide's, so the two agree. If it isn't easing after about 6 weeks, a physiotherapist can check your plan.
In a 2015 pilot, 17 people with tennis elbow all had standard occupational therapy, and the Pilates group "additionally completed abdominal strengthening, postural correction, and flexibility". Scores on a tennis elbow questionnaire improved by 38.1 points with Pilates added and 22.9 with therapy alone, but the difference between the groups wasn't significant. Group sizes and follow-up aren't in its summary. Our searches in October 2026 found no other Pilates trial, published or registered.
A 2024 Cochrane review (23 trials, 1,612 people) found that manual therapy and exercise, against minimal or no treatment, reduced pain by about half a point out of 10 and disability by 5 points out of 100 at 4 weeks to 3 months, which "may not be clinically worthwhile", and the effect wasn't sustained. Exercise beat steroid injection on most outcomes but differed little from wait and see (30 trials, low certainty), no treatment clearly beat placebo for pain in the short term, and at a year or more, exercise didn't differ from control.
In 165 people, 83% had recovered or were much better at a year after a steroid injection, against 96% after a placebo injection, and it came back in 54% against 12%. Earlier trials found the same pattern: the best results at 6 weeks, then relapse. A UK care pathway advises against steroid injections for tennis elbow.
Slow lowering eased pain a little faster than lifting in 120 people (one extra person improved for every 10 treated), with no difference in function. Still holds improved disability against wait and see in 40 people, but not overall improvement or pain-free grip, and gave no instant relief. Heavy slow resistance hasn't been tested on its own, and only 6 of 19 people kept it up in a feasibility trial, mainly because it aggravated their pain.
Adding shoulder-blade or rotator cuff strengthening helped in three small trials and not in a fourth (32 people). A 2025 review found the differences mostly fell below what patients would notice, and the US guideline suggests this work when the shoulder is weak. Pilates is a pleasant way to do it, not a substitute for forearm loading.
The NHS suggests a forearm strap or brace, and the US guideline supports one during activity for immediate relief, with conflicting evidence beyond that.
Within the elbow pain rule. Reverse wrist curl held still with the wrist level, as the first step, 5 holds of 30 to 45 s, once a day; then wrist extensor eccentrics, 3 sets of 15, once a day, lowering over 3 to 4 s; dumbbell forearm rotation, 3 sets of 10; band finger extension, 2 sets of 15; wrist and forearm flow, 10 slow reps each direction, 2 to 3 times a day (our tennis elbow guide's plan). If you have a flexible bar, the Tyler twist: 3 sets of 15, about 4 seconds per repetition, with 30 seconds' rest between sets (the move's page). Wrist extensor stretch: 3 holds of 30 seconds, after the strengthening exercises, once or twice a day (the move's page).
3D demoReverse wrist curlBeginner · A dumbbell + A bench or box
3D demoWrist-extensor eccentricsBeginner · A dumbbell
3D demoTyler twist (flexible bar, for tennis elbow)Beginner · Other / check instructions
3D demoDumbbell forearm rotationBeginner · A dumbbell + A bench or box
3D demoBand finger extensionBeginner · A band
3D demoWrist extensor stretch (tennis elbow stretch)Beginner · No equipment
3D demoWrist & forearm flowBeginner · No equipmentHands open and resting, never gripping or pressing; do the single-leg kick on your forearms with your hands open, and the mermaid with your supporting hand resting lightly or sitting on a chair (our suggestions). From the moves' pages: lateral breathing, 5 to 8 breaths at the start of every session; knee fold, 2 sets of 5 to 10 each side, every other day; the hundred, 50 beats to start, building to 100; single-leg circle, 5 circles each direction, each leg; single-leg stretch, 6 to 10 each side; side kick, 8 to 10 each side; swimming, 2 to 3 sets of 20 to 30 seconds; single-leg kick, 6 to 8 each leg; spine twist, 3 to 4 each side; mermaid, 3 each direction, each side. Pelvic tilts then bridges, 8 of each, and clamshell, 10 each side (our editorial starting points).
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoKnee foldBeginner · No equipment
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 demoSingle-leg stretch (Pilates one leg stretch)Intermediate · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSwimming (Pilates)Intermediate · No equipment
3D demoSingle-leg kick (Pilates one leg kick)Beginner · No equipment
3D demoSpine twist (Pilates)Beginner · No equipment
3D demoMermaid (Pilates seated side bend)Beginner · No equipmentAdd these if your shoulder is weak, as the US guideline suggests. Prone Y-T-W raises with your thumbs up and hands open, 5 of each shape (our editorial starting point); band row with a neutral grip and the lightest band, 2 to 3 sets of 12 to 15, and band external rotation, 2 to 3 sets of 12 to 15 (our tennis elbow guide's plan); wall angel, 8 slow reps (our Pilates for posture class).
Our suggestions, agreeing with our Pilates for tennis players and tennis elbow guides. Bring the moves back gradually once gripping and pressing are comfortable.
As our Pilates for tennis players guide says, while it's sore, "do the knee hover, leg pull front and side bend on your forearms, or skip them, and do scapular push-ups against a wall." Leave out the leg pull back and the high plank for now.
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"Don't squeeze a ring or ball hard." Hold the ring between your knees instead. The ball squeeze's own caution: "With tennis or golfer's elbow, squeeze only as firmly as you can without increasing your pain."
Rocking, the open-leg rocker, the seal, the crab and the hand clasp in the double-leg kick all grip. Skip them, or hold a towel in the double-leg kick.
Lifting with your palm facing down loads the sore tendon most, so leave out palm-down arm work with weights, including wrist weights, for now.
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Pulling straps on the long box, rowing, arm springs and anything that grips a strap or bar load the forearm. Put the loops round your forearms where the equipment allows, use the lightest spring, or leave them out. Footwork, leg springs, bridging and side-lying work are fine.
Hanging from a bar and pull-ups come back later; our guide to elbow pain from pull-ups covers them.
Pain on the outside of the elbow when you grip or press is the pattern of tennis elbow. Pain on the inside is golfer's elbow, and tingling into the ring and little fingers points to a nerve. Our elbow pain guide helps you tell them apart.
The same changes apply: gripping and weight on straight arms load the inside of the elbow too. No Pilates trial exists for it; our golfer's elbow guide has the loading plan.
Ease back into gripping and weight on your hands gradually, and follow your clinician's advice (our suggestion): in trials, people given an injection were more likely to relapse.
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Our class pairs a 10-minute forearm block to do every day with grip-free mat work and shoulder-blade moves; its order and doses are editorial. The wrist and forearm routine is our tennis elbow guide's class. Leave the Pilates for tennis players class until gripping is comfortable: it puts weight on your arms. The forearm workout is for later, to build strength.
A 25-minute Pilates class for tennis elbow: a 10-minute forearm loading block to do daily, then grip-free mat work and shoulder-blade moves.
25 minBeginner17 movesA dumbbell, A bench or boxWrist mobility and forearm strength for desk work, climbing, push-ups and handstands.
10 minBeginner7 movesA wall, A dumbbellA 25-minute Pilates class for tennis and padel players: trunk endurance, rotation both ways, shoulder blades, hips and single-leg balance, on a mat.
25 minBeginner19 movesA band, An anchor pointA 25-minute forearm size workout with dumbbells: hammer, reverse and Zottman curls for the big muscle on the thumb side, then wrist curls and a carry.
25 minBeginner7 movesA dumbbell, A kettlebellThese are the same warning signs as our elbow 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.
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Some discomfort during forearm exercises is fine. Keep it mild: no more than about 3 to 4 out of 10. It should settle within an hour or so, and your elbow should be no worse the next morning.
Tingling is the exception: stop any exercise or position that brings on pins and needles or numbness in your hand, especially in the ring and little fingers, and avoid holding the elbow fully bent while it settles.
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.
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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In the one pilot, adding Pilates to therapy gave no significant extra benefit. Forearm loading is the exercise with guideline support.
The NHS says to "avoid or reduce activities that make your symptoms worse", and the guidelines recommend loading the tendon. An NHS Lothian leaflet: "Continuing to use your arm will not cause long term damage".
Computer work, manual tasks and playing an instrument are common triggers, and forceful, repetitive work raises the risk.
It helps for about 6 weeks, then results at a year are worse and relapse is more likely (54% against 12% after a placebo). A UK care pathway advises against it.
Holds above the pain threshold raised pain for 30 minutes, and most people gave up heavy loading because it hurt. Keep it mild and settled by the next morning.
That is the idea behind the Pilates pilot, which found no significant difference, and shoulder-blade training adds a little at most.
It doesn't treat it: in the one small trial, adding Pilates-based core, posture and flexibility work to therapy didn't improve recovery significantly more than therapy alone. You can keep doing Pilates with the grip changed, alongside the forearm exercises that do help.
Yes. Do the knee hover, leg pull front and side bend on your forearms or skip them, do push-ups against a wall, and don't squeeze a ring or ball hard. Keep forearm discomfort to about 3 to 4 out of 10, settling within an hour and no worse the next morning (our elbow pain rule).
For now: weight on straight arms (the knee hover, plank, leg pulls, push-up and side bend), gripping your ankles (rocking and the open-leg rocker), hand clasps, hard ring squeezes, palm-down work with weights, and gripping straps or handles on the reformer. Bring them back gradually once gripping is comfortable.
Footwork, leg springs, bridging and side-lying work are fine. Moves that grip straps or handles against springs (rowing, pulling straps, arm work) load the sore tendon: use the lightest spring, put the loops round your forearms if the equipment allows, or leave them out for now (our suggestion).
No study links them. Tennis elbow comes mostly from forceful, repetitive gripping and lifting, especially palm down, so lots of planks, push-ups and gripped straps could aggravate a sore elbow (our reading).
Resisted exercise for the muscles that lift the wrist: still holds, lifting or slow lowering, about 3 sets of 15 for 6 to 12 weeks, without making symptoms worse. Slow lowering eased pain a little faster than lifting in one trial. Our 25-minute class starts with this block.
Usually months: in trials, about 89% of people were much better or recovered within a year without active treatment, and an NHS leaflet says it can take 6 to 24 months to settle. Exercise mostly helps the early weeks.
It may ease pain during moves that hurt, but long-term benefit is unproven. If it helps in class, wear it for the moves that grip, alongside the forearm exercises, not instead of them.
A little, perhaps: three small trials found adding shoulder-blade strength helped and one found it didn't, and most gains were below what patients would notice. A US guideline suggests it when the shoulder is weak, and Pilates is a good place to do it.
The same changes apply: golfer's elbow is on the inside of the elbow, and gripping and weight on straight arms load it too. No Pilates trial exists for it; our golfer's elbow guide has the loading plan.
Follow your clinician's advice and build up gradually: an injection helps for a few weeks, but people given one were more likely to relapse within a year (54% against 12% after a placebo). Keep the grip changes and the forearm exercises going (our suggestion).
See a GP or physiotherapist for "Elbow or arm pain that hasn't gone after a few weeks of looking after it yourself (for tennis elbow, the NHS says after at least 2 weeks of self-care). In many areas you can refer yourself to NHS physiotherapy." The warning signs on this page say when to get help the same day or call 999.
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.
