Pilates guide
Pain is more common in veterans than in people who haven't served, and back and joint pain are among the commonest kinds. Pilates is one of the structured exercise options a US veterans' back pain guideline suggests, and in adults generally it eases back pain about as much as other good exercise. No trial has tested it in veterans, so think of it as one good option among several, beside walking, strength training, yoga or swimming.
Pilates wasn't made for veterans, whatever you may have read: Joseph Pilates was a German civilian interned in Britain in the First World War, and the story about wounded soldiers and hospital-bed springs isn't in the records. Pilates isn't a treatment for PTSD (post-traumatic stress disorder) either; trauma-focused therapy is, and the services on this page can help.
This guide covers back pain, old injuries and limb loss, the real history, mental health and where to get support, a 25-minute class you can do from a chair or on the mat, and the warning signs.
If you are thinking about suicide or can't keep yourself safe, call 999 or go to A&E. For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988.
Joseph Pilates was a German civilian interned in Britain in the First World War, mostly at Knockaloe on the Isle of Man, described by the camp's heritage trust and a local historian as a camp for civilian men. Camp records show he refereed boxing there. The story that he rehabilitated wounded soldiers with hospital-bed springs isn't supported by the records.
In US survey data, 65.5% of veterans had pain in the past 3 months against 56.4% of people who hadn't served; joint pain (43.6%) and back pain (32.8%) were both more common. Musculoskeletal problems are one of the two commonest reasons for medical discharge from the UK forces.
The US veterans' back pain guideline suggests a structured exercise programme and names Pilates among the options, with no type clearly better. In adults generally, Pilates eases back pain about as much as other exercise. No Pilates trial has been done in veterans.
Back pain is common after an amputation, and US rehabilitation guidance includes trunk and core work. One small study without a comparison group found mat Pilates improved strength and walking speed after a below-knee amputation. Do it with your rehabilitation team's agreement.
No study has tested Pilates for PTSD. NICE and the US guideline recommend trauma-focused therapies, and make no recommendation for or against exercise or yoga. Exercise added to treatment eased symptoms a little in small trials. Pilates can be part of looking after yourself, beside treatment.
Our class has a seated version of every block, your eyes stay open, and you choose the positions. For a physical health problem caused by your service in England, Op RESTORE is the NHS route, through your GP.
Source 23
Each figure keeps its own group and measure. Most are surveys or clinic studies.
In US national survey data on 67,696 adults, 65.5% of veterans had pain in the past 3 months and 9.1% severe pain, against 56.4% and 6.4% of non-veterans; back pain was 32.8% against 28.5%, and joint pain 43.6% against 31.5%. Severe pain was raised most in younger veterans (7.8% against 3.2% at ages 18 to 39), and veterans aged 70 or over were slightly less likely to report it. In a US clinic for veterans with multiple injuries, the back was the commonest pain site (58%).
In UK men deployed to Afghanistan, about 8 years on, moderate or severe pain affected 24% of those injured in combat and 11% of those who weren't, and it was less common in those with amputations (19%) than in those injured without one (26%). Pain went with probable PTSD, anxiety and depression. A UK review found no UK data on veterans living with both chronic pain and PTSD.
In 2025/26, 40% of army medical discharges in the UK were for musculoskeletal problems, the knee, back and ankle and foot leading. In US active-duty personnel, diagnosed low back pain occurred at 40.5 per 1,000 person-years, and musculoskeletal conditions make up 44% of service-connected disabilities among compensated US veterans of recent conflicts. Carrying heavy loads is linked with back strains, knee pain and foot problems.
Chronic pain and PTSD often occur together in veterans and may keep each other going, and people with both have poorer day-to-day functioning than with either alone. How often they overlap varies hugely with the group and the measure. For people with both, trauma-focused treatments helped PTSD and eased pain a little, while mind-body therapies, yoga among them, did no better than comparison treatments (30 trials, low-quality evidence).
No Pilates trial in veterans; one tiny trial in serving pilots; more evidence from other adults and other exercise.
Our searches found no Pilates trial in veterans. In 15 Brazilian Air Force helicopter pilots with back pain, twice-weekly mat Pilates for 12 weeks eased pain by 3.5 points more out of 10 than their usual exercise, but disability didn't change. A similar core stabilisation programme using a Pilates ball and mat in 14 fighter pilots eased back pain by 2.3 points more, with no change in disability.
The VA and Department of Defense back pain guideline (2022) suggests a structured, clinician-directed exercise programme and lists aerobic, aquatic, motor control, Pilates, strengthening, walking and tai chi programmes among the options. It's a weak recommendation with very low confidence in the evidence, it found no clear winner among them, and it calls such programmes generally safe and well tolerated; for yoga it found too little evidence to recommend for or against. NICE says to consider a group exercise programme for low back pain, choosing the type to suit the person.
In adults with back pain, Pilates eased pain more than minimal treatment (a Cochrane review of 10 trials, low to moderate quality), and a network meta-analysis of 118 trials ranked it near the top, with the most helpful programmes 1 to 2 sessions a week for 3 to 9 weeks. Core stabilisation as a whole was no better than other active exercise in the long term.
In 4,325 US Army trainees, core stabilisation was no better than sit-ups at preventing back pain needing care over 2 years, while a single 45-minute education session reduced it. In 1,141 soldiers, it was no better at preventing injuries, and trunk endurance didn't predict who later got back pain. In 588 Chinese naval recruits, extra core training against no extra training halved back pain over 12 weeks, in an open-label trial with short follow-up.
In 150 veterans, twice-weekly yoga for 12 weeks didn't change disability at 12 weeks but did at 6 months, and eased pain a little. In 120 mostly older veterans, weekly yoga was no better than an education book, though more felt much improved. Our yoga for veterans guide covers yoga.
In 299 veterans aged 65 to 89 with chronic back pain, personalised care wasn't better than usual care for disability, a reminder that back pain later in life often has several causes. In the US, the VA's Gerofit programme offers supervised exercise for older veterans, and in a small study chair-stand strength improved even in veterans aged 90 to 99. The UK advice for older adults is strength and balance work on at least 2 days a week.
Across 51 studies, low back pain was the commonest pain after an amputation (62%), ahead of phantom limb pain (61%) and pain in the residual limb (58%); in an older US survey, 52% of people with leg amputations had persistent, bothersome back pain. How best to prevent or treat it is still a gap in the research, and only two exercise studies were found by one review.
Exercise 1 to 3 times a week for 20 to 60 minutes improved balance, walking speed and transfers in adults with leg amputations (23 studies, moderate confidence). The US amputation guideline suggests an individual, skilled rehabilitation programme, and its routine care advice includes trunk and core stabilisation exercises. Trip-recovery training on a special treadmill improved trunk control after a trip in US service members, which is specialist rehabilitation, not Pilates.
In 10 people with a below-knee amputation, 36 remote mat Pilates sessions over 3 months improved hip and knee strength and walking speed, but not how even their walking was. The study had no comparison group, and the people weren't described as veterans. A registered trial in prosthesis users has posted no results.
Beside your rehabilitation team's programme, never in place of it: trunk, hip and upper-back work, done seated or on the mat. In England, Op RESTORE is the NHS service for physical health problems caused by service; in Wales, there are specialist prosthetic and rehabilitation centres in Cardiff, Swansea and Wrexham.
What the camp records and well-sourced accounts support, and what they don't.
Joseph Pilates was a German national in England when the war began. The Isle of Man's heritage records list him as interned at Knockaloe on 12 September 1915 and transferred to Alexandra Palace in London on 16 March 1919. The Knockaloe Charitable Trust and an Isle of Man historian say he spent about a year at a temporary camp in Lancaster first. The Pilates Method Alliance says he was one of several physical culturists who led the camp's daily exercise, and the camp newspaper names him as referee of a boxing match.
Not supported. The trust, summarising a biography based on camp records, and the island historian both describe Knockaloe as a camp for civilian men, not soldiers. The Pilates Method Alliance's history says his thinking was shaped by work with injured soldiers during the war, but gives no source for it.
Not supported by the records. Later in life he spoke of helping internees who were ill and devising machines for them, but the trust says there's no confirmed record of him working in the camp hospital, and both main biographies doubt the bed springs because few metal beds were used in the camp. The Pilates Method Alliance's own account is that his first machine used a weight stack, and that coiled springs replaced it after he emigrated to the US in 1926.
This was his own claim, in a 1962 magazine interview, and there's no evidence for it.
No. It grew from his background in boxing and physical culture and his years as an internee, and was built up in New York with dancers. Many veterans use it today, which is a reason to try it, not its origin.
NICE recommends trauma-focused talking therapy, EMDR (eye movement desensitisation and reprocessing) and, if you prefer, medicines; the US VA and Department of Defense guideline strongly recommends trauma-focused therapies. Neither recommends exercise or yoga for or against, and the US guideline says such activities might be encouraged for overall wellness.
Across 12 to 16 small trials, exercise added to usual care eased PTSD symptoms by a small amount, but certainty is low or very low, and in the newest analysis the range where a new trial's result would fall crossed zero. No type of exercise was clearly best.
Across 32 trials, Pilates improved quality of life and self-esteem, but its effects on depression and anxiety were limited or unclear. No study has tested Pilates for PTSD; the only report is a single case. Our exercise for PTSD guide covers exercise and trauma in full.
Choose where you exercise, keep your eyes open, skip any position that feels wrong, sit or stand with a view of the room, and ask a teacher not to use hands-on correction. If strong feelings come up, stop, sit with your feet on the floor, look around and breathe slowly (our suggestions, as on our exercise for PTSD guide; these aren't a treatment).
Check each service's page for opening hours and local numbers before you call.
The NHS: "Op COURAGE is an NHS mental health specialist service designed to help serving personnel due to leave the military, reservists, armed forces veterans and their families." "It does not matter how long ago you left the armed forces or how long you served for." You can get in touch yourself, through a family member or friend, through your GP or through a charity, and "It's important to contact the Op COURAGE service for your local area."
Source 3
The NHS: "The helpline number is 0800 138 1619, and it's available 24 hours a day, 365 days a year."
Source 3
VALOUR: "Op RESTORE: The Veterans Physical Health and Wellbeing Service is an NHS service created specifically for people who have served (or are leaving) the UK armed forces." To use it: "Book a GP appointment and explain that your time in service has caused your physical health problem."
Source 23
"VALOUR is a new national programme that makes it easier for veterans and their families across the UK to access the care and support they deserve." "You don't have to be in crisis to use VALOUR." Its phone line is 0808 1914 218 (option 6 for Veterans Services).
"Veterans NHS Wales is a specialist NHS service for veterans who are experiencing mental health difficulties linked to their service." You can refer yourself online through the Veterans Wales website, or your GP, a veterans' charity or someone supporting you can refer you. In Northern Ireland: "MoD Veterans Services is a Ministry of Defence service that brings together specialist veteran welfare support into one joined-up offer." "You do not need to wait until you're in crisis."
"No matter where, when or for how long you served, we're here to support you and your family. Submit a form or call us on 0300 303 9888 if you have any questions."
Source 69
"Dial 988 then Press 1", or text 838255: "24/7, confidential crisis support". "You don't have to be enrolled in VA benefits or health care to connect." The VA adds: "Go directly to your nearest VA medical center. It doesn't matter what your discharge status is or if you're enrolled in VA health care."
Our suggestion is twice a week for 20 to 30 minutes, choosing chair, standing or mat versions, as the back pain research (1 to 2 sessions a week) and the UK strength advice (at least 2 days a week) support. Walk, wheel or swim on other days towards 150 minutes a week.
Lateral breathing, 5 to 8 breaths, sitting near the front of the seat; chin tuck, 5 reps, 3 s hold; seated thoracic rotation, 5 each side, 5 s holds; seated upper-back lift, 5 holds of 3 to 5 s; seated march, 1 to 2 minutes (all from our chair Pilates class).
Sit to stand pushing on your thighs, 5 to 8 reps; slow calf raise, 8 to 10 reps holding the back of the chair; wall side leg lift, 8 each side (all from our chair Pilates class). With a prosthesis, as your physiotherapist has shown you.
Pelvic tilt into bridge, 6 slow reps; dead bug heel taps, 6 each side; clamshell, 10 each side; bird dog, 5 each side, holding each for 3 breaths; cat-cow, 6 slow rounds (all from our Pilates for back pain class); knee fold, 2 sets of 5 to 10 each side, every other day (the move page's dose).
Side-lying open book, 5 each side, and slow breathing, 2 minutes (our somatic Pilates class), sitting or lying however is comfortable, eyes open; child's pose, 60 s (our Pilates for back pain class), or sit instead.
If lying on your back, lying face down or closing your eyes feels wrong, do the seated version, keep your eyes open and skip it (our suggestion).
Do standing work only as your physiotherapist or prosthetist has shown you, and check your residual limb's skin after floor work; get any broken or sore skin checked before you carry on (our suggestion, as our amputation guide advises).
Source 73
Use the back pain rule in the warning signs, and start with knee folds and heel taps before full dead bugs. If your back, neck or hips hurt after a class, our guides to lower back pain after Pilates, neck pain from Pilates and hip pain from Pilates say what to change.
Source 74
With osteoporosis, use head-down versions of curl-ups and skip roll-ups and rolling moves, as the move pages say, and peel up only part of the way in the pelvic tilt into bridge.
Don't kneel on the new knee until your doctor says you can, as the bird dog's and cat-cow's pages say; do them seated or standing at a wall instead.
Do standing work beside a counter or the back of a chair, with someone nearby if you've fallen recently, as the single-leg stand's page says.
Source 75
Our 25-minute class goes from a chair to standing to the mat, with a seated version of every block; its structure is our own and untested. The chair classes are fully seated, the back pain class is a mat start for back pain, the somatic class is slow with every move optional, the balance and over-50 classes suit older veterans, and the wheelchair workout and stump exercises are for limb loss.
A 25-minute Pilates class you can do from a chair, standing or on the mat: the upper back and neck, legs and balance, the lower back and a calm finish.
25 minBeginner15 movesBench or box, 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 movesBench or box, something with weightA 15-minute chair Pilates class done entirely sitting down, in a chair or wheelchair: breathing, spine moves, and leg and arm strength with water bottles.
15 minBeginner13 movesBench or box, something with weightA gentle 15-minute Pilates-based routine for ongoing low back pain, built from neutral-spine moves with options for backs that dislike bending or arching.
15 minBeginner10 movesNo equipmentA slow, 20-minute Pilates class with time to notice your breath and how each move feels. Every move is optional and you can pause or stop at any point.
20 minBeginner12 movesNo equipmentA 25-minute Pilates class for steadier balance: standing balance and leg strength at a kitchen counter, then mat work for your trunk and hips.
25 minBeginner17 movesWall, bench or boxA 20-minute beginner mat Pilates session for over-50s with no deep or repeated rounding of the spine, plus back strengthening and standing balance.
20 minBeginner13 movesWallA 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 movesBench or box, bandThe hip, thigh and trunk exercises physiotherapists give after an above- or below-knee amputation: lying and sitting, then standing at a support when ready.
20 minBeginner11 movesOther / check instructions, bench or boxA slow 15-minute Pilates wind-down for the last hour before bed: slow breathing, small lying moves and a few minutes of stillness, with no effort or holds.
15 minBeginner9 movesFirm cushionThe beginner Pilates plan builds the basics over 4 weeks, 3 days a week, at your own pace.
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.
In England, Op COURAGE is the NHS mental health service for people leaving the forces, reservists, veterans and their families. You can contact it yourself or through a GP or a charity, however long ago you left. Across the UK, the government's VALOUR programme says: "VALOUR is a new national programme that makes it easier for veterans and their families across the UK to access the care and support they deserve." and "You don't have to be in crisis to use VALOUR." For a physical health problem caused by service in England, Op RESTORE is the NHS route: "Book a GP appointment and explain that your time in service has caused your physical health problem."
If you're 18 or over (or 16 or over in some areas), you can also refer yourself to NHS talking therapies without seeing a GP.
Signs of infection in your stump: warm, red and tender skin, a discharge of fluid or pus, or increasing swelling.
Source 73
Call 999 if you or someone else has fallen and may have hurt the head, back, neck or hip, or cannot get up. Get help from NHS 111 after a fall if you may be in pain, injured or unwell.
Source 75
Source 74
Source 74
Some discomfort during exercise is fine, and it does not mean you are doing damage: the WHO counts "hurt does not necessarily mean harm" among the messages people with back pain need. Aim for pain you would call mild to moderate, no more than about 5 out of 10. It should settle within an hour or so, and your back should be no worse the next morning. If it is worse, do less next time (fewer reps, a smaller range, a lighter load), not nothing.
Leg symptoms are the exception: stop or shrink any movement that sends pain, pins and needles or numbness further down your leg. If leg symptoms move back towards your spine, that is a good sign, even if your back aches a little more for a while.
Source 74
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.
Source 81
The PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone) asks about a heart condition or high blood pressure, chest pain, dizziness or losing consciousness, other long-term conditions and their medicines, a bone or joint problem that activity could make worse, and being told to exercise only under supervision. If you answer yes to any, check with your GP or a qualified exercise professional first. If you're over 45 and not used to hard exercise, ask a qualified exercise professional before the hardest sessions, and delay if you're ill.
Source 82
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.
Source 83
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 83
Knockaloe was a camp for civilian men, there's no confirmed record of him in the camp hospital, the biographers doubt the bed springs, and the Pilates Method Alliance says his first machine used a weight stack, with springs added after he emigrated.
It grew from his physical culture and boxing background and his years as an internee, and was built up in New York with dancers.
No trial has tested Pilates for PTSD, and guidelines recommend trauma-focused therapies. Exercise can sit beside treatment and helps symptoms a little in small trials.
In the largest military trial, core stabilisation was no better than sit-ups at preventing back pain, and trunk endurance didn't predict who got it; one education session did more.
The classical exercises are mat work that needs no equipment, as our classical mat exercises guide shows, and the one Pilates study after an amputation used remote mat classes.
Source 19
One small study without a comparison group ran 36 remote mat sessions with 10 people with below-knee amputations and found strength and walking speed improved, and US rehabilitation guidance includes trunk and core work. Do it with your team's agreement.
No. Joseph Pilates was a German civilian interned in Britain in the First World War, mostly at Knockaloe on the Isle of Man, a camp for civilian men, where he helped run sport and exercise. The story that he rehabilitated wounded soldiers isn't supported by the records.
The records don't support it: there's no confirmed record of him working in the camp hospital, and his biographers doubt metal beds were used much. The Pilates Method Alliance's account is that his first machine used a weight stack, and that coiled springs replaced it after he emigrated in 1926.
It can be, especially for back pain: a US veterans' back pain guideline lists Pilates among the structured exercise programmes it suggests, and Pilates eases back pain in adults about as well as other good exercise. No trial has tested it in veterans, so it's an option to try, not a proven fix.
Pilates has never been tested for PTSD, and it isn't a treatment for it. NICE and the US VA guideline recommend trauma-focused therapies, and exercise added to treatment eased symptoms a little in small trials. If you're struggling, Op COURAGE in England or the Veterans Crisis Line in the US can help.
Often yes, with your rehabilitation team's agreement. One small study of 10 people with below-knee amputations found mat Pilates improved strength and walking speed, though it had no comparison group, and the US amputation guideline includes trunk and core work in routine care.
It may. Pilates reduced back pain against minimal treatment in a Cochrane review, and in 15 Air Force helicopter pilots it eased pain more than their usual exercise, though disability didn't change. Strength training, walking and other structured exercise are equally reasonable.
Mostly, if you start with the easier versions and use the back pain rule; the US guideline calls structured exercise programmes for back pain generally safe and well tolerated. Get anything new, worsening or after a fall checked first.
Yes. Our class has a seated version of every block, and our chair Pilates and wheelchair workouts go further. Seated work doesn't train standing balance, so add standing work if you can.
Not on its own. In 4,325 US Army trainees, core stabilisation prevented back pain no better than sit-ups, while one education session reduced it. Staying active and understanding back pain matter as much.
Some charities and studios offer them, the NHS has a free online Pilates video, and the classes on this site are free. Your local veterans' charity or VALOUR can tell you about activities near you.
Yes, with strength and balance work on at least 2 days a week, as the UK guidelines advise for older adults. In the US, the VA's Gerofit programme offers supervised exercise for older veterans, and in one small study chair-stand strength improved even in veterans aged 90 to 99. Anyone who falls repeatedly should ask a GP about a falls service.
Yoga has two trials in veterans with back pain, with mixed results, and the US back pain guideline found too little evidence to recommend for or against it. Pilates has no trials in veterans but is named among the structured exercise programmes the same guideline suggests. Choose what you'll enjoy and keep doing.
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.
