Pilates for weightlifters: bracing and breathing, hips and upper-back mobility, lower back, recovery, what the evidence shows, and a routine

Lifting injuries are uncommon

Weightlifting and powerlifting have about 1 to 4 injuries per 1,000 training hours, mostly to the lower back, knees and shoulders, low next to contact sports.

Sources 1, 2

No Pilates trial in lifters

Pilates was no better or worse than other exercise for strength in people who weren't training, and it doesn't replace progressive loading.

Sources 3, 4

Pilates breathing isn't a lifting brace

Pilates breathes out through pursed lips while you move. Heavy lifts use a braced trunk, which stiffened the spine more than drawing the belly in, in small lab studies of a few healthy men; no trial has compared them in lifters.

Sources 5, 6, 7

Timing

Long holds just before heavy sets cost a few per cent of force. Do Pilates after lifting or on a rest day, and lift first if strength is the goal.

Sources 8, 9

Mobility for the lifts

Squat depth went with ankle and hip bend, and arms overhead use upper-back extension. Pilates can work them; practise the lift itself so the range carries over.

Sources 10, 11

Leaking is common and treatable

Half of the women lifters in a Norwegian survey reported leaking urine. The NHS says to see a GP about any leaking, and pelvic floor exercises are among the first things a GP may suggest; our class leaves room for them.

Sources 12, 13

How oftenEmerging evidence

Across 9 mostly low-quality studies, weightlifting had 2.4 to 3.3 and powerlifting 1.0 to 4.4 injuries per 1,000 hours of training, mostly to the spine, shoulder and knee. Bodybuilding had fewer. Elite US weightlifters had 3.3 per 1,000 hours, and 90.5% of injuries cost a day or less of training; elite Swedish lifters had 2.6.

Sources 1, 14, 15, 16

WhereEmerging evidence

In weightlifting, the knee (21%), lower back (19%), hands and fingers and shoulder (15.3% each) led; in powerlifting, the lower back and pelvis (30.8%), shoulder (19.6%) and elbow and upper arm (8.0%). The lower back is mostly strains and sprains from squats and deadlifts.

Sources 2, 17

Aches that affect training are commonEmerging evidence

In 104 Swedish powerlifters, 70% had pain or an injury affecting their training at the time, and only 16% of them had stopped training.

Source 18

Teenage lifters' backsMixed evidence

In 12 young Japanese weightlifters scanned for 5 years, all had disc changes after 4 years and 7 had a stress fracture of the lower spine, though only 3 had back pain in the last year. It's a tiny study with no comparison group.

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

Source 19

Tendon tearsEmerging evidence

Of 664 pec tendon tears in 23 studies, all in men, 63% happened during weight training, and surgery did better than no surgery. Distal biceps tendon ruptures ran at about 2.6 per 100,000 people a year in a US database, mostly in men in their 40s, from the arm being forced straight against a heavy load.

Sources 20, 21, 22, 23

Leaking with liftingEmerging evidence

In Norwegian national-level lifters, 50% of 180 women and 9.3% of 204 men leaked urine, and most women with stress leaking said it hurt their performance. Across 5 studies of 1,809 women, 41% to 49% of powerlifters and 37% to 54% of weightlifters leaked, most often in the deadlift and squat.

Sources 12, 24, 2

What Pilates offers, and what it doesn't

Pilates trains trunk endurance while breathing, hip and upper-back mobility, single-leg balance and a lower-load session, on a mat or on spring-loaded equipment such as the reformer. It doesn't build maximal strength or muscle as well as progressive loading, replace coaching of the lifts, or prevent the injuries above (our reading).

Sources 25, 26

No Pilates trial in liftersStrong evidence

Our searches of PubMed, Europe PMC and ClinicalTrials.gov found no Pilates trial in weightlifters, powerlifters, bodybuilders or CrossFit athletes.

Source 3

Pilates and strengthMixed evidence

Across 11 trials in people who weren't training, Pilates was no better or worse than other exercise for strength, at very low to low certainty. In older women, Pilates and a resistance programme didn't differ on machine-measured strength in one trial, and core resistance training beat Pilates for trunk strength and leg power in another.

Sources 4, 27, 28

The deep tummy musclesMixed evidence

In 34 gym members, 8 weeks of unsupervised mat Pilates thickened the deepest tummy muscle only during a Pilates exercise, not when sitting or standing, while the strength training group gained more in the muscle above it.

Source 29

Pilates and stretching before a strength testMixed evidence

In 102 trained young adults, 3 holds of 30 seconds of Pilates-style or static stretching didn't change knee strength. One Pilates session in people doing high-intensity conditioning training was followed by better flexibility and wall-ball scores, with no comparison group.

Sources 30, 31

Pilates breathing during weight trainingMixed evidence

In 44 older adults, resistance training paced by Pilates breathing gained less ankle strength than the same training without it. It's one small trial, and not in lifters.

Source 32

Yoga in Olympic weightliftersMixed evidence

In the one trial of a mind-body class in lifters, 7 weeks of yoga changed neither flexibility nor power in 18 Olympic weightlifters, against a comparison group, as our yoga for weightlifters guide says.

Source 33

Core training in athletesEmerging evidence

Across 31 studies in athletes, trunk training improved trunk endurance most, and strength and power a little. It hasn't been tested in lifters.

Source 34

Strength training prevents injuriesStrong evidence

Strength training cut sports injuries to about a third across trials, and more volume meant more protection; stretching didn't help. No trial shows that bracing, belts, Pilates or core training prevent lifting injuries.

Sources 35, 36

Pilates breathing

Teacher-training schools teach breathing in through the nose and out through pursed lips, with a deep out-breath to draw in the deep tummy muscles. It's for steady, controlled movement at low load, and you breathe out on the effort.

Source 5

Bracing for heavy liftsEmerging evidence

Bracing means tightening the whole trunk at once. In small lab studies of a few healthy men, it stiffened the spine far more than drawing the belly in, and raised the pressure in the abdomen by about 116 mmHg against 10 for drawing in. A review of 22 trials found both techniques improved trunk stability measures, with few direct comparisons. No trial has compared them in lifters.

Sources 6, 7, 37, 38

The held breath near your maximumEmerging evidence

A brief held breath is close to unavoidable near your maximum or when a set goes to failure; its health risks are unconfirmed. Pressure in the abdomen was highest in heavy squats and lowest in the bench press. Blood pressure averaged 320/250 mmHg in 5 bodybuilders doing heavy leg presses, and a held breath raised it more than coached breathing in 44 young adults.

Sources 39, 40, 41, 42

BeltsMixed evidence

A belt raised the pressure in the abdomen in heavy deadlifts and squats, and added repetitions in a set to exhaustion, without making lifters steadier. A belt alone didn't change muscle activity; bracing did. No trial shows a belt prevents injury.

Sources 43, 44, 45, 46

How they fit together

Our reading: Pilates teaches you to keep your trunk steady while you breathe and your limbs move, and to breathe out on the effort, the default our breathing guide gives for most sets. Save the braced, held breath for heavy sets in the gym, and skip it altogether with high blood pressure, heart disease, glaucoma, a hernia, recent surgery or in pregnancy, as our guide to breathing when lifting explains.

The diaphragm and back painMixed evidence

Elite weightlifters with long-lasting back pain had smaller diaphragm movement on ultrasound than those without. It's a one-off measurement, not evidence that breathing training helps.

Source 47

The squatEmerging evidence

In 101 adults, squat depth went with ankle bend and hip bend in men, and with ankle bend and shin strength in women; in 20 people it went with ankle bend in a lunge. These are lab associations.

Sources 10, 48

Arms overheadEmerging evidence

Raising both arms took the upper back about 10 to 13 degrees towards extension in 21 men, varying between people.

Source 11

What we'd work on

Our reading: the knee-to-wall rock and 90/90 switch for the squat, hip hinge practice and a strap hamstring stretch for the hinge, and thoracic rotation, wall angels and upper-back extension on a foam roller for overhead work. No trial shows a Pilates or yoga programme deepens a loaded squat, so practise the lift with light weight so the range carries over.

Movement control isn't the whole storyMixed evidence

In 40 Swedish powerlifters, scores on a 7-test movement control battery didn't differ between the 12 with back pain and the 28 without. Don't assume back pain from lifting is a control problem Pilates must fix.

Source 49

Where Pilates fits

Our reading: trunk endurance while breathing (the dead bug, bird dog, side plank and Pallof press), hip strength and gentle back extension can sit beside a sensible return to lifting. Keep back extension small if arching hurts, and follow our back pain guides for what to change in the lifts.

Long holds just before heavy lifts cost a littleStrong evidence

Static stretching just before activity cut performance by 3.7% on average: 4.6% with holds of 60 seconds or more per muscle and 1.1% with shorter holds, with no clear loss when moving came afterwards. Across 104 studies, strength fell 5.4%. An international expert panel advises against holds over 60 seconds per muscle before maximal or explosive efforts.

Sources 8, 50, 51, 52

Lift firstStrong evidence

If strength is the goal, lift first: the American College of Sports Medicine's position stand puts strength work at the beginning of the session.

Source 9

Count it as trainingStrong evidence

The International Olympic Committee (IOC) says poor management of training load is a major risk factor for injury. A hard reformer class is a session, not a rest day.

Source 53

A week with Pilates

Our suggestion: keep lifting as you do now, and add Pilates once or twice a week, 20 to 30 minutes, after lifting or on a rest day. Not in the hour before heavy sets. Our guide to Pilates and strength covers doing both on the same day.

What helpsMixed evidence

In 480 women powerlifters, leaking was less severe in those who had had a pelvic floor assessment or could do the exercises correctly. In 3 lifters given 12 weeks of home pelvic floor training, one improved, one stayed the same and one got worse. Our reading: see a pelvic health physiotherapist, train the pelvic floor most days, and adjust breath and load in the deadlift and squat. Pilates classes can include the pelvic floor exercises, but Pilates alone isn't a proven fix.

Sources 54, 55

The hour before heavy lifting

No long holds and no hard trunk session; a few minutes of breathing and mobility can go in your warm-up (our suggestion).

Sources 8, 52

Breath holds

Pilates moves are done breathing. Save the braced breath for heavy sets in the gym, and leave it out altogether with the conditions in the breathing section.

After a pec or biceps tendon injury

Leave out the Pilates push-up, leg pull back and leg pull front until your surgeon or physiotherapist clears pushing (our suggestion).

A shoulder that slips at the bottom of a press

Leave out moves that load the arm near the end of its range (the leg pull back, push-up and side bend) and end-range shoulder stretches until a physiotherapist clears them.

Stop an exercise, or shrink its range, if you get the feeling the shoulder is about to slip out (editorial).

Back pain that's worse arching

Keep the swan, swimming and other back extension small, and get it checked if it lasts, especially in a teenage lifter.

Chest pain or fainting: call 999

Call 999 if:

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

Sources 56, 57

Unusual breathlessness

Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.

Source 58

A sudden, severe headache: call 999

Call 999 for a headache that "started suddenly and is extremely painful", or one with weakness in the face, arm or one side of the body, trouble speaking or loss of vision. Ask for an urgent GP appointment or call NHS 111 for a headache "triggered or made worse by coughing, sneezing, bending down or exercising".

Source 59

Numbness, tingling or weakness in a leg

Call 999 or go to A&E: loss of feeling or numbness around the genitals or bottom, new trouble peeing or controlling your bladder or bowels, changes in genital sensation during sex or problems with erections or orgasm, or pain, tingling, weakness or numbness in both legs. These are signs of cauda equina syndrome, which needs treating in hospital urgently. Don't drive yourself.

Same day: leg weakness that is getting worse.

Same day (urgent GP appointment or NHS 111): new difficulty lifting the front of your foot or toes (foot drop), or a foot that slaps down or catches as you walk, especially if it is getting worse. Weakness in both legs, or with numbness around the genitals or bottom or bladder or bowel changes, is the 999 emergency above.

Pain, tingling or numbness spreading below the knee that isn't settling after a few weeks, is getting worse or stops your normal activities: see a GP.

Sources 60, 61

Numbness, tingling or weakness in an arm

Same day (urgent GP appointment or NHS 111): severe neck pain that starts suddenly or gets worse quickly; heaviness or weakness in the arms or legs; pins and needles in an arm along with neck or arm pain; or pain between the shoulder blades.

Source 67

A pop or tearing feeling

Each tendon's own guide gives its own advice:

• Same day (NHS 111 or an urgent treatment centre): a pop or tearing at the front of the armpit or chest during a lift, a dip or a tackle, followed by bruising into the chest or upper arm, a change in the shape of the chest or armpit (a thinner or lost armpit fold, or a chest or nipple that looks uneven), or weakness pushing. Don't wait for it to settle: it can be a torn pec tendon, and repairs done within about 6 weeks did better than later ones.
• Urgent treatment centre or A&E: a pop or snap and sudden pain during an effort, which could be a torn tendon. At the front of the elbow, with bruising and a bulge in the upper arm, don't wait for it to settle: a torn biceps tendon is best repaired within the first 2 to 3 weeks. If it happened weeks ago, still get it checked: repair is often still possible, though it may need a tendon graft.
• Same day: a pop or tearing feeling at the front of the knee after a fall, stumble, jump or landing, then you can't straighten the knee or lift the straight leg off the bed, there's a dent above or below the kneecap, or the kneecap sits higher or lower than on the other side. Go to A&E or an urgent treatment centre, or get help from NHS 111. A torn quadriceps or patellar tendon does best when it's repaired soon.
• Same day: a sudden snap or pop at the back of the heel or calf, or a feeling of being kicked there, then walking flat-footed and being unable to push off, stand on tiptoe or climb stairs. It could be an Achilles tendon rupture or a broken heel bone. Go to A&E or a minor injuries unit, or contact NHS 111.
• Stop if you feel a sudden sharp pain, a snap or a pop at the back of the thigh during a stretch: it may be a hamstring strain. Get help from NHS 111 if it's very painful or getting worse, there's a lot of swelling or bruising, it hurts to walk or stand on the leg, or the leg feels very stiff. Our hamstring strain guide has more.

Sources 68, 21, 69, 70, 71, 72, 73

A shoulder that slips

Call 999 or go to A&E: after a fall or injury, or after the bar came down on you or the shoulder slipped during a press, your shoulder looks out of place or has changed shape, or you cannot move your arm. Do not drive yourself, and do not try to put it back in yourself.

See a doctor or physiotherapist if your shoulder has partly or fully come out of joint, or you worry it might, including a clunk or a feeling it will slip with the arm low and back at the bottom of a press.

Source 62

Very flexible joints

If you're hypermobile, don't use mobility work to push further: the NHS says "do not overextend your joints just because you can". See a GP if you think you have joint hypermobility syndrome: for example, your joints keep dislocating, or you keep getting sprains, strains, pain or stiffness.

Source 63

Stop the session if

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 64

Before you start

The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.

Source 64

"Pilates makes lifters weaker"Emerging evidence

No trial shows it. Long passive holds just before heavy sets cost a few per cent of force, so do Pilates after lifting or on rest days; short Pilates-style stretches didn't change strength.

Sources 8, 50, 30

"Pilates builds a natural weightlifting belt"Mixed evidence

In a lab model, the deepest tummy muscle added very little to spine stability and bracing the whole trunk far more, and Pilates thickened that muscle only during a Pilates move.

Sources 6, 37, 29

"Draw your belly button in before a heavy lift"Emerging evidence

Drawing in didn't reduce trunk movement under sudden loads in a lab study, while bracing did. Use Pilates breathing for control work and a brace for heavy lifts.

Sources 7, 38

"Pilates can replace weight training"Strong evidence

Pilates was no better than other exercise for strength, and strength and muscle come from progressive loading, as our guide to Pilates and strength explains.

Sources 4, 9

"Leaking when you lift is normal, so ignore it"Strong evidence

It's common, about half of women lifters in one survey, but treatable: the NHS lists pelvic floor exercises among its first treatments. Women powerlifters who'd had a pelvic floor assessment leaked less severely.

Sources 12, 13, 54

"Pilates flushes lactic acid and speeds recovery"Mixed evidence

A Pilates teachers' body says so, but 4 weeks of gentle mat Pilates didn't significantly change lactate in active women. A rest-day class can feel good; it isn't a recovery treatment.

Sources 65, 66