You may have heard that Pilates is one of the safest forms of exercise. Or perhaps you’ve been advised to avoid certain movements, or even exercise altogether, because of an injury or orthopaedic condition.
So, does having a medical condition mean Pilates is no longer an option?
Not necessarily. Exercise is not one-size-fits-all, and Pilates is no exception.
As Pilates instructors, we often meet people who are unsure whether they can safely participate in a class. They may be managing ongoing pain, recovering from an injury, navigating a joint condition or experiencing changes in their bodies during pregnancy.
The important thing to understand is that Pilates exercises can often be adapted to suit an individual’s needs.
The same exercise might be appropriate for one person but need to be modified or temporarily avoided by someone else, even if they have the same diagnosis. It depends on several factors, including their symptoms, medical history, stage of recovery and what their body can comfortably tolerate.
Let’s look at some common examples.
1. Osteoporosis
Osteoporosis affects bone strength and can increase the risk of fractures. However, it does not automatically mean you need to stop exercising or practising Pilates.
Movements and exercises to explore:
- Postural awareness and alignment.
- Balance and stability exercises.
- Controlled strengthening movements.
- Supported standing exercises and appropriately selected Reformer work.
Movements that may need modification:
Exercises involving repeated, uncontrolled or heavily loaded spinal flexion, such as certain Roll Downs, Roll Ups and Roll Overs, may need to be adapted, particularly for people with spinal fractures or a high fracture risk.
The focus should be on controlled movement, appropriate strengthening and protecting the spine while maintaining activity.
2. Disc Herniation and Lower Back Pain
Disc-related conditions and lower back pain can affect people differently. Some movements may feel comfortable, while others may aggravate symptoms.
Movements and exercises to explore:
- Comfortable, controlled Reformer Footwork.
- Gentle core activation.
- Supported bridging, where appropriate.
- Exercises that encourage comfortable movement and stability.
Movements that may need modification:
Exercises such as Roll Ups, Spine Stretch or spinal rotation may need to be adjusted or temporarily removed if they increase symptoms.
The aim is not to push through pain, but to find movements that support strength and confidence without aggravating the condition.
3. Knee Osteoarthritis
Knee osteoarthritis can affect joint comfort, mobility and the ability to perform certain movements. However, appropriate strengthening can form part of an individual’s exercise routine.
Movements and exercises to explore:
- Controlled Reformer Footwork within a comfortable range.
- Supported bridging.
- Appropriate standing and functional strengthening exercises.
- Gradual, controlled movement.
Movements that may need modification:
Deep squats, lunges or exercises involving heavier resistance may need to be adjusted, particularly during painful flare-ups or when the movement increases discomfort.
The focus is on finding a suitable range of movement and gradually building strength without unnecessarily aggravating the knee.
4. Joint Replacements and Recent Surgery
Returning to exercise after a joint replacement or surgery requires additional care. The type of procedure, healing stage and individual rehabilitation plan all influence which movements are appropriate.
Where to start:
- Follow your surgeon’s and physiotherapist’s recommendations.
- Begin with exercises appropriate to your stage of recovery.
- Prioritise supported, controlled movement where cleared.
- Gradually progress as your recovery allows.
What to be mindful of:
Certain ranges of motion, positions, resistance levels and exercises may be restricted during recovery. Advanced movements should not be introduced until you have received the appropriate clearance.
Your rehabilitation plan should always take priority over a general Pilates programme.
5. Spinal Fusion
Following spinal fusion surgery, exercise needs to be approached according to the procedure performed and the individual’s stage of healing.
Movements and exercises to explore, when cleared:
- Breathing exercises.
- Postural awareness.
- Gentle core activation.
- Controlled strengthening within the permitted range.
Movements that may need modification:
Spinal flexion, extension, rotation and heavier loading may be restricted during recovery. The appropriate movements and timing for reintroducing them should be guided by your surgeon or physiotherapist.
The goal is to support recovery without placing unnecessary stress on the healing area.
6. Shoulder Injuries
Shoulder injuries can affect strength, mobility and the ability to comfortably bear weight through the arms.
Movements and exercises to explore:
- Controlled shoulder movements within a comfortable range.
- Appropriate resistance exercises.
- Scapular stability and control.
- Gradual strengthening as symptoms allow.
Movements that may need modification:
Heavy overhead movements, planks, push-ups and exercises that place significant weight through the shoulders may need to be adjusted or avoided if they aggravate symptoms or are not yet appropriate.
The focus is on rebuilding strength and control progressively, rather than forcing the shoulder into movements it is not ready for.
So, Is Pilates Completely Contraindicated?
In many cases, no. Having an orthopaedic condition or recovering from an injury does not automatically mean you have to give up Pilates.
However, there are situations where a particular exercise, class or form of exercise may be temporarily unsuitable. Some people may need individual rehabilitation before returning to group classes, while others may be able to continue with a modified programme.
Often, an exercise can be adapted by changing:
- Position: Finding a more comfortable or supported starting position.
- Range of motion: Working within a suitable range rather than forcing the full movement.
- Resistance: Adjusting spring tension or equipment resistance.
- Repetitions: Changing the number of repetitions to suit your current capacity.
- Support: Using equipment or assistance to make a movement more manageable.
Sometimes a small adjustment is all that’s needed. In other situations, an exercise may need to be temporarily removed and replaced with something more appropriate.
This is why individualised programming and good communication between the client, instructor and healthcare professional matter.
The Importance of Finding the Right Pilates Approach
Pilates should never be about forcing your body through movements it is not ready for. It should be about understanding your body, finding appropriate ways to move and building strength progressively.
Before starting or returning to Pilates after an injury, surgery or diagnosis, speak to your doctor or physiotherapist about what is appropriate for you. Make sure your instructor knows about your condition, symptoms and any movement restrictions or recommendations you’ve received.
At Nova Pilates, we believe movement should be individualised, progressive and appropriate for the person doing it.
Your body is not the same as anyone else’s. Your Pilates practice shouldn’t have to be either.
Whether you’re managing a condition, returning to exercise or simply looking for a way to build strength and improve mobility, the right guidance can help you make informed choices about movement.
Move with intention. Build with confidence. Find what works for you.
Explore Pilates at Nova Pilates