How to Prevent Pain After Pilates?
After a small break I’m back on the Pilates support bandwagon, because I’ve had another group of patients come in with pain that is likely caused by a slight Pilates addiction.
If you want to nerd out and get all the anatomy and deeper workings of how Pilates could cause pain check out part one here and part two here.
When patients come in with pain or stiffness, we always chat about your body history, this includes work life (what position do you spend your days in), hobbies, and movement practices (yoga, weights, pilates, bjj, iron mans, etc), and big injuries or surgeries. These things start laying down the clues as to what might be happening in your body.
I’ve noticed a couple of patterns with patients who frequently do Pilates (or who might be obsessed with it). Specific neck and shoulder pain, or back and hip pain.
On the record, I love Pilates, I do it weekly. It was created to support practitioners' health and strength. Pilates is amazing for core strength and mobility, and absolutely supports people with chronic pain. But when pain creeps in, it can feel like something’s gone wrong.
Pain isn’t a sign that you need to quit Pilates, it’s your body’s way of asking for a new approach. Let’s look at ways to keep you practicing, in a sustainable way.
In this blog we’ll chat about:
✅ Common symptoms + causes
✅ What you can do if Pilates is causing you pain
✅ A quick post class routine to prevent pain
Common Symptoms + Causes
There are many reasons that you can get pain from Pilates. From previous injuries, to undertrained instructors. Here are some of the most common reasons people get injured during pilates as shown in some pretty cool (read: nerdy) research:
poor concentration leading to technique mistakes
teachers not explaining the anatomy and techniques properly
going through the exercises too quickly
over emphasis on core muscle activation, and
pain over function
Here is the article if you are interested!
Pain in Pilates shows up differently in everyone, and depends on how your body moves. Here are some common pain points and their possible causes:
Low Back Pain
Possible Causes:
Technique mistakes from poor instruction or concentration
Over-reliance on hip flexors or superficial muscles instead of deep core muscles
Too much lumbar flexion (rounding) or extension (arching)
Weak glutes or hamstrings, leading to compensation in the low back
Example Movement That Might Trigger It:
Leg lifts or teaser - if the hip flexors take over instead of the core
When the deep core isn’t engaging properly, movements like leg lifts can cause the hip flexors to take over, pulling on the pelvis and increasing stress on the lumbar spine.
Neck + Shoulder Tension
Possible Causes:
Overuse of superficial neck muscles instead of deeper postural support
Poor breathing mechanics (shallow chest breathing instead of diaphragmatic breathing)
Insufficient cool down leading to a contracted functional front line
Over engagement of superficial abdominal muscles
Example Movement That Might Trigger It:
Ab curl exercises where the head and neck lift without deep core engagement
This is a classic example of trying to advance too quickly, paired with technique mistakes. If you push yourself to do poses that are a little too challenging your body will compensate to find a way to do the action. That might mean neck muscles engage faster than your core muscles.
Hip Pain + Tightness
Possible Causes:
Going through the exercises too quickly
Technique mistakes from poor instruction or concentration
Constant gripping of hip flexors (instead of using the lower abs and glutes for control)
Lack of mobility in the pelvis and spine
Over-reliance on hip flexors instead of deep core muscles
Over engagement of hip extensors and external rotators
Example Movement That Might Trigger It:
Single-leg stretches or any movement that requires strong hip flexor engagement without proper core control
This is another classic example of trying to advance too quickly, paired with technique mistakes.
What you can do
A good first step if you have pain from a Pilates class is to chat with your teacher about your symptoms, and when you notice them. If it's a technique problem, a holistic and well trained teacher should be able to help you.
Here’s a technique check list:
Test Your Core Activation
Take a deep breath into your lower belly then engage your core. Feel for a gentle tension rather than a hard contraction.
Check Your Hip Flexors
If you grip through your hips, try lightly engaging your lower abs and pelvic floor first before lifting your legs.
Modify exercises by doing one leg at a time while you build strength.
Support Your Neck
If ab curls give you neck tension or headaches, go back to your breath-to-core engagement. You can practice engagement without any movement until you have a better connection with your deep core.
Focus on Breath & Control
Breathe through movements and focus on pairing your exhale with your deep core engagement.
Slow down the exercises to fine tune your muscle recruitment.
After addressing technique, my personal go to is to add in dynamic stretches after a workout. Dynamic stretches will help soothe the muscles you’ve worked during your class. Here is my go to routine:
Quick Dynamic Stretch Routine:
A chest opener
A hip flexor mobilizer
Deep diaphragmatic breathing
Gentle spinal range of motion
It is important to add in dynamic stretches of your front line for a couple of reasons
It helps maintain the mobility of your spine.
The big abdominal muscles and some of the deep muscles are attached to our ribs. One of the ways we achieve spinal flexion is by activating these muscles and pulling our ribs closer to our pelvis. Dynamic stretching takes these muscles and our spine through their full range of motion. This prevents us from getting stuck in a static flexed position.
It ensures that you maintain a healthy tone in your musculature
When you work out without a proper cool down your muscles stay primed at their peak capacity. While this sounds great it can lead to DOMS (delayed onset muscle soreness), muscle cramps, injuries, and progressive increase in tension. Doing dynamic stretches after Pilates encourages your body to return to a resting state, for your muscles, circulatory system, and nervous system. Dynamic stretching will help you maintain the work you’ve done in class, without putting strain on your body.
It helps in recovery
As you are moving through your full range of motion you are encouraging blood flow, supporting your diaphragm, and making space for your lungs to take deep nourishing breaths. All of these are vital for a fast recovery after a workout or a Pilates class.
It's important to note that mobility work does not mean static stretching or increasing flexibility. Mobility work is about the health of your joints, and being able to move your body into and out of positions.
Hot Pilates Rehab Questions 🔥
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Description tIn due time, gentle movement is an important part of a full recovery. The key is PEACE and LOVE. You’ll find the addition of movement at the end of LOVE.
Protect: Avoid movements that activate pain for 1-3 days
Elevate: Elevate the injured area higher than your heart as often as possible.
Avoid anti-inflammatories: Avoid anti-inflammatories (including ice!) as they reduce tissue healing.
Compress: Wrapping the area can help reduce swelling
Educate: Your body knows best! Let your body do its thing!
After day 3:
Load: Let your body guide you as you return to normal activities. Pain indicates that you should slow down.
Optimism: Your brain can affect your healing! Be confident and positive! Your body is already doing a great job!
→ Vascularization: Add pain free cardiovascular activity to boost blood flow. Increases blood flow (incl. White blood cells - our repair team)
→ Exercise: Take an active approach to healing! Exercise improves mobility, strength, proprioception, and reduces risk of reinjury.
I wrote a full article about this, so check it out if you need more of a deep dive on the subject.
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The most common types of injuries in Pilates are low back pain, neck and shoulder tension, and hip pain.
Prevention is absolutely the best way to avoid getting hurt. My top tips are:
Do a thorough warm up
Pay attention to technique instructions
Ask LOTs of questions about what anatomy you are using and get clarification on the technique directions
Go through the exercises slowly and progress at your own pace
Ask the instructor to help make sure you are engaging your deep core, rather than your superficial muscles.
Listen to your body when you are in pain!
Make sure to do a juicy cool down.
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Pain in these areas is often linked to improper muscle recruitment. If your neck hurts, your deep core may not be supporting your head lift. If your lower back aches, your hip flexors might be compensating for weak abs. Addressing imbalances and refining your technique can help.
But unfortunately, you’ll only get vague answers on the internet. The best way to get answers specific to your body is to go in person to a manual therapist (Osteopathic Manual Therapist, Physiotherapist, Chiropractor, Massage Therapist, etc.).
If you do have pain after a Pilates class, it’s important to find out why, specific to your body. You want to make sure you don’t have an underlying injury, or you’ll want to try to avoid making it worse by trying to fix it yourself (yes, I see this all the time in my clinic).
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Yes! (but I’m totally biased). Osteopathy is a great tool for people recovering from Pilates related injuries. By improving alignment, releasing excess muscle tension, enhancing circulation, and supporting lung function, it helps your body heal efficiently – so you can get back to your practice feeling strong.
Research shows that osteopathic manual therapy (OMT) has lasting benefits for neck and low back pain, restoring functional movement and reducing discomfort. Whether it’s a minor strain or a lingering issue, osteopathy supports a smooth, pain-free recovery!
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Absolutely! Pilates is incredibly adaptable, and modifications can help you move safely while still gaining all the benefits.
If you have a history of chronic pain or injuries, let your instructor know—they can tailor movements to support your body’s needs. Take it slow and listen to your body; gradual progress helps prevent flare-ups and builds strength in a sustainable way. Pilates should feel supportive, not painful!
Reframing perspectives
Pain during Pilates isn’t a sign of failure, it’s your body’s way of saying “Hey, look at this!”. By listening to your body and making small adjustments, you can move with more ease, strength, and confidence.
If pain persists, an Osteopathic Manual Practitioner (hi! 👋) can assess your movement patterns, restrictions, and nervous system function to help you move more freely and comfortably.
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Franke, H., Franke, J. D., & Fryer, G. (2014). Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC musculoskeletal disorders, 15, 1-18.
Langevin, H. M. (2021). Fascia mobility, proprioception, and myofascial pain. Life, 11(7), 668.
Licciardone, J. C., Brimhall, A. K., & King, L. N. (2005). Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC musculoskeletal disorders, 6, 1-12.
Nadler, S. F., Malanga, G. A., Bartoli, L. A., Feinberg, J. H., Prybicien, M., & DePrince, M. (2002). Hip muscle imbalance and low back pain in athletes: influence of core strengthening. Medicine & Science in Sports & Exercise, 34(1), 9-16.
Nadler, S. F., Malanga, G. A., Feinberg, J. H., Prybicien, M., Stitik, T. P., & DePrince, M. (2001). Relationship between hip muscle imbalance and occurrence of low back pain in collegiate athletes: a prospective study. American journal of physical medicine & rehabilitation, 80(8), 572–577. https://doi.org/10.1097/00002060-200108000-00005
Orrock, P. J., & Myers, S. P. (2013). Osteopathic intervention in chronic non-specific low back pain: a systematic review. BMC musculoskeletal disorders, 14, 1-7.
Parkhurst, T. M., & Burnett, C. N. (1994). Injury and proprioception in the lower back. Journal of Orthopaedic & Sports Physical Therapy, 19(5), 282-295.
Have questions about injury and pain prevention?
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