Does Pilates Actually Help Joint Pain?

Written by the Nuvirox Research Team

Short answer: yes, with a genuinely consistent (if small-scale) evidence base behind it. Pilates shows up favorably across several independently run randomized controlled trials in knee osteoarthritis, improving pain, stiffness, range of motion, and physical function. It’s one of the more consistently positive exercise modalities in the joint-pain literature — the open question is less “does it help” and more “how much better is it than other supervised exercise, and for how long does the benefit last.”

Why would Pilates specifically help an arthritic joint?

It combines core and hip-stabilizer strengthening with controlled, low-impact movement through a full range of motion — which addresses several of the mechanical contributors to knee osteoarthritis pain at once. Weak hip and core muscles change how load is distributed through the knee during walking and standing. Pilates emphasizes precise, controlled movement and core engagement without the impact loading of running or jumping, which makes it a plausible fit for a joint that’s sensitive to both instability and high-impact stress.

What do the actual trials show?

Head-to-head against a standard isometric exercise program, Pilates came out ahead on both pain and function. An 8-week randomized controlled trial conducted at the National Orthopaedic Hospital in Bahawalpur, Pakistan, randomized women with knee osteoarthritis to either isometric exercises or Pilates, three one-hour sessions per week. Both groups improved significantly on pain, range of motion, and physical function — but the Pilates group showed significantly more improvement in pain and physical function than the isometric group.

A separate randomized controlled trial of mat Pilates in older women with knee osteoarthritis found significant improvements in functional capacity (measured by the SF-36 quality-of-life scale) and WOMAC scores after a twice-weekly, 60-minute protocol. And a 2023 pilot randomized controlled trial went further, testing whether adding pain neuroscience education before a Pilates program improved outcomes beyond Pilates alone — evidence that researchers are now refining how Pilates is delivered, not just whether it works at all.

What’s the honest counterweight?

These are small, short trials — typically a few dozen participants each, mostly women, run for 8 to 24 weeks. None of the available randomized trials followed participants for a year or longer, so it’s not clear how durable the benefits are once a supervised program ends, or whether the effect holds up in men, who are underrepresented in this specific research. As with most exercise-based osteoarthritis interventions, there’s also no way to fully blind participants to whether they’re doing Pilates or a comparison exercise, which leaves some room for expectation effects to inflate the reported benefit.

What Pilates won’t do

It won’t reverse cartilage damage, and going too hard too fast can aggravate an already-irritated joint. The trials that showed benefit used gradual, supervised progressions — not an intense studio class taken cold. See a doctor or physical therapist before starting if you have significant joint instability, recent surgery, or pain that worsens (rather than eases) with gentle movement.

How does Pilates fit alongside other exercise-based approaches?

Pilates isn’t unique in showing benefit for knee osteoarthritis — it joins a broader group of supervised, controlled-movement exercise programs that consistently outperform no treatment, and often perform comparably to (or better than) simpler strengthening protocols. What sets the Pilates trials apart somewhat is the direct, favorable head-to-head comparison against isometric exercise, a genuinely common first-line recommendation for knee osteoarthritis. That doesn’t mean Pilates is inherently superior to every form of exercise — it means that, among the exercise modalities tested so directly, it has held up well. For people who find generic strengthening routines boring or hard to stick with, the structured, class-based format of Pilates may also have a practical adherence advantage that isn’t always captured in a trial’s outcome measures but matters a great deal in real-world, long-term use.

Frequently asked questions

Mat Pilates or reformer Pilates — does it matter? The published trials used mat-based Pilates protocols, so that’s where the strongest evidence sits; reformer (equipment-based) Pilates hasn’t been separately tested in this population as far as the published literature shows.

How does Pilates compare to yoga for joint pain? Both show benefit in trials, though Pilates places more emphasis on core-driven, controlled strengthening while yoga blends flexibility, balance, and strength; see our coverage of yoga for joint pain for that comparison.

Is Pilates safe with hip or shoulder arthritis, not just knee? The strongest trial evidence is specific to knee osteoarthritis; the core-stability principles plausibly transfer, but you should adapt exercises to avoid provoking whichever joint is affected, and a qualified instructor can modify positions that load an arthritic hip or shoulder directly.

How soon might I feel a difference? The trials that reported significant results generally did so at the 8-week mark with 2–3 sessions per week — consistency mattered more than any single session.

Do I need special equipment to start? No — the trials with the strongest results used mat Pilates, which typically requires only a mat and, at most, small supplementary equipment like a resistance band or small ball, making it one of the more accessible exercise interventions in this research area.

What if I’ve never done Pilates before — is it too advanced for a beginner with joint pain? The trial protocols were specifically designed for people with knee osteoarthritis, not fitness enthusiasts, and used gradual progressions appropriate for beginners; look for a class or instructor experienced in working with joint pain rather than a general athletic Pilates class.

What if a session leaves me sorer than usual the next day? Mild, short-lived soreness after starting a new movement program is common and not itself a red flag; persistent swelling, sharp pain during a specific movement, or soreness that worsens rather than fades over 48 hours is worth bringing to whoever is leading your sessions so they can adjust the program.

FROM NUVIROX

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The bottom line

Pilates has one of the more consistently positive small-trial track records among non-drug knee osteoarthritis interventions, including outperforming a standard isometric program in a direct comparison. It pairs naturally with other movement-based approaches we’ve covered, including exercise for arthritic joints and swimming for arthritic joints, and it can reasonably sit alongside other modalities like dry needling as part of a broader plan.

References

1. Effect of Pilates based exercises on symptomatic knee osteoarthritis: A Randomized Controlled Trial. PMID: 35099429.
2. Effects of mat Pilates on older adult women with knee osteoarthritis: A randomized controlled trial. PMID: 36775508.
3. Rabiei P, Sheikhi B, Letafatkar A. Pain neuroscience education followed by Pilates in knee osteoarthritis: a pilot RCT. Arthritis Res Ther. 2023. DOI: 10.1186/s13075-023-03079-7.

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. This article is for informational purposes only and is not a substitute for professional medical advice.