Who should skip Pilates – and why?

Pilates is a low-impact exercise that strengthens your core and improves stability. Through controlled, precise movements – either on a mat or specialized equipment like a reformer – you engage muscles using resistance and breathing techniques. The workout offers many benefits, but it isn’t safe for everyone.

“Pilates can be a great way to improve posture, balance and flexibility,” says Dr. Jennifer Frank, a family medicine physician at Aurora Health Care. “However, some movements involve spinal flexion, twisting or weight-bearing positions that may not be appropriate for people with certain health conditions.”

Situations and conditions where Pilates may need to be avoided or modified:

Severe osteoporosis

If you have severe osteoporosis, approach Pilates carefully. The condition weakens bones and raises your risk of fractures.

Some Pilates movements involve bending forward or twisting the spine. “These movements can place stress on fragile vertebrae,” says Dr. Frank. “There is a risk of a spinal fracture if you aren’t cautious, so working with an instructor who understands safe modifications is important.”

Acute back or neck pain

Avoid Pilates if you’re experiencing sudden or severe back or neck pain. Exercises that require strong core engagement can worsen pain if you have a herniated disk, muscle strain or another injury.

“When someone has acute pain, it’s best to get a proper diagnosis before starting or continuing any type of exercise,” adds Dr. Frank.

High-risk pregnancy

Exercise is often encouraged during pregnancy, but some Pilates movements may not be safe for everyone.

People with high-risk pregnancies may need to avoid positions that involve deep twisting, lying flat for long periods or intense abdominal work.

Dr. Frank recommends reviewing your exercise plans with your obstetrician if you have a high-risk pregnancy.

Unstable joint hypermobility

Some people have joints that move beyond the typical range of motion. This is known as joint hypermobility, which is commonly referred to as being double-jointed.

While Pilates emphasizes flexibility, excessive joint movement can increase your risk of injury. Without proper guidance, certain Pilates exercises could overstress the joints.

To help prevent injury, focus on stability over flexibility. Controlled, smaller movements can help strengthen muscles that support your joints.

Recent surgery

Your body needs time to heal after surgery. Pilates movements may strain healing tissues or surgical areas.

Procedures involving your abdomen, spine, hips or knees often require activity limitations during recovery. “Even low-impact workouts like Pilates can be too much too soon,” Dr. Frank cautions.

When Pilates may still be possible

Avoiding Pilates doesn’t always mean giving it up completely. Many exercises can be modified to make them safer.

“In many cases, Pilates can still be beneficial with the right modifications,” Dr. Frank says. “Talk with your health care provider before starting Pilates and let your instructor know about your health condition so they can help protect your body.”

Overall, physical activity is important for everyone. Your health care provider can help advise you on what exercises may be more appropriate.

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