Does Pilates Help Knee and Hip Pain? What the Research Says
Exercise is the first-line treatment for osteoarthritis of the knee and hip, and hip strengthening is central to treating runner's knee. This page sets out what Cochrane reviews, randomised trials and guidelines say, and where Pilates-specific evidence stands.
8 studies and guidelines reviewed · Each one linked to its primary source · Last reviewed 1 October 2026
Yes. Cochrane reviews and NICE agree that therapeutic exercise reduces pain and improves function in knee and hip osteoarthritis. Randomised trials and two 2025 meta-analyses show Pilates helps knee osteoarthritis compared with no exercise; evidence for hip conditions and joint replacement is still early.
Several controlled trials support the effect, but sample sizes are modest or results vary between studies.
The general case is strong: exercise is a core treatment for knee and hip osteoarthritis in NICE guidance, with Cochrane reviews showing moderate pain and function benefits. The Pilates-specific case is moderate for knee osteoarthritis, where eight to eleven small randomised trials show gains over no exercise but not clearly over conventional exercise, and evidence certainty is low. For hip osteoarthritis and recovery after joint replacement, Pilates evidence is limited to a preliminary clinical report, so the rationale rests on general exercise research. For runner's knee, strong evidence supports hip-focused strengthening, which Pilates delivers.
Key findings from the research
- Land-based exercise reduced knee osteoarthritis pain by 12 points and improved function by 10 points on 100-point scales immediately after treatment, with smaller benefits still present two to six months later (Fransen 2015, Cochrane review of 54 trials).
- For hip osteoarthritis, exercise reduced pain by 8 points and improved function by 7 points on 100-point scales, with the pain benefit sustained at three to six months (Fransen 2014, Cochrane review of 10 trials).
- NICE lists therapeutic exercise, including local muscle strengthening and general aerobic fitness, as a core treatment for everyone with osteoarthritis, and notes pain may rise briefly when starting (NICE NG226, 2022 guideline).
- Eight weeks of Pilates improved pain and disability in knee osteoarthritis more than conventional therapeutic exercise, with both beating no treatment (Mazloum 2018, RCT).
- Pooling eight randomised trials, Pilates significantly reduced WOMAC pain-and-function scores compared with no intervention and reduced pain compared with health education, but evidence certainty was very low to low (Zhang 2025, meta-analysis).
- Across eleven trials, Pilates reduced knee osteoarthritis pain versus no intervention (SMD −1.09) and increased range of motion, but was not superior to conventional exercise (de Oliveira 2025, meta-analysis).
- Strong evidence shows that adding hip and trunk strengthening to quadriceps work reduces pain and improves function in patellofemoral pain, with hip-focused rehabilitation outperforming knee-only exercise (Lack 2015, meta-analysis).
The studies, one by one
Listed with design, year and a link to the original so you can check every claim. Findings are reported as the authors reported them.
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Exercise for osteoarthritis of the knee
Finding: Land-based therapeutic exercise reduced knee pain by 12 points on a 0–100 scale (95% CI 10 to 15) and improved physical function by 10 points (95% CI 8 to 13) immediately after treatment, a moderate effect. Two to six months after treatment ended, pain remained 6 points lower and function 3 points better than control.
Why it matters here: Any structured exercise programme, Pilates included, should be expected to produce moderate rather than dramatic improvement, and benefits fade without continued practice.
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Exercise for osteoarthritis of the hip
Finding: High-quality evidence showed exercise reduced hip pain (SMD −0.38; about 8 points on a 0–100 scale) and improved function (SMD −0.38; about 7 points) immediately after treatment, with a number needed to treat of six for each. The pain reduction was sustained at three to six months.
Why it matters here: Hip osteoarthritis responds to exercise, but the effect is smaller than for the knee; expectations should be set accordingly.
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Osteoarthritis in over 16s: diagnosis and management (NG226)
Finding: Therapeutic exercise tailored to the person, such as local muscle strengthening and general aerobic fitness, is a core treatment for all people with osteoarthritis, alongside weight management where appropriate. Supervised sessions should be considered. NICE advises that joint pain may increase when exercise starts, but regular, consistent exercise benefits the joints and long-term adherence increases the benefit.
Why it matters here: The UK standard of care is exercise first; a Pilates programme fits the recommendation when it includes progressive strengthening around the affected joint.
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The comparison of the effectiveness of conventional therapeutic exercises and Pilates on pain and function in patients with knee osteoarthritis
Finding: After eight weeks, both exercise groups improved significantly in pain, disability, functional performance and knee joint position sense compared with control (p<0.001). The Pilates group showed a significantly greater improvement in pain and disability than the conventional exercise group (p=0.003); proprioception gains were similar in both.
Why it matters here: The most-cited Pilates knee osteoarthritis trial is positive, but with 14 people per group it needs replication before claiming superiority.
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Pilates training for use in rehabilitation after total hip and knee arthroplasty: a preliminary report
Finding: Surgeons and Pilates instructors developed pre- and post-arthroplasty Pilates protocols modified to respect hip and knee replacement precautions. Early observation of a small series suggested the approach could be used without early complications, and the authors stated that controlled investigation was still needed. An earlier description of the regimen appeared in the Bulletin of the NYU Hospital for Joint Diseases (2007).
Why it matters here: This is feasibility evidence, not proof of effect; Pilates after joint replacement should follow the surgeon's precautions and standard rehabilitation milestones.
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Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis
Finding: Strong evidence showed that combining proximal (hip and trunk) rehabilitation with quadriceps exercise decreased pain and improved function in the short term, with moderate evidence at medium term. Moderate evidence also showed that proximal rehabilitation reduced pain more than quadriceps-only rehabilitation in the short and medium term.
Why it matters here: Runner's knee programmes should load the glutes and trunk, not just the front of the thigh, which is the emphasis of Pilates-based lower-limb work.
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The efficacy and safety of pilates exercise in patients with knee osteoarthritis: a systematic review with meta-analysis of randomized controlled trials
Finding: Compared with no intervention, Pilates significantly reduced WOMAC scores (SMD −1.70, 95% CI −3.14 to −0.25). Compared with health education, it reduced pain on a visual analogue scale by 1.74 points (95% CI −2.51 to −0.97). No significant advantage in range of motion was found over other exercise. Evidence certainty was very low for pain and low for range of motion.
Why it matters here: The direction is favourable but the confidence intervals are wide; larger, better-blinded trials are needed.
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Effect of Pilates Exercise on Health-Related Outcomes in Patients With Knee Osteoarthritis: A Systematic Review and Meta-Analysis
Finding: Pilates reduced pain versus no intervention (SMD −1.09, 95% CI −2.04 to −0.14; low-quality evidence) and increased knee range of motion (SMD 1.07, 95% CI 0.56 to 1.57; low-quality evidence). Against conventional exercise, there was no significant difference in pain (SMD −0.28, 95% CI −1.06 to 0.50; very low-quality evidence).
Why it matters here: Pilates is a legitimate exercise option for knee osteoarthritis, but the evidence does not support claiming it beats a physiotherapy strengthening programme.
How Pilates is thought to help knee & hip pain (osteoarthritis, replacement, runner's knee)
Osteoarthritic joints hurt more when the muscles around them are weak and the joint is loaded unevenly. Strengthening the quadriceps, glutes and hip abductors improves shock absorption and joint alignment, and the Cochrane reviews show this translates into less pain and better function. Pilates trains these muscles through controlled range with an emphasis on alignment, which suits painful joints that cannot tolerate heavy or fast loading.
Pilates also targets proprioception, the joint's sense of position. The Mazloum trial measured knee joint position sense directly and found it improved with exercise, which is relevant because impaired proprioception is common in osteoarthritis and after joint replacement.
For patellofemoral pain, the mechanism runs through the hip. Weak or poorly controlled hip abductors and external rotators allow the thigh to drift inward under load, increasing stress at the kneecap. Hip-focused rehabilitation, the kind Pilates delivers with side-lying and bridging series, reduces pain more than knee-only exercise in the meta-analysis evidence.
What the evidence does not tell us
- Pilates trials in knee osteoarthritis are small (mostly 14–30 people per group), short (8–12 weeks) and rated low or very low certainty by both 2025 meta-analyses.
- There are no randomised trials of Pilates for hip osteoarthritis or after hip or knee replacement; the only Pilates-specific evidence in arthroplasty is a preliminary clinical report.
- Head-to-head comparisons with conventional physiotherapy exercise show no consistent advantage for Pilates.
- Most trials excluded people with severe (Kellgren–Lawrence grade 4) osteoarthritis, significant comorbidities or planned surgery.
- Follow-up rarely extends beyond the end of the programme, so it is unclear how long benefits last without continued exercise.
Practical takeaways
- Exercise is the first-line treatment for knee and hip osteoarthritis, and a structured Pilates programme is a reasonable way to deliver it.
- Expect moderate improvement: roughly 10–12 points on a 100-point pain scale for the knee and a little less for the hip in the general exercise research.
- Some discomfort when starting is normal and expected by NICE; steady, consistent sessions matter more than intensity.
- For runner's knee, prioritise glute and hip strengthening alongside quadriceps work; hip-focused rehabilitation has the strongest evidence.
- After a hip or knee replacement, follow your surgeon's precautions and physiotherapy plan first; Pilates can be adapted to fit them but has not been trialled as a replacement.
- Keep going. Benefits in the Cochrane reviews faded within months of stopping, so plan for exercise as ongoing management.
Programmes built on this evidence
Each protocol below applies the principles above as a structured, progressive 8-week plan, with the exercises the trials actually used.
Frequently asked questions
- Does Pilates help knee osteoarthritis?
- The evidence points to yes. Two 2025 meta-analyses pooling eight and eleven randomised trials found Pilates reduced pain and improved function compared with no exercise or health education, and one trial found it outperformed conventional exercise. The trials are small and the certainty of evidence is low, so the honest summary is that Pilates works about as well as other structured exercise, which NICE and Cochrane both recommend as the core treatment for osteoarthritis.
- Is Pilates good for hip pain and hip osteoarthritis?
- Exercise in general helps hip osteoarthritis: a Cochrane review of ten trials found high-quality evidence of reduced pain and improved function, sustained for three to six months. No randomised trial has tested Pilates specifically for hip osteoarthritis, so the rationale is that Pilates delivers the hip strengthening and mobility work those trials used. Expect smaller gains than for the knee, and get hip pain assessed if it is severe, night-time or sudden.
- Can I do Pilates after a knee or hip replacement?
- Many people do, and a preliminary report from a New York orthopaedic team described modified Pilates protocols used before and after replacement without early complications. However, there are no randomised trials, so Pilates should complement rather than replace your surgeon's precautions and physiotherapy programme. Typical adaptations include avoiding deep hip flexion, crossing the legs or inward rotation after hip replacement, and progressing knee bending gradually after knee replacement.
- Does Pilates help runner's knee (patellofemoral pain)?
- The mechanism is well supported. A British Journal of Sports Medicine meta-analysis found strong evidence that adding hip and trunk strengthening to quadriceps exercise reduces patellofemoral pain and improves function, and that hip-focused rehabilitation beats knee-only work. Pilates lower-limb series load the glutes, hip rotators and trunk in exactly this way. No trial has tested Pilates by name for runner's knee, so the support is indirect but strong.
- How often should I do Pilates for knee or hip pain?
- The knee osteoarthritis trials mostly used two to three sessions a week for eight to twelve weeks, and the Cochrane reviews found benefits faded within months of stopping. NICE stresses that long-term adherence increases the benefit. A sensible plan is two or three sessions a week indefinitely, accepting that some joint discomfort when you start is normal and should settle as the surrounding muscles strengthen.
- Mat or reformer Pilates for knee and hip pain?
- Most osteoarthritis trials used mat Pilates, sometimes with small equipment, so that is where the evidence lies. Reformer springs can make it easier to load the legs in a controlled, partially supported way, which some people with painful joints find more comfortable, and it is widely used in rehabilitation settings. The essential ingredients, progressive strengthening of the quadriceps, glutes and hip abductors with good alignment, can be achieved with either.
Citing this summary
You are welcome to quote or link to this page with attribution. Please also cite the primary studies listed above.
Pilates Protocols, "Does Pilates Help Knee and Hip Pain? What the Research Says", https://pilatesprotocols.com/evidence/pilates-for-knee-and-hip-pain/ (reviewed 1 October 2026)Note. This page summarises published research for general information and is not medical advice. This page summarises published research for general information and is not medical advice. Sudden, severe or night-time joint pain, a hot swollen joint, locking, or pain after a fall needs medical assessment. If you have had a joint replacement, follow your surgeon's and physiotherapist's precautions before starting any exercise programme. Pilates Protocols programmes are educational products, not a substitute for individual clinical care.