Pilates Injuries & Safety: A Guide for Athletes

This article contains affiliate links: if you buy through them we may earn a commission, at no extra cost to you. Learn more.

Saturday morning, the week after the season ends. A college midfielder signs up for her first reformer class, clips her feet into the straps, and the carriage slides out faster than she expected. Nothing happens, this time. Pilates is one of the most controlled, low-impact things an athlete can add to a week, and that’s exactly why people forget it can hurt you: a spine rolled forward one time too many, a neck that does the work the abs should, a spring that wasn’t hooked right. This page covers the Pilates injuries and accidents that keep coming up, who should modify, how to prevent problems and when to see a professional, for high school and college athletes, pros, older athletes and anyone doing mat or reformer classes alongside their sport.

This page is general information, not medical advice. If you’re hurt, see a sports medicine doctor, physical therapist (PT) or certified athletic trainer (AT). For the big picture, start at our Pilates for athletes hub.

How risky is Pilates?

Honestly, nobody has counted well. Unlike yoga, Pilates doesn’t have a large national injury study behind it; we couldn’t find one. What we do know comes from three places. First, general fitness data: in an Australian study of emergency-department visits for injuries at fitness facilities, overexertion was the most common cause overall (36.2% of cases) and the main cause in group exercise classes (35.9%). Pushing too hard, not the equipment, is the usual story. Second, incident reports from the equipment side, collected by the fitness industry (below). Third, clinical guidance on who should change what, mainly for bone health and pregnancy.

The good side of the evidence: for adults with non-specific low back pain, a Cochrane review of 10 trials (510 people) found low- to moderate-quality evidence that Pilates reduced pain and disability compared with minimal intervention, but no clear difference in disability compared with other types of exercise. That’s about back pain managed with a clinician, not a reason to push through a fresh injury.

Overflexion of the spine

A lot of the classic mat repertoire rounds the spine forward: the roll-up, rolling like a ball, the hundred, the teaser, spine stretch forward and rollovers. For most healthy athletes, done with control, that’s fine. The problems start with volume and force: dozens of flexion reps in one class, momentum to get up, or someone pressing you deeper in a stretch.

Where it really matters is bone health. In an older study of 59 women with postmenopausal spinal osteoporosis, new spinal fractures over follow-up occurred in 89% of those given flexion exercises, compared with 16% of those given extension exercises. It was small and is now decades old, but it shaped how clinicians teach people with low bone density. A later case series from the same researcher described three healthy people with low bone mass who developed pain or fractures after yoga flexion positions. The Bone Health & Osteoporosis Foundation advises people with osteoporosis or spinal fractures to avoid exercises that bend forward from the waist, such as sit-ups, crunches and toe touches, and says yoga and Pilates may need to be avoided or modified because they often involve bending and twisting.

Who that touches in sport: older masters athletes, athletes in sports with a known risk of low bone density (distance runners, dancers, gymnasts and others with low energy availability), and anyone told by a doctor they have osteopenia or osteoporosis. If that’s you, ask your doctor or PT which movements fit, and tell your Pilates teacher before class. Many teachers know how to swap flexion for neutral-spine and extension work.

Neck strain

The most common complaint after a first mat class is a sore neck, not sore abs. In the hundred, the chest lift and the single-leg stretch, the head is lifted for a long time, and when the abdominals tire, the neck takes over: chin pokes forward, the front of the neck strains. Practical fixes many teachers use:

• Head down is fine. Keep the head on the mat (or on a folded towel or block) for some or all reps, especially early on.
• Support it. Lace your hands behind your head and let them carry the weight; don’t pull on the neck.
• Look toward your knees, not the ceiling, and keep space between chin and chest.
• Skip the rollover and the jackknife (and anything that loads the neck with your legs overhead) if you have a neck injury, a history of concussion or neck symptoms, until a clinician clears you.

Reformer springs, straps and carriage accidents

Pilates machines are spring-loaded, and most serious equipment incidents come from springs, straps or a carriage that moves when you didn’t expect it. Incidents described by IDEA Health & Fitness Association include a Wunda Chair spring that pulled free because of a loose bolt, so the bar snapped down and broke a client’s toe; a trapeze-table bar that hit a client in the face because the safety chain wasn’t secured; and clients who fell from the reformer during standing work when the carriage released quickly, with back and shoulder injuries. EMD UK, a group-exercise body, warns about a “catapult effect” in tall-kneeling and standing reformer work and about loose or mismatched ropes pulling people off-center.

• Check before you load. Springs hooked properly, straps or ropes even, headrest and footbar set, and the carriage still before you step or kneel on it.
• Change springs with the carriage home and no load on it, and never let go of a loaded strap or bar.
• Standing and kneeling work: three points of contact and a teacher watching. EMD UK suggests leaving standing rope work out of group classes and keeping groups to about six, ten at most.
• Studio basics: IDEA recommends at least 30 inches between reformers, inspecting springs quarterly and replacing them every 2 to 3 years under heavy use. If the equipment looks worn, say something.
• Grip socks help feet stay put on the footbar and platform; many studios require them.

Who should modify (and ask first)

• Pregnancy. The American College of Obstetricians and Gynecologists (ACOG) considers modified yoga and Pilates safe in pregnancy as long as positions that reduce blood return to the heart are avoided, advises against lying flat on the back for long periods, and advises avoiding “hot” yoga and Pilates. Prenatal classes and a teacher trained in pregnancy are the simple route; check with your obstetric provider first.
• Osteoporosis, osteopenia or a past spinal fracture. Follow your doctor’s guidance; the Bone Health & Osteoporosis Foundation says forward bending and twisting at the waist should be avoided or modified.
• A current or recent injury, or surgery. Get a plan from your surgeon or PT. Clinical Pilates, taught by physiotherapists, exists for exactly this.
• Back pain that goes down a leg, neck pain with arm symptoms, or a concussion you’re still recovering from. Wait for clearance.
• Very flexible athletes (dancers, gymnasts, swimmers): the risk is going further than you can control. Work on control in the middle of your range, not on depth.

How to prevent Pilates injuries

• Find a trained teacher and tell them your sport and injuries. In the US, the National Pilates Certification Program’s comprehensive exam requires at least 450 hours of training covering mat, reformer, Cadillac, chair and barrels; it’s a voluntary credential, so also ask about experience with athletes.
• Start on the mat or in a beginner reformer class, not a fast-paced fusion class, and learn spring settings before standing work.
• Control over reps. Momentum is how flexion exercises become strains. Fewer, slower reps beat more, faster ones.
• Don’t stack it on a wrecked day. A hard reformer class the day after a heavy game or lift adds load; see Pilates in your training for how to fit it into a season.
• A dense mat protects the spine in rolling exercises on hard floors.

Gear that helps: a thick, dense mat like the Manduka PRO for rolling work, grip socks such as toesox Half Toe Grip Socks for the reformer, and a foam block from the Gaiam Block & Strap Combo to rest your head on when your neck tires. For aches outside class, see our foam roller guide.

When to see a sports medicine doctor, PT or athletic trainer

• Right away (emergency): a fall from equipment with a head or neck impact, sudden severe back or neck pain, or numbness, tingling or weakness in the arms or legs. Head impact: follow the CDC HEADS UP approach, stop and get checked.
• Within a day or two: a pop or sharp pain in a muscle, back pain after a rolling exercise that doesn’t settle, or a joint you can’t put weight on.
• Soon: neck or back pain that comes back every class, pain that lasts more than a few days, or pain at night or at rest. If you have known low bone density and new back pain, don’t wait.

A sports medicine physician diagnoses and decides on imaging; a PT guides rehab and can tell you which Pilates exercises to keep, change or drop; your school or club athletic trainer can often take the first look. Tell them you do Pilates. For the other mind-body option on our site, see yoga injuries; for your main sport, its own injuries page, for example soccer injuries. More on gentle sessions after hard weeks: Pilates for recovery.

Pilates injuries and safety: FAQs

Is Pilates safe for athletes?

For healthy athletes taught by a trained teacher, it’s one of the lower-risk things you can add to a week. The risks come from overdoing flexion, letting the neck do the work, and reformer accidents with springs, straps or a moving carriage. Tell your teacher about your sport and injuries.

Why does my neck hurt after Pilates?

Usually because the head is lifted for long sets (the hundred, chest lifts) and the neck takes over as the abs tire. Rest your head down between reps, support it with your hands, and look toward your knees. If neck pain persists or comes with arm symptoms, see a professional.

Can I do Pilates with osteoporosis?

Ask your doctor first. The Bone Health & Osteoporosis Foundation advises avoiding forward bending at the waist, such as sit-ups and toe touches, and says Pilates may need to be modified. A teacher who knows bone-safe Pilates can swap rolling and twisting exercises for neutral-spine and extension work.

Is Pilates safe during pregnancy?

ACOG considers modified Pilates safe in pregnancy if you avoid positions that reduce blood flow back to the heart, such as lying flat on your back for long periods, and avoid hot Pilates. Check with your obstetric provider and look for a prenatal class.

Is reformer Pilates more dangerous than mat?

It adds equipment risk: springs, straps and a moving carriage. Reported incidents include falls during standing work and bars or springs releasing. With a trained teacher, small classes, checked equipment and three points of contact in standing work, many athletes use it safely.