Pilates Exercises – Are Your Pilates Reformer Exercises Pelvic Floor Safe?

This Pilates exercises Physiotherapist article outlines 7 Pilates exercises using equipment to avoid or modify with pelvic floor dysfunction.

Pilates studio exercises use specific Pilates equipment to perform a wide range of Pilates exercises. The traditional equipment developed by Joseph Pilates comprises: The Cadillac (or trapeze table), The Reformer (shown here), the Wunda Chair, Low and High barrels and a variety of small apparatus.Pilates reformer exercises

Studios offer individual and small group exercise sessions that usually involve a ‘tailored’ exercise program to suit the client’s needs. Some Pilates studios and gyms offer ‘Reformer classes’ where multiple, low to the ground or ‘a ll egro’ reformers are used and clients all work together.

The Pelvic floor muscles are part of our ‘Deep Core’ muscles and can be difficult sometimes to activate and maintain in a co-ordinated way when we add in the more demanding mat and studio exercises.

Studio equipment based Pilates exercises can be an excellent way to assist and control some of these more demanding mat exercises. All the Pilates exercises listed below are great if you are able to maintain your pelvic floor muscle lift and breathing control. These exercises can have the potential to increase pressure upon the pelvic floor.

7 Pilates exercises – equipment with potential for pelvic floor dysfunction

Pilates exercises – Reformer based

1. Supine Arm series

2. Standing side split series

3. Long stretch series

4. Quadruped

5. Reverse abdominals

Pilates exercises – Cadillac (trapeze table)

6. Rolling down

7. Teaser prep

These exercises are all described in detail below. They are commonly taught, and often in ‘group reformer classes’. With the exception of the long stretch series these studio exercises if modified correctly can be used to assist clients with pelvic floor dysfunction.

A. Pilates Reformer exercises and pelvic floor safe exercise

1. Supine Arm Series

Pilates exercises

This exercise is performed lying on your back on the reformer with legs in ‘table top’ position. Hands are holding the reformer straps and a series of arm pulling exercises are performed.

The ‘tabletop’ position is a difficult position for some women to maintain.

The added load of moving the reformer against spring and body weight resistance may increase the IAP (intra abdominal pressure) and overload causing downward pressure on the pelvic floor muscles.

2. Standing Side Split Series

Pilates exercises


This exercise is performed in standing sideways. The standing legs ‘open wide’ position may be too much of a challenge for some women who may brace and bear down with the increased  IAP (intra abdominal pressure) onto their pelvic floor muscles



3. Long Stretch Series

Pilates exercises


This exercise combines upper body and core strength, similar to the mat push up. The carriage movements will alter the intensity of this challenging ‘Core’ exercise.

This exercise position into ‘plank’ may cause raised IAP (intra abdominal pressure) beyond the strength of the pelvic floor muscles.


4. Quadruped

Pilates reformer and pelvic floor

This exercise is performed on all 4s and is a great progression from lying on your back, to hands and knees. The carriage is moved out and in by using coordinated movements that challenge the trunk and upper body strength.

This all fours position is often used in Pilates exercise and is an excellent alternative to sitting when gaining awareness and control of the pelvic floor muscles. The resistance of the springs, outward distance of the carriage and speed are all factors that may overload the pelvic floor muscles.


5. Reverse Abdominals

Pilates reformer pelvic floor safe exercises

This exercise facing the head end of the reformer uses the movement of the hips and knees on the carriage to strengthen the Rectus Abdominis (or “six pack muscles”)

In this pelvic floor muscle ‘aware’ position of 4 point kneeling; the whole trunk is working. Care must be taken not to overload the pelvic floor in an attempt to ‘work’ the ‘six pack’.


B. Cadillac exercises and pelvic floor safe exercise

6. Rolling Down.

Pilates pelvic floor


This exercise performed on the Cadillac is an assisted abdominal roll down using springs and a bar to help support the trunk movement.

Care must be taken not to hold the breathe and lose the pelvic floor muscle connection on the concentric roll up phase of the exercise


7. Teaser Prep

Teaser Prep Cadillac exerciseThis mini roll-up on the Cadillac uses the push through bar and springs to assist the chest raise.

Keeping neutral spine and working through a small range with  adequate spring support will help to avoid excessive increases in  IAP (intra- abdominal pressure)



If you are concerned that your Pilates exercises may be too demanding for your pelvic floor then seek help from a Women’s Health Physiotherapist working with your Pilates teacher.

Expert article with many thanks to Vanea Atwood Physiotherapist in Women’s Health. Vanea practices at Sports Focus Physiotherapy on Sydney’s lower North Shore, in the suburb of Northbridge. www.sportsfocusphysio.com.au


Vanea Attwood is a physiotherapist with qualifications in Pilates in addition to specialised training in continence and women’s health. She has a special interest in assessment and treatment of women with concerns about their pelvic floor muscle function. She combines her assessment skills in Women’s Health together with her Pilates and exercise rehabilitation knowledge to empower women of all ages to exercise in a ‘pelvic floor safe’ way. Vanea is passionate about helping other exercise health professionals understand the need for ‘pelvic floor first’ education when dealing with women of all ages.


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  1. This article was excellent. Is there any chance you could do a similar one for Pilates mat work, listing the potentially unsuitable exercises and possible alternatives?

  2. Exercise no 6, Rolling down, looks similar to rowing. I used a rowing machine pre prolapse surgery but am worried about using now that I have had the repair. Is this a valid concern?

    • Rowing and prolapse repair

      Hi Jan

      Yes I do believe that rowing is a potential concern after prolapse surgery. I think the amount of pressure exerted on your pelvic floor with rowing is potentially influenced by a number of factors…
      1. How much resistance you use when rowing (keep resistance to a minimum for pelvic floor safe exercise)
      2. How much you lean foward on the return from the outward row (try to keep your spine tall throughout and minimnise the lean forward reach component)
      3. The strength and function of your pelvic floor to support your prolapse repair during this particular resistance exercise.

      Unfortunately as is often the case there is not to my knowledge good research into this particular exercise and its affect on the pelvic floor after prolapse surgery. I also believe that there are safe options and if in doubt, leave it out.

      Hope this helps a little Jan

  3. I am attending pilates classes following extensive pelvic surgery and very much appreciate your advice. Fortunately my instructor is excellent and knowledgable re my specific problems and limitations and ensures that nothing I attempt will place too great a strain on the pelvis. I will be passing on your information to her for the benefit of others.

    • Hi MJ

      Thanks so much for your feedback. Great to hear that you have such a good instructor, sounds as though you are in good hands!


  4. Hi Thanks for this great article. I am a Pilates instructor and this information about Pilates exercises and the pelvic floor will really help me with my clients.

  5. Hi
    Having had a number of family members suffer prolapses, I've been really diligent with pelvic floor exercises. I had my first baby four months ago (forceps and episiotomy!), and it just doesn't feel that I have the same strength I used to. While I have no continence issuesf, i I use my bowels while I am wearing a menstrual cup, it now feels like the cup is moving down. Is it possible to get back to pre-pregnancy/vaginal birth strength or am I facing a new normal?

    • Forceps and prolapse risk

      Hi Sera

      Thank you for your comment. It is great to hear that you are being very diligent with your pelvic floor exercises – especially in view of the family history you have or pelvic floor dysfunction with prolapse.

      Unfortunately forceps delivery is one of the biggest predictors of having pelvic floor problems later on and it would be reasonable that you would not feel the same strength as prir to childbirth and yes you may be facing a new ‘normal’.

      The best approach long term is to really adhere to your pelvic floor exercises and make this a priority life- long particularly if you have any more pregnancies and with menopause. It is difficult to say whether you could get back to your pre pregnancy vaginal birth strength. There will undoubtedly be some stretching to the tissues including the pelvic floor muscles following your forceps delivery, so definitely adhere to your pelvic floor safe exercise routine in addition to your pelvic floor exercises long term.

      Best of luck, Michelle

      • I just wanted to update – I decided I wasn’t happy with my ‘new normal’ so I went to see a pelvic floor specialist physio – and I feel almost completely back to normal with the new exercises. I had been doing the exercises properly, but having someone customise what I was doing to target the problem has made a huge difference!

        • Hi Sera
          This is good news, doing the exercises correctly is vital and this is one area where a pelvic floor physio can help tremendously. Unfortunately some women believe pelvic floor exercises don’t help when in fact they haven’t been doing their exercises correctly. Great to hear you’ve sorted this out post -op.
          Best of luck

        • Michelle Kenway says:

          Great news Sera!
          Thank you for the update and so glad to hear this news and the benefits of seeing a Pelvic Floor Physio post op.