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Hip Replacements and Fitness Pilates: What Every Instructor Needs to Know in 2026

Summer Solstice

Hip Replacements and Fitness Pilates: What Every Instructor Needs to Know in 2026

As part of our ongoing series looking at common orthopaedic conditions, this week I wanted to focus on hip replacements as I am seeing an increasingly number of clients coming to FP and Reformer every week having had a hip replacement.

Music

Pure Energy have released some fantastic new music this week. If you’re an app user, have you tried:

• Feel Good Flow – I used this for the Mini Ball Masterclass on Friday and it worked beautifully.

• Glow Up Reformer – A stunning album and perfect for Pilates, mobility and mindful movement sessions.

• Hot Sculpt & Stretch – Another excellent release with a great mix of energy and flow.

Mini Ball Masterclass

Over 60 Fitness Pilates teachers signed up for Friday’s Mini Ball Masterclass, which was fantastic to see.

The overwhelming feedback was how much content we covered in just 60 minutes and requests for even more masterclasses/workshops like this. If you missed it, don’t worry – the replay is now available on the dashboard.

Bristol Fitness Pilates Reformer Course

Due to changes at the original venue, I have moved this course to Nuffield Health Gloucester on 7th August.

Full details are below if you’d like to join us.

Summer Solstice Classes

Are you running a Summer Solstice class this weekend?

I’ve taken the Reformers outside and held a wonderful Friday evening session. I’m also teaching another outdoor class tonight at 7.30pm and can’t wait. The weather forecast looks perfect, and there’s something really special about moving, stretching and strengthening outdoors on the longest days of the year.

Hip Replacement

The great news is that hip replacement surgery and rehabilitation have evolved significantly over the last decade. Many of the traditional restrictions we were taught are no longer applied in the same way, and modern rehabilitation is far more focused on helping people return to normal movement patterns, exercise and everyday activities.

Hip Replacements Are Changing

Many instructors still think of hip replacement clients as being fragile or heavily restricted. In reality, modern hip replacement surgery is designed to get people moving again.

The most common procedures being performed today include:

Total Hip Replacement (THR)

The most common type of surgery where both the ball and socket of the hip joint are replaced.

Anterior Hip Replacement

A newer approach that accesses the hip from the front of the body.

Benefits often include:

Less muscle disruption
Faster recovery
Reduced risk of dislocation
Earlier return to activity

Posterior Hip Replacement

Still widely used and accessed from the back of the hip.

Historically this group had more movement precautions, although many surgeons now take a more progressive approach once healing is complete.

Lateral Hip Replacement

Accessed from the side of the hip.

These clients often require additional work on:

Glute strength
Balance
Single-leg stability

Hip Resurfacing

Often performed on younger and more active individuals. These clients frequently return to a very high level of activity after rehabilitation.

Revision Hip Replacement

A replacement of a previous hip replacement which may require a slower and more cautious return to exercise.

The Old Rules Are Changing

For many years we were taught to avoid:

Crossing the legs
Bending the hip beyond 90 degrees
Internal rotation
Twisting movements

Whilst these precautions may still be important during the early stages of recovery, many surgeons and physiotherapists are now encouraging a gradual return to normal movement patterns once healing is complete.

Rather than focusing on blanket restrictions, current best practice is to assess the individual sitting in front of you.

Questions Every Instructor Should Ask

Before teaching a client with a hip replacement, find out:

When was the surgery?
Which hip was replaced?
What type of surgery was performed?
Have they completed physiotherapy?
Are there any ongoing restrictions?
What activities are they currently doing?
What movements feel uncomfortable?
What are their goals?

What Challenges Do We Commonly See?

In Fitness Pilates classes, the most common issues are:

Glute weakness
Reduced balance
Fear of movement
Reduced single-leg stability
Hip flexor tightness
Compensatory movement patterns
Reduced confidence

Many clients have become deconditioned before surgery due to pain and reduced activity levels, making strength and balance work particularly important.

How Fitness Pilates Can Help

Fitness Pilates is an excellent modality for clients following hip replacement surgery because it focuses on controlled movement, alignment, strength, mobility and confidence.

Benefits can include:

Improved hip stability
Better balance and coordination
Increased glute strength
Improved posture
Enhanced gait mechanics
Greater confidence with movement
Improved overall quality of life

Recommended Fitness Pilates Exercises

Some excellent choices include:

Pelvic tilts
Hip rolls
Bridge variations
Glute strengthening exercises
Dead Bug progressions
Four-point kneeling stability work
Standing balance exercises
Heel raises
Sit-to-stand movements
Functional squat patterns
Gentle lunge progressions
Controlled side-lying leg work

Exercises to Approach with Caution

Depending on the individual and stage of recovery, consider modifying:

Roll Up
Teaser
Deep seated hip stretches
Aggressive hip-opening stretches
Loaded twisting movements
High-level rotational exercises
Deep hip flexion positions

Remember that movement quality is always more important than range of movement.

Respect the individual rather than the replacement.

Modern hip replacement clients are often capable of far more than we once believed. With appropriate progression, good coaching and sensible modifications, many people can return to Pilates, strength training, walking, golf, tennis, hiking and a highly active lifestyle.

As Fitness Pilates instructors, we are perfectly positioned to help clients rebuild strength, confidence and movement quality following hip replacement surgery.

Have a fantastic week and whats app me with feedback or questions

I love to hear from you 07976 268672

Rachel Holmes

Rachel Holmes

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