Hip Replacements & Pilates – A Deeper Dive for Instructors

Welcome to this week’s Fitness Pilates newsletter.

This is for all teachers who love Pilates and are passionate about delivering amazing classes and experiences for their members — whether you teach in community venues, run small group sessions in your own or home studio, or work within a health club or leisure centre.

In this newsletter, I aim to share practical tips, ideas and educational content to help you continually improve, grow your confidence and support your clients to get stronger, feel fitter and ultimately feel happier.

Fitness Pilates has always been about sharing knowledge, supporting each other and building a strong community of instructors through education, encouragement and inspiration.

Thank you for being part of it and I appreciate you reading this newsletter.

I know I have covered hip replacements before but this week I saw 4 clients come to Reformer with hip replacements and I sat next to a lady on the plane yesterday who had recently had one. It really is so common so here is a recap.

What health conditions would you like me to cover? And are these helpful?

Hip Replacements & Pilates – A Deeper Dive for Instructors

Hip replacements (Total Hip Arthroplasty – THA) are one of the most common orthopaedic procedures, particularly in midlife and older populations. As instructors, understanding the mechanics, precautions and programming considerations is essential.

Clinical reasons for hip replacement

The primary indication is end-stage osteoarthritis, where articular cartilage has significantly deteriorated, leading to:

• Joint space narrowing
• Osteophyte formation
• Subchondral bone changes

Other indications include:

• Rheumatoid arthritis (inflammatory joint destruction)
• Avascular necrosis (loss of blood supply to the femoral head)
• Hip fractures (especially femoral neck fractures)
• Congenital or structural abnormalities

Surgical procedure (overview)

In a total hip replacement:

• The femoral head is resected
• The acetabulum is reamed and fitted with a prosthetic cup (often polyethylene-lined)
• A femoral stem is inserted into the shaft of the femur
• A prosthetic head (metal or ceramic) articulates within the socket

Fixation can be:

• Cemented
• Uncemented (press-fit)
• Or hybrid

Surgical approaches & movement precautions

Understanding the surgical approach is key, as it dictates early movement restrictions:

Posterior approach (most common)

• Avoid: hip flexion >90°, adduction past midline, internal rotation
• Higher risk of posterior dislocation early on

Anterior approach

• Avoid: excessive hip extension and external rotation
• Typically fewer movement restrictions

Lateral approach

• Often involves abductor disruption → watch for hip stability and Trendelenburg patterns

Rehabilitation phases (exercise considerations)

Phase 1: Acute 

• Goals: protect joint, restore basic mobility
• Focus: circulation, gentle ROM, early weight-bearing
• Exercises: pelvic tilts, heel slides, static glute/quad work

Phase 2: Early strengthening 

• Goals: improve muscular support and gait
• Focus: glute med/max activation, pelvic stability
• Exercises: bridges, supported standing work, controlled abduction

Phase 3: Functional integration 

• Goals: return to functional movement patterns
• Focus: multi-planar control, balance, coordination
• Exercises: step patterns, sit-to-stand progressions, low-load dynamic work

Key muscular considerations

Post-surgery, common deficits include:

• Gluteus medius weakness → reduced pelvic stability
• Gluteus maximus inhibition → reduced hip extension power
• Deep stabiliser dysfunction → altered movement patterns

This often presents as:

• Trendelenburg gait
• Reduced stride length
• Compensatory lumbar or pelvic movement

Fitness Pilates programming principles

When integrating clients into Pilates:

• Prioritise pelvic alignment and neutral control
• Focus on closed-chain stability before progressing to open-chain load
• Build glute strength before increasing range or complexity
• Emphasise slow tempo and proprioceptive awareness
• Avoid end-range loading in early stages

Contraindications & caution

Be mindful of:

• Combined movements (flexion + adduction + rotation)
• Lever length in long-lever exercises
• Loaded rotation through the hip joint
• Fatigue-induced loss of control

Always check:

• Surgical approach
• Time since surgery
• Clearance from physio/consultant

Long-term considerations

Even after full recovery:

• Joint lifespan is typically 15–25 years depending on load and activity
• High-impact activity may accelerate wear
• Strength training is essential for joint protection

Well-programmed Pilates can:

• Optimise biomechanics
• Reduce compensatory patterns
• Support longevity of the prosthesis

Instructor takeaway

Our role as a FP Teacher is  long-term movement optimisation.

With the right progressions, clients can:

• Regain strength and stability
• Move with confidence
• Return to an active, pain-free lifestyle

Have got many clients with a hip replacements?

MUSIC – I am loving the Feel Good Flow playlist on Pure Energy Music 

and lastly I filmed a video on how to fill your classes on Youtube Check it out here 

Have a great day

Whats app me for questions 07976 268672 

Love Rachel 

SUMMIT SPECIAL 19th September – Everyone is welcome at the summit you don’t have to be Fitness Pilates trained  to join us.

The Fitness Pilates Summit is our annual flagship event, now in its second year at University of Nottingham, taking place on 19th September.

This year, why not make a full weekend of it?

Join Kelly and myself on the Friday at my private studio for:
• HOT Infrared Fitness Pilates Training
• Fitness Pilates Reformer Training special summit pricing 
• Or both for the ultimate learning experience
• Plus, a brand new twilight masterclass to round off the day

It’s the perfect opportunity to immerse yourself, elevate your skills and connect with like-minded instructors.

For accommodation, take a look at The Orchard Hotel, located right on campus, with the Summit held at the excellent David Ross Sports Village.

We have 10 spaces for the SUMMIT left at the early bird pricing.

Check out the booking details HERE

BOOK the 2026 Summit here

Join the FP VIP club