As Pilates teachers, our goal is to help our clients find, feel, and correct bad alignment, and muscle imbalances so that they can improve their whole-body health and enjoy life!  It’s frustrating for us and them, when problems or pain lingers longer than we think it should.  Chances are if a client walked through your door with pain, and it’s been there awhile – making changes isn’t going to happen overnight!  But generally speaking – Pilates has fantastic things to offer for improving body awareness and developing new posture and movement habits to help pain and problems go away and improve your quality of life!

Here’s a Great Question about Neck Pain and Pilates that I received recently:

Hello: I receive your newsletter and I have to say thank you for your time and your commitment. I would really appreciate your point of view about people who practice Pilates for a very long time, but still feel pain in their necks, and this stops their progress in the work. I have two students with this problem. They are good physically (don’t have any structural problems in their bodies) which makes me think this is more than a physical problem. Thanks for your time! Any insights would be great. ~ Regards, Barbara

Thoughts from Aliesa George on Neck Pain and Pilates Exercises for Healthy, Experienced Students:

Neck pain during Pilates is a common problem for new students who don’t have great spine flexibility or the strength to get into a good curled up position for exercises like the Hundred, but I think it’s probably a more common issue than one might think for experienced students too!

Because you’ve indicated that the clients you are working with don’t have any structural or health issues that would be causing neck pain during their Pilates exercises, my guess is that mechanically they do not yet have full articulation through the spine for flexion and extension – especially through the upper back (thoracic region). And there’s a chance that even though they are strong, they may not be really using their core muscles as well as they could to support them.

When you evaluate standing posture position, is their head placement appropriate – ears over shoulders? Or are the ears slightly forward which would indicate a shearing of the neck bones, and will create more neck stress even in a vertical position.

If the head is forward at all, the natural curve of the neck is compromised. For that matter if the curves of the entire spine are not well balanced the ability for free and functional movement of the whole spine in any direction (flexion, extension, side bending, or rotation) will be compromised. Your clients probably won’t notice these limitations in extension, side bending, and seated rotation as much as they will for forward flexion, and exercises like criss-cross during Matwork – because when they lay on their back and have to hold their head up, or curl up AND twist, those are the exercises that makes their neck hurt!

If anyone has an issue with their neck – healthy or otherwise, I start making alignment changes from the feet! You can’t just realign a neck, because everything beneath it is a part of why the neck and head are sitting where they’re at. Fine-tune foot and leg alignment, then get all the curves of the spine to be functionally correct for both stabilization and movement, and you’ll discover that the head and neck have no choice but to happily follow along and end up well placed on the body!

There are definitely a couple of things that I always do, and look for, when I know that I need to help my Pilates clients get out of their necks.

Here are some things for you to consider when developing your Pilates exercise programs for your healthy clients that continue to be challenged with neck pain during exercise:

1. Go back to basics.

There is some additional detail work that their body needs to continue improving technique. While the may be able to do wild advanced exercises – in the long run they will get more benefits from everything when they are better and more correctly supporting every exercise. This is easiest to work on during private sessions. If your clients are only participating in group classes, that is the first change I’d make. Encourage them to schedule some one-on-one training so you can help figure out what exercises, cues, and concepts need to be reinforced and corrected.

2. Evaluate their movement technique for a Standing Roll Down on the Wall.

I would place bets that your two clients drop their heads forward, then begin bending somewhere in the middle of their torso to fold forward, and that there really isn’t any articulation of the spine happening through the upper back. Since the breastbone is a solid vertical, if it is held rigid and you try to bend forward, the only thing that moves is your head and neck, resulting in neck strain. Then the articulation needed by every segment from T1 down to flex forward is skipped and the body folds forward somewhere around T12. This is not an ideal movement pattern; since we have so many Pilates exercise that require full articulation of the spine.

The breastbone should be pliable. To bend forward it should soften back towards the spine and slide down the front of your shirt. This allows the upper back bones to lift in opposition creating the space for good movement and that one by one articulation of each segment of the spine.

When the breastbone softens and slides back and down as the body bends forward into flexion, the shoulder blades should spread apart and each segment of the spine has the ability to move independently, so you can learn to peel your back away from the wall and roll forward one segment at a time. In reverse, to roll up – each segment lifts and stacks and is supported from below, the eyes stay looking at the front of the shirt for as long as possible to lift through the spine, through the neck, and then stack the head. Getting an understanding of this feeling of pliability with the breastbone and flow of movement when you’re not fighting gravity is helpful to keep stress out of the neck and begin changing bad habits.

3. Look at their eye placement during every flexed spine exercise. If their eyes aren’t looking in the right position, their head and neck won’t be in optimal alignment either.

Examples of exercises to pay attention to eye position:

  • Pilates Matwork: The Hundred, Series of 5, Rolling Like a Ball, Open Leg Rocker, etc…
  • Pilates Reformer: Hundred, Short-Spine Massage, Coordination, Back Stroke, Up Stretch, Stomach Massage Round, Short Box Round & Flat, Long Spine Massage, and Kneeling Knees Off are all good ones to spot check.

Basically you need to pay attention to their neck and whole-body alignment on every exercise they do!

Here are a few examples of what to look for and why it’s important:

Example: The Hundred

If the body is lying down and curling into say the 100 position, and the eyes are looking at the ceiling instead of the stomach – the head did not curl around the corner to flex the neck so that the higher abdominal muscles could weight-load the lift. If the cervical and thoracic spine flexes appropriately – the body should easily curl up to the bottom tips of the shoulder blades which places the head in a vertical position and held here with the abdominals, there is no stress or tension in the neck.

Example: Short Spine Massage / Long Spine Massage

These two exercises are very similar from the neck’s perspective. If the eyes look backwards to follow the line of the legs and feet lifting overhead, the neck is being pulled into extension, while the spine is bending into flexion to roll upside down. The neck or back will tense up to avoid injury and a strained or pulled muscle will result. Be sure that throughout the exercise, the eye focus is on the abdominals to allow the neck and upper spine to flex more deeply the higher the body lifts upside down.

Example: Short Box – Flat

If the eyes lead the movement to hinge backwards instead of the hips, the head moves backwards off the spine and the body arches back instead of hinging placing more stress on the neck and shoulders. Keep the eyes looking down and forward towards the toes, so that the head and neck just go along for the ride on a stabilized spine. This way the movement is correctly initiated from the hips and pelvis to go backwards and return to vertical.

4. Focus on exercises that move into forward flexion with gravity assistance to help find better abdominal support and allow the head and neck to hang forward and relax to create the space between the bones needed for better movement.

Pilates Exercise Examples:

Wall Exercises – Roll down on the wall

Spine Corrector – breathing over the barrel

Reformer – Up Stretch, Elephant Round, Kneeling Knees Round & Knees Off

Chair – Washer Woman, Pike, Cat

Pilates Cadillac / Trapeze Table – Kneeling Rolling in and out (the prep part – just rolling down and back up, or rolling down and doing the arm circles then rolling back up), Kneeling Cat with the push through bar, Push Through, Standing Roll Down with the roll down bar (2nd half of the Standing Squat exercise), Spread Eagle

There are lots of choices, and many other exercises I utilize to reinforce these concepts. Hopefully this short list will get your brain thinking about exercises that you know, or modifications you can do to work on this.

5. Change the arm and hand placement for exercises that roll upside down to assist in deepening the upper thoracic spine’s ability to move into flexion and practice softening the breastbone. If the arms are lying on the mat by your sides and you use them to actively push against the mat to roll the body upside down, you are actually cueing the back muscles to tighten and move into extension. Ideally with the arms by your sides all you should do is depress the shoulder blades and elongate the arms in opposition to the lift so that the shoulder blades can spread apart as the breastbone softens and the body bends to roll upside down.

Here are three options for arm placement to help articulation of the upper spine:

a. If you are on the Reformer – bend the arms behind the head and hold onto the back of the shoulder pads. Elbows will be in towards the body and pointing to the ceiling to help spread the shoulder blades wide.

b. If you are on the Reformer – lift both arms up to the ceiling while executing the exercises like Short Spine, Long Spine, and Pelvic Lift

c. If you are on the Cadillac and holding onto the upright poles, be sure that the arms are high enough on the poles to get the blades to depress and spread so you see the breastbone drop towards the mat into a more functional upper thoracic curve that is supported by the abdominals.

6. Spine rotation will facilitate improvement for both flexion and extension. If you’ve identified that the upper spine is not very flexible…you might want to incorporate additional rotation exercises into their program to assist in mobilizing the upper back.

Final Thoughts on Pilates and Neck Pain

No client should be in pain during any Pilates exercise.  It’s our job as a well-trained Pilates teacher to look at every client’s posture, alignment, and movement habits, as well as ask questions about daily life activities that may be contributing to any issue, so that we can make smart choices in the exercises we teach first, and progress into.

You’ve got lots of information to digest here! Hope that this helps you continue to develop your critical thinking skills for selecting the best exercises to assist your Pilates clients, and hopefully so new things to look at when you’re watching your clients and cueing corrections.

I’m always available for workshops, and it’s way more fun to actually work with bodies and see them change. Contact me if you’re ever interested in hosting a workshop!

And for all of my fellow Pilates teachers who are reading this, keep me posted on how it’s going with your clients, and let me know if you’ve found this information useful or helpful to add to your expertise!

Have a Fit and Fabulous Day!

Aliesa George

Aliesa George: Over the past three decades, Aliesa George has helped assist people with their personal health journeys by sharing, teaching, and developing Pilates, Foot Fitness, and other Mind-Body programs.

1 Comment

  1. Neck Exercises

    Great information about neck pain with pilates. I can use this information even with my own patients who have neck pain.



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