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Neck Pain During Pilates: Practical tips on how you can help your clients (part 1).

Do your clients experience Neck Pain during Pilates exercises? 

Neck pain during Pilates exercises can be a common complaint. From basic abdominal exercises through to upright exercises, there are some common reasons for clients experiencing tension in their neck. 

I am going to break down this issue into 2 parts, as I feel there are 2 distinct reasons this can occur (and clients may exhibit both/all of them!). This blog is going to focus on all of the aspects listed in Part 1. Part 2 will be in the next post.

Part 1: Head Position, Abdominal Strength & Trunk Flexion

Part 2: Are the arms connected to the back muscles?

Head position: 

If the crown of the head was considered the top of the spine, is the spine following a continuous line as it moves? 

When lying supine, curling the upper trunk forward - no matter what style of Pilates you practise or teach -  can be very difficult for some people. And neck pain during certain exercises can be, well, a literal pain in the neck!  

I see this most commonly in exercises such as: The Hundred, Abs Series and even upright positions such in Spine Stretch Forward & Saw.  

Things you may notice:  

  • Head is protracted, aka “Chin poking” - leading the movement with the chin, overworking the muscles at the front of the neck and placing pressure on the facet joints of the cervical spine. 

  • Lifting head back - the chin is upward, eyes to the ceiling and they struggle to look towards their legs/centre. Often, not lifting very high off the mat. This head position places strain on not only the muscles at the front, but also the back of the neck as they carry the full weight of their head in their neck. This is hard to maintain, and often clients fatigue quickly in this position. 

Sonia's Tips: 

  • Cue eyes to thighs, or eyes to your centre. 

  • Encourage to lengthen the back of the neck. It’s not chin down, but drawing the chin and head backwards, to reduce that forward, protracted position of those facet joints in the neck.

  • Cue drawing the lowest rib towards the hips, lifting from the sternum. Try to the scapulae off the mat, keeping just the bottom tips of the scapulae on the floor.

Chances are, when people move this way, they likely already have these habits day to day; they are probably sitting, driving, etc in this protracted position. So what a great opportunity to teach them good habits they can carry over to their daily habits!  Therefore, it may not be a ‘quick fix’, but regular reminders and positive reinforcement can to ensure they are feeling their abdominals, not their neck!

Abdominal Strength

Sometimes, it is simply reduced abdominal strength & endurance. Thankfully, this can be trained, like any other muscle. Often, if they are lacking abdominal strength, they will lead with their chin!

Sonia's Tips:  Here’s what I do to help during that time building strength and endurance, and watching form:

  • Encourage clients to do the exercise, but give full permission to rest their head down as often as needed, then join back in after a few seconds. This is a great way to build endurance. 

  • Ask them to place both hands behind their head to take off some of the weight of the head. Whilst this can be helpful, watch they don’t use their hands to pull their head forward. Think ‘head pushing back into hands to keep length in the neck’. 

  • If needed, keep their head down on the mat throughout. If legs are moving as well,  such as The Hundred, One leg Stretch,Double Leg Stretch, Scissors, etc.,  then ‘Feet to the sky!’.  If they do not have the strength in their abdominals to lift up yet (it will improve!), they are unlikely to have the strength to reach their legs forward along the mat and keep the ribs down, which may put too much pressure on their lumbar spine. 

Trunk Flexion

Stiffness in the Thoracic Spine and upper back may mean people rely on their lumbar & cervical spine more to carry out a movement. If the thoracic spine is stiff and unable to flex forward with ease, this is going to make curling up/forward difficult, which means they are not always deeply contracting their abdominal muscles strongly (hello, read above), which can mean they lead with their chin (omg, what?!)…Sheesh, what a vicious cycle!

I wouldn’t shy away from doing flexion based exercises in this scenario, but I would definitely look at other ways you can start to encourage strengthening and mobilising the upper back. Some of my “go to’s” are:  Arm series on the Spine Corrector, leg series on the SC (can use a roller, soft pilates ball, bolster, rolled up blankets instead), Arm Springs on the Cad, Roll Downs, Cat/Cow, Rolling like a Ball, etc. 

In the meantime, I would also help the client into flexion by using some type of support to assist the flexion in the upper spine.

Sonia's Tips: 

  • Prop the shoulders up on a soft ball or against a spine corrector. Lumbar spine remains long with tailbone down, whilst the upper body is supported. This is a lovely way to support the feeling of the ‘curl up’ from the deep abdominals, whilst reducing the weight of the head. 

  • For movements such as Spine Stretch Forward, sit with a wall behind you and don’t allow your lower back to leave as you reach forward, lifting the ribs away from the thighs. That tailbone anchored to the floor is going to give you that spinal stretch! Flexing forward at the hips, is not. 

Most of all, it is important to keep up motivation. If using some support helps them feel like they are rocking it, then great! And if they are feeling their abdominals, not their neck, we are winning!!! With time and consistency, strength and flexibility will improve and those props can be slowly removed. 

I hope this blog has given you some practical ideas and advice you can implement right away to help reduce neck pain in your clients during Pilates!

Look out for Part 2 in the next post where we look at connecting the arms to the back to reduce neck/shoulder pain! 

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