Have you ever thought about what your tongue is doing during exercise?

If you or your Pilates clients are interested in:  Better breathing habits, reducing neck pain / neck tension, improving the execution of exercises that articulate the spine, freeing up the whole body for flow and ease of functional movement.  Then I recommend that you play with, introduce, and think about what the tongue is doing in your mouth during a workout.

This may not be something to add into the mix for a beginner Pilates student who is still getting in touch with basic body awareness and just figuring out how to execute the exercises. But for intermediate Pilates students who are focused more on fine-tuning their exercise technique, the tongue can be one more thing to pay attention to that will help enhance and improve performance.  And, if where your tongue is in your mouth and what it’s doing improves performance for Pilates – Imagine all the other sports, and daily life activities that paying attention to your tongue could be a valuable asset for helping improve overall wellness, functional movement, and improved athletic performance!

The tongue is a pretty large & powerful muscle sitting up there in your head. It shares a common nerve root with the Diaphragm.  So what the tongue is doing in your mouth can dramatically affect how well the diaphragm is working, and your ability to move higher volumes of air (oxygen) into and out of the body.

If you are familiar with Eastern concepts and Meridians, the tongue placement on the roof of the mouth closes the circuit for the Central & Governing Meridians.  This is used during circular breathing and Cosmic Egg meditation techniques, but during these meditation techniques, on the exhale the tongue remains on the roof of the mouth.

During Pilates workouts we are doing more vigorous exercises, and a part of our breathing goal is to transfer as much oxygen as possible into and out of the lungs.  To accomplish this we must change the tongue position in the mouth, allowing it to drop to the floor of the mouth on the exhale, to cue the diaphragm to release, lifting and pushing air out of the body as quickly as possible for the “forced exhale” that Joseph Pilates encouraged during exercise.

How To Use Your Tongue Effectively During Pilates & Exercise

• When you inhale, the tip of the tongue should be lightly placed on the roof of the mouth right behind the front teeth.  The tongue placement here cues the diaphragm to drop on the inhale so the lungs can fill with air.
• When you exhale, the tongue should drop to the floor of the mouth. This cues the diaphragm to lift up and assists in emptying the lungs.

Any exercise that the neck and head are involved with can benefit from paying attention to the tongue during exercise.  If your goal is to facilitate better breathing, reduce neck tension, improve neck mobility, and assist better articulation of the entire spine for flexion, extension, side bending and rotation, spend a couple of workouts focusing on what your tongue is doing in your mouth during your Pilates workouts.  Discover how being aware of what your tongue is doing affects the freedom and ease of spine articulation and your overall movement experience.

Pilates Exercises To Practice with This Tongue Technique

On every exercise there is the opportunity to train the tongue to better support your breathing and movement.  But on some exercises you may find this particularly helpful.

Play with the Tongue Placement on the following Pilates Exercises:

For Improving Spine Flexion / Bending Forward

• The Roll Up
• Spine Stretch Forward
• Neck Pull
• Rolling Like a Ball
• Short-Spine Massage
• Long Spine Massage
• Elephant-Round
• Kneeling Knees – Round/Off
• The Roll Down w/Bar
• Parakeet
• Tower
• Teaser

For Improving Spine Extension / Arching Backwards

• Swan prep
• Pull Straps & T
• Down Stretch
• Short Box – Round to Arch
• Swan w/Push Through Bar
• Spread Eagle
• Back Bend over Barrels

For Improving Lateral Flexion / Side Bending

Hint for Side Bending:  When you side bend, allow the tongue to drop to the floor of your mouth, and go towards the side you are bending to.  (Side bend  to the right – the tip of the tongue will be on the roof during the inhale, and it will lay on the right side of the teeth on the exhale.)  If you side bend right, and the tongue goes left it is counter-balancing the bend and will restrict your neck and head from moving in the correct direction causing more neck strain and eliminates the body’s ability to sequentially articulate through the spine sideways.

• Mermaids
• Short Box Side Bends
• Seated Side Bend
• Standing Side Bend

For Improving Spine Rotation / Twisting

• Seated Simple Twist
• Saw
• Stomach Massage Twist
• Short Box Twist
• Snake/Twist

This is by no means a full list of exercises to play with tongue support on!  But hopefully a good starter-list with a few of the exercises I have used with my clients to introduce this concept with to discover the benefits that tongue placement has to offer for improving form, function, and exercise technique.

As with any new concept – add this thought in to simple, more basic exercises first, where technique and body awareness is already in place so clients don’t have a million and one things to pay attention to, but can maintain their body placement and can put their primary focus on feeling what the tongue is doing and how it affects their movement.  Then progress to incorporating this “Tongue Technique” with the intermediate and advanced Pilates repertoire.

I would love to hear from you about what discoveries you have made as a Pilates student, or Pilates teacher with incorporating a little emphasis on working and releasing the tongue muscle on your inhale & exhale during exercise.

• Can you notice a difference in the ease of your movement? 
• Is your neck more relaxed? 
• Does this help you get through your sticky-spots on exercises like the Roll Up & Neck Pull? 
• Is it easier to roll down out of Short-Spine?

Play with this, share it with your friends, and then please drop me a comment and update me on what interesting things you’ve discovered while paying attention to your tongue during your Pilates exercises and any other health & fitness workouts.

Have a Fit & Fabulous Day!

This “Runner’s Lunge” stretch on the Ladder Barrel is a great addition to your Pilates workout program and it can also be done at home on your stairs, or even with a chair.  It’s a good exercise to do anytime, but is especially important after a long walk, run, or bike ride, or if you’ve been sitting for awhile – working on your computer, or driving in the car.

I’m going to demonstrate the exercise with the Pilates Ladder Barrel so you get a good visual of body alignment.  Then we’ll talk about how to adapt this to a home exercise program using your stairs or with a chair.

Pilates Ladder Barrel Exercise:  Standing Runner’s Stretch

Click here to view the embedded video.

A Few Tips for Exercise Technique on the Hip Flexor Stretch

1. Stand facing the Ladder, and hold onto the top rung for balance.
2. Place the ball of the right foot on the highest rung you are comfortable with. (If your hips or hamstrings are tight – start on a lower rung and as your flexibility increases you can progressively put your foot higher on the Ladder.
3. Bend the front knee to lunge forward bringing the hips towards the Ladder, until you feel a stretch along the front of the hip and top of the thigh.
4. Hold the stretch and take 3-5 deep, long breaths.

*To tweak your technique and improve your stretch, paying attention to your body alignment is very important.

• Be sure the foot on the floor is parallel – with the toes & heel facing straight ahead.

• Keep the heel reaching down to anchor the standing leg and stretch the calf.

• The standing leg should stay straight with an unlocked knee.

• Be sure both knees are facing straight ahead, same direction as the toes.

• Your tailbone should lengthen down and out towards the back heel just a little to lengthen the lower back, while the lower abdominals pull up and in for support. This may place the pelvis in a slight tuck or scooped position.

• If you had headlights on your hip bones, both lights should be shining straight ahead.  Be sure to keep the top crest of the back hip (ASIS) reaching forward to the Ladder.

• Press forward with your standing leg from the back of the thigh where the leg meets the pelvis to help open the front of the hip for the best stretch.

• The farther forward your pelvis moves towards the Ladder, the more you should strive to lift your torso up, while you keep pressing the back heel down.

• Strive to find a long diagonal line with your body from your head to the heel.  Hips and shoulders stay square and even to the front.  Body lifts up, shoulders relax down.

A Few Tips for Exercise Technique on the Hamstring Stretch

1. After your 3-5 breaths for a hip opening stretch in the forward lunge, slowly straighten the front leg until you’re standing with two straight legs for a hamstring stretch.
2. If you started a good distance from the Ladder, when you straighten the top leg, your standing leg should be perpendicular/vertical to the floor.
3. Keep your hips square to the Ladder
4. Lengthen from the tailbone through the entire spine and out the top of the head, to bend forward over the top leg reaching your head to your knee (or ankle!)

• Ideally the pelvis will be hinging forward to give you a great stretch high in the back of the hamstring where the leg meets the butt.

• Hold this Hamstring stretch for 3-5 breaths.  On every exhale – if your leg and back relax strive to deepen the stretch and bend farther forward.

• BONUS STRETCH: You can also – flex the ankle and reach the heel for the next rung down for a deeper stretch down the back of the leg from the heel to the hip.

After 3-5 breaths here, shift your weight back to the upright diagonal and repeat the hip flexor stretch for another 3-5 breaths.  Then straighten the front leg out and repeat the Hamstring stretch.

Do this Alternating Runner’s to Hamstring Stretch  3-5 times on one side, then repeat the entire exercise with the other leg.

How To Do This Stretch Without A Pilates Ladder Barrel

If you’re at home, or out at the park and don’t have a Pilates Ladder Barrel handy, but your front foot up on a stair, park bench, back of your car bumper…  anything that’s an appropriate height to get a good stretch.  This exercise isn’t about balance – so be sure you’ve got something to hold onto, otherwise your legs will stay tense and restrict your ability to get a good stretch.

Remember, the better your body alignment, the better your stretch!  Continue to scan your body and tweak your technique for the best stretch possible in both positions during your Standing Pilates Ladder Barrel Runners Stretch.  The goal is to really open and stretch at the front of the hip – to release tight hip flexors at the top of the thigh, and lengthen and release tight hamstrings down the back of the thigh.  This combination will help you enjoy a freer swinging motion of the leg from the hip joint, and help keep your hips, legs and back healthy & injury-free.

This is one of my favorite non-traditional Pilates barrel exercises.   I love this exercise for a supported whole body stretch.  It helps to benefit improved shoulder mechanics, maintaining/improving core support, increasing lateral flexibility of the spine, and finding the balance between the work needed to strengthen hip extension while stretching the hip flexors and front of the thigh.  It feels GREAT!

Click here to view the embedded video.

I like to call this my Pilates Arc Barrel “Rainbow Hip Stretch” aka Side Bend with Hip Extension.

• Start sitting on the lip of the barrel facing sideways.  Legs are in a Z position.
• Side bend over the barrel.  The bottom arm rests under your head, top arm begins palm down along the side of the thigh.
• The top arm is going to “paint a rainbow” lifting from the hip to the ceiling, to overhead for a side stretch.
• At the same time as the arm is moving overhead, the top leg is going to extend out to the back corner to stretch through the waist and the front of the hip.
• Then, pull the abdominals in for support, and bring the arm and leg back to the starting position.

Inhale and exhale to extend the arm and leg away from center, lengthening the whole side of the body.  Inhale lengthen farther, exhale, pull the stomach in, shoulder down, and lift the arm while bending the leg back to your resting position. Repeat this 5-8 times.  Inhale and exhale to “paint a rainbow” with the arm while the leg extends to the back corner.  Inhale stretch away farther, exhale and return to center.

A Few Things To Watch For:

1. Be sure the hips and shoulders stay stacked.
2. If your neck is stiff and doesn’t lay comfortably on your arm, use a pillow or towel under your head for extra support.
3. Move the shoulder blade and the arm.  When the arm is by your body, palm faces the body.  When the arm is lifted to the ceiling, palm faces the front.  When the arm is overhead, palm faces the floor.  AND…  It’s NOT the palm that does the rotating.  Rotate the whole arm from where the arm meets the shoulder to change the direction the palm is facing.
4. Initiate moving the arm in both directions by pulling the shoulder blade down and moving the arm from where it’s attached to the body.
5. Keep the head relaxed and resting on your arm while painting your rainbow to deepen the stretch through the neck and shoulder.
6. Squeeze the Glutes to extend the leg to the back corner.
7. Be sure the top hip doesn’t lean back as the leg extends.  If anything it should shift slightly forward the farther back the leg goes.
8. Be sure the lower abs stay lifted for support as the leg moves out.  Avoid a “banana back.”
9. Keep the pelvis still while the leg returns to the starting position.  Avoid pulling the abs in and tucking the hips to move the leg.  Your tailbone and pubic bone stay still and just the leg moves.

This is a great exercise to stretch your body sideways and open your hip with gravity helping. If you don’t have an Arc Barrel you can get a similar stretch on a Bosu® (but it’s not quite as effective.) Or if your inspired to buy a Pilates Barrel to have at home, I’ve got barrels and a book filled with lots of easy to do Pilates Arc Barrel exercises that makes a great addition to your at-home exercise program.  You’ll find my book “A Barrel of Fun!” and Pilates Arc Barrels in the Pilates Exercise Equipment section of the store at Centerworks.com

Thanks for sharing a couple of minutes of your day with me for this Pilates Exercise Tip today!  Look forward to seeing you again soon for more thoughts on easy things you can do to stay inspired, have fun with Pilates, and enjoy whole-body health!

Make it a Great Day!  See ya soon!

I’ve seemed to have a flurry of issues with Pilates clients lately who are dealing with neck pain.

Pilates exercises done correctly are excellent for strengthening core muscles for support, which over time helps  to reduce neck tension.  However, sometimes getting started – newer Pilates participants can aggravate a neck problem, by not understanding, or having the strength and flexibility needed to support the body well and keep the stress out of the neck.  If you’re doing any exercise and you begin to feel stress or strain in your neck –Stop!  Better to take a break, then start to use muscles that shouldn’t be doing the work and continue to aggravate neck issues. There are hundreds (maybe thousands) of exercises that can be done without neck pain.  The challenge is finding the right exercises for your body to start with, and continue to progress. 

Regardless of the exercise, good breathing habits are critical for opening the joint space in the neck and helping to lengthen the neck muscles to reduce neck strain and improve posture and body alignment. Our head is basically an 8-10 pound bowling ball sitting on a straw.  If the ball is not well-balanced on the straw, the straw will lean or bend and the head will tip to funny angles striving to stay perched at the top of our body.  At this point, some muscles are working too hard, and others are not pulling their weight.  Over time, the body accepts this way of holding the head and neck as correct (whether its good or bad)  and the pattern of muscle use becomes a habit – whether we like it or not!

The good news…It’s never too late to change a habit!

With a little effort, and having some new strategies to play with and practice, you can effectively reduce neck tension and neck strain quickly and easily just by paying attention to where you are holding tension and practicing better breathing habits during  your Pilates exercises.

Here Are Six Tips To Help Reduce Neck Strain During Pilates Exercise
(AND Daily Life Activities!)

1.  Posterio-Lateral Pilates Breathing Technique

Learning how to utilize the Pilates style of posterior-lateral breathing is KEY to helping lift the head up off the neck and lengthen the spine. Emphasis is placed on inhaling to fill the back of the ribcage from the bottom to the top.  In effect, what happens is as you fill the lungs with air, you are increasing the natural curves of the spine.  This should happen from the tailbone to the top of the head.  So your inhale helps to float the head up off the neck.

For more details on a variety of Breathing Exercises to practice your Posterio-Lateral Pilates technique check out my blog post Breathing Basics

2.  Keep the Front of the Neck and Throat Relaxed on Your Inhale

I notice that a lot of people actually inhale through the torso and tense up so much through the front of their neck that the head actually gets closer to the body on the inhale!  When this happens – the neck muscles are pulling the neck bones closer together (when things should be lengthening apart!)  Watch yourself breathe in front of a mirror and see if you notice your neck get longer, or shorter as you inhale. Do you see the muscles in the front of your neck tense up on your inhale?  Or do they stay loose and relaxed? Think about your neck and throat being an open tube that air can easily flow in and out of.

3. Tongue Placement

Where your tongue is placed in your mouth can make a difference!  Lightly touch the tip of the tongue to the roof of your mouth on your inhale, and drop the tongue away from the roof of your mouth on your exhale. This helps facilitate proper use of the diaphragm, and as the tongue drops on the exhale, you may notice that the muscles in the front of the neck soften and relax a bit.

4. On Every Exhale Use a “HA” Sound To Release and Open the Jaw

Using “HAaaaaaa”  and opening the jaw to exhale moves the primary support lower in the torso to help activate core muscles. You might actually make the “HA” sound as you exhale until this becomes a familiar habit to release the neck and open the jaw.

The habit I notice if people aren’t doing a “HA” breath, is exhaling like you’re playing a flute, through a slightly pursed lip.  This creates the look of a sour lemon face.  If you make a sour lemon face, you’ll notice that the front of the throat tenses up, scalene muscles grip, and the head and neck get pulled closer to the body.  Plus,  it is more difficult to feel the activation of core support – support almost gets stuck in the throat instead of dropping lower into the center.   Can you see how this can create or aggravate a neck problem? Strive to make “HA” breathing your new habit!

5. Pelvic Floor

While I’ve got this as #5 on my list….It probably should be #1!  Effective use of the pelvic floor provides the anchoring at the base of the spine which is necessary for lift and lengthening that occurs during breathing.  Without an active, engaged pelvic floor, it’s impossible to get the ribs to lift away from the pelvis, the neck to lift away from the torso, and the head to lift away from the neck! How do you effectively find and use the Pelvic Floor?  If you’re not already familiar with using your Pelvic Floor, check back soon, for a blog post on this very important topic!

6. Shoulder Depression

Our body is a system of levers and pulleys.  Think of a teeter-totter.  Both ends can’t go up!  One goes down and the other goes up.  So for our body, the shoulder blades doing down provide the leverage for our upper spine, neck, and head to lift up. If your shoulders are wrapped around your ears, chances are your head and neck are jammed in too close to your torso.  Pull the shoulders down and you should feel your head shoot up another inch or two closer to the ceiling.

Which Pilates Exercises Should You Apply These Six Tips to Reduce Neck Strain?

ALL of Them!!! Whether it’s a Pilates Matwork Exercise, or Exercises on the Reformer, Cadillac, Chairs, or Barrels.  If you’re walking, running, riding a bike, swimming, lifting weights, dancing, riding a horse, playing golf, tennis or other sports…  You have lots of opportunities to apply these six tips to get your support where you need it and reduce the amount of tension and stress you feel in your neck.

Don’t forget about moments throughout your day too– at work, driving the car, doing things around the house…anytime you remember to take a minute or two and practice utilizing these six important neck lengthening tips – you’ll be changing your habits for better health!

Don’t worry if you can’t make them all happen at once!  Pick one and practice for a few days.  When it gets easier, see if you can add another one, then another – until you’re able to incorporate all six into any and every exercise you do!

It’s interesting the difference in perspective between traditional “Aerobic” class ab work and Pilates ab exercises.  You know how everybody always complains that their neck hurts?  Or they feel more work in their neck, chest, and shoulders than they do in their middle, which means it takes tons of reps of a variety of targeted exercises before you “feel” like you’ve really worked your abs?

While with Pilates Matwork, once you figure it out… you only do 3-5 of most exercises, and with good body mechanics your abs are well worked with this very  low number of reps, and the variety of Pilates exercises you do are not only working your abdominals, but the rest of your body as well!

One of the differences between general fitness programs and Pilates training is in the focused concentration on working the body through a full range of motion, and developing good spine articulation from the head to the tailbone.  Our back should easily and naturally bend forward, backwards, sideways, and twist at every single segment.  The Pilates system puts the body through all of these different ranges of motion with every workout which is why it’s such a beneficial training method for whole-body health.

Why Does Where You Look During an Exercise Matter?

So why should it matter where our gaze goes during exercise?  Our head is basically an 8-10 pound globe on the end of a flexible straw!   In order to keep the weight of our head from creating more tension in the body (in unnecessary places like our neck and shoulders) it is important to do the following:

a) Support the head with the muscles of our upper abdominals and middle back during every exercise and daily life activities.

b) Pay attention to where we are looking during every exercise so that the head and neck can be in as “neutral” a position as possible to avoid neck strain, and improve body mechanics.

Examples of Eye Focus During Abdominal Sit-Up Exercises

Here are two photos for to help you “see” the difference in posture and body alignment for the upper body, neck, and head between an abdominal exercise with the eyes looking at the ceiling, and the eyes looking towards the belly.

Both positions are working the abdominals, but in photo #1 the head and neck are not in good alignment which will create increased stress and strain for the neck and back when she curls up off the floor.

Can you see in photo #1 that while her body is striving to bend forward to work her abs, her head and neck are not doing the same bending and flexing action? Instead, her chin is actually jutting forward which is shearing the neck bones farther out of good alignment!

If in photo #1 her eyes were looking towards her stomach, it would bring her head and neck into a more neutral position (similar to the vertical position for standing posture) The abdominals would be working harder, and she would be more freely articulating the full length of the spine to bend into flexion to maximize the benefits from her ab work.

If you asked participant #1 to continue rolling up to a sit, chances are she would get to a sitting position by using her back muscles, and almost hinge up with a flat or arched back, since her “line of lift” is to a high forward diagonal, or she would make it up just a little higher than she is now – and then use her back to get the rest of the way up, or get stuck – unable to go any farther and fall back to the mat.

Participant #2 has an eye focus that places her head and neck in the vertical “neutral” that we have for normal standing and seated posture. Notice how the curl of her body shape continues from her low back on the mat, all the way up the back and over the top of her head and around to her stomach.  She has a more circular shape to her forward bend.  If you asked her to continue bending forward to roll up to a sit, her upper body is moving in the right direction to make that happen, and she’ll be using her abs to get there!

Although the photos I’ve used as an example for body position and eye focus, the hand and arm positions are different, it really doesn’t matter where the arms are.  Whether they are reaching up, out, or forward to either assist or challenge the exercise, or the hands are placed behind the head for support, it’s the focus of the eyes that will best help improving the technique of the exercise and train the whole spine to improve mobility and articulation. (As well as provide an excellent and effective abdominal training workout!)

Practice and Apply the Principle of Eye Focus to Movement in Any Direction

In forward bending, or abs work, the eyes should be the initiators to begin the curl.  To move in other directions, the eyes may not “look” first, but as the rest of the body moves, and the head is going along with the movement– pay attention to your eye focus to assist and you’ll find less stress in your neck and shoulders, and perhaps freer movement through your entire spine from the tip of your tailbone all the way up to the top of your head.

Additional Benefits of the Eyes Looking Towards the Stomach on Abdominal Work

There are three natural curves of the spine in standing posture.

1   An arch in the lower back (lumbar curve)

2.  A forward bend through the middle back (thoracic curve)

3.  An arch in the neck (cervical curve)

These three curves help to provide shock absorption and balance the weight distribution of our body for improved posture, support, and movement.

The lumbar and cervical curves also act as a team.  If one is in an arch, the other strives for balance and moves towards the same arched position.  When you apply that thought to bending forward, it makes sense that to help the lower back release, lengthen, and stretch the body has to bend out of the arch and into more of a scoop or c-curve.  And to do this well, both the lower back and the neck need to move into flexion/forward bending.

The change in focus to look forward towards the stomach begins to move the head and neck in the right direction and cues the lower back to do the same.  When the eyes look towards the ceiling, since the neck is being held in an arch, the lower back will tense up to hold its arch too and the body really can’t do any effective forward bending exercise.  Paying attention to where you are looking can make an advantageous and positive difference in your ability to execute your Pilates and general fitness exercises to improve strength, flexibility, and mobility of the abs and back.

Use Your Eyes While You Exercise!

Enjoy efficient and sequential articulation of the spine.  Focus your gaze in the right direction to maximize your results. Not only will it help your head, neck and lower back become stronger and more flexible, but while you’re looking at your abs for the Hundred, Roll Up, Series of 5, and other Pilates or fitness exercises, you’ll be able to see if your abs are pulling in for support, and can watch them pull in farther with every repetition!

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

www.Centerworks.com

Here are her comments and question:

“I have some very hip flexor dominant students that suffer from hip click in quite a few of the Pilates exercises, big one being Leg Circles and virtually anytime they extend their legs out away from the body.  I cue to bring balance with the antagonist muscles (tva and Glutes) but am still having issues.  Could you guide me in helping these people a little more effectively?  (I do ask them to stretch with a lunge prior to class, and even do a recumbent jazz attitude movement before leg circles.)  So is there something I am not seeing or doing?  Any advice would be greatly appreciated.”

I then dove into a folder on my computer to find an article in hiding that I had written, but never posted on my blog – think I may have posted in on a Podiatry forum where I read a clicking hip question!  Interesting to me that Podiatrists are also dealing with this issue with their patients.  It doesn’t do anybody any good for me to keep things a secret!  So I hope that for those of you out there challenged with clicking hips – you will find some of this information useful.  Please let me know how it goes with teaching or doing Pilates exercises and using this info to get out of the hip click!

Here are my thoughts:

In my 15 years of experience teaching Pilates, when a client experiences “clicking” or popping in the hip with movement, strengthening the pelvic floor muscles and increased lower core support, as well as focused exercises to improve hip mechanics with a softer (un-gripped) rectis femoris muslce will assist with this issue.

I was really blessed that when I started learning Pilates my first teacher, David Mooney, spent many, many hours during my private sessions helping me learn how to use my quads less and everything else more to support movement – especially when doing Pilates exercises that involved moving my legs away from and back to center, and not gripping the fronts of my thighs!  I then spent a ton of additional hours propping my feet up on things when I practiced on my own to re-train my body to relax my rectus femoris (top of the thigh hip flexor) , and support the weight of my legs in the air with my abdominals, psoas (under the thigh hip flexor), hamstrings, and glutes.  Then later on,  from my mentor Dianne Miller,  I got a greater appreciation of the value of an appropriately engaged pelvic floor to also benefit better support and reduce hip clicking.

In a Mat class there are a few things I do immediately to modify the One Leg Circle, until clients can make it happen with no noise or aggravation.

1.       Decrease the size of the circle and range of motion of the leg while it’s circling. A smaller range of motion should temporarily solve the problem, and allow the client to reach the leg longer creating more free space in the socket for movement, and helping them focus on the support and stability needed through the pelvis and “standing” leg.

2. Bend the knee while doing the circles. This shortens the lever and will adjust where the ball is sitting in the socket through the range of the circle.  It also takes some of the work out of the quads and shifts support to the hamstrings so the leg can swing more freely from the hip during movement.

3.      Use the support of a strap and assistance of the arms to help hold up the leg. If the hamstrings are very tight (back of the thigh), or the quadriceps are gripping to pull the leg around and up (front of the thigh) the leg cannot move freely from the hip because of the tension caused by muscle contraction and over-holding at inappropriate moments.

If I’m working privately with a client and have access to the Pilates Trapeze Table, the use of one leg spring to practice circles provides a similar support along with resistance to strengthen the leg throughout the range of movement.

In fact, all the Pilates equipment exercises where the legs are in a strap or spring, or knees folded over the roll down bar, are helping to retrain the body to reduce issues with clicking hips – IF a client is cued to keep the pelvic floor active, work from the back of the legs to extend and return, and maintain a softer “un-gripped” rectus  femoris.

This is why Pilates is a system.  Clients will benefit the most by working on both the equipment and Matwork to help retrain the body,  undue bad habits, and strengthen the most efficient muscles for functional movement.  It is extremely difficult to retrain  the quads to let go when they’re the guys used to doing all the work when the legs are extended, unsupported in space.

From the tweaks to the Leg Circle exercise listed above, education about the benefits of using and finding the Pelvic Floor is the next thing to incorporate into classes or client training programs. I teach how to find and use the Pelvic Floor as an exercise all by itself first, and then add this into other exercises until clients can confidently find and fire it at will!  Contracting the pelvic floor for support during exercise helps to take the pressure off the hip joint, frees up the ball in the socket, and allows movement without the noise or aggravation.  It’s the front and back walls of pelvic floor support  (tailbone to pubic bone connection) that is most difficult to find and use that is needed for free hip motion.

Then, watch your clients walk across the room.  Do the thighs stay in front of the body?  Or swing evenly with one leg moving behind the torso (the rectus femoris is releasing on every stride.)

With poor gait mechanics, a shortened stride, slightly posterior tilted pelvis, and overuse of the rectus femoris (one of the four quadriceps muscles,) the thigh bone is held to far to the front of the socket. Try to move the leg in a free range and it’s not going to happen easily until the pelvis and hip muscles have a different relationship.

In my experience – this postural and mechanical use of the body is apparent in many if not most of the people who have walked through my door for Pilates.   We spend too much time sitting, have lower back issues, and don’t take much time to stretch.

The great news is things can quickly improve with an understanding of how to find and use the pelvic floor as well as exercises to get a better understanding of posterior/inferior ball & socket placement, how to move the ball in the socket, and how to move the socket around the ball. If the leg is working mechanically well from the hip, the foot and lower leg have a better shot at good mechanics too!

Not only is the clicking apparent on one leg circles, but for some clients doing the Roll Up, or Neck Pull, you may see one or both hips make a funny, clunky shift in the transition from laying down to a seated position.  The reason for this again might be not enough pelvic floor, clients are “hanging off their hip flexors” and trying to move.

Think about the levers of the body –what parts of the body are moving and supporting during exercise?

• In the One Leg Circle, the thigh (ball & socket) are moving with a stable pelvis.
• In the Roll Up, the pelvis is moving (around the ball & socket) with a stable thigh.

So you’ve got movement from above, the ball and socket, and movement from below…the support to move is the same!  More pelvic floor action (especially the connection between the tailbone and pubic bone) will free up the movement and reduce / eliminate the “clicks.”

Hope this info is helpful!  Any instructors or Pilates clients out there who would like to comment on things you’ve done, cues you’ve found helpful, or exercises that have been beneficial to assisting  with the saying good-bye to the clicking hip issue,  please share!!!

Here’s my revelation for the week!  (or perhaps it’s just today’s revelation – and something else will pop up eager for me to share tomorrow.)

I’ve always cued my clients to begin learning their exercises with the awareness of working within the framework of the Pilates “Box.” Think about the torso from shoulder to shoulder, and hip to hip.  Every exercise starts from the center of the box, moves away from, and back to center.  The farther away from center you move, the stronger you have to be to maintain balance, control, and core support for your exercise or movement.  Feeling where the corners of the “box” are help create an awareness of being evenly  distributing your weight and staying centered.  Great concept!

So when the knees bend in towards the chest on any exercise where should they go? 

I encourage clients to stay within the framework of their “Box” and here’s why:

When the knees don’t open wider than the body there are multiple benefits for strength, flexibility, joint range of motion, core stability and control.

Here are 5 Great Benefits for “Knees Over Chest is Best – For Pilates Training”:

1. Better abdominal support for a safe and healthy back. The abdominal muscles have to pull in – out of the way when the thighs/knees pull in towards the chest.  This cues the core muscles to work and get stronger while the legs are moving.
2. This improved abdominal support, and the relationship with the thighs to the chest, provide a massaging action on the internal organs to assist the digestive system and elimination processes. If the knees open wide and the abdominals “pop” out to the front – support for the spine is lost, as well as the strength to hold the organs in a natural resting position in the torso.
3. Strengthen the Adductor Muscles. The inner thigh muscles work more effectively to stabilize leg control, and guide the legs in a precise plane moving away from and back to center.
4. Improve Knee Flexion. The medial hamstrings will do more work and get stronger as the legs bend in towards the body. This will help strengthen the knees and assist with smooth, controlled movement.  (With the legs opening wider than the body the inner thighs and medial hamstrings might not be working much at all!
5. Moving the legs while tracking within the Pilates Box, strengthens efficient alignment and allows the ball to drop in the hip socket to a good posterior-inferior position.  This helps to develop a free full range of motion for the hip joint (which is necessary to maintain and improve bone density),  trains the legs to move independently of the pelvis, and effectively stretches the glutes, and lower back.  AND while all this is happening, you are maintaining support with the back and core muscles.

I encourage you to play with this concept and see how it feels.

With which Pilates exercises can you see value in thinking about the “Box” and Knees Over the Chest position?

Has this post changed your perspective on wide knees vs. knees over the chest?

I’d love to know what you think!  Comments please….

Exercise Underutilized for Chronic Back and Neck Pain

About the Research Study

A recent study, funded by the National Institutes of Health, looked at exercise prescription-who is prescribing it, who is getting it, and what type of exercise is being prescribed-and found that exercise may be underutilized for chronic back and neck pain.

This study was published in the February 2009 issue of Arthritis Care & Research. Led by Timothy S. Carey and Janet K. Freburger of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, researchers conducted a phone survey of almost 700 individuals who saw a physician, chiropractor and/or physical therapist (PT) and were treated for chronic back or neck pain during the previous 12 months. They asked participants the following questions: if they were prescribed exercise, the amount of supervision they received, and the type, duration and frequency of the prescribed exercise.

The Benefits of Exercise for Chronic Pain

Exercise can commonly be used to improve physical function, decrease symptoms and minimize disability that can be caused by chronic low back or neck pain. Numerous randomized trials and clinical practice guidelines support exercise as a beneficial modality, and studies suggest that personally designed, supervised exercise programs are associated with the best results.

Results of the Study

“Less than 50 percent of the subjects in our research study were prescribed exercise, one of the few moderately effective therapies for the highly disabling illness of chronic back and neck pain,” the authors state. Also, health-care provider seen played a major role in whether participants received a prescription for exercise. Of those who received exercise prescription, 46% received the prescription from a PT, 27% from a physician, and 21% from a chiropractor. The authors note that these findings correlate with previous studies that have shown that “who you see is what you get.”

The authors conclude: “Considering current evidence on the efficacy of exercise, these findings demonstrate that exercise is being underutilized as a treatment for chronic back and neck pain.”

Pilates Exercise Programs for Chronic Pain Clients

As Pilates practitioners, it is beyond our scope of practice to “prescribe” anything. (Exercises included!) However, you can grow your business with an excellent source of client referrals if you work closely with the doctors, physical therapists, and chiropractors who have prescribed exercise and work to develop personalized Pilates training programs that meet the guidelines and “prescription” recommended by your client’s health-care providers.

The following things I always request from clients who are starting a Pilates program and have special considerations / health issues:

1. A written release \ authorization to begin an exercise program from their physician.

2. Contact details for both the doctor and physical therapist, and permission from the client to contact these professionals and discuss how we can work together to solve the problems, alleviate symptoms and pain and restore a healthy, active quality of life.

3. Information about any medications they may be taking for pain management.

4. A copy of the exercises they have been “prescribed” by their health-care provider (physician, physical therapist, chiropractor)

5. Any other information they think might be beneficial and relevant.

Physician and Physical Therapy Referrals for Pilates and Exercise

It’s actually been my experience, that when a physician says, “you need to exercise.” That’s as specific as it gets. They rely on my expertise to develop a safe and effective Pilates exercise program. I actually had one new Mat class participant show up with stitches from recent back surgery because her doctor told her she was ready to go, didn’t need physical therapy and needed to get started with an exercise program right away!

I believe that as Pilates professionals it’s our job to help educate the medical community as to the benefits of Pilates, and appropriate place to start for their post-rehab patients. Doctors who have never done Pilates themselves need to be educated about the differences between a personalized Pilates equipment program and group Matwork class so when they refer their patients, they’ll be confident that they are in the safest, most appropriate program to start.

While some physical therapists are in a situation to provide supervised care, unfortunately, our health-care and insurance system is not set up for them to provide patients with the length of care they might require for a full recovery. This is where communicating with a client’s PT can be an excellent networking opportunity to establish a lifetime Pilates wellness program for ongoing post-rehab care.

If a client is currently in therapy and has been given the ok to begin Pilates, it’s important to know what the safe movement guidelines are for them at this point in their recovery. As they progress, it is only with physician or P.T. approval that increased resistance, and additional ranges of movement should be incorporated into their program. Always defer to the recommendations of their medical health-care providers.

If a client has been released from therapy, it’s still important to check before beginning a program or adding anything new-until their physician, and physical therapist are confident that they can do whatever they want with no restrictions.

The Medication Consideration (and effects on exercise)

Many people with chronic pain may be managing it with medication. This is an important piece of information, as their medications may mask their ability to assess how their body feels before, during, and after exercise. Encourage clients to work closely with their physician to monitor how much medication they may actually need, as this may change as they get stronger and more flexible with their exercise program. And be aware that you might easily push too, far too fast, because with their medication they can’t feel the pain that would normally indicate the need to stop or modify an exercise.

Ask lots of questions before starting an exercise program.

Here are some I usually start with when interviewing a new client with chronic pain:

• Is your condition related to an injury? What happened and when?
• How long has this bothered you?
• Do you ever experience numbness or tingling?
• What do you do for a living? Sit more, Stand, Active?
• What activities, exercises, movements aggravate your condition the most?
• What activities, exercises, movements give you the most relief?
• Is your pain a dull, ache? Sharp? Stabbing?
• Are there times of the day when you feel better or worse?
• What things are you doing now to improve your health?
• What things have you tried in the past? How long? What were the results?
• What has your doctor told you to do and/or avoid?
• What exercises have been prescribed by your doctor or physical therapist?
• How often are you supposed to do these exercises? How often are you doing these exercises? How do you feel while you’re doing them? How do you feel after?
• How can I help you the most?
• What are your goals for participating in Pilates?
• Are there any other injuries or accidents that you’ve had during your lifetime? (Related or unrelated to the current issue?)
• Is there anything else you feel it’s important that I know?

The answers to these questions, the information provided by their health-care providers, and an initial assessment of standing and walking posture provides the starting point for developing a safe and effective Pilates exercise program to assist in the care and management of chronic back and neck pain with the goal of using exercise to improve function, decrease symptoms, and minimize disability for an improved quality of life.

Be Pro-Active and Incorporate a Pilates Exercise Program into your Lifestyle to Manage Chronic Back and Neck Pain

As a Pilates practitioner, take the time to network with the health-care providers in your community to build a referral source for quality care. As a client searching for ways to improve your health, be pro-active! There are many traditional and non-traditional methods for reducing pain and improving your quality of life-Pilates and exercise can be a great choice! Consult with your doctor, P.T., and chiropractor to determine the options available in your community. It is never too late to improve your health!

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Resources:

Article: “Exercise Prescription for Chronic Back or Neck Pain: Who Prescribes It? Who Gets It? What Is Prescribed?” Janet K. Freburger, Timothy S. Carey, George M. Holmes, Andrea S. Wallace, Liana D. Castel, Jane D. Darter, Anne M. Jackman, Arthritis & Rheumatism (Arthritis Care & Research), February 2009.

http://www.ptproductsonline.com/SOAPNotes/2009-02-04_01.asp

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Aliesa George is a wellness consultant and author with 25+ years of professional experience. She is founder and president of Centerworks® Pilates Institute. Certifications include: PMA Pilates Teacher, ACE Personal Trainer & Group Exercise Instructor, and Bigu Qigong Weight-Loss/Weight Management Instructor. Ms. George is available for private/group training and offers workshops in Pilates, movement re-education, and mind-body health enhancement. For additional resources and to contact Aliesa, please visit www.Centerworks.com.

I may be a bit behind the times when it comes to enjoying the fun and benefits of all the new interactive video game products on the market – like the Nintendo Wii Fit…  but recently my techno-geek boyfriend purchased a Wii Fit for home.  (He’s had one at work since they first hit the market.)  Being a bit shy about actually getting a computer to do what I want, for me is intimidating, never mind the hand-eye coordination it takes to “win” a computer game…..I was never any good at these games as a kid.

I have to admit my extreme skepticism about the benefits of staring at a TV screen and using a computer game for fitness.  But am always excited to hear about new ways to inspire and encourage people to increase their exercise and activity level, and ANYTHING that people enjoy doing that involves movement can be a great way to improve health and fitness.

After playing with the Wii Fit only a couple of times, I am a happy to report that I am a fan of the fun, interaction, and health benefits that this gadget can provide!  Last night my family spent 6 hours playing Wii Fit games together!!!  Tennis, Baseball, Boxing, Bowling, Golf, balance games, yoga.  I think we explored the gamut of options!  I can honestly say that I can feel my abs this morning – so core muscle strengthening was definitely happening, and I wasn’t one of the folks that spent tons of time playing! So can only imagine how sore a few other people might be today!  We had more fun, spent more time laughing, talking, and encouraging each other in competition that the evening flew by and nobody wanted to stop playing.

While I wouldn’t want to spend all my workout time on the Wii…I think it’s a great option for friendly competition, a way to check-in on your health status with weight, Body Mass Index (BMI), goal setting, and some basic fitness testing for strength, balance, and control.  This gizmo provides instant feedback to see where you’re at, games and skill challenges to improve your health, and a way to do something besides just be a couch potato in front of the TV.  I also think that the balance awareness and assessment tools are excellent.  More about that in an upcoming blog post!

Do you Wii???  If you’re doing or teaching Pilates and haven’t tried this yet…find a friend who’s got one – create your Mii (your own personal cartoon version of you!) and go play!  I’d love to hear what you think about using Wii Fit as a tool to help your clients track improvements with their health and check-in with Posture and being “on center” for balance and body control that is such a key aspect of Pilates training.

Share your Wii Fit experience!