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’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….

Question: Is Pilates appropriate for someone with peripheral atrophy? Balancing is becoming more & more difficult so yoga is no longer an option. If appropriate, please tell me where I might find a certified teacher/instructor. Please advise.

Answer: I do not feel it’s appropriate for me to answer this with a specific yes, or no – because I’m out of my scope of practice to recommend Pilates for a specific person, with a specific medical issue. (Especially someone I’ve never seen or worked with!)

However, here are my personal thoughts on the subject:

There can be many different reasons for peripheral atrophy. It would be important to know the causes, what parts of the body are being affected, how long it’s been an issue, symptoms, challenges, goals, a personal medical and exercise history, AND get prior approval from your primary care physician and medical specialist who is treating you for this — before starting a Pilates program. Your physician should give you the green light that it’s ok for you to begin (or continue) an exercise program – Pilates training or other forms of exercise.

Based on my years of Pilates teaching experience, and having worked with several clients with moderate to severe health challenges related to degenerative nerve and muscle diseases, Pilates training didn’t help reverse the clock and make everything “normal” but I have watched my clients enjoy substantial benefits in regards to gaining and maintaining strength, flexibility, balance, and body awareness for an improved quality of life.

Because a training session with the Pilates equipment can get you off your feet, and into more supportive positions – the challenge of balance can be taken out of the equation while learning different ways to improve strength and body control. The goal, of a Pilates program (in my opinion) would be to help identify things in your daily life activities, movements, and posture that are becoming a challenge, and then develop a program with the Pilates exercises that will best help to maintain and improve your fitness.

Some of what I do with my special needs clients is Pilates. Some exercises have been creatively modified; other exercises I pull from my experience in dance and general fitness that I feel are applicable to continue gently encouraging the body to stay strong and healthy. This is my approach! It might be different with a different teacher.

If your Physician agrees that Pilates might be beneficial and recommends you give it a try, then you can start the search for a qualified Pilates teacher with the knowledge and background to work with you.

Not all Pilates teachers are created equal. With health challenges, it would be best to find a teacher with good experience, and it might be advisable to find someone with rehabilitation background or physical therapy experience (You want to find a Pilates teacher who is confident to work with special populations.)

Ask your potential Pilates trainer if they’ve worked with other clients with special needs or peripheral atrophy. If you’re lucky enough to be in an area of the country with an abundance of Pilates professional, I’d recommend visiting several studios, asking lots of questions, and possibly take lessons from a few different teachers to be sure you’ve found one that has a personality that clicks with yours and fits the bill for knowledge, expertise, ability to help encourage you, and can design a Pilates training program that allows you to work at your own pace.

Begin with private one-on-one Pilates training, and let the teacher you are working with help guide you into Pilates Mat or other equipment classes if and when it’s appropriate for you. (Private Pilates lessons may be your long-term best and safest option.) Chances are there will be lots of exercises and concepts that you will be able to take out of the studio for “homework” as a supplement to your Pilates personal training routine.

To locate a Pilates Teacher near you:

• See what’s listed in your local phone book under Pilates.
• Inquire with your local health clubs.
• Call sports medicine / physical therapy / or kinesiology / chiropractic clinics and ask where they refer their patients for Pilates Training.
• Check with the Pilates Method Alliance. The PMA is an international membership organization for Pilates. You can search on their website to locate a PMA member Pilates Teacher/Studio at http://www.pilatesmethodalliance.org/curntmemb.html
• PilatesStyle Magazine also has a good studio referral network at http://www.pilatesstyle.com/web/directory.aspx

It’s so important – that we maintain a good level of wellness! Finding an exercise program that you can do safely to maintain strength and flexibility will keep you as healthy as possible. It doesn’t have to be a wild and vigorous workout to get results. There is a difference between a professional athlete training for sports performance, and you or me enjoying exercise to maintain a good quality of life. Check with your doctor to be sure it’s ok for you to be active, and then find exercises you can do and enjoy that keep you moving at your own pace… and keep on moving!

*************************************

If you’re looking for more general info on peripheral atrophy visit: http://www.nlm.nih.gov/medlineplus/ency/article/000593.htm

I had a blast teaching Shoulder Mechanics and Fantastic Feet workshops in Little Rock in April, as well as a Matwork master class. Thanks to the fantastic group of students and teachers that participated in these workshops!

I am looking forward to being back in Little Rock for a full series of Centerworks Pilates Teacher-Training Workshops starting the end of June.

If you’re interested in these courses, you can download the flyer & registration forms at: Centerworks Pilates Teacher Training Program Info Flyer for 2008-2009 Little Rock Workshops

If you have questions, drop me a comment on the blog, or email me a question with the contact form at http://centerworks-pilates.com/contact.html

Hope to see you in a workshop soon!

Here’s my new cue of the week for improving Spine Extension.

Pretend your ribs are like an oriental fan, and as you lift into extension open the fan.

The pivot point for the fan is under the armpits, (assisted by shoulder depression and the lower trapezius.) By visualizing each rib sequentially pulling away from the next and lifting apart the spine moves more freely, and pulls away & up, reducing stress on the lower back while moving into a glorious well-supported backbend.

I have found this cue particularly helpful on Down stretch on the Reformer, where the goal is to be light on the arms while lifting into spine extension. But it works equally well on many other back extension exercises. Try it on Swan, Short Box Round (into the backbend) Extension exercises on the Spine Corrector, Pulling Straps on the Long Box, Kneeling Knees Arched, Even on Mermaid – opening one fan, and closing the other. (If you have success using this image on one exercise – associate it to other exercises and you should get similar results!) It might also be helpful on Spine Flexion in “Fanning the ribcage into a good C-Curve” bending the other direction.

Depending on the exercise you’re teaching, you might also consider which end of the fan is opening first. Pulling apart from the top of the ribcage to the bottom, or opening from the bottom of the ribs to the top. The image of the fan works both ways. Evaluate what you’re doing and what will be best for the body to determine which end of your fan should be opening first. Then see how many different exercises you can apply your “FAN” image visualization for improving exercises understanding and technique.

Try it and drop me a post to let me know how it works for you!

Do you remember reading Dr. Suess as a kid?  One of my favorite stories was the Starbelly Sneetches.  And how wonderful that that star is in the perfect spot to think about pulling the abdominals in for support and Core Control.

Here’s my tribute to the great Dr. Suess from a Pilates perspective!

Is your Starbelly hanging out – which might be a factor, or cause, or concern – for  lower back pain that you’d like to relieve?  

Or perhaps you have realized that whether or not there’s a star on your belly – pulling it in is the thing that you need.  

For strength in your abs, and a core that is working, all that you need for your spine feel fine is to remember the spot where the star might be placed and keep pulling in with your will and your might, so as you get stronger your back will not hurt. Yes…That is Right! 

With practice your star will shine with great strength.  And I know you will see…with each Pilates exercise, longer and leaner your body will be - as you learn to do each movement quite precisely. 

If Joseph Pilates were here still today, he would cheer your success and be proud of your efforts.  So enjoy your good health and keep in your mind, your star-belly IN very close to your spine. 

Here’s my best advice to all teachers & students out there….

1. Never stop thinking things through.

2. Try different versions, techniques, and modifications to see what agrees with your philosophy about the work.

3. Be open to new ideas.

4. Challenge & question things you’re not sure are right.

5. Search & research to find the answers to things you are unsure about.

6. Take the best that other teachers have to offer that makes sense to you, and leave the rest behind.

If I think about my understanding of Pilates 14 years ago, vs. what I know now – there is light years of difference. But even so, when I hear things that contradict how I teach – I still doubt what I know sometimes. Plus, I am completely secure in my belief I’ve got lots more to learn about the body.

So…Here’s the question I was asked:
“How do I ask this question succinctly? (It will be difficult!) You speak of the incorrect use of the thighs when speaking of the psoas. What about when you are rolling up or rolling down from standing? The venerable Mary Boyd advocates using the inner thighs along with the pelvic floor and navel-to-spine. I get confused–there are contradictions in the field! Please advise. THANK You.”

My Response: As I read back over my psoas article, my usage of the word “thighs” was mainly in reference to the quadriceps muscles, in particular the Rectus Femoris as it tends to be the over used and inefficient hinger of the leg/pelvis.

For me the Pelvic Floor is a given starting point on every exercise as it provides support for elongation of the spine and freedom for hip movement.

While I used to cue navel-to-spine, personally, I’m looking for everything from the crotch to the navel to be pulling towards the spine (for a flattening band of support for the low back and belly). Some folks are really good at just pulling the belly button to the backbone with a pooch below. If your teacher is getting the correct action from your body with that cue – it’s working.

Rolling Up or Rolling Down – whether you’re standing or doing the Matwork Exercise Neck Pull or the Roll Up I agree that the inner thighs are active – not a death squeeze, but definitely energized. (It doesn’t matter whether the legs are together or apart there is still “action” in the inner thighs.)

In reference to the inner thighs and psoas…In my opinion, I don’t think that squeezing the inner thighs harder is going to keep the quadriceps out of the equation so the psoas can do it’s job. There should be some life in the inner & outer thighs, but the engagement through the glutes & hamstrings will be more important for the support & action of keeping the legs down on the floor to articulate through the spine and pelvis when rolling up & down when laying on the back. Same would be true in a standing position (only it might feel easier here since gravity is helping hold the legs still.)

The short & condensed version…I don’t think the information you feel is conflicting really is! I agree with what you’ve been told. And we all have to remember that with so many parts and pieces to think about during a Pilates workout, you’re teacher can’t possibly pick on, or correct everything every time. Some days you might be reminded more about the pelvic floor, other days what the abs are doing, or the glutes & legs, or the psoas, or the movement of the pelvis, or the breathing. Plus – once you understand and are doing some things well, we tend to start reminding you about other things to keep tweaking your technique – until there is nothing left to remind you of and you’re brain and body are beautifully connected for efficient movement!

Good Execution of the Up Stretch
First, look at the starting position. In the UP position the “center” is strongly pulling to the spine in a C-Curve.(Look for an even back position from the tail to the head.) This should put the center of gravity in the center of the carriage – with the body weight balanced evenly between the hands and the feet.

Second, as the hips and legs extend to press the carriage out, the center/center of gravity should remain in the same spot and just lower so that the body is in a straight line from the head to the heels. (Depending on the height of your client and the length of their legs – the legs will be over the carriage and the “center” will be over the stretched springs.)

As they pull the carriage in, the “center” should remain in the “center” – so the body weight remains more evenly distributed between the hands and feet and there is less weight in the arms and shoulders so they can move freely to hinge forward over the bar.

Done well, once forward over the footbar, returning to the Up position is easily accomplished because the shoulders are free and the spine articulate easily from the top to the tail back to the Up position with the “center” over the center of the carriage.

What To Watch For:

1. If the center of gravity moves out with the legs – the arms and shoulders have a tendency to grip to put the brakes on and keep from going too far out. When this happens, clients pull themselves in with the shoulders and the “center” moves forward into the chest & shoulders. The result – no control and tons of weight on the arms and wrists. 
2. If the back sags as the carriage goes out, the movement is being initiated from the low back instead of the hips to extend the legs. This gives the “saggy old mare” visual and causes the center of gravity to be unsupported dropping the belly & back too low -the result the deltoids, upper traps, rhomboids, and back extensors are trying to do the work that the abs, multifidi, and serratus should be doing to support the body as it moves forward over the bar. (In simple terms…the shoulders will take over to pull the “center” into the chest & shoulders causing the upper back to hunch more while moving the body towards the footbar.) And too much weight on the hands and wrists.
3. To compensate for the lower body moving out – the “center” may be shifted forward from the “center” to the upper body as the legs extend. The deltoids are cued to do the work as the body hinges forward over the bar, PLUS all the body weight is moving forward with the carriage – assisted by the closing of the springs. Gripped shoulders, scrunched neck, folding the hips too soon, lots of weight on the hands. Panic will set in for sure!

Add a head position that’s looking forward over the footbar rather than down at the feet to any one of these three possibilities (or for some clients – a combination of 1,2, or all 3) and they are set up for that scarey “flying over the footbar” feeling.

In all my years of teaching, I’ve never had anyone actually fly over the bar! Comforting to tell folks, but they will be more reasurred by having complete control over their own body during the exercise. So the SECRET’s out…

Keep Your “Center” in the Center
With the “Center/Center of Gravity” staying supported and IN the pelvic bowl throughout the exercise, it is easy to keep the body lifted with less weight on the wrists, move freely – hinging from underneath rather than on top of the shoulders, articulate well through the spine and have great control over the body throughout the whole Up Stretch exercise.

Try it and let me know how it goes!