Why Do I Have Neck Pain When I Do Pilates?

Alignment, Strong Abs and Back Muscles Support the Neck

Young woman in sportswear with neck pain. You may also like:
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A sore neck, neck pain, and tension in the neck and shoulders are not uncommon complaints for Pilates beginners. Readers have even written to me asking for neck strengthening exercises to help them get past the sore neck stage. While neck muscles that are strong enough do factor in, a weak neck is often not the main cause of neck pain in Pilates.

When the neck and shoulders are not properly supported in an exercise, they take on too much of the work.

Weak abdominal muscles, weak back muscles, and poor alignment are likely culprits. The abdominals, back, and alignment must work together to create the stability in the trunk that frees the neck. Of course, if you have constant back and neck pain or it gets worse, you need to work with a health care provider and look to potential other causes.

Here we will take a close look at the factors that contribute to straining the neck in regular Pilates exercise and what you can do to remedy that. This is not an article about therapeutic exercises. If you think Pilates is bothering your neck, please pay attention to the points I make on all 3 pages of this article. They are all relevant, interrelated, and important.

Your Neck Needs the Support of Strong Abs

In Pilates we do a lot of exercises where we are on our backs lifting our heads away from or returning them to, the mat. Chest lift, the hundred, and roll up are examples of these kinds of exercises.

Coming up or rolling down, at a certain point, your abdominal muscles have to be really strong to support your upper body in resisting the pull of gravity as your relationship to the floor changes.

If your abdominal muscles aren't doing a lot of the work, the neck muscles tense, taking on more effort than they should.

Further, if the neck muscles are really weak and can't support the head and neck, then the bones are not supported and that can lead beyond soreness and tension to muscle strain and misalignment of the vertebrae.

Developing Abdominal Strength

Two related practices will help you develop the strength and coordination you need for your abdominal and neck muscles to work together to support your head. First, neck and shoulder tension are often chronic habits. We use these muscles even when we don't need to. The cure for that can be as simple as increased awareness. Notice, let go, and put the effort where it belongs, in the abs. Second, the neck muscles are going to get work, but you do have to develop the core abdominal strength that will allow the abdominal muscles to relieve extra pressure on the neck muscles.

Pilates exercises are all about creating strong abdominal muscles and overall core strength. The first thing you need to know is how to pull your abdominal muscles in correctly because this is almost always the supportive move that happens before anything else.

Once you have that, we use a lot of forward bending (flexion) exercises to focus on increasing abdominal muscle strength.

Making sure that your abs are working throughout an exercise is very important but if you are experiencing neck pain, you might need to modify your exercises as you build strength and release neck and shoulder tension. Here are some ways to modify exercises to protect your neck:

  • Don't keep your head up for long. As soon as the neck muscles take over, you might as well put your head down and come up again - engaging the abs for the lift.
  • If you are rolling down, stop when the neck and shoulders get tense, back off a bit then go again - keeping your abs working this time. You might not roll down all the way - just move to your limit and back off. You will get stronger and go further with practice.
  • Place your hands behind your head for light support (elbows out).
  • When the legs are outstretched, raise them or bend them to tabletop position to take strain off the abs until they get stronger.
Read How to Modify Exercises

Next, A Strong Back Supports the Neck

Your abdominal and back muscles work together to support your spine and neck. When we go for a long spine as we do in Pilates exercises, we are asking for the support of back extensor muscles. When those don't work for us, we get extra tension in our shoulders and necks. This is true when we do exercises that are forward bending, back bending, or in neutral spine. To strengthen the back extensor muscles, we do extra back bending exercises like swan, swimming and the more advanced, double leg kick.

To protect your neck when you do back extension exercises, you must engage your abs and get your mind to help you use your back muscles to lift and support your upper body and head instead of lifting with the neck and shoulders. This is true all the time but if you have neck pain you might have felt it more in exercises like swimming where you are lying face down and lifting the upper body away from the mat.

Modifications you might want to use for back extension exercises are similar to those we talked about with the flexion exercises: Use a smaller range of motion, reduce the hold time for the exercise, and stop when you don't have the core support you need to continue. Another tip is that the arms being up adds extra weight and difficulty to exercises. For example, swimming is harder than half swan because the arms are extended. If you have neck pain, try keeping your arms by your sides or use them for light support as we do with half swan.

  • Keep Your Head in Line with Your Spine:
  • Half Swan (notice how beautiful the alignment is in the photo that goes with these instructions)
  • Swimming

Next, Good Alignment Supports the Neck

Your head and neck should be aligned as natural extensions of your spine. Breaking the line at the neck is one of the easiest ways to wreck an exercise and get neck pain. This can look like a back tilt of the head when you do back extension exercises, or jamming the chin too far down in forward bending exercises, or tilting too far to the side in sideways exercises.

When the spine is in it's natural, neutral position as it is when we sit, stand, and do many Pilate exercises, the ears should be right in line with the shoulders.

When you change that alignment to do forward bending exercises like wall roll down or the hundred, the head needs to do a little nod forward to remain in line with the intention to curve the spine. (see head nod)

When we do back bending exercises, we want the neck to extend as part of the line of the long spine. We don't want the head to tilt back which is a tendency many people have that causes neck strain. For example, people often have the urge to look up when doing extension exercises like swimming or even single leg kick. What you really want to do is think of energy extending out the top of your head so that the sense of length through the spine helps lift you, not the act of picking up the head separately. That way your shoulders and neck do not get overly involved.

There are more ways to modify exercises to help relieve stress on the neck. For example, when the abs aren't strong enough to hold the legs out straight as we do in many exercises, the neck and shoulders try to jump in. You can read about that and more in Ways to Modify Exercises. If you are having neck pain when you do Pilates or after, please work with a Pilates Instructor who can help you with your particular movement patterns.

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