What to do. What Not to Do.

By Shari Berkowitz

The human neck is fascinating in its simplicity and complexity. It is lovely to look at as it holds up a head.  It is the conduit for breathing and eating and, most importantly, is the link from the brain and brain stem to the torso.  It houses the top of your spinal cord. The human neck is fascinating, and strangely delicate.  Breath, Digestion, Voice and Neurological function all rely on a healthy neck. We must take great care of necks, no matter what level our client is: Beginner, Intermediate, Advanced.

The Cervical Spine (C-Spine) is made up for 7 vertebrae (C1-C7).  These vertebrae are quite narrow compared to the Thoracic or Lumbar vertebrae.  They afford great mobility in flexion, extension and rotation.  The combination of movements amongst the 3 planes are remarkable, all the while holding up a rather heavy head.  C1 and C2 (The Atlas and Axis, respectively) have unique design that allows for a transition support of the skull and incredible range of motion in rotation.  C7 has an extra long spinous process that assists in limiting damaging extension as well as being a strong attachment for muscles. The many muscles that traverse our neck are in a delicate balance and their ability is remarkable, but they are vulnerable to great strain.

Let’s take care of the neck through our clients development from Day 1:

Beginners: Beginners come to Pilates with both weak abdominals and neck muscles. The combination can be dangerous. We start our client on the mat with The Hundred and curling her head and chest up for the exercise, but our client with weak abdominals, neck muscles and a tight back has a hard time with this. We must be aware that this may be a strain on our client’s neck until she is strong enough to curl the head and chest up from abdominal strength and not just from cranking her neck. So, please, by the 4th breath, tell your client to rest her head if she her neck is tired. Then perhaps she can lift her head and chest up again for the last repetition/breath. Remember that it takes time to build up the abdominal strength to curl the head, neck and chest up.

“Curl your head and neck up. Look into your abdominals”. This is a great phrase! It’s far better than “chin to chest”. When your client is lying down, “chin to chest” is exactly what we do not want our clients to do.  They will just be straining their necks compressing the front/anterior portion of the spine.

So, how do we do it?  It’s the upper abdominals that need to strengthen, the middle back that needs to open so that it is effortless on the neck to curl up.  It takes time to develop this balance.  Working the entire Method of Pilates with all of its tools (reformer, trapeze table/Cadillac, wunda chair, etc.) makes it happen!  Sure, it can happen just on the mat with proper cueing especially when we allow our client to rest the neck when they need.

We don’t want our new clients going away after day 1 saying, “Pilates hurt my neck”.  It will hurt if we aren’t aware that they need permission to rest their necks and we have to watch out for signs that they are straining.

What are the signs?  As they are doing exercises with that lifted head and chest, the chin must be a little away from the chest.  The entire chest and upper back must be lifted until just the tips of the shoulder blades are still on the mat. Once you start seeing your client fall backwards in their upper back, then you must cue their abdominals in and up and curl their chest up higher.  If they can’t, they must rest their heads.

Whenever heads are rested in mat exercises that would usually have them up, the legs must either be in tabletop position or straight up to the ceiling.  For example: Single Leg Stretch: Your new client can do 5 repetitions with his head and chest lifted and the outstretched leg at a high diagonal, but then when his neck tires and must rest it down, he must lift that outstretched leg up to the ceiling so he doesn’t continue to strain his neck or end up straining his back. That’s a good rule to work with.

Intermediate or Advanced: Intermediate clients are in the midst of developing the balance of stretch and strength that is lacking in Beginner clients.  What you might find with Intermediates is if they come in one day to the studio with a sore neck.  What do you do?

There are a few guidelines to keep in mind:

1 – Anything that affects the shoulders will affect the neck. Start the session with a range of motion (R.O.M.) test of raising arms straight up and a down out front and out to the side only to the level that there is no pain or strain on the neck.  Now, you’ll know what to do with arms during the session.

2 – Neck and Shoulder Stretches -  These are physical therapy based exercises and good for:
• Shoulders first (might loosen the neck and will show client’s R.O.M.) – Do not force these positions and only do the ones that cause no pain.
- Raise shoulders Up and Down  - 4-6 reps
- Draw shoulder Forwards and Backwards - 4-6 reps
- Circle shoulders in both directions - 4 reps each direction.
• Neck next – Again, do not force these positions and only do the ones that cause no pain.
- Tip head side to side – ear towards shoulder – 4 sets
- Turn head right to left – watch that head stays level and ear doesn’t tip towards shoulder – 4 sets
- Draw chin in to a “double chin” and look down toward abdominals, then return level – 4 reps

3 - Mat Work Guidelines:
• Keep the head and chest down in exercises they’re usually lifted in.
• Use a small pillow under the head if this relieves some pressure.
• If head is down, in exercises where an extended leg would usually be out on a diagonal, raise it up to the ceiling (i.e. Single Leg Stretch, Double Leg Stretch, etc.)
• No overhead exercises (i.e. Roll Over, Jackknife)

4 - Reformer Guidelines:
• You might reduce a spring on footwork exercises to reduce any possibility of strain.
• Take note of the headpiece elevation.  Your client may need it down or a pillow on it or higher.  Find out.
• No overhead exercises (i.e. Short Spine, Overhead, Long Spine)
• Any shoulder girdle exercises may be painful on the neck.  Just be aware.
• The use of straps in the hands recruits the shoulder and neck muscles.  This might cause discomfort.  You might have them do the exercises without straps.
• Any exercise where arms are lifted may cause strain (i.e. Short Box Straight/Flat, Side-to-Side, etc.).  You might have your client cross her arms over her chest, hands at her acromion process.

5 - The greatest rule of all: “When in doubt, leave it out!” If you’re concerned that an exercise might cause trouble, then modify or leave it out and chose only exercises that will be of benefit.

Take care of weak necks by giving them a chance to rest.  Take care of sore necks with proper stretches and appropriate modifications as well as leaving out any exercises that may cause strain.  As in all good teaching, choosing which exercises to do and which not to do is the key!  Use your critical thinking and continue to educate yourself.  The more information you have, the less afraid you’ll be and the better care you can give!

About the Author: Shari Berkowitz is the Power Pilates Director of West Coast Education and Teacher Trainer. She owns The Vertical Workshop Pilates studio in Beverly Hills, CA. Her fascination of necks emanates from her 100% recovery from a traumatic accident where she herniated 3 disks in her neck that brought on a longer than desired spell of paralysis in her left arm and shoulder from it. It ought not take personal injury for us to learn about the body, so let’s educate ourselves so we can safely train our clients. Shari writes a Pilates blog that is directed to Pilates teachers at www.TheVerticalWorkshop.com and you’ll find more great information at www.powerpilates.com.

Other articles by Shari: Taking the Mystery Out of Pilates

Tags: cadillac, long spine, neck injuries, power pilates, reformer, shari berkowitz, single leg stretch, the hundred, theverticalworkshop.com, wunda chair