Pilates for neck and shoulder pain

As the image above shows so well, pain in the neck and shoulders can be closely related, so we’ve grouped them together for this post. There are many muscle, nerve and fascial connections between neck and shoulder, so pain in one can easily lead to pain in the other. In addition, as we will see, Pilates exercises tend to be focused on the mobility, conditioning and alignment of both together, because anatomy-wise, it is very difficult to make a change to one part without influencing the other.

The neck consists of seven vertebrae, with joints between the bodies of the vertebrae (through discs) and between the outer points of the vertebae as well. The spinal cord runs through the middle and nerve branch out to supply the shoulders and arms and also affect the head.

There is also an artery running up each side of the spinal column in the neck (marked in red on the diagram) which supplies blood to the brain. Problems within the joints, caused by wear and tear, posture, prolonged static positions or muscle imbalances, can cause pain around the neck area but also refer pain to other parts of the body. This is usually due to the distribution of the nerves as the run from the neck.

So pain arising in the neck can be manifested in different places, lower and middle neck problems can cause hand and shoulder pain, while upper neck pain can cause jaw pain and also headaches. This can be difficult to make sense of but we can get great results  when we identify that the problem has arisen from the neck and treat the cause.

Problems with neck and shoulder posture are frequently seen together. People who work at computer screens or spend a lot of time sitting will tend to have a bit of a forward head posture, compressing the back of the neck, and the shoulders will begin to round forwards. This is called upper crossed syndrome and causes tightness in the front of the chest and back of the neck, and weakness in the upper back and front of the neck:

Look around you, does the posture above look familiar?! It can be the source of a lot of discomfort.

The shoulder and shoulderblade form a very mobile and complex joint system. The only joint connection to the rest of the skeleton is where the collarbone meets the sternum (the sternoclavicular joint below). The remainder of the shoulder relies on the support of the muscles around the shoulderblade and around the shoulder (glenohumeral) joint itself to remain in good shape and continue to provide the mobility that a  shoulder is capable of. Take a moment to reach overhead, to the side, behind you – if you have no shoulder problems you should be able to get an incredible range of moments from your shoulder, all of these supplied by groups of muscles working in combination. Sorry to get a bit geeky about this, but I think it’s a pretty incredible feat of engineering!

 

Shoulder problems can arise when an imbalance occurs in these complex relationships between muscles, with dysfunction of a nerve or if there is a problem within the joint itself – tightening of the capsule that surrounds the shoulder joint  for example. Anyone who does repetitive tasks or sits in sustained postures can be affected by shoulder problems. Within sport, swimmers and cricketers are a couple of examples where shoulder injuries can occur.

Pilates exercises work to balance the muscles around the shoulders, but also work the shoulders in different positions to achieve the dynamic stability the shoulders need to support them through the full range of movement they can achieve. The shoulders and neck are encouraged to work together to achieve improved posture throughout the upper body. This is great for preventing as well as treating neck and shoulder problems.

Some Pilates exercises use body weight to encourage correct control around the shoulders whilst maintaining good neck alignment. Specific movements encourage good coordination between muscles and allow muscles to switch on in the correct sequence which is vital for good shoulder function.

A Pilates client of ours had struggled with neck and shoulder pain for years and been to various Physios, chiropractors and osteopaths before giving Pilates a go. We have given her a programme of one-to-one Pilates sessions twice weekly as well as a few key exercises to work on at home. In the one-to-one sessions she has very close supervision of her positioning to ensure she gets the best out of the exercises. She has found that each session’s effects are lasting longer as she continues working with us, and we have been able to progress her to challenging exercises. Her posture has improved, pain reduced and movement in her neck and shoulder is now much better. She reports that Pilates has been much more beneficial than any previous treatment.

So, what can you do to help prevent neck and shoulder pain? Move, little and often. If you have to sit in a static position for a period, sit well supported with good neck and shoulder alignment (chin tucked in, length in the back of the neck and shoulderblades slid back and down into your mid-back) and take frequent rest breaks. During a rest-break you could try a couple of simple exercises to improve the mobility and dynamic stability of the neck and shoulders:

The V-W. Lying on your front with a cushion underneath your forehead, your chin tucked in and you belly button drawn up and away from the floor/mat. Start with the arms beside your shoulders in a W shape, then hover the arms a couple of inches and exhale sliding them overhead into a ‘V’ shape. Inhale and return to the start. Repeat 10 times. To make this exercise more challenging, lift the forehead a couple of inches, keeping the chin tucked in and continuing to look down.

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Upper back extensions: with your hands either on the chair behind you or on your low back, keep the chin tucked in and length through your neck, feel for the stretch between your shoulderblades, not in your low back. Hold for a breath and release. Repeat 5 times.

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Spine twist exercise (which can be done with or without a band or towel). Inhale, lenthen through the spine and exhale, rotate to the side, inhale hold and rotate a little deeper, exhale release back to the centre. Repeat 5 times each way.

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Please see your instructor if you have any questions about the exercises described here.

Enjoy the benefits!

 

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Pilates for Low Back Pain

Low back pain is a condition which affects almost all of us from time to time. It can range in severity from irritating to debilitating, and many untypeable ****ing’s in between! As physios, the phrases we often hear are ‘it just started out of the blue’, ‘I didn’t do anything’ or ‘it was lifting that chest of drawer/sweeping leaves/shovelling snow that did it’. Possibly the shovelling snow was the final straw in years of lack of movement, poor movement patterns and an imbalance in the repetitive loading of tissues.

The causes of back pain can be complicated and confusing, with everyone around you weighing in with their opinion. ‘ooh, that sounds exactly like when I slipped my disc and was flat on my back for three months’. Gosh that sounds terrifying, is that really what’s happening to me? Probably not.

 

The actual structures involved in causing back pain could be any one or any combination of muscles, joints, ligaments, connective tissue, nerves, discs. I am deliberately putting discs last, because there is a lot of mystery and confusion surrounding the intervertebral discs. The theory is that when pressure is put on one side of the disc for a prolonged period, there is a possibility that some of the jelly-like substance in the middle of the disc can protrude out the other side. The disc itself is very firmly attached to the vertebrae above and below it, and is not going to ‘slip out’. The other reason discs are last on the list is that disc protrusions account for approximately 5% of all back pains, and of those, only a tiny proportion will require surgery, most can be resolved over time by adapting the way you move and with targeted exercises..

 

The reasons for back pain occuring are as many and varied as the people experiencing the pain. It could arise from an imbalance in muscle function, deconditioning through our increasingly sedentary lifestyles,  the trauma of a fall from height or a number of conditions such as osteoporosis and osteoarthritis. Even people who have a these conditions can make drastic improvements to how they function and their pain levels by improving muscle function around the affected joints and improving joint alignment.

The worry when someone thinks they have hurt their back by doing an activity such as sweeping leaves or shovelling snow is they is they associate movement and exercise as the cause of the pain; therefore not moving and reducing exercises is seen as the solution. Unfortunately this can lead into a downward spiral of deconditioned muscles, poor posture and stiffening up resulting in more pain. This cycle can be broken by introducing gentle Pilates exercises gradually and building up stability, control and flexibility. So, first of all move, then improve functional movement and increase to higher performance Pilates.

 

Movement itself is known to reduce painful stimuli to the nerves and your physio or Pilates instructor can help you find the best ways to move and advise you on balancing movement and structured rest.

Pilates is great for back pain because it can be tailored to your level of ability and you can progress at your own rate. A balanced Pilates class will find and challenge areas you need to work on: The flexibility of joints and muscles, balance, body awareness and control. You will work on your posture and alignment of joints, improving your sense of how to hold yourself well when not moving. Your core stability,  the deep muscles in your torso which should work at a low level all the time, will improve to help you maintain an aligned posture. Recent research has shown that Pilates can improve bone health, therefore reducing your osteoporosis risk. For our older clients, your risk of falling is reduced through improved balance, but if you are unlucky enough to fall, you will have reduced your fracture risk by doing Pilates.

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Our clients have long known the benefits of Pilates for their back pain. I wanted to share some feedback we received from clients recently:

I managed to do the Chicago marathon, which was a complete medical miracle as I literally couldn’t walk with the pain two weeks previously. The consultant can’t believe it either so I had another MRI Scan on Monday – with the results coming next week……

I have to say I was unsure about Pilates before as I always wanted to go to classes that got the ‘sweat on ‘! There are massive benefits for all ages groups – whether you are sporty or not.

“Having suffered lower back pain of varying degrees for many years my frustration with it increased in line with my interested in cycling.  I decided to seek a long term solution which came in the form of Pilates.  This increased my core strength providing more stability in my back and worked wonders on and off the bike including eliminating my pain.”

The best time to start Pilates is now. Whether you have never had low back pain or had it frequently, the sooner you get started, the sooner you can reduce the number of episodes of back pain and if you do get pain, you can reduce the duration and intensity of it. You may even manage to prevent it all together.

 

Take what you learn in your Pilates class and apply it in how you move every day. This will make a huge difference in how quickly you progress your practice and you will notice far more benefits than practicing for your one or two hours of Pilates a week.