Pilates for Neck and Shoulder Pain: Beyond Good Posture
Why neck and shoulder discomfort isn’t always a question of sitting up straight, and how Pilates can help us explore movement, strength and support.
When Your Neck Starts to Complain
I’ve been spending a lot of time writing lately, which means spending a lot of time sitting. And despite teaching Pilates for more than a decade and knowing how to exercise my neck and shoulders, I’ve noticed my neck becoming uncomfortable.
I know the familiar advice: take regular breaks, stretch, adjust your screen, sit up straight. Some of it is useful. But when we’re absorbed in reading, writing or working, we’re probably not going to interrupt ourselves every twenty minutes to do neck exercises. And with the amount of health advice we’re exposed to, it’s easy to feel that we’re somehow failing if we don’t follow it all.
Fortunately, I have a few tools at my disposal. I move my neck, explore different positions of my head, work on upper-back extension and gently press my head against my hands or a wall. Sometimes I simply take a few minutes to move through my whole body. Nothing particularly elaborate, and certainly no magic exercise.
I also have the advantage of teaching movement for a living, with Pilates equipment and props readily available. But even that doesn’t make me immune to the effects of spending long periods in one position.
What matters is knowing how to respond, and having enough movement options and physical capacity to meet the demands of everyday life.
Your Neck Needs Strength, Not Just Relaxation
We readily accept that our abdominal muscles or legs need to work during exercise. We might even feel rather pleased when they remind us of that effort the following day. Yet when we feel our neck muscles working during a Pilates exercise, we often assume that something has gone wrong.
The neck is frequently treated as an area that should be relaxed, protected or kept out of the movement. But our neck muscles have an important job. They support and move a head weighing approximately five kilograms, and they need both strength and endurance to do so.
This doesn’t mean that every uncomfortable sensation should be ignored or that more effort is always better. It means that muscular work is not automatically a sign of poor technique.
Think of a familiar Pilates exercise such as an abdominal curl. We lift the head and upper body from the mat, and the neck muscles participate in supporting the head. If someone experiences discomfort, supporting the head or reducing the range may be useful. But we can also explore how they organise the movement and gradually develop the strength to perform it with less assistance.
The question isn’t always how to stop the neck from working, but how to help it do the work the movement requires.
Finding Your Head in Space
Our cervical spine is designed to flex, extend, rotate and side-bend. It consists of seven vertebrae (the same number as a giraffe’s neck, although theirs are considerably larger).
The uppermost part of the cervical spine also has a particular relationship with the skull. Small movements of the head can occur at the atlanto-occipital joints, while rotation involves several regions of the cervical spine, particularly the joints between the first two vertebrae.
These distinctions become useful when we begin exploring how the head moves.
One of the first things I often do in a Pilates lesson is ask someone to stand for a moment and notice how they organise themselves against gravity. Before we begin exercising, we might pay attention to breathing, the position of the head and the relationship between the spine and pelvis.
I sometimes ask clients to trace a line with their fingers from their ears towards the crown of the head, then gently tap the point where their fingers meet. It gives them a physical reference for the top of the head and helps us begin exploring where movement is taking place.
This is part of developing proprioception: our sense of where our body is and how it moves.
We can then explore a simple exercise from Kathy Grant’s repertoire, which I learned through the Pilates Heritage Training. With the eyes closed, we turn the head as though listening with one ear and then the other.
It sounds simple, but we may discover that we are also tilting the head, extending the neck or moving away from the axis of rotation we intended to explore. The aim isn’t to eliminate every accompanying movement, but to recognise what we’re doing and discover what other possibilities are available.
That awareness becomes useful later in the lesson, when we turn the head during Chest Expansion on the Reformer or explore more complex movements involving the whole spine.
Beyond Shoulders Back and Down
The neck doesn’t work independently of the shoulders and upper back. Yet many people have only a vague idea of what their shoulders actually look like or how they move.
When I ask clients to think about their shoulders, they often identify the top of the arm or the area where they carry tension. They may know that they have shoulder blades somewhere behind them, but have rarely explored how those bones move in relation to their arms, collarbones and rib cage.
And when we begin talking about posture, something interesting often happens: people immediately try to correct themselves. They pull their shoulders back, straighten their spine and hold everything in place.
But what happens when they need to reach overhead, push, pull or support their body weight?
The shoulder girdle is designed for movement. The clavicles, scapulae and upper arms change their relationships as we move, and the shoulder blades do considerably more than travel up and down.
One of my favourite discoveries to share with clients is surprisingly simple. I ask them to place their fingers on the front of the shoulder and feel the bony structure beneath them as they raise their arm. As the shoulder blade rotates upwards, part of the acromion moves away from their fingers.
They are often surprised to discover that the bone they were touching belongs to their shoulder blade, not their upper arm.
It is a small anatomical discovery, but it changes how we understand the shoulder. The shoulder blade isn’t simply sitting on our back while the arm moves independently. It participates in the movement, changing its relationship with the upper arm and rib cage.
We might then explore how the humerus rotates, how the forearm turns in relation to the upper arm, or how changing the position of the arm affects the support we experience through the shoulder.
This is why we should be cautious about treating “shoulders back and down” as a universal instruction. Sometimes that position may be useful, but holding the shoulders there throughout every movement can limit the very possibilities we are trying to develop.
Support doesn’t necessarily mean holding everything still.
From Awareness to Strength: How We Work in Pilates
These explorations are not separate exercises that we complete before beginning the real Pilates lesson. They are tools I use throughout the session to help clients understand familiar movements and gradually take on more demanding tasks.
We might begin with a small movement of the skull, explore a neutral position for the neck and then introduce a supported head lift.
I know from my own experience that finding neutral can take time. When I first began exploring it more carefully, I had the strange sensation that I was looking upwards, almost towards my own eyebrows, even when my head was in a more neutral position.
Sometimes what feels familiar isn’t what we expect it to be.
In a Pilates lesson, I might place a small towel beneath someone’s head during a Roll Up, use a ball under the chin as a physical reference, or introduce a resistance band behind the head and spine during a seated roll-down. These tools give us information about how the head and neck are moving.
We can also explore isometric strengthening, gently pressing the head against resistance while maintaining a chosen position. This can become preparation for exercises such as the Bridge, Short Spine Stretch or other movements in which the neck and upper back need to provide support.
The progression matters. We might begin with a small movement, develop a clearer sense of the task, introduce resistance and gradually increase the demand.
On the Pilates apparatus, we have many ways to change those conditions. The Cadillac offers a stable surface and different possibilities for support and resistance. The Reformer introduces a moving carriage, springs and straps, while the Springboard allows us to work against resistance from a fixed wall.
The point isn’t to use every piece of equipment in one lesson. It is to have choices, and to understand how changing the task can help the person in front of us.
What Happens Outside the Pilates Studio?
One of the things I enjoy most about teaching is when clients return and tell me that something from our lesson has found its way into their everyday life.
I remember a client from many years ago telling me that he had thought of me while cutting branches in his garden. He had caught himself using something we had practised together and noticed that he could perform the task without the discomfort he had previously experienced.
These moments interest me because the aim of Pilates isn’t simply to become better at performing Pilates exercises.
Many of my clients spend long hours at desks, travel frequently or carry bags and backpacks. Some experience recurring shoulder discomfort, while others have a history of injury or find that tension becomes more noticeable during stressful periods.
We cannot remove every physical demand from their lives, nor should we need to. What we can do is explore movement, build strength and develop more ways of responding to those demands.
Sometimes a client discovers that their shoulder blade can move in a way they hadn’t previously considered. Sometimes a familiar exercise becomes more manageable when we change the position of the head. Sometimes a movement explored on the Pilates equipment becomes useful in an entirely different situation outside the studio.
And sometimes, as I recently reminded myself while spending so much time writing, we simply need to give our bodies more opportunities to move.
Pilates for Neck and Shoulder Pain in Amsterdam West
At Pilates Incorporated, I work with clients individually and in small groups of no more than three people. Both offer opportunities to explore movement, strength and coordination, but there is an important difference in how we approach individual needs.
In a small-group class, I pay attention to everyone and adapt exercises where needed, but the lesson follows a shared movement plan.
If someone wants to address recurring neck or shoulder discomfort more specifically, a private Pilates session is often a useful place to begin. We can take time to understand their movement history, explore what they find difficult, establish short- and long-term goals and revisit those goals as their practice develops.
The aim isn’t to find one perfect posture or a single exercise that will solve every problem. It is to develop a practice that gives you more possibilities, more strength and a better understanding of how your body moves.
Your neck and shoulders are not simply parts of your body that need to be corrected. They are parts of you that can continue to learn.
Start with a private Pilates session
If neck or shoulder discomfort is affecting your daily activities, we can explore your movement together in a private session at Pilates Incorporated in Amsterdam West.
Individual instruction · Fully equipped studio · 55-minute sessions
Further reading
For those interested in the research on neck pain, posture and exercise:
