Pilates Training Program Design: A Discussion About Client Safety and No Neck Flexion

Designing safe and effective Pilates training programs that are client-specific, goal-oriented, and help improve whole-body health is the primary function of a great Pilates teacher. You can know lots of good exercises, but it's the subtle changes, adaptations, or order for workout sequence that help your clients get the results they are looking for from their Pilates program.

The Pilates program outlined here was designed by an Apprentice Teacher and is being used as an example for a critique on designing effective Pilates programs.

This article is designed to assist Pilates teachers, and especially new Pilates trainers with assistance in thoughtful and safe exercise selection to design safe and effective workout programs. I do not recommend that you precisely follow this program, but analyze the program and my comments and suggestions - then use this information to help develop your critical thinking skills, make good exercise choices, and design great Pilates programs for your clients.

Below is an example of a beginner's Pilates Workout Program with the consideration of no neck flexion that I recently reviewed for an apprentice teacher. The exercises that were chosen for this program are not right or wrong... Any exercise can be a good choice if done correctly.

Apprentice Program Design: Beginner Student - No Neck Flexion

Warm Up Exercises
Breathing (seated) 5 reps.
Pelvic Tilts (12 to 6) 3-5 reps.
Shoulder Elevation/Depression 5 reps.
Ribcage Arms 5 reps.
Knee Drops 5 reps.
Leg Slides 3 each side / 5 both

Reformer Exercises
Footwork 1-4 8 reps. 3 springs
Hundred 1 - 10 Breaths Head Down
Frog 8 reps. 2 springs
Leg Circles 5 each way 2 springs
Hamstring Stretch 4 reps 2 springs
Stomach Massage - Hands Back 5 reps. 2 springs
Stomach Massage - Reach 5 reps. 2 springs
Stomach Massage - ??? 2 each side 2 springs, Stretch side to side
Elephant - Arched 8 reps. 2 springs
Kneeling Knees - Arched 8 reps. 2 springs
Running 10 reps. 3 springs
Pelvic Press 5 reps. 2 springs

Trapeze Table
Arm Springs: extensions, triceps press, adductions 5 each
Parakeet 5 reps. Roll up only

Matwork
Single Leg Circle 5 each direction
Single Bent Leg Stretch 5 each
Double Bent Leg Stretch 5 reps.
Corkscrew 3 each direction
Saw 3 each side Hinge version
Swan Prep 4 reps.
Swan: Flight 4 reps.
Single Leg Kick - Prep 4 each side
Side Leg Series:
Lift & Lower 5 reps.
Kick Front & Back 5 reps.
Small Circles 5 reps.
Magic Circle between Knees 10 reps.
1 Arm & Leg Reach 4 each side

Trapeze Table
Standing Arms: Chest Expansion, 1-arm Lat Pull, Long-Back Stretch Arms 4 each

Matwork
Seal 3 reps. Balance ONLY

Ladder Barrel
Ballet Stretches 3 each

***Please consult with a Pilates professional, and your Health Care Provider, before following this, or any other fitness program.

Comments and Suggestions for Tweaking and Improving this Pilates Workout Program:

Since I don't know the reason for this individuals need to avoid neck flexion, I have to ask if it's because of an injury, Doctor's request, or just because it's uncomfortable and creates pain to curl up into exercises like the 100 (due to weakness, muscle imbalance, or lack of body awareness to be mechanically efficient with the movement.)

In my experience – while we play it safe and typically choose exercises that keep the neck in a more neutral position, it's important to watch closely to see if client's are "gripping" with their neck and upper traps to hold the head steady. Too many exercises laying on their back, or side lying and you can exacerbate their problems....even when you're choosing to stay flat!

With neck issues, I tend to do 2-3 exercises laying down (see if they are more or less comfortable with a pillow), and then change to doing 2-3 exercises seated or standing. This will help reduce strain as the head and neck can sit in its normal balanced position on the torso, plus you won't have clients snoozing after a whole hour in a reclining position!
In The Pilates Program Example above - Here Are the Things I Might Do Differently:

* I would choose to NOT do #3 Shoulder Elevation and Depression. But start from a resting position and cue "diamond down", then arms hang down lower. The elevation of the shoulders will create more neck tension, but they need to learn how to better utilize lower traps to release shoulder tension. By doing this seated or standing, gravity is assisting the release of neck and shoulder tension.

* 100: I might choose to start with the legs in the straps, and no resistance (straps) in the arms. Or feet on the bar, No Straps. Head down – legs up, and straps could aggravate the neck, especially if the legs are lower.

Here's where knowing WHY you're avoiding neck flexion is important...

If a client just has a tense personality and needs to understand how to relax their neck and shoulders...doing Flexion exercises INTO gravity will help you over time progress into safe, strong, well-supported flexion working against gravity. If the head is going along with the rest of the spine in a relaxed state – this might be beneficial.

If a client has experienced an injury, accident, surgery...or other issue that has a medical limitation to avoid neck flexion - the exercise choices may be altogether different! (This limitation may be prescribed by a doctor forever, or for a limited period of time suitable for recovery. This information is vital to a Pilates professional making appropriate exercise choices.

Continuing on with things I would consider changing for this program...

* Ex: Stomach Massage Round – The head should be in a good posture position over the shoulders. The primary flexion is through the pelvis and low ab scoop, with a focus change down and forward, but not the head sheered forward off the neck. There's a chance this might be safe and appropriate – but if in doubt, better to start with the 2nd exercise (hands back)

* Ex: Elephant – Round. If the spine is in a properly flexed position, the head and neck are relaxed and handing forward. Gravity is assisting in stretching the neck for someday being able to do flexion and lift the head off the floor. (Same concept for Kneeling Knees Round)

* Arm Springs lying down on the Cadillac may have a tendency to create more neck tension, so watch for this and be prepared to find alternate exercises. Leg Springs – (when you brace the arms on the poles) are strengthening your lower traps if you cue "diamond down" and remind them to keep the shoulders & neck relaxed. Or – you can do with arms by the sides. But long-term you want to work to that overhead arm position, and understanding how to use the arms and shoulders without creating any problems for the head and neck.

* I might choose to do the Standing Cadillac Arm exercises right after the Reformer for a moment of standing, and reinforcement of "Diamond Down," good posture, and a lengthened, relaxed neck and shoulders. Then would do Parakeet, some of the Matwork, then consider the Arm Springs lying down.

* I would NEVER choose to do Double Straight Leg in Matwork with the head down. Esp. for a beginner with neck problems. The modified one leg at a time version will be safer for their whole body! Until someone can curl up safely – I would personally opt for this one-leg modification.

* I would probably add Alternate 1 Arm Reach (Climb a Rope) as a modified Criss-Cross to cue the Oblique Abdominals, and work on coming from under the shoulder, around the ribcage to a diagonal scoop of the torso.

The STRONGER a client's core muscles are, the less they will use their upper traps and shoulders for body support. When the core is working, the neck and shoulders will begin to relax – you then focus on transfering this feeling to every exercise, daily life activity, and movement.

* Corkscrew will be a challenge to keep no tension in the neck and a good position. I might consider doing Knee Drops or Can-Can. (This is the 8th exercise in a row that they've done lying down, perhaps a seated exercise would be a nice choice – even though this is not a classical order.)

* If you're doing a hinging Saw it means that spine rotation is not contra-indicated. I might suggest that you add a Seated Twist to your reformer. This will warm up rotation in a vertical position (if it's appropriate for them to twist) Rotation improves muscle length for flexion and extension. Seated Twist will help your Swan, and as appropriate progression into gravity assisted flexion, and finally working against gravity.

* There is a chance you'll need to alternate sides for EACH exercise in the Side Leg Series. Look at neck placement and tension and switch sides before they feel anything in their neck. Ask how they feel while working - and change sides as often as needed - or do the series in a standing position.

* Because you've chosen the SEAL, I'm assuming that spine flexion is OK, but neck flexion against gravity is not. If you needed to avoid spine flexion altogether – I would do Dead Bug here instead.

* Because you've chosen the SEAL – I would definitely have done Stomach Massage Round, and probably Elephant and Kneeling Knees Round. Stomach Massage round will be warming up the correct body placement and support. It might also indicate that over time – the Roll Down on the Wall and 100 on the Wall would be good progressions.

* It also make more sense to finish your Matwork with the Seal or Dead Bug (a centering exercise,) and then move on to something else. By my re-arrangement of the Arm exercises, this happens automatically, and you finish mat and proceed to your ending stretches.

Other GREAT Exercises to consider for this program:
Chair – Footwork, Going Up Front, Spine Stretch forward, Swan on top, Pump 1-leg Demi-pointe

If gravity assisted flexion is OK – add "Washer Woman" to your safe list.

Spine Corrector – Breathing Over the Barrel, Swan, Hamstring Curl, Leg Extension

If there are NO medical limitations for the neck, and flexion into gravity is OK... I would also incorporate some gentle neck and chest stretching.

Wall – Clock Stretches, Standing W
Gentle Neck Stretch: Ear-to-Shoulder, Nose-to –Shoulder, Forehead-to-Shoulder, Chin- to-Chest, Center head.

* Ballet Stretches on the Ladder Barrel involve Forward Flexion and articulation of the spine & neck through flexion to recover to center. AGAIN – this may be OK, useful, and beneficial for your client. IF I had to play it safe – I would either stretch with the Magic Circle lying down, OR do the Split portion of the Ballet Stretches on the Cadillac with the Trapeze so the head can stay stacked on the spine in a neutral position during your leg and hip stretches.

*****

Now that you've had time to read and review this beginner Pilates Program... What choices would YOU make, and how would you progress your client if avoiding Neck Flexion was something you had to take into consideration when choosing exercises to develop a safe and effective Pilates workout program?