Wrist Pain During Pilates: Causes and Prevention

After years of taking HIIT classes and deadlifting your body weight, you finally resolved to pick up a more joint-friendly workout. So you started sprinkling Pilates into your fitness routine. Except at the end of every class, you notice your wrists feel achy and strained.

If you resonate with any part of this (my) story, you might be wondering why your wrists feel like they’re about to fall off after every Pilates class. After all, this popular workout is constantly being touted as a “low-impact” way to stay fit yet leaves your wrists feeling anything but.

Here, we spoke to a physical therapist and Pilates instructor on why Pilates can cause wrist pain, and tips and modifications to help prevent it.

Why Pilates can cause wrist pain

There are several different reasons Pilates can strike up wrist pain. For starters, wrist pain usually ails those of us who don’t have much experience using the reformer.

“Reformer Pilates requires high amounts of wrist extension mobility and stability, as well as forearm and hand muscular strength to achieve the proper positioning for the movements,”says Katherine Kalaj, PT, DPT, a physical therapist at Bespoke Physical Therapy Grand Central. So if you’re lacking in any of these areas, or you don’t know how to maintain good alignment, you’re more likely to feel the pressure on your wrists.

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In fact, Emma Stallworthy, certified pilates instructor and founder of Your Reformer, says beginners are especially prone to wrist pain if they work through advanced exercises too soon or with improper alignment.

General wrist strength also plays a role here. People with poor wrist flexibility may also be prone to pain if they don’t have enough wrist extension range of motion to hold themselves in a plank position without compressing the back of their wrists, Kalaj says. But there’s a silver lining: “By engaging the proper muscles throughout your forearms and hands, reformer Pilates can actually be a great way to work on strengthening your wrists,” Kalaj says.

7 ways to prevent wrist pain during a Pilates class

Keep these tips top of mind when doing positions where your wrists are holding your body weight, such as plank variations, push-ups, quadruped position (where you’re on all fours), and side-lying movements.

1. Nail down your alignment

Your alignment sets the foundation for movement that doesn’t put too much strain on one area of the body. First and foremost, you’ll want to make sure your wrists are aligned with your shoulders—meaning, not too far forward or backward. You’ll also want to practice centering, one of the key principles of Pilates.

“Centering means activating of our deepest stomach muscles, as well as our deep lower back muscles and the pelvic floor, to support the body,” Stallworthy says. “Imagine you’re wearing a low-slung belt just below your belly button, and as you exhale, imagine that belt getting tightened just half a notch.”

To keep a more stable base so your wrists aren’t overworking, pay attention to your shoulder, head, and neck placement. “Keep the collar bones broad and imagine each shoulder blade reaching back and down as if to reach into the opposite back pocket of a pair of jeans,” Stallworthy says. Also, keep your head in a neutral position where it’s supporting the natural curve of your neck.

“During my classes, I encourage clients to activate the entire arm, shoulder girdle and core to share the load and reduce strain,” Stallworthy says.

2. Keep your wrists in a neutral position

A neutral position means you’re avoiding excessive flexion or extension. This helps reduce the risk of overstretching or overloading your wrist joints, which can contribute to that achy pain.

When performing exercises like a plank on the reformer, align your wrists directly under your shoulders and avoid letting them bend inward (toward your body) or outward (away from your body). “Think of your forearm and hand as a straight line, with your palm pressing evenly into the surface, spreading your fingers wide for stability,” Stallworthy says.

3. Distribute your body weight through your hands

When you distribute your body weight evenly across your hands and fingers, it reduces the amount of pressure on any single point of your wrist. So how do you put this into practice? When you’re in a weight-bearing position like a plank, engage your finger muscles and actively press your fingers into the reformer to better support your wrists, Kalaj says.

“By engaging the proper muscles throughout your forearms and hands, reformer Pilates can actually be a great way to work on strengthening your wrists.” —Katherine Kalaj, PT, DPT

4. Shift some of your weight to your feet

Shifting some of the weight distribution to the feet can reduce the amount of body weight that the wrists need to bear. “In a plank, instead of focusing all your body weight on your hands, press your toes into the reformer and engage your legs,” Stallworthy says. Essentially, you’re shifting some of the pressure to your feet, which naturally takes some load off the wrists.

5. Use props if needed

Adding extra cushioning—such as a towel, foam padding, or a Pilates ball ($9)—under the hands during exercises can reduce pressure on the wrists. “This helps decrease flexion in your wrist so that your body weight is more evenly distributed throughout the hand and shoulders,” Stallworthy says, adding that wrist wedges ($20) are also a great prop. Wrist wedges help keep your wrists in a comfortable, neutral position by slightly raising your hands.

6. Tweak your plank position

If you’re feeling wrist pain while moving through weight-bearing exercises in the plank position, Kalaj recommends holding a plank on your fists instead of placing your palms flat on the reformer. This slight modification can help keep your wrists completely straight, so there’s less pressure on the back of your wrist.

And just like with any plank variation, switching to your forearms can help shift the load off the wrists while still targeting the core and shoulders. Stallworthy recommends starting on your hands directly under your shoulders and knees under your hips. Then, slowly lower your forearms to the ground or the reformer carriage, keeping your elbows aligned under your shoulders. Remember to keep your body in a straight line from head to heels, and engage your core, glutes, and legs.

7. Take breaks

Both Stallworthy and Kalaj agree that you shouldn’t push through the pain. If you’re concerned about your wrists, talk to your instructor before class so they can offer alternatives and check your form throughout the flow. And don’t shy away from taking breaks—especially during a sequence that requires you to be on your wrists for a while. “I will always encourage taking breaks to shake out and stretch your wrists between sets to prevent overuse,” Stallworthy says.

A quick warm-up to help prevent wrist pain

Stallworthy always encourages a thorough warm-up before a round of Pilates, “mainly to get the blood flowing and connecting the body and mind.” She recommends wrist stretches, rotations, and mobility exercises, such as rocking back and forth on all fours, to get the joints ready for movement.

To get your wrists primed for a Pilates session, Kalaj recommends doing 1-2 sets of 10-15 reps of each exercise below:

• Wrist flexor stretches: These can help improve wrist range of motion, especially for people having a hard time with proper wrist form during planking exercises.
• Wrist extension banded self-mobilizations: These can also help improve your wrist range of motion if you feel a hard block in the back of your wrist when you’re getting into a plank position.
• Dumbbell wrist curls: When done in a slow and controlled way, these can help stabilize the wrist and strengthen the forearm muscles to better support your bodyweight during weight-bearing movements.