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How to manage wrist pain during Pilates

Are you someone who struggles with wrist discomfort during exercise?

Within Pilates, we practice a lot of exercises in a four-point kneeling position and for some people, this can feel uncomfortable very quickly and leave a feeling of strain afterwards.

In Pilates, we often flow through a series of movements that explore all muscle groups working and lengthening in many positions, with large sections of exercises being performed on our hands and knees. For some, it can cause large discomfort in the wrists and can sometimes leave a feeling of strain after being on them for a while. What if I told you that our hands are not weight-bearing joints? Unlike our knee which has evolved with a meniscus and cartilage, helping us to take impact and load, our wrist is made up of lots of very small bones, ligaments and tendons. The movement required for us to be able to tolerate the four-point kneeling position (hands & knees) is the extension of our wrists and the strength to hold that. Day to day we often don't spend a great deal of time with our wrists in extension eg gripping a pen when we write, typing on our phones or keypads at work or even driving, how many times in the day do you find yourself weight bearing on your hands...I'm guessing not much? We then come to a class and wonder why our wrists hurt, even after we have been doing Pilates or Yoga for years and the simple answer is your wrists are most probably not flexible in extension, weak from not loading them and overused in other positions. Athletes spend a great deal of time doing warm-up work and rehab on their wrists to help them feel strong and supple and now you can do.


When doing exercises on our hands and knees around 85% of our weight goes through the inside section on the heel of our hand. To try and take some weight away from the upper body you could try sliding your bum back slightly to transfer more of your weight to the lower limbs. Everything in our body is connected so if you have limited movement in your thoracic spine (mid back) this will affect the mobility you have through the shoulder complex, in turn, this can affect the rotation available in our forearms and this can then alter how much weight we distribute the hands, so I would recommend continuing with spinal mobility work and shoulder moments to help.

Our core is also incredibly important in our four-point kneeling position as it acts as a bridge between the upper and lower body. If we are not active through our centre we end up with a hollowing in the spine and dumping in our shoulders. This in turn increases the load we place on our upper body and transfers down into our wrists. When in this position try to keep an active engagement, think of lengthening your collarbones to create space in your chest and when doing any sort of lifting eg a hover of plank, try to push your hands and feet down onto the floor, engage your core and this creates a feeling of lifting from the centre rather than it coming completely from your arms and legs.


An exercise that can easily be added throughout the day is the prayer position. You start with your hands together in a prayer in line with your nose and your elbow together in front of you. You then start to slide your hands down towards your waist, your elbows will start to part but keep your hands pushing together. Take it to the point where you feel a stretch and can go no further without your hands parting.

Simple wrist circles throughout the days to get circulation and movement through them.

The only way to build strength in the wrists in a weight-bearing position is by practising exactly that. You could start just by staying on your hands and knees, trying to balance the weight between both hands equally, spreading the fingertips wide and pressing your little finger into the floor to take some weight off the inside part on the heel of your hand. From there you could start to add some rocks forward and back to challenge the range of motion in your wrist. If you feel quite happy here you could then start to progress this by doing hovers, downwards dogs or superman style movements.


A great modification is placing some yoga blocks under your hands to lift the height at the front end of your body, this transfers some weight onto your lower body and in turn takes a bit of pressure off the wrists whilst keeping them in a weight-bearing position to improve strength and stamina.

Another alternative is changing the angle of your wrists by holding on to dumb bells If you place the dumb bells into portrait lines and hold on to them, your palms will be facing one another, helping to put your arms into a more neutral position. You can also try going on to a fist or on your forearms. Due to the wrist being under load in extension when we weight bear, placing a small wedge under the heel of your hands also helps to open out this angle.

We'd love to hear whether any of these suggestions help you, leave a comment below to let us know how you get on!

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