Pilates modifications to four point kneeling

Making four-point kneeling exercises more comfortable

Don’t let knee and wrist pain affect your enjoyment of Pilates.

Wrist pain? Knee problems? This can often be factors as to why people avoid doing exercises in four-point kneeling but there are often some modifications that we can use to help make exercising in this position more comfortable or alternative exercises to work the same muscle groups.

Modifications for wrist pain

Let’s start with the wrist!  Four-point kneeling does put more pressure through the wrists and if you can do it, it is a good position to help strengthen the muscles around the wrist, as well as through the shoulder and upper body.  So even if you can only do it for short periods it can still be beneficial to practice.

For some people it is difficult to extend the wrist joint enough to get your hands flat onto the floor,  which can cause pain around the wrist. The easiest way to overcome this is to grip your hands into a fist so that the knuckles are on the mat, allowing the wrist to stay in a more neutral position which can be much more comfortable.

Push up bars

Using  ‘push up bars’ is another way  to help maintain a more neutral position of the wrist. Push up bars allow your hands, wrist and forearm to line up in a straight line, making it easier to maintain a neutral position and reduce the strain through the wrist joint.  

When we are doing exercises that involves movement of the leg such as leg lifts, donkey kicks, one leg circles in four-point kneeling position then it can be more comfortable to come down onto your forearms, again taking the pressure off the wrists and can be another good alternative. 

Modifications for knee pain

The Kneeling element to this position can be a problem for some people but it doesn’t always need to be avoided. Placing a small one inch pad or similar under the knees in a four-point kneeling position can help to cushion the knee and feel much more comfortable.

Exercises such as a child pose where we increase the amount of knee flexion can also be difficult for some people. Placing a pillow or foam block in the crease of the knee can help make this exercise much more comfortable and reduce the pressure on the knee.

If four-point kneeling really isn’t for you and these exercises are included in the class then there are always variations and modifications you can do which work the same muscle groups and are just as effective. For example:


Lying on your tummy. Reach your arms above your head on the mat, with your thumb up towards the ceiling and shoulder width apart. Engage your core. Inhale to prepare, as you exhale raise your right leg and left arm inhale to lower back down. Exhale to lift the left leg and right arm, inhale to lower. Continue to alternate sides with opposite arm and leg.

Alternative exercise for the swimming Pilates movement for those with knee pain

Donkey kicks

Lying on your tummy. Bend the knee to 90 degrees. Lift the heel up towards the ceiling extending at the hip. Pulse the leg x10 in this position. Repeat on the opposite side.

Alternative to Donkey kick Pilates exercise if you suffer from with knee pain

Fire hydrants

Instead of this you can lie on your side and do a clam exercises as this is working the glutes as well. Lying on your side with your knees bent and your feet and hips in a line. Keep your feet together and lift your top knee and lower. Repeat x15-20 on each side.

Alternative fire hydrant exercise
  • Lynn Frenette

    These are great tips. I enjoy Pilates and have for years. At almost 70 now some moves and balance are something I struggle with. It will not stop me. Once I retire I will be able to do this on a far more regular basis. Looking forward to it. Thank you so much for sharing all this with your followers. You are amazing!

  • Vicky

    Thank you for these tips they are really useful

  • Gill saunders

    Thank you Vicky, useful tips here.
    I have intermittent trouble with my knees and find a folded bath-mat a good under-knee support. It’s softer than a folded towel but firmer than lightweight foam. Also I find a layer of 8mm neoprene from an old exercise mat is helpful.

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