Poor posture = loss of function = pain

Do you have nagging pain in your low back? Do you carry chronic tension in your shoulders? If you have chronic discomfort in an area with no known injury, you may wonder why that is. The best answer is postural stress. Can you relate to the photo at left?

There are several very common postural stress patterns that I see in my clinic: posterior neck pain and stiffness, shoulder pain with restricted range of motion, a painful knot near the shoulder blade, low back ache, and hip tightness. People typically describe these areas as tight and restricted, with nagging pain. These patterns are quite frustrating, because they are stubborn and resistant to treatment.

How to think about postural stress—the back has a front

When we have pain in our shoulders, we typically massage our shoulders. When we have pain in our backs, we massage, twist and stretch out our backs.  Though this offers relief as we’re doing it, it often doesn’t fix the problem. 

We would do better to remember that our back has a front. How we hold our body has a big impact on how we feel.

The common pain patterns that I see are a result of tight flexor muscles (generally, those on the front of the body) and/or stretched, weak extensor muscles (those on the back of the body). 

Looking at the figure above, we can see that the front of the body is collapsed and contracted, while the back is arched and stretched, like a hinge closing on itself. We need to figure out how to pry open the hinge, stack the body the way it was meant to be, and focus on healthy, functional movement.

Shoulder or scapular pain

If someone has shoulder or scapular pain, I not only work on the area where it hurts with acupuncture and massage, I also work to loosen and stretch the front of the upper body, specifically the pectoralis muscles (pectoralis major illustration) on the chest and the subscapularis (subscapularis illustration) in the armpit. If you don’t loosen these muscles, the pain in the shoulder and around the scapula will come right back. 

With this pain pattern, it is common to see rounded shoulders and shoulder blades that seem to be sliding down the back. In this case, relaxing the chest isn’t enough; the back muscles must be strengthened as well.

The door stretch shown above is a helpful exercise you can do yourself. Hold each stretch until you feel the muscle fibers releasing. It is also important to do the stretch with your hand positioned at different heights to open the chest more completely.  

Neck pain

Once the upper torso is loosened and more functional, the neck will typically feel and move better.  If there is still residual pain, then the muscles of the neck need to be addressed. 

The best place to start is by massaging and pinching tender points along the scalene (scalene illustration) and sternocleidomastoid (SCM)(SCM Illustration) muscles on the sides and front of the neck, as seen in the first illustration. These muscles should also be stretched, as seen in the second illustration. 

It is also important to stretch and loosen your sub-occipital muscles (at the base of your skull) by tucking your chin and gently pressing it posteriorly, and massaging them with your thumb or pressing them into a tennis ball.

Low back pain

If someone has low back pain, it is very important to be sure the iliopsoas muscle (iliopsoas illustration) isn’t contracted. It often becomes shortened with extended sitting. If it is contracted, all the back stretches in the world aren’t going to solve the problem. I recommend lunges with an arched back (below, left) to stretch the iliopsoas, before stretching the back itself.

Prying open the hinge of the hip

For hip pain and tightness, I always recommend using a tennis ball to roll out the hip flexors, with a focus on the tensor fasciae latae (TFL) muscle (TFL illustration). Look for the most tender spot that may refer pain down the leg or into the buttocks, then allow yourself to sink onto the tennis ball. A foam roller can also be used to roll out the tight areas on the hips and legs. Don’t forget to also roll out the gluteus muscles to improve hip function. 

Once the muscles have been softened, you can stretch out your low back with a forward bend (above, right). This has the added benefit of stretching out your hamstrings, in case they are tight and pulling down on your pelvis. The pelvis forms the foundation for your structure, and when it is functioning properly, your whole body will stack and move as it is meant to move.

Helpful homework

These are a few simple exercises you can do to support your body and correct postural negligence in between acupuncture and bodywork treatments. Over time, your body will become more functional and your pain and discomfort will decrease. 

For the best, most  efficient results to reestablish proper posture and function, I refer my clients to Michelle Mariska for Healing Motion Therapy, based on the Egoscue Method. This method has helped me and many of my clients tremendously. Read the following article to learn more about this powerful method.


Healing Motion Therapy


by Michelle Mariska

Healing Motion Therapy (HMT) takes your whole body alignment into consideration when treating your symptoms. The therapy’s basic principle is that everything in the body is connected. The body needs to be evaluated and treated as a whole, rather than just focusing treatment on areas of the body that are experiencing pain.  

During an initial appointment, I will obtain an understanding of the pain you are experiencing and evaluate your body’s posture and alignment to understand the source of the pain. I then walk you through an evaluation, including use of photos that are helpful in understanding postural and alignment issues. 

Based on my analysis, I’ll next guide you through a short series of exercises, designed specifically for you. The exercises are simple, gentle, and easy to replicate. Clients are expected to complete the exercises at home, then come back for another session in two to three weeks.

Most clients see and feel positive results at the first session. Typically, four to eight sessions are necessary for clients to maximize the postural changes. At each subsequent visit, your static posture and gait are re-evaluated and a new set of exercises is provided.   

I often see overused and tight muscles in the mid-back from too much sitting. We sit at work, we sit in the car, and then we sit at home. For example, a client comes in with knee pain. Upon evaluation, I explain that tightness and decreased motion in their mid-back contributes to a lack of motion in their pelvis. The pelvis has muscles connected to the knee, and is thus causing the knee pain. The client is often amazed how their knee pain is relieved after doing the individually designed exercises that are focused on their upper body, not on the area that is painful.

HMT differs from physical therapy because it treats the cause, not the symptom. The therapy also works great as an adjunct to other modalities, including acupuncture and massage. HMT enables another practitioner to reach a new level of healing, since we are releasing the superficial layer of muscle compensation.   

Symptoms treated—muscle and nerve pain of the back, knee, hip, shoulder, ankle, foot, neck, elbow and hand. If it’s connected to your body, I’d like to think I can help you.

Michelle Mariska has a bachelor’s degree in exercise physiology. She has over 17 years experience helping clients relieve their symptoms and live a pain-free life. HMT is based on the teachings of Pete Egoscue and The Egoscue Method in San Diego, CA, where Michelle worked for four years.

Healing Motion Therapy is located at 1038 Cleveland Ave. S., St. Paul, MN 55116

(612) 799-6946 or michelle@healingmotiontherapy.com