Posture as Symptom
We tend to think of "bad posture" as a problem to be fixed. But what if posture is just a symptom of an underlying cause?
Standing in a slight squat, "J" (my client) tilted to the right at his waist, head bending in the same direction, and his left shoulder rotated forward. J came in complaining of sharp pain in his left back under the bottom angle of his shoulder blade. His muscles were inflamed and stringy, and there was at least one very large adhesion knotting up his lower traps, latissimus dorsi, and thoracic erectors. The pain originally started when he was running and currently reactivated whenever he assumed that defensive squat position - an annoying inconvenience (at the very least) for a basketball player. When I had him correct his posture, the pain would decrease, but the off center position was his natural response whenever I had him return to the squat.
Typical thinking would lead us to believe that all that need be done is for J to be more body aware and to continually self correct his posture until the correction stuck. But how likely is that in the middle of a game? Would he be able to take that few seconds to check in on how his body was aligned, correct it, and then proceed? Or would that cost him valuable time and potentially the ball? What about in your life: how often do you try to correct your posture? How often do you find yourself in the same slumped position that you have shrugged and shaken out a hundred times before? Do you still walk on your toes? Jut your head forward? Tuck your butt under even though you have consciously repositioned yourself over and over again?
If posture itself were really the key, the body’s own homeostasis or desire for balance would work with you to retain those changes, not fight you and return to the same maladaptive posture.
To make that point, let’s look a little bit more a J’s structural history. Two other major injuries stuck out to me when going over J’s intake. The first was a bad sprain to his left ankle about two years prior to his visit with me after which time his low back would occasionally feel fatigued. The second was a fall onto bricks to his coccyx which left him hobbling for several days about two months prior to his shoulder/back injury. Both of these heeled with no seemingly lasting consequences within a few weeks or less; nothing had been done to address either beyond giving them time to heal and a small amount of rest.
As J and I worked, I could tell that the pain point under his left shoulder blade was connected to his erector muscles which were extremely tight all the way down to his sacrum. After doing some releases on his sacrum and coccyx, J’s squat was significantly more straight and his pain lessened and became more concentrated. Next the pull shifted and down his left leg into his left foot and ankle. As we worked there, J suddenly remembered he had mildly hurt his left ankle in a game the day before his back pain started. He did not even think to mention it before because it hadn’t caused him any major discomfort and he had continued playing without any issues.
You have probably noticed by now that all of J’s major complaints were on the left side of his body. J’s posture in his squat stance pulled as much weight as possible to the right. His body was trying to put as little stress on his left ankle - the one that had been injured two years prior and reaggravated just a day before his back pain appeared - as it possibly could. My best assessment is that the left ankle injury that he had thought fully resolved left a weakness in his ankle that affected his entire lateral kinetic chain (all of the muscles that activate when you have full weight on one leg during walking) which the fall to his coccyx probably exacerbated. When he mildly sprained his left ankle again the compensation his body had created from his ankle all the way into this upper back was no longer functional, it was over taxed, leading to the pain at the top of the compensation pattern. The altered posture was simply the body’s way of trying to support his injured ankle and still keep him upright.
So how’s J doing now? We did four SMRT moves: one to his talus, his calcaneus, his 5th metatarsal, and to the tarsals in general. When he returned to the squat… His posture was perfect! Head straight, shoulders square over hips. There was no pain even as he continued to hold the position and his muscle tissue had returned to a healthy texture. J was able to resume basketball training later the same day. In his entire session, we did no direct work on his area of pain, nor did we spend time trying to force his body to remain in a posture that did not serve it.
What hidden messages is your body sending you? What might your posture be trying to support? What do you think of the idea that your posture is the symptom of an imbalance, not the problem itself? Let me know in the comments!
Rhiannon loves helping you solve your pain puzzles! A chronic pain specialist with a sub-specialty in pelvic dysfunction, she understands the huge impact pain can have on your life and is dedicated to helping you reach your health goals so you can enjoy your life fully and whole. Though her style can sometimes be described as "therapeutic fluff," she is not the therapist to see for a "just to treat myself" massage.
Augmenting her initial massage training with multiple courses and certifications including SMRT, ATMAT, and IHPS she has the skills to create effective and lasting change for you. But don't go on blind faith - check out her amazing reviews!