Posture Part I: Does It Matter?

Posture is an extremely complex and nuanced subject that often gets oversimplified into “good” and “bad” posture. What is posture, and is there such a thing as good or bad posture? How much does posture matter when it comes to comfort, function, and overall well-being? 

Posture vs Acture

There is no one “correct” posture, as our bodies are dynamic, and it is literally impossible to stay in the exact same position if we are alive and breathing. The position that we are in depends largely on our environment and situation in real time. Moshe Feldenkrais encourages paying attention to dynamic posture rather than static posture. Feldenkrais uses the word “acture” as an alternative to posture, which he defines as the “ability to move equally easily in all directions without additional preparation for action”. This action-oriented word is perhaps a better description of human function compared to considering static posture. Our nervous system should allow us to be adaptable, changing our position quickly and easily depending on the demands of our environment. To achieve this, we need efficiency. It is not efficient for us to hold unnecessary tension in our backs to achieve an arbitrary “correct” posture, as this tension uses energy, is uncomfortable, and does not allow movement in any direction at any time. It places excessive and unnecessary forces across joints causing joint and tissue stress. Living in the other extreme of a slumped, folded-in posture is also inefficient, as this limits our readiness for action and can decrease spinal mobility over time. A sign that the posture (aka acture) that you are in might be inefficient would be the development of discomfort after sitting, standing or moving about for a while, indicative of musculoskeletal strain.

“Good” vs “Bad” Posture

A lot of our ideas about posture come from society, our parents, even teachers at school. “Stand up straight, shoulders back.” “Don’t slouch.” Beliefs like this cause us to work hard to try to keep an artificially straight spine, which we associate with “good” posture, and as soon as we stop paying attention to it we will slip right back to where we were. Our spine is not meant to stay in one effortful position for a long time, as this requires certain muscles to be working hard to maintain the position, thereby limiting our acture. Rather than muscles having to tense to maintain our posture, our spines should be able to “stack”, like a column of blocks with minimal muscular effort. When that is the case, each of our bones can receive support from the bone from below, rather than relying on muscles to maintain posture. (It should be noted that the spine is not exactly like a straight column of blocks, as we have a natural curvature inwards at the low back and neck, and outwards at the mid/upper back). Unfortunately, many people begin to lose this effortless stacking, and more effort becomes required to find an upright carriage. 

As we age, many of us begin to adopt a forward flexed posture known as kyphosis, characterized by an exaggerated rounding particularly of the thoracic spine. This condition and associated loss of spinal and rib cage mobility, contributing to increased strain on the musculoskeletal system and thereby impairing functional mobility (e.g. balance and agility, reaching overhead, turning with ease, lying prone). Kyphotic posture can even compromise our respiration, making it difficult to breathe deeply and effortlessly. This forward flexion is what many people consider to be “bad” posture. These changes happen very slowly over time, and sometimes we don’t realize it until we see a photo of ourselves perhaps at a wedding, or someone we haven’t seen in a while makes a comment about our posture. The posture in the moment is not what is “good” or “bad”, but the issue lies much deeper than surface level in how we developed habitual postures over time, and if we have lost the ability to effortlessly achieve different postural options.

Posture and Pain

Many people associate their pain with their posture, or their posture with their pain. The chicken or the egg relationship may be unclear in many cases- are we adopting a posture because we are in pain, or are we in pain because of our posture? The relationship between posture and pain is extremely nuanced and depends on many individual factors. However, the relation is clearly present and worth investigating for those of us with pain influenced by prolonged sitting and standing. Check out this research study to learn more about how postural awareness and pain are related. The researchers found a clear association between self-reported postural awareness and clinical symptoms in people with chronic spinal and shoulder pain. In conclusion, they found that improvements in postural awareness facilitated by participation in activities including mindfulness training, yoga, and qi-gong were longitudinally associated with reduced pain.

Inefficient Postural Tendencies: How did we get there?

It is not the posture itself that is good or bad, but rather how we got there. A person who spends some time slouching is probably not harming themselves in the moment, unless pain is present. However, is slouching the new normal, with spinal stacking no longer feeling easy and natural? Does slouching become the only option as time goes on and the joints and tissues become habituated to this set point? Is posture a source of frustration and having a negative impact on confidence and self-image? Is the habitual posture associated with pain, discomfort, impaired breathing, and a decline in functional mobility? If so, the posture has become a problem. 

Dysfunctional postural tendencies can happen over time, and can be influenced by many factors. Some people tend to gravitate towards certain postures more on a subconscious level, based on their own personalities, confidence in their bodies, insecurities, histories of trauma, lack of body awareness, and internalized societal norms. Other factors that can contribute are our society’s lack of celebration of embodiment, comfort, and regular mindful movement, and tendency towards encouraging productivity above all, disconnection from our bodies, and sedentary behavior. Additionally, our life is becoming increasingly lived within the context of an extracorporeal two-dimensional world that is situated below and in front of us, thereby facilitating a forward-flexed posture (smart phones and computers). Over time, our physical structures and nervous systems become very much habituated to our go-to postures, creating a negative feedback loop that makes it increasingly more difficult to achieve a variety of efficient postural options.

Where To Go From Here?

To answer the question of Does posture matter?, the answer is certainly yes. However, posture can not be simplified to good vs bad, as such a complex subject requires multifactorial considerations. Becoming more cognizant of your habitual postures and implementing strategies to improve your body awareness, movement hygiene, joint mobility, and sitting strategies can all be very helpful in improving posture or preventing postural decline. Tune in to the next blog to learn some practical strategies to bring into the rhythms of your life.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

1. https://free2move.com.au/improving-posture/#:~:text=Focusing%20on%20dynamic%2C%20not%20static,This%20may%20cause%20breath%20holding. 

2. https://feldenkrais.com/posture-or-acture/#:~:text=The%20word%20%E2%80%9Cposture%E2%80%9D%20originates%20from,coined%20the%20term%20%E2%80%9Cacture.%E2%80%9D 

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889545/ 

What Does It Mean to “Explore Movement”?

The concept of “exploring movement” is extremely important for anyone pursuing therapy at the Wellness Station to understand. In a client interaction, I often make the suggestion for the client to explore a particular movement. This is sometimes met with confusion. What does it mean to explore? Am I doing the movement right or wrong? How many repetitions should I do? What next? By asking questions such as these, it is clear that the fundamental nature of the therapy we are providing is not yet understood. By understanding and applying movement exploration in the clinic and during home practice, clients will have a much higher likelihood of experiencing positive outcomes throughout the therapeutic experience and beyond. 

Exercise vs Movement Exploration

Many people who have not experienced the Feldenkrais Method or other somatic movement practices may have difficulty distinguishing between traditional exercise and movement exploration. Exercise is a broad term, and of course movement exploration could be considered a form of physical exercise. However, exercise has become more of a societal construct that implies hard work, high effort, rigid rules of what is “right” and “wrong”, and even a “no pain no gain” mentality in certain circles. While traditional exercise can play a crucial role in sustaining health and fitness, the manner in which many people exercise can actually contribute to various issues. Falling out of love with movement, because exercise starts to be related to effort and discomfort. Repetitive strain injuries from overdoing certain movements without incorporating variations. Triggering pain and inflammation in arthritic joints. Sometimes, the way exercise is performed is like trying to fit a square peg into a round hole. 

Movement exploration is a process that involves learning, attentiveness, and body awareness.

This is how we naturally learn to move, starting from infancy. It is the parent’s job to provide a safe environment, external props, and opportunities to explore, and the child begins to learn and develop in their own unique way. Child researcher and Feldenkrais Practitioner Esther Thelen demonstrated with her research that no two children move through the developmental stages identically, but in their own individual way based on the dynamic interaction between person, task, and environment (known as Dynamic Systems Theory). (1) Us adults are really not all that different from our younger counterparts, especially when it comes to how we learn to move. Approaching movement with curiosity and a sense of exploration recognizes that every person, task, and environment is unique, and therefore movement should be an individualized experience. Exploring movement allows people to recognize the unique characteristics of their own self, and develop various options that could be more helpful than the “right” way to do a movement that is taught through traditional exercises.

The fundamental difference between traditional exercise and movement exploration is that the former is goal-oriented, and the latter is process-oriented. (2)

It is not just about the destination, it is about the journey itself! Traditional exercise tends to be close-ended (one path leading to one desired result), whereas movement exploration is open-ended (multiple possible paths with no specific desired result, although positive results will still occur). By paying attention to the process of movement without only being concerned with the end result, we can learn to be mindful and attentive to our bodies. This helps to facilitate the learning process, which creates a virtuous cycle in which we begin to get to know our own selves with greater precision. 

A real-life example is hiking. Say you are to engage in a three mile hike to the top of a mountain, sprinkled in gorgeous wildflowers, waterfalls, and various paths to the top that will culminate in a panoramic view of glaciers and rocky peaks. In doing this hike, one might reflect on their intentions. Is the intention to walk three miles to get your “steps” for the day, burn 500 calories, and to check the box that you got to the top? If so, the journey itself does not matter. Might as well get on a treadmill for exercise, then drive to the top of the mountain later on. If the intention is to explore, then the journey itself is where the value lies. What feelings emerge as you soak your senses in the variable landscapes? What can you learn from fellow hikers along the way? What new discoveries will occur if an alternative path is taken? What is the qualia of the panoramic peak after engaging in such a journey? It should be noted that the two intentions are not mutually exclusive. One can value the benefits of the exercise (supporting muscle strength, cardiorespiratory fitness, healthy body composition, etc.) while also valuing the experience itself. 

Clinical Example: Spine like a chain vs bridging

To distinguish traditional exercise from movement exploration in the clinic, consider the example of the bridging exercise, often referred to as “spine like a chain” in Feldenkrais contexts. Even the language can distinguish some of the differences between the two methods. To “bridge” implies an end result, a goal-oriented approach. The goal is to lift your hips up into a bridge. On the other hand, calling it “spine like a chain” implies a process-oriented approach, in which attention is paid to the actual process of moving the spine one vertebrae at a time towards and away from the floor. 

Bridging (Traditional Exercise Context)

Lying on your back, bend your knees so your feet are close to your bottom. Now, engage your glutes to push your hips up towards the ceiling. Hold. Lower back down. Perform three sets of 10 repetitions.

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Spine like a Chain (Movement Exploration Context)

Lying on your back, bring your legs up into a bent position, paying attention to where your feet are relative to each other, and relative to your bottom. Press through your feet to observe how your body responds. Notice your tailbone will start to lift. Then release this pressure, lightening the feet, to notice how the body responds. Repeat, with more force pressing through your feet, and notice what starts to lift away from the ground next. Moving throughout your comfortable range, practice peeling one vertebrae at a time from the ground until a comfortable height is reached. Hold this position if desired to sense the stability of your muscles. Lower down in reverse order, one vertebrae at a time until the tailbone is back down. Repeat, resting often. Any variations are encouraged, such as changing where the feet are placed or what range you are moving in. Explore this movement until you are no longer feeling engaged, or your body asks for something different.

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Although the latter might be more wordy and perhaps confusing to some, it is a process-oriented approach that leaves space for the person to explore and discover. While the end-result of strengthening the core and hip muscles might be the same for the two options, the exploratory approach is more apt to facilitate additional benefits such as improved motor control, spinal mobility, and a refined ability to be present with oneself in order to sense and respond to the needs of the body throughout each moment in time. If one can approach traditional exercises through an exploratory lens, the greatest benefits can occur with a deeper enjoyment of the process and a lower likelihood of reinforcing strain-inducing movement patterns.

Challenge: How might one turn spine like a chain into a unilateral exercise? See the last blog “The Importance of Unilateral Exercises” for more on this topic.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Sources:

1. https://www.canchild.ca/en/resources/36-dynamic-systems-theory-a-framework-for-exploring-readiness-to-change-in-children-with-cerebral-palsy 

2. https://trans4move.com/blog/2018/6/15/movement-exploration-vs-exercise 

3. https://drlexgonzales.com/wp-content/uploads/2021/09/Blog_Segmental-Bridge-300x225.png 

My Feldenkrais-Inspired Journey

Almost three years ago, my life changed for the positive when I was introduced to the Wellness Station and the methodology that influences our practice. I had barely heard of the Feldenkrais Method® at this point as a PT student, and certainly had no idea how to implement its principles into my own life or into therapeutic care. This was a pivotal moment in my life in which the end of my academic journey and the start of my career was just around the corner. I knew that I wanted to bring some new ideas into the therapeutic space, as my experience with traditional physical therapy left me searching for deeper meaning. Beginning to blend my learnings of the traditional therapy model with my study and practice of yoga was extremely helpful, but I knew I had much more to learn.

Following an auspicious introduction to the Wellness Station team, I began to open my mind and body to the greater possibilities that are achievable through a Feldenkrais approach. I began to receive mentorship, attended Feldenkrais movement classes, participated in my own body explorations at home, and improved my knowledge through reading various books on the topic. Through this journey, I have achieved personal growth and a refinement in motor skills, which are gifts that keep on giving.

Below I will reflect on some of the key takeaways of my journey that have helped me feel better in my body and motivated me to share these tools with the world. 

Keenly aware of more body parts and connections between

A key part of the Feldenkrais Method is to become more aware of our body in a non-judgmental way. With a background in anatomy as well as yoga, Feldenkrais helped to deepen my self awareness to a greater level of precision. Using the spine as an example, I used to be only generally aware of my spine, more as a series of “chunks”: my low back, mid/upper back, and my neck. Through slow, controlled movements with a keen attentiveness, I have been able to expand my sensorimotor skills to be aware of specific parts of my spine, and how to move and adjust my position to feel more comfortable in these various areas. Key lessons that helped to build this ability have been the pelvic clock, as well as piano keys and spine like a chain. This idea of each vertebrae being like a piano key can allow us to move with the precision of a skilled piano player- flowing up and down the scales with ease, rather than being limited to mashing many keys all at once. These practices allow us to feel “flow” and connections between various body areas, as the spine is our center, our core, the foundation for our head, and the bridge between our upper and lower body. 

Moved away from strain and over-efforting

Many of us have a tendency to put in too much effort, which can contribute to strain and tension. In fact, we all have inefficient movement patterns, which is just part of the human experience. These neuromuscular inefficiencies may present themselves during exercise, daily tasks, occupational duties, and more. For me, this tendency may have related in some part to perfectionism and competitiveness, as well as a reflection of the overall psyche of our society: do more, work hard, no pain no gain. Certainly it manifested into the way I exercised and practiced yoga to some extent. The Feldenkrais Method teaches us to do just enough, and no more. To become aware of unnecessary effort and tension, and find ways to move without our typical patterns of strain. By practicing movement in this way, I became aware of some of my habits that may have been less than helpful. Fitting myself into a tight yoga shape that didn’t feel good, but doing it because I felt like I should be able to. Overtraining because more is always better. Judging and being hard on myself when I felt like I wasn’t achieving something perfectly. My journey with Feldenkrais has not erased all of these habits, but it has done wonders to help me become more aware of them, and has allowed me to be able to make the conscious decision to be more kind to myself and my body. This has actually done wonders for my yoga and other fitness practices. By finding ways to unlock my emergency brake (unnecessary tension), work with my body instead of on my body, as well as a refined sense of awareness and biomechanics, I have been able to find new growth in terms of the physicality of my movement practices. Better ability to move into difficult shapes with ease, strengthen my body in three dimensions, walk and run with a sense of flow, all while respecting the limits of my body in the moment. 

Expansion of therapeutic toolset

One of the most important characteristics of an effective physical therapist is to walk the walk. These practices are part of my life not only for myself but also for my clients. Even though I am not currently a certified Feldenkrais practitioner, my experience with the method greatly influences my therapeutic style to provide clients with a unique approach to therapy. By practicing what I preach, I am able to share an integrative person-centered therapy that can be very helpful for those who are looking for an alternative option. While every person is very different, the tools obtained from mindful awareness practices can be applied to any person. We all have tissues, and our tissues all want attention!

At the Wellness Station, the therapist and client work together as “body detectives”, discovering neuromuscular inefficiencies that may be contributing to pain and movement challenges.

Based on these findings, lessons that are unique to each individual are taught with improved comfort, biomechanical efficiency, and fitness as the outcomes. To learn more about how Feldenkrais can be applied into physical therapy, read our Feldenkrais Method White Paper.  

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

PT Recipe: What to Look for in a Therapist

Physical therapists come in many flavors, and it can be challenging to figure out if your therapist is a good fit. It was interesting and informative to read this article by the NY Times that describes qualities to look for (and some qualities to stay away from!) in a PT. One common misconception in the public is that one size fits all, that PT either works for someone or does not. This is certainly not the case. Sometimes, there is a personality clash in which the therapist and client simply are not a good fit for each other. Other times, the therapist might not be utilizing the best treatment options, or might have difficulty with empathy, critical thinking skills, or other factors that can determine therapeutic outcomes. And of course, sometimes clients do not “buy in”, do not participate in the prescribed exercises, and perhaps may not be ready to make substantial lifestyle changes. All of these factors will determine whether the therapy is successful or not. A strong therapeutic alliance between practitioner and client is required, and the best way for this alliance to be created is for the client to have faith in their therapist.

Here are some qualities to consider when embarking on your therapeutic journey. Keep in mind that these qualities are also important for other therapeutic treatment options, including mental health therapy, chiropractic, as well as speech and occupational therapy. 

Prioritizing active over passive interventions:

Historically, physical therapy has relied heavily on passive treatment modalities, such as ice, heat, ultrasound, electrical stimulation, and laser therapy. Manual therapies could also be considered passive, in which cases the practitioner would “perform” techniques such as joint mobilizations, manipulations, and massage on the client without the client having any kind of active role. This type of therapy has a different intention and effect than a hands-on Feldenkrais-inspired lesson. In a passive manual therapy procedure, the practitioner has the mentality of “fixing” something. They may use language such as describing joints as “out of alignment” or something of that nature. This type of treatment can be harmful for several reasons, one of which is that it teaches clients that they do not have agency over their own healing, and require an external source. This differs from a Feldenkrais-inspired technique in which the client may not be participating with volitional movement, but is instead actively participating by visualizing, sensing and feeling effortless movement, and may be asked to join in as the therapist initiates various movements. In the latter case, learning will occur, as clients will begin to feel how they can improve their movement without strain.

While passive manual therapy techniques may have their place, they should certainly not be the primary intervention. Fortunately, over the past several years the field has begun to move away from these options in favor of more active interventions. The passive treatment options are generally not evidence-based, and are often no more effective than sham or placebo interventions. Additionally, relying on these passive modalities could potentially have negative impacts on client’s self-efficacy, or the belief in their intrinsic capacity to heal and improve. By feeling like you need to see a practitioner every week so you can be the recipient of passive interventions can really take away from your motivation to improve independently and trust in your body’s natural healing abilities. Active treatment options are more effective, sustainable, and help to improve your self-efficacy as well as your body’s resilience and healing response. Active interventions are typically exercise and movement based- make sure your therapist is helping to guide you towards these options rather than relying solely on passive modalities. 

Using evidence-based treatments:

Research in a field often takes up to 17 years to become implemented in clinical practice. That is why it is important for clinicians to stay as up to date on new research as possible, and not rely on outdated or inefficacious treatment options. The best evidence shows that movement is medicine. Movement and exercise should be the primary lines of treatment in physical therapy to help people move better, feel better, and participate more in life. At the Wellness Station, the primary interventions are almost exclusively movement-based, because this type of intervention has been shown to be the most effective and long-lasting. The services we provide are influenced by the Feldenkrais Method®, which is a gentle and highly effective complement to traditional physical therapy. To learn more about the Feldenkrais Method®, its application into physical therapy, and clinical research that supports its use, please read our white paper written by Paul McAndrew.

Walking the walk:

It is extremely important for a client and clinician to develop a strong therapeutic alliance that is rooted in honesty, genuinity, and integrity. Clinicians must set a positive example, and clients must be able to trust and believe in their clinicians. Perhaps the most important way to find a therapist that you can believe in is considering the question of whether they “walk the walk”. Does your therapist seem like they take their own fitness, health, well-being very seriously? In order for a therapist to be an effective teacher and role model, it is crucial that they are able to feel in their own body the recommendations and lessons that they suggest. They should be able to relate to what you are doing that could be contributing to strain, and help you devise a way to improve the efficiency of various tasks. For example, imagine a client that is having trouble looking up or reaching overhead due to neck pain or mobility restrictions. The therapist should be able to demonstrate how functional movements involve relationships between various body areas (e.g. how movement of the tailbone relates to movements of the neck), rather than isolated movements of specific body parts. If someone is having trouble with this task, the therapist should be able to feel in their own body and help teach the client that by lifting the tailbone while sitting, ease of looking overhead or reaching overhead can be greatly improved. Over the course of therapy, the practitioner should also help develop a plan to improve overall fitness using biomechanical and physiological principles in the context of the client’s individual characteristics.

Interpersonal skills:

Interpersonal skills are exceedingly important for a provider to have. Without good bedside manner, it will be very challenging for clients to feel comfortable, safe, and able to discuss sensitive topics. A therapist must demonstrate empathy, which is the ability to understand and share the feelings of others. Without empathy, the client will not feel listened to, understood, and cared for. Empathy requires the therapist putting themselves into their clients metaphorical shoes, understanding the pain they feel, and meeting them where they are at in life with sensitivity and grace. An empathetic therapist will listen, make eye contact, not interrupt, and not try to force changes. They will ask questions that demonstrate understanding of your life circumstances, express genuine interest and care, and refrain from unsolicited “fix it” advice (e.g. telling you what you “should” do).

Another factor to consider is, how do you feel during your sessions? Is your therapist encouraging? Do they help to calm you down and feel optimistic about your healing journey? Or perhaps, do they make you feel rushed? Does the therapist seem to be rushed? Unfortunately, many providers are rushed, with unrealistic productivity requirements that limit the time they can spend with each client.

At the Wellness Station, we are able to take the time needed with every client in a supportive environment to facilitate healing and enhanced lifelong fitness.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Movement Snacks

What is a movement snack, you ask? This catchy term (which I do not take credit for) describes taking brief movement breaks throughout the day. These breaks are especially important if we spend a long time sitting in the same position, such as during computer work, in the car, or on the couch. They can also be used as a way to warm the body up in the morning after sleep, or perhaps simply as something to do while waiting for the coffee to brew or the food to heat up.

Many people fall into all or nothing thinking when it comes to movement. Some less than helpful ideas out there are… “It has to be intense to be effective.” Or, “I went to the gym already today, so I checked that box.” Or, “I didn’t have time to do all my PT exercises, so I will wait to do them on a day when I have more time.” These mentalities are not so helpful, as they can contribute to moving less throughout the day, as well as equating movement to a chore that we should do as opposed to something joyful that we get to do. Rather than all or nothing, it can be helpful to shift to a mindset in which we reframe our daily movement practice into realistic, bite-size chunks, incorporating the mantra: “a little bit, very often.”

The brain and body respond well to repetition, so it is important to develop a routine that we are doing often in order to get the greatest benefits out of our practice. However, this does not mean that we have to spend a very long time all at once on our movement practices. A better strategy is to have “snacks” throughout the day in which we get our body moving in order to change positions, take strain and tension off our joints, get our blood flowing, and bring about positive changes to our mood and energy levels. Of course we want to also have “meals” regularly in which we are spending a longer period of time moving and exercising, but snacks throughout the day are an excellent way to stay moving in between these metaphorical meals, especially if we are busy.

The snacks you choose should ideally incorporate movement in more than one dimension, as well as include options for variations. Variety is the spice of life- you wouldn’t want to have the exact same snack every day! You might also choose snacks that are specifically targeted towards areas that you want to bring movement into based on what your day has been like. For example, number one below (back extension with thoracic pivot point) is an excellent way to mobilize the upper back, an area that can get stiff and stagnant after spending a long time hunched over a computer.

Here are some of our favorite movement snacks:

Back extension with thoracic pivot point-

Thigh to chest, tail wagging, circles-

Hip and shoulder extension-

Bridge gliding with figure 4 option-

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team