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Posture And Pain: Does Your Back Hurt?

Case Studies

• Chronic Back Pain
• Chronic Neck Pain and Overuse Syndrome
• Self-management - Rheumatoid Arthritis

There is no shortage of advice and injunctions. We all know about the desirability of relaxation, flexibility, good posture and the absence of tension.

Yet by the end of the day your shoulders ache, or perhaps it's your neck or your lower back. You've tried to improve your posture. You've done various exercises, stretches, treatments. They work, up to a point. Your approach is palliative, a management strategy. Things are OK most of the time, but occasional periods of more pain, or a real "back attack" get you. You see your therapist of choice, the pain mostly goes away, until next time. Perhaps you feel you are "just getting older"; some activities are a little circumscribed, perhaps knees are giving a bit of trouble, or your flexibility is decreasing.

Or else you've had a diagnosis of something actually "wrong" - scoliosis perhaps, or part of your spine is "too straight", or else you have osteophytes, or disc degeneration. You have been told that "nothing can be done, you'll just have to live with it". Maybe you have a special exercise or stretching routine that keeps the symptoms under control, but you know you might be in trouble if you miss a day or two.

Despite our best intentions, despite relaxation classes, fitness classes and Eastern disciplines, despite stretching exercises, posture exercises, taping and Californian know-how, we're still tense and uncomfortable in our bodies, with aching backs, sore necks, stiff shoulders, injuries and named conditions. Diagnosis of a named condition can also give the impression of permanence, so that one does not look further for a solution, not learning to exercise the choices that can make a big difference.

What information are we missing? It should not have to be this way! If it's aging, the passage of time, why doesn't everyone over a certain age have these problems? And why do some very young people, in their 20's and teens even, have these problems? Why do some of us recover more fully from accidents than others? Why do some of us remain fit and active far longer than others? What makes the difference between those who breeze comfortably through life, and those who seem to suffer successive aches, pains and injuries?

"Everyone wants to be right, but no one stops to consider if their idea of right is right" FMA

We don't even know it is there. The hidden part, the unseen portion of the problem, is that many of us get stuck at some point in a certain level of tension, or fixity, or distortion, or holding, which becomes built in to our habitual way of being. We become accustomed to "typist's hunch", "jogger's slump", "mother's hip", "driver's neck", "student's shoulder" and the like. Because it is there all the time, our own individual holding pattern simply slips below the level of our conscious awareness.

Our own personal pattern of "use" can levy a hidden strain, lowering performance and predisposing us to injury and back pain. Yet we remain unconscious of the fact that the pain we are in may be a cumulative result of strains we are inadvertently imposing on ourselves day in, day out.

Our individual movement, holding and postural patterns, comprising our way of applying ourselves across all our activities, may encompass compensatory mal-adaptations to earlier injuries or on-going adjustments that generate further strain and injury.

Our personal pattern Our personal pattern, for better or worse, comprises the matrix out of which all our actions are performed; exercise, relaxation, work, leisure. It is precisely in unravelling these patterns that the Alexander Technique of neuromuscular re-education sheds light and may be invaluable.

In other words, it's the things that we don't know that we are doing, that may be at the root of back or neck pain.

Case Study - Chronic Back Pain
John G, a senior public servant in his 50's, had chronic back pain. He had been to his GP, an orthopaedic specialist,two physiotherapists and a Chinese-trained doctor. A cat scan had revealed two prolapsed discs. John had been particularly diligent with an exercise/stretching program, and with trying hard to maintain "good posture". While previous treatments had resulted in some improvement, particularly in regard to flexibility, there was still lots of low back and hip pain; on walking, sitting or standing, in each case within minutes. As it turned out, a great deal of John's pain stemmed from the excessive effort required to maintain his overly rigid "good posture". John's concept of "correct posture" involved lots of tension and rgidity.

Initially the Technique brought: (1) release from pain, and (2) a feeling of wellbeing. John also noticed a looseness/freedom in the limbs which was new. John learned how to be upright (i.e. good posture) without excessive tension or "holding up". This meant he was in less pain, and movement was freer.

There was a positive reaction from others to both his general wellbeing and the fact that his posture had so clearly improved. "I now play tennis 2-3 times a week and ride my bike - these are activities which I haven't done for 10 years, which I had been told I would never be able to do again. I couldn't contemplate being able to do these activities even 3 months ago."

Case Study - Chronic Neck Pain and Overuse Syndrome
Forty-six year-old Debra C started Alexander Technique lessons to see if it would help her chronic neck pain. She had bulging discs in her neck, and tenosynovitis extending back over three years.

Debra learned to make links between her (controllable) habits of use of herself, and the functioning which they affect. She was able to progressively reduce the vice-like grip her muscles had held on her neck, allowing it to find a less strained position. Neck pain, a constant companion for the preceding 3 years, gradually disappeared. Her arms became significantly less painful. She was able to sit comfortably for longer and able to write more freely. An unexpected further benefit was a very noticeable increase in energy, as she learned to not invest energy in unproductive and pain-inducing tension.

Case Study - Self-management - Rheumatoid Arthritis
Jackie M, a 47 year-old pharmacist, started Alexander Technique lessons hoping to reduce pain levels, especially in her neck. She had suffered from rheumatoid arthritis for 10 years. She found that she was indeed able to influence her pain levels and to be more comfortable in everyday life, as well as learning a procedure to help her when things were particularly bad. Of course, the Alexander Technique did not address the rheumatoid arthritis, but it helped Jackie to cope better. It helped Jackie to recognise where she had more power and control over her situation than she had thought. Jackie found there was scope for applying her lessons in all the activities of everyday life, with valuable pain-reducing results. Her back improved generally, particularly her neck and lower back.

An intelligent woman, Jackie had been doing her best to manage her condition, including paying attention to her posture. Like John and also Debra, her understanding of what good posture consisted of, how to achieve it and how to maintain it, were all based on a series of common but potentially dangerous misconceptions. Their Alexander Technique teachers were able to gradually correct these.

No other body of knowledge encompasses this depth of understanding of (body)-use, which can simplify and cut through problems which have defied specialists of all persuasions.

How are you "wearing" yourself? Aches, pains and even degeneration may be symptoms of a hidden problem. Until the "conditions of use", ie the individual's habitual holding pattern or way of "wearing" themselves, has been adequately assessed, the diagnosis has only been partial. If there is an undiagnosed pattern of movement which involves, for example, unremitting pressure through the lower back, then until that pressure-producing habit is changed, the results of the pressure (ie pain) will continue.

Pain may start to dissipate. An Alexander Technique teacher is highly trained to recognise poor habits of "use", assessing where and how a person is introducing unnecessary strain into their way of being. The Alexander Technique teacher brings to your attention things you are doing that you are unaware of. That is, (s)he helps you to extend your choice in the way that you move, act and react. ....You learn a new way of moving; sitting, standing, applying yourself across the range of your activities with less strain, less effort and less energy. You begin to feel lighter and freer as old habits are unlearned. Pain, even of many years' standing, may start to dissipate.

Whatever our situation, we can learn to minimise strain, and work with ourselves, rather than mechanically performing mindless exercises, stretches or forcing "right" positions, and ultimately fighting what is perfectly natural, comfortable, strain-free and sustainable.

© M Stenning, Canberra 2002