Chapter 21

Posture Yourself:
Balancing Your
Body in Space

I want to alert you to the importance of posture as well as muscle strengthening and flexibility. You can use this introductory information as you start to work with your physical therapist (PT) in coming up with a healing plan to move you forward.

The focus here is to establish physical balance in your body posture. This will allow you to gradually increase your level of physical activity with greater comfort. Place your emphasis on slow, steady progress in achieving one exercise at a time to improve function and healing from your chronic pain. Your PT will likely work with you on the following goals:

•Posture: develop awareness of proper posture

•Strengthening: exercises that build stronger muscle (e.g., wall push-ups or bicep curls)

•Cardiovascular: light to moderate aerobic exercises (e.g., walking, swimming, or bike riding)

Let’s discuss each of these components in a little more detail.

Posture

Attention to proper posture is critical to improving chronic pain symptoms. It can affect mood, blood pressure, pulse, lung capacity, and the function of your muscles and connective tissue. Poor posture has been shown to strongly affect such chronic pain issues as tension and migraine headache, temporomandibular disorders, back pain, and fibromyalgia. Poor posture can lead to fatigue, muscle spasm, and increased chronic pain.

Your PT will likely teach you postural exercises for multiple goals. One goal is strengthening core stabilizer muscles. The other goal is increasing somatic awareness, so you can begin to sense when your body is out of proper postural position. The PT will also likely teach you similar exercises for activating your core (abdominal muscles) and walking with improved biomechanics.

Let’s go through what a postural exercise might be like. For example, if you have chronic headache, neck or shoulder pain, or jaw pain, your PT might show you what is called the “neutral spine” position. This refers to the correct position of your head, neck, and torso, to allow for the least amount of stress and strain. It also means that the surrounding musculature of your head, neck, and back can remain “neutral,” in other words, not having to engage in overworking to support your upper body. When you are in this position, it maintains the natural curves of your spine. Then, the goal is to develop and support the surrounding muscles so that they can firmly yet comfortably help you maintain this neutral spine position while engaging in your normal daily activities.

How can you experience this example of neutral spine? First, settle into a chair. Pull your belly button in just slightly, to engage your core muscles lightly, mindfully. One way of accomplishing this is to do a chin tuck.

•Settle into a chair.

•Pull your belly button in just slightly, to lightly engage your core muscles.

•Gently bring your shoulders back and down, almost as if you were trying to bring your shoulder blades together.

•Do a chin tuck. While keeping your face in a vertical position (not tilting either up or down), gently push your chin back toward your spine.

•Another way to establish proper head position is to imagine that you have a string suspended from the crown of your head, and that you are going to pull upwards on that string until you have reached full extension.

Once you have learned how to reach neutral spine, your PT will encourage you to remember it in two ways. One way is sensory—pay attention to how it feels when you are in this position. The second way is sensory and visual—look in the mirror once you have established neutral spine so that you can connect how it looks and feels. This will help you to practice and reach it more easily in the future. Your PT might show you other types of neutral spine exercises in addition to this one.

Strengthening

In addition to posture, muscle strengthening is very important. Whenever there is pain, your core stabilizer muscles become weakened. They are responsible for keeping your head, neck, back, legs, and torso in the proper position.

Then, even if your pain is relieved, the core muscle groups may not have been strengthened. This is part of the reason why people with chronic pain are so fatigued and often relapse. For this reason, strength exercises help ensure that you can maintain your improvements over time.

However, while you work on strengthening, awareness of muscle tightening is equally important. We know that people routinely tighten up sore areas—it’s natural to brace and guard against pain. When it comes to strengthening, the muscles must be relaxed before they can be strengthened. Otherwise, trying to strengthen a tight muscle causes it to spasm. This not only increases pain but interferes with the strengthening process. Muscle tension is closely connected to the level of arousal in your autonomic nervous system. Many pain patients know this daily experience of being constantly on guard. This creates both chronic tension and exhaustion, part of the vicious cycle of chronic pain. So, learning to be aware of feelings of tension is very important.

Finally, your PT will encourage you to engage in some ongoing aerobic exercise, starting out gently. Aerobic exercise such as walking, biking, swimming, or elliptical machine increases tissue healing, improves muscle strength and flexibility, reduces nervous system sensitivity, and increases your body’s production of endorphins (natural painkilling substances). An additional option is to find a PT who specializes in warm-water movement (exercises in a warm pool), so you can experience exercise benefits with the reduced gravity-resistance of water. (Note: you will find more detailed information about how to get started with physical exercise for healing chronic pain in the “Cultivating” section.)

Cardiovascular

Cardiovascular fitness is vital to your overall health, and it also supports your healing from chronic pain. This helps to explain, in part, why the ability to walk increasing distances is a very important index of recovery from chronic pain. Your healing team will be invaluable in helping you set up and follow your particular, titrated fitness plan.

Your PT will review all these considerations with you and come up with an individualized plan to help you gain the strength, flexibility, fitness, and somatic awareness to support progress on your healing path.