Back Pain Solutions II:
Posture-Movement Education
(Part One)

As I saw more and more people with back and neck problems, I continued to have many successes. I found that people often were able to control their symptoms through exercises using different positions and movements, with manipulative treatment (passive movements) supplementing this when needed. As part of this work, I also emphasized the importance of dynamic posture in daily life. However, as the following story shows, I discovered difficulties in helping people adopt new, healthier habits.

The Problem of Habit
One day, while visiting a friend’s house, I noticed something different about his 15-year-old son. I had gotten used to seeing Jeremy slumping, his spine in the shape of a big letter C and his head protruding in front of the rest of his body. This day, although this usual posture hadn’t changed, Jeremy moved carefully and stiffly. What was the problem?

Jeremy had woken up with a pain in his neck and upper back on one side. He had difficulty turning his head. He had no idea what had caused this to happen all of a sudden. I asked him and his father if I could help. Knowing that I worked as a physical therapist who specialized in this kind of problem, they both agreed.

I first asked Jeremy to tell me a little bit about the pain. (See Index Your Symptoms, in Chapter 10, for more on the skill of accurately describing symptoms.) Jeremy’s pain felt constant. That is, he noticed some discomfort even when resting. I asked him to show me on his body exactly where he felt the pain. It spread from the right side of his neck and upper back to several inches along the top of his right shoulder blade.

His head and neck movements appeared restricted and painful, especially towards the right. He also couldn’t extend his head and neck very far back to look up towards the ceiling.

I asked him to rate his symptoms on a scale from 0 to 10, with 0 meaning no pain and 10 meaning the worst that he could imagine. Using a simple scale like this provides a way to become a better observer of your symptoms and thus to practice being a personal scientist. Jeremy said it felt like a 6.

I explained to him that these kinds of symptoms are often related to positions and movements of the body. Seeing his greatly distorted protruded-head position, I thought that working on his posture would be a good place to start.

I asked him if he would allow me to help him to experience a different position of his head and neck in order to see what effect it would have on his symptoms. He agreed to this and I invited him to sit on a chair. I proceeded very gently to guide him into a position where his back was no longer rounded and his neck and head were brought back closer to the top of his spine. This took several minutes, during which time I talked with him, asking him to let go of tensions or holding here and there and encouraging him to let me know how he was feeling.

After getting repositioned, he sat erect, an unusual position to see him in. He himself felt quite odd, almost crooked. I asked him what he felt in his neck. There was now only a small amount of discomfort, about a 3, along his spine in the mid to lower neck. Just changing his sitting posture had changed his symptoms for the better. Interestingly enough, his ability to move had also improved.With my hands gently guiding his head and neck movements, he could now turn his neck more fully to both sides with little increase in pain.

Since I had to leave soon, I reviewed the importance of everyday posture in the best way that I could under the circumstances. I demonstrated good and bad postures and explained how maintaining good posture would help. He acknowledged that he already had experienced evidence of this.

Then I instructed him in the “chin-tuck” exercise (described in Chapter 15), a movement that emphasizes the opposite direction of his habitual protruded-head position. He had some difficulty doing it on his own and I guided him through the movement with my hands. The small amount of pain decreased and, after about twenty repetitions, had altogether vanished.

While I talked with his father, Jeremy walked around for a few minutes. After awhile I could see that he had begun to return to his habitual slump. When I asked he said that some of the neck pain, not as severe, had also returned. I urged him to do the exercise I showed him, even if he had a bit of trouble with doing it correctly.

I didn’t see him again until several weeks later. He was slumping as much as ever. When I asked him how he was doing, he thanked me. He had done the exercises and corrected his posture as best he could and he reported that he had no pain. Given his slumping, how long-lasting would this be, I wondered.

Working with people with back, neck and other activity-related pain, I had many similar experiences. A few people, who it clearly seemed could benefit from improving their posture, didn’t see the point. “I’ve slumped all my life,” they might say, “but I just started having pain in my back so how can you tell me that my posture is a problem?”

Many others did see the point but despite their best efforts to comply often were unable to maintain the good postures that I showed them for sitting, bending and moving. And more often than not, people thought they were doing the exercises correctly and moving with better posture and body mechanics when they weren’t.

It seemed clear here that so-called ‘subjective’ or ‘mental’ factors—people’s desire to change, their body awareness, their willingness to experience themselves in new and unfamiliar ways and their persistence and willingness to work, among other factors—had as much importance as the ‘objective’ exercises and instructions I gave them.

Fortunately, what people could do often seemed good enough temporarily. But I felt frustrated about not being able to make further inroads in helping people change their habits —habits that might prolong their symptoms and make them more vulnerable to future episodes of pain. I wondered about the bent-over elderly people I saw in the hospitals and nursing facilities where I had worked, as well as on the street. To what extent was this condition due to years of postural neglect?

My study of therapy approaches had brought me to the edge of what appeared to be an educational problem. It is easy to treat your body as an object and let your attention go somewhere else while doing exercises. This can reinforce the illusion that there is a separate ‘mind’ and separate ‘body’. Then you can neglect the so-called ‘mental’ aspect. However, for posture-movement education to have any chance of success, ‘subjective’, or ‘mental’ factors, cannot be left out.

Education and ‘Body’–‘Mind’ Unity
By the time I went to physical therapy school in the late 70s and early 80s, lip service—perhaps more commonly given nowadays—was already being paid to the unity of the ‘mind and the ‘body’ (ironically, by talking in terms of two separate things—the ‘mind’ and the ‘body’).
In practice the split of ‘body’ and ‘mind’ pervaded physical therapy and medicine, as it does today. The approaches I learned in physical therapy school emphasized the ‘body’ as a machine made of isolated parts and downplayed or neglected the role of the inner life (consciousness) of the individual.

Understanding the mechanisms (how they work) of nerves, muscles, joints, exercise, etc., was and still is considered ‘objective’ and ‘scientific’. Understanding the role of consciousness—the mechanisms (how they work) of my own inner life and that of the individuals I sought to help—was considered ‘subjective’ and less ‘scientific’, or at least not a part of ‘real science’.

As a physical therapy student, I observed that the best clinicians and teachers were able to unify the so-called ‘objective’ and ‘subjective’ elements in their work. Nonetheless, my interest in dealing with both the outer and inner person seemed odd and peripheral to the main business of exercise science that I studied.

As a student of the practical philosophy of General Semantics, I had already rejected the divisions of ‘objective’ and ‘subjective’, ‘body’ and ‘mind’, as unsound.

With biologist C.H. Waddington, I agreed that:
"An attempt to make a clean cut break between the subjective mental observer and the objective material observed [what philosopher Alfred North Whitehead called the ‘Bifurcation of Nature’], is a basic error. They are initially parts of a whole, and if one wants for some purposes to separate them, that can only be a matter of convenience that should be indulged in with great caution."1

I began to put this understanding into practice by becoming more aware of my language and that of others. I worked to remember what
general semanticist Alfred Korzybski wrote:
"Linguistic and grammatical structure also have prevented our study of human reactions. For instance, we used and still use a terminology of ‘objective’ and ‘subjective’, both extremely confusing, as the so-called ‘objective’ must be considered a construct made by our nervous system, and what we call ‘subjective’ may also be considered ‘objective’ for the same reasons."2

I began to think, talk and write about myself and others in terms of Korzybski’s phrase “organisms-as-wholes-in-environments.” 3 I worked at remembering that successfully dealing with the living reactions of individuals (myself included) must involve the so-called ‘subjective’ factors as nervous system functions of the organism. I began exploring practical methods of working with people that did not divide a fictional ‘mind’ from a fictional ‘body’. These studies included Sensory Awareness (discussed in Chapter 12) and F.M. Alexander’s work. Eventually I became a teacher of the Alexander Technique.

A New Old Approach to Posture-Movement Education
Posture-movement education almost undoubtedly goes back to the first efforts of early humans to help their young learn the motor skills related to hunting, gathering and other aspects of daily life. Written records of posture-movement education can be found in accounts of the several-thousand-year-old practices of Chinese Kung-Fu (Qigong), Indian Yoga and Greek and Roman gymnastics, which paralleled the work in therapy that I discussed in the last chapter.4

In Europe in recent centuries, singing teachers and voice coaches focused on their students’ posture habits in relation to breathing and movement.5

During this same period, posture-movement education also continued in the work of a number of physicians and associated workers in physical education. These people realized the importance of engaging the body-mind (organism-as-a-whole-in-an-environment) when working to help people with posture, movement and breathing difficulties.6

Probably influenced by translations of Chinese Qigong texts,7 the Swedish Gymnastics movement founded by Pehr Ling, had particular importance in both the medical and non-medical areas.8,9

Dr. Mathias Roth wrote this about Ling’s system of Medical Gymnastics in his 1856 Handbook of the Movement Cure:
"The oneness of the human organism, and the harmony between mind and body, and between the various parts of the same body, constitute the great principle of Ling’s gymnastics."
"The development and preservation of the harmony between mind and body, as well as among the various organs of the body, is the object of Ling’s system with regard to healthy persons, and this is the educational or prophylactic part of the system, while the restoration of the disturbed harmony of the different organs produced by diseases, forms the object of the medical part."10

It is against this background that Australian-English actor F. Matthias Alexander (1869–1955) sought a solution to the vocal problems that he developed in the last decade of the nineteenth century.

According to Alexander’s account in his 1932 book, The Use of the Self,11 he worked over a period of time observing himself in the act of speaking. Although obscure about his sources, it seems likely that in order to work out his own problems he supplemented his self-observations with study of some of the available literature and consultation with professionals in the field.12

“Synthesizing parts from voice pedagogy and physical therapy,” as Ed Bouchard and Ben Wright state in their book Kinesthetic Ventures, Alexander “...developed a ‘technique’ employing gentle touch to teach natural posture and breathing essential to effective vocal use.” 13 This work has also been found effective in working with people with back pain and other posture-movement related problems.

Alexander’s synthesis follows a number of basic principles. Patrick Macdonald, a student of Alexander’s who became a well-known teacher of his technique, listed these as follows (modified by me and in a different order):
Recognition of the Force of Habit
Head-Neck-Back Relations
Importance of Sensation/Perception
Inhibition
Sending Directions 14
I will briefly discuss each of these notions in turn, as together they cover some of the main issues of posture-movement education.

Recognition of the Force of Habit
Alexander emphasized the role habit plays in our posture and movement. William James, in his 1890 classic Principles of Psychology, had already written a great deal about habits. In a lecture based on this work he said:
"All our life, so far as it has definite form, is but a mass of habits, — practical, emotional, and intellectual, — systematically organized for our weal or woe, and bearing us irresistibly toward our destiny, whatever the latter may be."15

James wrote directly about posture-movement habits (what Alexander called “the use of the self”) in his essay, “The Gospel of Relaxation”:
"The general over-contraction may be small when estimated in foot-pounds, but its importance is immense on account of its effects on the over-contracted person’s spiritual life. ...For by the sensations that so incessantly pour in from the over-tense excited body the over-tense and excited habit of mind is kept up.... [O]ver-tension and jerkiness are primarily social, and only secondarily physiological, phenomena. They are bad habits, nothing more or less, bred of the imitation of bad models and the cultivation of false personal ideals."16

As Alexander found, those who seek to help themselves or others move towards better posture will need to deal in one way or another with the force of habit.

Head-Neck-Back Relations
In his later writings, Alexander emphasized the importance of the relations among the head and neck, the back and the rest of the body. Years after his initial explorations, he noted that these relations constituted “the primary control” for body use (posture-movement habits).17

Talking about “the primary control” can imply that something exists as a more-or-less separate and all important entity. Some have attempted to locate “the primary control” in a single part of the anatomy or as an isolated physiological function. However, the mutual, dynamic postural relations among the head, neck, back (spine), torso and limbs exist in a larger context of the external environment, a person’s internal physiology and his/her conscious state. These complex interrelations make it inadvisable to label any one part or factor ‘the primary control’.
Nonetheless, in posture-movement education, the head, neck and back (spine) relations do have importance. Many recognized this prior to Alexander.

Japanese, Chinese and Indian practitioners in various meditative and movement practices recognized long ago the importance of the head, neck and back in “right posture.”18

The singing teachers and teachers of medical gymnastics mentioned before taught this as well. Scanes Spicer, M.D., a physician who studied these approaches and with whom Alexander was acquainted, wrote early in this century about the importance of the head, neck and spine in posture education for respiratory and other problems.19

These students of posture and movement understood the mutual relations among the limbs, the lower torso (the belly and lower back), the rest of the torso (chest and upper back) and the neck and head. They knew that inadequate support from below can encourage poor posture of the head and neck. In turn, habitually tightening the neck and pulling the head backwards, or letting it slump into this position, can encourage a downward direction and shortening of the rest of the body.This is the protruded head position that Jeremy habitually assumed.

By contrast, adequate support from below allows freedom in the neck so that the head can move from the backwards- pulled position to a more forward and upright one. This means, in Spicer’s words, a “passive, loose balance of head on spine; no active muscular tension or rigidity.”20 In turn, this encourages a continuing upward direction and lengthening of the rest of the body with “fullest spinal extension...straightening out not only dorsal spine (to enlarge chest), but also cervical spine (to enlarge throat) and lumbar spine (to make room for viscera backwards).”21 This is the more neutral, erect position that Jeremy assumed with my help. Figure 4.1 illustrates the head and neck portion of these two contrasting postures.

Figure 4.1 – Head Back and Down vs. Forward and Up

A phrase used by Alexander summarizes this second, more beneficial posture: “Let the neck be free, to let the head go forward and up, to let the back lengthen and widen.”

Continue to Chapter 4 - (Part Two)

Chapter 4 (Part One) Notes
1. Waddington, p. 24

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