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Posture Awareness and Practice with PRT


By Ashley Osier
MA, HHE, CPS, CSMT, CAMT, CAYT, CWHP

It brings me great joy to live in a body that is fifteen years older
and no longer limited by moment-to-moment pain.

Posture Chart showing progress over a 9 month period

Posture therapy has been a bit of an obsession with me since being injured in 1997 and working with a posture specialist twice a week for six months. He was able to open my eyes to the repetitiveness of my sliding back into incorrect posture, the need for strengthening the core to support a lengthened spine, and the micro-practice of awareness, stretching and strengthening needed to maintain a corrected posture. I had no idea how much of an impact he would make on my life both personally and professionally, but am ever thankful. 

My challenge was that the work itself was incredibly painful and often put me into spasms that prevented me from practicing. So when I created Point Release™ Technique, I was thankful to get relief from the pain, which then enable me to practice more of the posture therapy. Here is one example of what I did using PRT in the car and what I teach my clients and students.


Photo shows tennis ball placed on outer UB meridian (between UB38 and UB42). Ball placement was to help with this particular student's postural correction needs. Placement along the UB line will change to meet the needs of each individual. You can see how the other student has a foam roller for support. There is no actual acupressure point stimulation from a foam roller and the dimensions of the foam roller cannot isolate postural point corrections the way the tennis ball can with PRT. You can see the difference in each back in the photo. SO-take your ball with you in the car, on the plane, at work, at school and any other place where you will be sitting-even the movie theater!
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Putting the tennis ball at specific acupressure points was critical for me to continue practicing postural corrections. Getting weekly therapeutic bodywork sessions was immensely helpful and I highly recommend it if it fits in your budget and time. Stretching was also helpful, but I often pulled muscles and strained ligaments and tendons in the yoga classes, so I ended up creating something new that worked for my body. I have more about this micro-stretching practice at the end of the article. The daily micro-stretching and moving practice was also necessary to keep the muscles, tendons and ligaments from chronically tightening and drying out. Integrating all three approaches and committing myself to a daily practice ended up being a huge blessing by increasing function abilities, resolving chronic pain, and improving resiliency when injured. I have had no surgeries, cortisone shots or epidurals. I have seen the benefits with clients and students who are willing and able to practice each approach and continue to be amazed with how much more I am able to do so many years later. 

The commitment, though, is one many people have to determine every morning they wake up in pain, yet again. And it is easier said than done. There are more people than you would think who are too discouraged by pain to consider a daily commitment. One woman I spoke with was in so much pain, she couldn't drive and hadn't worked in over two years. Being able to work, grocery shop, or get in and out of a car are major goals for many. Chronic pain impacts one's posture and ability to maintain an upright posture so much so that it can make it impossible to think about correcting posture at a subtle level. But regardless of how your body feels right now, correct posture is critical, regardless of age. So don't lose heart and don't push yourself beyond your body's current state of pain, fitness, and function. Stay committed and you will gradually begin to notice a difference. In my mid-twenties, I could only swim 20 laps. Twenty years older, I can swim 50+ laps. 

An excellent way to begin your mornings to get ready for postural practice. Those who practice the exercise below in bed can use two or three pillows to elevate the legs. The point below is UB42, but some people will prefer UB47 for low back pain and for upper back/neck/shoulder, UB38. Remember that the acupressure points are bilateral, so when you finish one side after 2-5 minutes, access the same point on the opposite side. When you are finished, bring your knees to your chest, then roll on your side and gently push yourself up into a seated position.


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I have been thrilled to see the documentation in my personal training program that points to the importance of correct posture and proper form. Studies have found posture so important that as a personal trainer, we are taught to teach correct posture before getting into strength training. Form, whether you are at a computer desk or lifting a barbell, is essential. Most people have heard of ergonomic specialists and vocational therapists who go to people's work and correct the heights and angles of chairs, desks, and computer screens. A personal trainer does the same thing for clients who are using machines, weights, cables and the like. The head, shoulders, butt and feet need to be properly postured for optimal performance. And it is important to be able to recognize this proper alignment in the mirror when you are by yourself or with a workout buddy. The National Academy of Sports Medicine equates correct posture with "neuromuscular efficiency, equal bilateral muscle development, aligned joint motion, increased strength ability, and decreased risk for injury" (NASM Essentials of Personal Fitness Training, 4th Ed, 2012). I have been teaching clients and students that posture also impacts the function of our digestive, respiratory, endocrine and nervous systems. So the stakes for basic function maintenance and pain management as we age are high.

Now, take away the office chair, computer screen, or bench press and bring in the sofa chair, the big screen tv, the vacuum, and the dinner to prepare. The chin instantly presses out, shoulders roll forward, the chest collapses, the belly releases, the back sways and the legs become disengaged. If I were to follow people around with a camera, they would be shocked to see how quickly they lose the integrity of correct posture, pain or no pain. I often watch people as they are walking and talking to others and easily notice postural discrepancies. Later in the article, you will see photos showing subtle discrepancies and what it looks like to make micro-corrections.

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So, if you are one of those people who thinks your posture is correct, then
:

√ you have no pain issues 
√ you have no imbalances between your left/right sides and top/bottom of the body  
√ you have had few to no injuries or muscle strains
√ you wake up without stiffness in the mornings
√ you are the exact height you were when you younger (when was the last time you were measured?)
your posture requires little correction whether you are standing or sitting for long periods of time
you walk with even weight distribution on both feet
√ you don't change your posture to talk to people who are taller or shorter than you are
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There is a longer list, but these points are good bullets to check off for yourself. If you cannot answer "yes" to all of them, you may be doing a great job but have some subtle discrepancies that can use a little tweaking. Or you may need some major postural correction. The truth is that most every person will need to self-correct to some measure throughout any given day. The difference is the amount of effort and time required to correct, to re-educate muscle memory, strengthen, and maintain. I hadn't realized how bad my posture was and how weak my core was until my posture therapist asked me to stand straight for an extended period of time. Though I grew up doing 1000+ crunches every day, the chronic pain from injuries impacted the nerves which overrode the strength of my core muscles. So core weakness, from my personal experience and education, is not simply how strong your core muscles are (abdominal, pelvic, back), but how strong they are in relationship to the other systems in the body. 

One example of this is of men who have "buddha" or "beer" bellies. They may be strong, but you will often see these men with shoulders rotating forward, chest sinking, and/or a low back that is swayed. You can even see a slight twist in their body or the chin jutting forward if they are overcompensating for the exaggerated chest lifted to compensate for the sway in their low back. It is virtually impossible to properly engage the core muscles. Another example is women who have monthly menstrual cramping. The pain is so great for some that the belly will distend, the low back will sway, and the shoulders and chest will collapse. In either example, each of these people can be olympic core builders and still be impacted posturally by core disengagement, intestinal inflammation, or abdominal pain. On an emotional level, those who are chronically depressed, angry, or anxious often have postural discrepancies as a psychosomatic response. Individuals who grind their teeth from daily stress often have TMJ, which can cause severe migraines and create postural changes to the head, neck and shoulders. So an effective posture practice, from a holistic perspective, is one that does more than just strengthen the core muscles. 
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Here are the steps needed for proper postural correction: 


1. Awareness of incorrect posture and the systems impacting or impacted by incorrect posture needs to be assessed.
2. Systems that are affecting correct posture need to be addressed to allow for long-term postural corrections.
3. The muscles around your incorrect posture need to release long enough for your structure(s) to lengthen or release.  
4. In order for the structure(s) to lengthen or release, the muscles have to macro and micro stretch. 
5. Once the structure(s) have lengthened or released, the muscles then need to be strengthened to hold the new posture. 
6. To maintain, the muscles need to continue to be stretched and strengthened. 
7. Adjustments to affected systems may need to be addressed to support new postural corrections.
8. To gain additional corrections, this process needs to be repeated until full corrections and/or desired outcomes are achieved.
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Looking Back


I would highly encourage you to look at photos you may have of yourself as a child and young adult and see if there are any insights to a longstanding postural pattern. I saw a photo of myself when I was seventeen and was shocked at how badly I slumped. You can see in this photo my rounded back, collapsed chest, forward chin and bent knees from tight hamstrings. What you don't see is the disengaged core. Remember, I did 1000+ crunches everyday. There was no physical reason for me to slump as I did except for subtle postural patterns that were not impacting my ability to do that many crunches, to workout, or to function, at that time - until I got hurt in my twenties. It was no surprise then that practicing correct posture daily was painful. Many of the clients and students I work with regularly share concern about their back hurting from trying to practice correct posturing throughout the day. My response is always the same. "It will take 6-9 months before your  core is strong enough, holistically, to keep you upright in the correct posture without it hurting. Some people think I am joking until they actually start practicing. Therapeutic bodywork during these months, or at least a daily practice of the Point Release Technique will help with the soreness from stretching and strengthening your muscles. The time will fly by and your changes can be documented either through a postural chart (shown above) or through before and after photos (shown below).
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More photos showing postural discrepancies.

David
David has had a curvature in his mid and upper spine since I began working with him. He came to me with a shoulder issue but then asked if it was possible to change the curvature of his spine. My initial response was that it was not possible but that he might be able to make improvements in his overall posture, muscle reeducation, flexibility, and pain relief with daily effort and concentration. He started off coming once a month, but when I charted his posture on my wall chart, I began noticing subtle changes and his attitude changed drastically. After showing him PRT for his back, he created a way for the ball to be attached to his chair to force awareness and posture correction while he worked. You can see the subtle differences in David's before (left) and after (right) posture. First, the strip above his head is different as well as the windows in the building across the way because he has engaged his core, activated his diaphragm, lifted his chest, pulled his chin to a neutral position, and dropped his shoulders back and down. I am shooting him at the same angle. You can actually now see his Adam's Apple and if you look at the collar of the back of his shirt, you will see that the distance is shorter in the after photo. He hasn't moved his entire body, just the front that has been pressing forward and slumping downward.

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Steve
Steve came in with back, neck and head pain. His left ear was in so much pain he could not touch it and it felt as though it was on fire. This prevented him from sleeping through the night without waking from the pain. His posture was collapsed and weakened by the constant pain and he was not able to stretch. Though he experienced relief after one session, other symptoms remained, reflecting more postural discrepancies. Since he has been practicing PRT with the tennis ball at varied UB points, his back pain is much less and his core muscles are more engaged. He has since been able to translate this new muscle memory over into his morning walks, furthering his progress. His biggest challenge is his neck (mostly on the right side) and from this photo you can see a very subtle discrepancy by how his nose lines up with the buttons on his shirt (in the after/bottom photo). Sometimes the corrections needed are this subtle. Since he was able to see these photos, he has made more progress with his neck and being able to decrease the pain and discomfort.

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Lily
You can see the difference in the photos below for my client Lily (before/left, after/right). The critical piece is that her before photo was taken right after a 2-hour therapeutic bodywork session. It wasn't 20- minutes until she went back to her default posture. I am so thankful I walked out with her that day. Lily is best suited to use the tennis ball at UB38 during her long days at work, so that she can be reminded to lift up through the sternum, roll the shoulders back and down, and pull the chin back. If you get massage, acupressure, therapeutic bodywork, physical therapy and the like, don't let this be you! Bodywork can be incredibly relaxing and also very therapeutic. To keep the benefits going, try to maintain an upright posture after your sessions for at least the day of your session and the benefits from your session will likely last longer.  
                                             

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Shoulders
I work with a number of clients and students with shoulder pain regardless of their work. However, sitting jobs that require us to look at a computer screen for many hours or even sit in meetings can create postural discrepancies with the shoulders, which is a set up for strains and tears when we want to be active. Here is a really good example of a shoulder that is disengaged and unstable and one that is engaged holistically. You can see how correctly posturing her centerline adjusts the shoulder, giving her more strength to complete the exercise we were practicing that day. How can you adjust your posture while sitting in front of the computer screen, in a meeting or even out at dinner? Try placing the tennis ball at UB38 or UB42 and see if it does not assist you in your practice. My next posting will follow up on the shoulder and arm using PRT to increase joint mobility, decrease pain, release tension and muscular holding, warm up for sport, activity, and workout, improve flexibility, and support correct posture. So check back for more information on this part of the body.

Before


After





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Here are a couple more photos of my before posture when I was younger (left) and my current photo (right). In the photo on the left you can clearly see how my shoulders are rotated forward, my chest is collapsed, my core is disengaged and my back is rounded. The photo on the right shows a back that is straighter (but still relaxed) because my core muscles are engaged and do not require my arm strength to hold me in an upright position. This allows for my shoulders to relax and no longer pulls on my neck. Using PRT at UB42 was essential in reminding me of the correct posture I was to establish throughout the day. I drove a lot and was able to utilize the tennis ball in the car. Driving in traffic will never be the same! The "After" photo is the starting position for the StretchFit™ Method exercise below.




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Core Strengthening Exercise

This StretchFit™ Method exercise is a full body practice. Often times I will see the neck shift forward along with the shoulders to hold the body up and forward. The back rounds at the upper, middle and lower sections, the abdominal muscles disengage along with the hips, and the knees have to be held together by the forearms. Done correctly, all movements are controlled by activated muscles allowing this posture to lengthen the spine, provide micro-stretching, strengthen the core muscles, stabilize the hips and re-educate the muscles on how they are suppose to correctly hold the structure of the body.
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Work

Many jobs put us in positions to create and maintain postural discrepancies. No matter how glamorous or relaxing the work may be, incorrect posture that is long-standing is only going to worsen over time and create more imbalances throughout the body. Posture from a holistic perspective, includes all internal organ systems as well as the structural, muscular, and nervous systems. Be mindful when you are at work, at school, out with friends, home relaxing, working out and the like. I had a client coming to me for many months with back pain and multiple postural discrepancies and it took me a good 10 months to find out that her perfectionist house cleaning was injuring her body. So we had to look at postural changes and exercises needed for her to continue without prematurely aging her body and worsening her pain symptoms. If you are tall and you are speaking to someone really short, lower your eyes without dropping your head or widen your stance. This will drop you down lower.  I remember watching a man in his twenties in a conversation with someone much shorter and his posture was painful to watch. Be smart! The same will be for people who are shorter and regularly have conversations with much taller people. The hyper extension is not good for the cervical spine either. Just raise your eyes up and step further away or move the conversation to chairs. 
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Active Lifestyle

Before
Though I am showing photos of a 10-yr old girl, this could be anyone who plays a sport, works out, or has/works with children and is active with them. You can clearly see the discrepancy in her starting, jumping and landing postures. Without intervention, she will continue to have weak hips, legs, knees and ankles, she will not utilize her core muscles to provide maximum stability and support for the other muscles used in her sport, and repetitive landing with her knees inward will gradually break down the stability of the knee joint attachments, preparing her for a future ACL tear. 

Placing the tennis ball at Sp10 will give her a muscle memory of her inner knees because this particular point is usually quite tender due to the tension and lack of muscle integrity of the inner thigh on most people. After a short time of practicing, this young athlete will automatically line up her joints. You can look back at one of my previous postings on the knees for the Sp10 location and placement of the tennis ball.

After
Though not perfect, her posture is much better. I would prefer her feet to be straight, but this will come with strengthening exercises and a better awareness of her body through micro-stretching and a daily posture practice.

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Last summer during a class, one of the students shared about how she tore her ACL when she got up out of her car and stepped wrong-meaning she was not posturally engaged through the abdominals, back and hips enough to line her hips up with the knees and ankles and the knee gave out. I have had two clients who shared stories of their husbands going out on the weekend to play a pickup game of basketball, not the same game, and because they landed wrong, they both broke their landing foot. Be conscious of how you walk, how you jump, how you run and how you land. It is all connected to correct posture and is being proven over and over again to be an essential part of our health maintenance and aging process.

A Short Take Home List  
Daily posture awareness and practice 

Watch your posture in windows and mirrors
Take photos and put them up
Have someone check you and give you feedback
Get therapeutic bodywork
Learn to relax your muscles
Strengthen your core muscles (they are your spinal, abdominal, pelvic-
    lumbo-sacral muscles)
Watch your midline weight (stay trim in the middle)
Learn how to have good posture in all your activities
Wear a support brace or posture brace if it will be helpful
Use a tennis ball along PRT points suggested to encourage correct posture 
    while seated
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Corrective Posture Tailored Planning

If you are interested in correcting postural imbalances and discrepancies, contact me to set up an initial consultation. A tailored plan is one that is designed three months at a time with testing before and after to determine postural gains, assess obstacles and solutions to counterbalance, and setting new goals for the next phase. Therapeutic bodywork is available to assist you in making additional gains in your postural corrections as well as stress management counseling, nutrition coaching and stretching and strength training. Stay healthy!



Ashley Osier is a holistic health educator and therapist, stress management therapist, an acupressure and massage therapist, stretching, massage, acupressure, and self-acupressure instructor and creator of the Point Release™ Technique and StretchFit™ Method. She specializes in working with stress management, injury prevention and pain relief, therapeutic stretching for individuals and couples, and posture awareness. She also offers coaching in nutrition and support for women going through divorce. She can be reached at ewsomatherapy@gmail.com.



Disclaimer: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available on this blog is for general information purposes only. You agree that your use of this blog is at your sole risk. Consult your physician before beginning any stretch, exercise or self-acupressure suggestion. By using this site, you are agreeing to indemnify, defend and hold harmless Ashley Osier against any and all losses, expenses, damages and costs resulting from using the information contained within this blog. 

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