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postural_integrationPostural Integration - from a Practitioner

Postural Integration (PI) is a comparatively recent addition to the 'bodymind' approaches to health, having been developed by Jack Painter in the USA in the sixties and early seventies. Its twin concerns are the effect that body structure has on physical health and how a person's emotional stress can affect their posture. In this article I'd like to concentrate on what PI can do for purely physical ailments like bad backs, though of course the findings of psychosomatic medicine means the distinction between emotional and physical causation is often rather blurred. In a subsequent article I'll look at what PI has to offer in combating emotional stress.

Balanced Posture

The posture which allows human beings to stand erect with the minimum of effort, is one in which a plumbline dropped from the ear would pass through the centre of the shoulder, the hip joint, the knee and the ankle. In this balanced alignment each segment of the body rests on and is supported by the one below and the body's weight is evenly distributed.

postural_integration_fig01If you look at the two figures (Figure 1) you'll immediately notice the difference in the position of their heads. In one it's craned forward and also 'stuck' into the shoulders. In the other it's upright and the neck has length. We all know someone who 'leads with their head' like this, who's head is in front of their body, often resembling a chicken pecking. The average human head weighs around 15 lbs and should be supported by the bones and fascia of the shoulder girdle. If it isn't, then it is the muscles of the upper back which must bear the strain. This they aren't built to do and the burden soon begins to tell. Waste products, such as lactic acid and urea, begin to accumulate in the tissues, because the lymphatic system can't discharge the extra toxins produced by the constant pull of the head. Unfortunately these wastes are gummy substances and they literally stick the individual muscle fibres together. Over time these knots build up and eventually the person begins to feel a dull ache and find they can't turn their head the way they used to be able to do. (As an analogy, if you picture a rope which has had glue spilt on it, the rope no longer has the 'give' it used to have as all the strands are stuck together and it therefore no longer fulfills its function.)

At this point the person may either put it down to encroaching old age (maybe they're 40) and decide to just put up with it, or to seek some treatment. Fobbed off by their GP, who has more life threatening ills to deal with and given a bottle of painkillers, they may seek a massage. This will certainly provide temporary relief. The masseur will work the muscles, loose, squeezing the waste products out of the tissues and into the bloodstream and lymph system and the person will feel better for a time, but the actual causation of the problem has not been addressed. In time the pressure exerted by that craned forward head will result in the same pattern of pain and restriction of movement being repeated.


The solution is to alter the position of the head. The individual no longer has the flexibility in their neck and shoulder muscles to simply pull their head back to where it was 20 years before. The muscles have thickened and become invaded by their fascial envelopes, which dry up and become immobile once a muscle has become chronically tense. Fascia, or connective tissue as it is also known, is the forgotten organ of the body. It starts just below the surface of the skin to form an inner covering for the entire body like the fine, white network under the skin of an orange. Fortunately fascia is very responsive to pressure. By the use of deep strokes it is possible to free the fascial layers and restore their blood supply and mobility and so in turn the mobility of the muscles they envelop. The nutrients carried by the blood, which had trouble penetrating the thickened muscles, can now feed the muscles properly and tone is restored to those muscles, along with the disappearance of the pain. Most importantly the head is now free to find its proper relationship to the shoulder girdle, in other words the underlying problem of the individual's posture is solved.

Unfortunately it's not quite as simple as that. Our bodies function as one unit. If one area is imbalanced or rotated another will attempt to compensate for it. Every movement has an equal and opposite reaction, so if one part is pulled back another comes forward. So we usually find when someone has their head riding forward of their shoulders, their pelvis will be pulled backwards to compensate. Correcting the position of the head will put pressure on the muscle attachments at the pelvis, but for the pelvis to come forward to its original position vis a vis the plumbline will mean freeing all the muscles which attach to it ie the abdominals and all the upper leg muscles.

The word pelvis means 'basin' in the original Latin and this gives us a key to one of its functions - to act as a 'basin' for the abdominal organs, to support and restrain them. Often men think they are putting on weight when they look down at their gut, when in fact what has happened is their pelvis has tilted back, causing their guts to 'spill' out; so it looks like it's a weight problem when actually it's a postural one. If you can re-position the pelvis the gut magically disappears.


Now we don't normally think about the fact that we all exist within a gravitational field, but as you are reading this, whether standing, sitting or lying down, gravity is trying to push you flat onto the floor and you are using energy to resist that pressure. There's a wonderful Kurt Vonnegut story where the hero finds himself on a planet, where the gravity varies from day to day, the same way our weather varies each day here on Earth. So one morning you throwback the covers and find yourself floating up to the ceiling and the next day gravity is so heavy you can barely crawl through to the bathroom on all fours. Here on Earth we're somewhere in between, but the amount of energy it takes us to remain upright can be minimized. What we do in PI is to look at a person's posture from the front, from the back and from both sides, looking for the areas of greatest tension and also where their body is out of alignment with the notional plumbline. We also pay attention to the symmetry between the right and left sides of the body. The collar bones should be parallel to the ground and not pulled up by hunched shoulders and the spines of the pelvis should be at the same height - rarely seen if an individual has broken a leg at some stage.

Western medicine is chemically not structurally oriented, so it deals with aches and pains by altering the bio-chemistry of the body via drugs - tranquilizers, painkillers, sleeping pills and so on, but it doesn't look at the effect of posture on health.

Bad Backs

The commonest complaint people consult me about is the ubiquitous 'bad back'. Often when you examine the posture of someone complaining of recurrent back problems you'll notice that their legs are very tense. They have what we call 'locked knees' - the calf and hamstring muscles are overstretched, while the muscles at the front of the leg are shortened and squashed. There is very little flexibility or 'give' at the knees. This in turn causes the pelvis to 'tip' as in figure 1 and strain gets transmitted to the lumbar vertebrae along with an exaggerated curvature of the spine. So it would be pointless only freeing up the lumbar muscles, although that would provide temporary relief, the calf and thigh muscles have to be worked loose too and the pelvis will have to be restored to the horizontal.

The main culprit in causing the pelvis to 'tip' is the psoas muscle. This is an absolutely crucial muscle to get functioning properly, as the abdominal and pelvic nerve plexi are embedded in its fascia. Tension in the psoas plays a significant role in lower back pain and sciatica and its shortening is a large factor in scoliosis. When it has good tone and moves freely it contributes significantly to optimum visceral functioning. (See Figure 3)

PI is therefore a method of deep, fascial manipulation aimed at releasing tense muscles and encouraging balance, relaxation and lengthening throughout the whole body. We use fingers, thumbs, knuckles and sometimes even elbows, to exert deep and specific pressure on tight areas in order to restore flexibility to the entire structure. It's designed as a series of 10 sessions taken weekly and lasting about an hour each.

The Sequence

In the first session we work on the breathing structures - the ribcage and diaphragm as many of us are relatively poor breathers. One nurse I treated measured her vital capacity before the first session and after the 10th and found a colossal increase. She'd also, halfway through the sequence, taken up cycling the 7 miles to her work which obviously helped too. Frequently this is what happens, people find that extra bit of energy to go ahead and do things, like getting the bike out of the garage that they've been meaning to do for ages.

In another session we work the feet, ankles and knees; in a third the muscle attachments to the pelvis; a fourth covers the head and neck, a fifth the abdominal area and so on until the body has been given a thorough 'overhaul'. All the muscles, from the top of the head right down to the toes, are worked on, starting with the superficial muscles and gradually working in to free up the deeper ones. Some people have likened it to a car getting its 40,000 mile service.

One of my first ever clients came to me because he'd suffered back pain on and off for 16 years. Since I finished the PI. sequence with him 14 years ago, he's barely had a twinge and even drives to London from time to time.


Few of us, by the time we reach adulthood, possess the kind of balanced, optimum posture which we aim at, for many reasons. Firstly there's the long-term effects of accidents - breaking a leg, spraining an ankle, whiplash injuries after car crashes etc. When we break a leg, we tend to shift our weight onto the good leg while the break is healing. Since this takes a number of weeks, the weight shift often turns into a habit so that we end up with a slightly lopsided posture. This in turn puts strain on the lower back and there will also be an attempt to compensate for the weight being more on one leg, by pulling the trunk across in the other direction just to remain balanced (after a fashion).

Any kind of accident - a fall while ski-mg or out hill-walking or falling off your bike when you're little, can cause various twists and rotations at different points in the body creating unnecessary pressure and long-term pain. Our medical system is very good at dealing with the local damage but seems to have little to say, or to offer, concerning long term effects. A recent in depth American study of whiplash injuries found that 40% of victims still suffered considerable pain two years later.

Hospital operations can leave soft-tissue problems, due to the buildup of scar tissue at the site of the incision. The fascia there becomes gnarled up like gristle and the nutrients flow round, not through the damaged tissue. Deep connective tissue work is very effective at breaking down the adhesions surrounding the injury site and allowing better blood supply to the organs.

Your Bed

One of the questions I always ask clients is what kind of bed they sleep on. Your bed is probably the most important thing you ever buy since you spend one third of your life in it, yet because we’re unconscious for most of that time we often give it very little thought. If your bed is too soft, your back will sag into the mattress instead of being supported, creating strain on the surrounding muscles. This is going on for hours and is often the cause of people complaining "my back always hurts in the morning but it wears off after a bit once I'm up". What happens is that once you move about, your muscles pump the blood round your body and you stretch your stiff, strained muscles out so the pain eases, but gradually the morning stiffness will get worse and it'll take longer to "work it off", if you don't get the mattress your body requires. The only time I ever suffered a bad back was after spending one night sleeping on an appalling mattress when I was 23. Fortunately I've gone another 20 years without another twinge. Similarly a badly designed car seat, or just one which doesn't suit your particular frame, will lead to stiffness and pain in time unless you get it adjusted.

Some occupations notoriously put your posture at risk. Dentists, side-bending over their patients, suffer from problems in the mid- thoracic area, while architects, hunched over their drawing-boards for hours at a time, get chronically sore backs. It's almost de-regeur in the profession. Any kind of repetitious behaviour will have detrimental effects on our bodies. One of the most extreme cases was the Welsh darts player who had to retire, because he was literally wearing away the vertebrae of his neck, through the continuous action of throwing darts at a board hundreds of times every day for years on end.


Fashion can be a major culprit from the sheer daftness of platform shoes to the more socially acceptable, but equally bad from a postural point of view, high heels. Most footwear is mass produced for fashion ie to make a buck, not with the human body in mind. Wearing a heel pitches your body weight forward so you have to pullback in your trunk to remain upright. Usually the woman will compensate too much and the head will then get pushed forward to maintain balance. So you get a zig-zag pattern of tension which causes strain at two places in particular - the lumbar spine and the base of the neck. Many times I have had women consult me about neck pains whose root cause we traced to their footwear.

Women also often suffer neck, shoulder and arm pains from lugging around handbags or shoulder bags which are much too heavy. They'll hitch them over one shoulder and then have to tense the muscles of the upper arm and the shoulder girdle to stop the bag slipping off their shoulder. In addition the weight of the bag exerts a constant pull on the vertebrae of the neck, which in time will begin to get pulled out causing nerve pains down the arm. Meanwhile as this is all developing, the rest of the woman's body has been accommodating to the strain and adjusting itself as best it can.

When I was 15 the school doctors were paying their annual visit. This doctor took one look at me and said;"do you always carry your schoolbag in your right hand?". "Yes"; I replied in amazement, thinking she must be psychic."How do you know"; I asked? "You're like this"; she answered and mimicked my posture by sagging her right shoulder. When I got home that night I checked in the mirror and sure enough my right shoulder was noticeably lower than my left. That's a test you can do for yourself. Another interesting test to do in pairs is to run your finger down the line of your friend's vertebrae. Your finger should move down in a straight line, but with most people there will be various detours to left and right as you run down from neck to pelvis.


Surprisingly perhaps many exercise programmes produce body imbalance. For example I've worked with men who've lifted weights for years. They think they're fit and they are strong, but often they're pretty muscle bound and lack any real flexibility. I much prefer people doing something like yoga where there's an emphasis on lengthening the muscles.

'Ballet dancer's knee' is endemic amongst professional dancers due to the excessive strain put on their legs during training, particularly the constant aversion of the feet. Naturally one's feet should be in parallel and track straight ahead.

The craze for marathon running of the 1980's is showing up now as pain in the ankles, knees and hips for many ex- marathoners due partly to poor footwear. Pounding along for mile upon mile on concrete pavements, jars the entire body and will eventually cause joint inflammation unless cushioned by good running shoes. Also many of the marathon runners would have made good sprinters or milers - that's what their bodies were built for, but instead everyone decided to run 26 miles regardless of the kind of body and metabolism they had.

Your body can also become imbalanced due to copying your parents. When we're young we ape our elders. I once saw some film of a man who'd been badly injured in a car crash so that he was left hirpling when he walked, dragging his right leg. His 7 year old son, who'd nothing wrong with his body, walked like Dad, hirpling along dragging his right leg. That's an extreme example, but next time we are yelling at the kids to 'stand up straight' perhaps we should take a look at our own posture in a mirror and see where they maybe got it from.

The Scots are notorious for the 'no neck' posture where the head is hauled down into the shoulders, which are themselves hunched up, usually to keep the cold out. Forty years of this leaves the whole area a gummed up mass where the person no longer has any flexibility.


PI can help restore fallen arches or flat feet. Connected to archless feet are thick ankles and shins. Any abnormally thickened part is the outward sign of lack of muscle movement. When leg muscles do not expand and contract, fluid (lymph and interstitial fluid) collects through the pull of gravity, and the result is a characteristically patternless lower leg. Through manipulation, these errant muscles can be organized to work together again.

I've even seen improvements in vision through PI. The traditional view is that bad eyesight is bad luck and it'll get worse. In fact when the head is set comfortably on the neck and shoulders the muscles of the eye are relaxed. If however the neck is arched forward with the head tilted back, the eyes, when looking straight ahead, are actually tilted downward in relation to the skull. This puts strain on the eye muscles, distorts the shape of the eye and thereby causes problems with vision. Releasing the tension from those muscles and re- positioning them, removes the cause of the strain and improved vision can result.

Finally the question everyone asks, "Does it last?". The answer is; "it depends what you then do with your body". I always remember the client who lit a fag while he was getting dressed after a session. If you're determined to return to your old ways then PI will work temporarily only. Unless you invest some time in looking after yourself by, for example taking up swimming or dancing (I often recommend a course of the Alexander Technique, Tai Chi or Pilates to follow on from PI), and also investing in a decent bed or running shoes or whatever it is you need, then your old aches and pains will in time return.

Generally people report feeling more energetic, more open, looser, and more aware of their bodies, more positive and to react more spontaneously to things after PI. The scientific research has found more efficient use of the muscles, conserved energy and a tendency for motor control to shift towards the more reflexive spinal centres. Often also you are slightly taller, simply through being more upright.

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