Expert Advice

Some clients return for massage sessions and repeatedly present with the same pain patterns. What part might posture play?

Jennifer Soames responds

How many times has a client walked into your treatment room with the same complaint: “I have the usual pain in my upper back and neck”? You can massage your client’s trapezii, rhomboids and levator scapulae session after session, yet this scenario repeats the following week or month.

Does this sound familiar? I thought so. The culprit behind your client’s recurring pain might not be stress or repetitive activities; instead, muscle pain and tension might be recurring due to the client’s postural patterns.

Postural assessment is a valuable tool most massage therapists don’t receive much, if any, training in while in massage school. Yet, this skill can tell you a lot more about what is happening in your client’s body than just what conditions he presents with. As Rolfing® Structural Integration creator Ida Rolf, Ph.D., said, “Form and function are a unity, two sides of one coin. In order to enhance function, appropriate form must exist or be created.”

First, let’s define posture. Most people think of posture and immediately sit up or stand a bit straighter and draw their shoulders down and back. Usually, people think of posture as a static position, such as a ramrod-straight pose adopted when they sit at their computers—but, truthfully, posture is as dynamic as we are.

According to the Merriam-Webster dictionary, posture is:

1a : the position or bearing of the body whether characteristic or assumed for a special purpose

1b : the pose of a model or artistic figure

2: state or condition at a given time especially with respect to capability in particular circumstances

3: a conscious mental or outward behavioral attitude

Posture, then, is how someone’s structure is stacked up in space; how the person appears; and even how the person sees the world—all based on how her bony parts are oriented.

Posture is affected by cultural ideals. Consider the posture of someone living in military culture, for example, as well as events that have happened to us and our mental state. If I ask you to picture how someone looks when he is depressed, happy, tired or confident, your mental image of that person’s posture will change with each emotion. Events such as car accidents, injuries and occupational or recreational activities can also influence how our parts are positioned—but really, the combination of all these create our postural pattern. When it comes to posture, I often refer to what Caroline Myss wrote in Anatomy of the Spirit: The Seven Stages of Power and Healing: “Biography becomes biology.”

Why is this important for your massage practice? Because the way your clients’ bodies—as well as your own—are positioned tells you how well each segment is balanced, or not, on another, and what tissues are shortened or lengthened.

Take the typical, hunched-forward computer jockey, for instance. Sure, she comes in with upper-back and neck pain, but did you notice how closed off the front of her body is and how her sternum is drawn down toward her belly button while her head is significantly forward of her shoulder girdle? Maybe it’s not that her trapezii, rhomboids, levator scapulae and neck muscles are tight, but that these tissues are locked long; and her hip flexors, abdomen, pectorals and anterior neck are locked short. Instead of the same back-and-neck session you usually do, why not massage her anterior body to bring more ease, length and balance to these tissues? This will often yield better, longer-lasting relief for your client than addressing conditions alone.

The next time you see a client from the perspective of posture, instead of jumping right into massaging the symptomatic areas, take a minute to really look at your client. How does he sit as you perform the intake? He might be slouched forward, sitting back on his sacrum and forming a C-shape with his spine, or perched forward on the edge of his seat like a sprinter waiting for the gun. Notice how he stands. Does one shoulder appear lower than the other? Does he always stand with one leg bent? Is his head stacked and supported on his shoulders, or stretched forward? You don’t even have to tell your client you’re observing his postural pattern, but you can point out what you notice, tell him why it might contribute to his chronic problems, and then explain how you will address his posture that day. Taking an extra minute to obtain and share this information with your client is a great teaching opportunity, as your client will often have no idea what his postural pattern is until you discuss this with him.

If noticing and addressing postural patterns isn’t in your skill set yet, then utilize some of the postural assessment resources or classes available today (; You can also study other forms of bodywork that use postural assessment as a key component, including Rolfing® Structural Integration (;, Feldenkrais (, Aston Patterning ( or Hellerwork ( These alliances are a great way to build your referral network as well.

Jennifer Soames has been a licensed bodyworker since 2006. She is a board-certified Structural Integrator, specializing in Kinesis Myofascial Integration, and is the founder of the Integrated Health Professionals Association ( Soames lives and practices in Maple Valley, Washington.