Successful neuromusculoskeletal (NMS) professionals are skilled at managing symptoms, but the challenge lies in effectively addressing the root causes of LBP to prevent recurrence and improve long-term outcomes.

As a posture expert, I’ve spent years developing the StrongPosture® methodology, a melding of biobehavioral somatic interceptive exercise and common-sense education designed to enhance the benefits of other exercises by improving awareness and perceived accuracy of posture, balance, and motor control.

Today, I want to share insights from a fascinating study by Ippersiel et al. and show how StrongPosture® techniques can amplify your approach to LBP care, grounded in science and tailored to your clinical practice.

The Science of Movement and LBP

The study, published in Gait & Posture (2021), dives into the biomechanics of bending in adults with, and without, low back pain (LBP).  They focused on inter-joint coordination and the flexion-relaxation phenomenon (FRP).

For clinicians who don’t regularly dive into academic journals, here’s the gist: the researchers compared how people with LBP move differently than healthy individuals during a forward bending task. They measured coordination between the hips, lower lumbar spine, and upper lumbar spine, as well as muscle activity in the erector spinae (longissimus, iliocostalis, and multifidus).  

From a StrongPosture perspective, their focus was observing patterns of buckling in the kinetic chain.

Key findings include:

1. Altered Inter-Joint Coordination: People with LBP showed more out-of-phase coordination between the hip and lower lumbar spine compared to healthy individuals. This means their movements were less synchronized, potentially reflecting a guarded or compensatory strategy to avoid pain. Interestingly, coordination between the lower and upper lumbar spine showed no significant group differences, suggesting that regional lumbar differences might not matter.
2. Reduced Flexion-Relaxation: The FRP—where back muscles like the erector spinae typically “relax” at full spinal flexion—was significantly reduced in the LBP group. This suggests that individuals with LBP maintain higher muscle activity (less relaxation) during bending, likely to protect painful spinal structures. The multifidus muscle showed the most pronounced difference, which is not surprising considering that they along with intertransversarii are the deepest and shortest intervertebral muscles, closest to the center of movement of each motor unit.  
3. From a StrongPosture perspective: this underlines the clinical value of retraining subtle, single arcs of coupled control, and its critical role in restoring LBP movement patterns.
4. Muscle-Specific Differences: The study found that the extent of reduced FRP varied by muscle, with multifidus showing the greatest guarding behavior in LBP patients. This muscle-specific insight highlights the need for targeted interventions.  The challenge is preventing well meaning patients from substituting more accustomed compensatory patterns of motion that feel “easier”.
5. Heterogeneity in LBP: The researchers noted variability, with some LBP patients (outliers) showing coordination patterns similar to healthy individuals. This underscores that LBP is not a one-size-fits-all condition—individual motor control strategies vary, which aligns with clinical observations of diverse patient presentations.

These findings point to a core issue: altered movement patterns and muscle behavior in LBP reflect compensatory strategies that may protect in the short term but likely increase spinal load over time, especially in conjunction with episodic reinjury. This is where StrongPosture® comes in, offering a framework to retrain these patterns and empower your patients.

StrongPosture: A Biobehavioral Approach to LBP

StrongPosture is built on the idea that posture is more than just “standing up straight.” It’s a dynamic interplay of awareness, balance, and motor control that shapes how we move and load our bodies. For LBP patients, who often exhibit guarded movements (like those seen in the study), StrongPosture® provides a structured, interceptive approach to retrain the body and mind.

Here’s how it applies to your clinical practice:

1. Enhancing Postural Awareness

The Ippersiel study highlights that LBP patients move differently, with less synchronized hip and lumbar motion. In other words, poorly coupled patterns of whole body recruitment of kinetic chain musculature. 

StrongPosture exercises focus on somatic awareness towards more accurate control of their body’s mass is space.  We advocate teaching patients to consciously perceive, and then more accurately control their body’s zones of postural mass (aka their 4 PostureZones- the lower extremity, the pelvis, the torso and the head).  

Initially, clinicians observe static erect stance bipedal stability and symmetry with an IPP (Interoceptive Posture Picture), and then challenging the ability to balance and maintain erect posture in single leg stance. Improvement with discrete and small but observable arcs of motion allow progression to dynamically challenging regional motion, and observing changes in whole body symmetry, by PostureZone, and then building to whole body ADL movement (Activities of Daily Living) and sports specific movement pattens. 

2. Restoring Flexion-Relaxation through Motor Control

The reduced FRP in Ippersiel’s LBP patients suggests a protective strategy where muscles like the multifidus stay “on” to guard the spine. This can lead to fatigue and increased spinal stress over time. 

With the StrongPosture® method, stabilizing compensating arcs of the kinetic chain becomes the target of MUST vs TRY cues which focus attention and control on single arcs initially, and progressing quickly to the core (which is why we focus on the Torso-Pelvis musculature early and often- beginning with the StrongPosture Pelvic Tilt). Combined with in-sync breathing, it’s a surprisingly easy and elegant way to address the out-of-phase coordination seen in the study. 

The basic exercise removes Lower Extremity (PZ1) compensation by having the person lean against a wall to stabilize the postural base of support.  This allows a subjective alignment of the Pelvis (PZ2) and Torso (PZ3 to objective vertical), the somatic perception of which is proprioceptive and cognitive, as well as interoceptive.  

Maintaining tight stabilization of the lower body and head, then focusing to tilt the pelvis forward and then back, phased with inspiration on the lumbar spine arch, and expiration on flattening with a tuck defines the StrongPosture® Pelvic tilt.  It’s an interoceptively aware motor control exercise that trains patients to relax muscles appropriately during movement, helping them regain the ability to “let go” at end-range flexion, reducing unnecessary muscle tension and promoting the natural FRP seen in healthy individuals.

3. Targeting Muscle-Specific Patterns within Whole Body Movement

The study’s finding that the multifidus showed the greatest FRP reduction in LBP patients is a game-changer. StrongPosture emphasizes this value for functional muscle retraining, particularly for deep stabilizers like the multifidus.  After incorporating whole-body balance awareness during exam with an Interoceptive Posture Picture,  incorporating StrongPosture Stork one-leg balance with core engagement engages the multifidus in a controlled, low-load environment, helping patients strengthen this muscle without triggering pain. By improving multifidus control, you can help patients shift from a guarded to a confident movement pattern.

4. PFF-RoC: Addressing Individual Variability

The heterogeneity in LBP movement patterns noted in the study aligns with what you see in practice: no two patients are the same. StrongPosture is adaptable, allowing you to tailor exercises to each patient’s unique motor control profile. We call this PFF-RoC- their Pain Free, Functional Range of Control. For those “outliers” with healthier coordination patterns, you might focus on maintenance and refinement, while for patients with more guarded movements, you can start with foundational awareness drills to build confidence and control.

Why StrongPosture Works for Clinicians

You don’t need to wade through academic journals to know that LBP is complex. The Ippersiel study confirms what you’ve likely observed: patients with LBP move differently, often in ways that protect but ultimately perpetuate their pain.

StrongPosture bridges the gap between science and practice by offering an interoceptive biobehavioral framework that’s easy to teach, patient-friendly, and adaptable to your existing protocols. It enhances other exercises—whether rehab, chiropractic adjustments, or physical therapy—by giving patients the tools to own their posture and movement.

By incorporating StrongPosture into your care, you’re not just treating symptoms; you’re empowering patients to retrain their bodies for better somatic function. This aligns with the study’s call for better understanding movement characteristics to guide treatment. Plus, it’s a low-cost, low-risk approach that boosts your professional credibility by delivering measurable improvements in patient outcomes.

Take the Next Step

Ready to bring StrongPosture into your practice? Start by assessing your LBP patients’ bending patterns.

• What moves first, and most?
• What stops first, and limits other movement? 
• Where’s the compensation, and the pain? 

Guarded movements and maintaining contraction at end-range can be indicate of functional compensation &/or structural adaptation. 

Introduce StrongPosture basics, step-by-step with the BAM protocols, and observe how patients respond. Connect with the patient education concepts using the 5 Posture Principles to engage the patient, and empower them to inform others.

StrongPosture Training

Enroll in the Posture, Balance and Motor Control Exercise course and other programs at CEsoup.com, where you’ll find clinician-focused tools to integrate posture retraining into your practice.

Let’s help our LBP patients move better, feel better, and live better, standing tall, one step at a time.

Dr. Steven Weiniger, Posture Expert and Creator of StrongPosture®

The Neurophysiological Foundation of Attitude and Rehab

When a patient approaches rehab or postural exercise with a negative attitude (“My balance will never improve” or “I’ve always had poor posture“), this mindset activates neural circuits associated with anticipated failure. This emotional prediction comes true, recruiting autonomic responses, perceptions and behaviors. 

Conversely, a positive, engaged attitude focuses attention and effort in ways that improve interoceptive somatic awareness and enhances neuromotor recruitment patterns.  In other words, strengthening your attitude shapes your aptitude.

The Perception-Performance Loop

Attitude Shapes Aptitude is a concept that captures the relationship between mental disposition and functional capacity in postural rehabilitation, and leveraging that connection is a target for the StrongPosture® framework.

Attitude directly influences what people, and especially patients, notice about their bodily sensations. A curious attitude opens the door to exploration to detect subtle variations in balance and perceive their previously unconscious shifts in alignment in ways that escape those with a negative, defeatist  mindset.

Nurturing the cycle between perception and performance, what some call the Perception-Action Loop, is a tool to heighten perceptual awareness, and begins the positive feedback loop where improved perception leads to more precise movement, which in turn reinforces positive attitudes about one’s capabilities.

Clinical Application

In practice, Attitude Shapes Aptitude is an axiom addressing mindset and biopsychosocial factors which can be as important as our physical interventions. When patients shift from viewing postural rehab exercise as “just another treatment I have to do” to “an opportunity to reconnect with and strengthen my body,” their functional outcomes often improve dramatically.

The StrongPosture® protocols leverage this principle with Interoceptive Posture Pictures (IPPs).  Visualizing the individual’s abstract concept of posture concrete become concrete, and actionable.

By sharing with a patient images of their objective patterns of static balance and single leg stance, alongside a realistic positive attitude and strategy to strengthen both, you transform their mindset from skeptical to engaged, paying attention and enhancing their aptitude to successfully strengthen subtleties of balance and postural control, and thus reshaping movement patterns.

Beyond Physical Performance

This principle extends beyond physical performance to encompass therapeutic relationships as well. A clinician’s attitude toward a patient’s potential for improvement shapes their aptitude as a healer. When practitioners approach patients with genuine curiosity and confidence in the rehabilitation process, they create a therapeutic environment where improved function becomes not just possible but expected.

In essence, “attitude shapes your aptitude” embodies the core of the interoceptive biobehavioral approach—recognition that our mental frameworks and emotional dispositions are not merely psychological overlays but fundamental components of our physicality and physiologic function.

By intentionally cultivating attitudes of awareness, curiosity, and engagement, both practitioners and patients can significantly enhance their aptitude for creating a positive attitude…and a life habit of paying attention to body awareness and control of how their body Balances and Aligns the zones of postural mass (the 4 PostureZones®) to Move pain-free, biomechanically fluidity and strength- BAM!

Internal feedback in the cortical perception–action loop enables fast and accurate behavior

Stand Taller Live Longer: A Posture & Anti-Aging Strategy Weiniger, S., BodyZone Press, 2008

Interoceptive posture awareness and accuracy: a novel photographic strategy towards making posture actionable, Front. Neurosci., 2024

It’s a question often asked by doctors and therapists who incorporate StrongPosture® as a foundational base for more traditional rehab. If you teach a hands-on BAM* framework integrated with other rehab, or you’re using the 7 Steps to StrongPosture® HEP (Home Exercise Program including motor control exercise) along with, or supported by in-office care, my answer is the same.

It depends…

As a doctor of chiropractic my preference is to start with pain relief focused passive care. The feedback I receive from other DCs tends towards spinal and extremity manipulation first, along with targeted muscle therapy as indicated. The rationale is that unlocking segmental motion allows a person to retrain and recruit different motion patterns when learning the new stabilization patterns of strengthening posture.

Diagnostic and Therapeutic

When fascial adhesions and/or other mechanical restrictions are lessened or removed, accessing subtleties of motion with StrongPosture® protocols becomes more possible. The value of MUST vs TRY cueing is that when precisely taught, it is both diagnostic to observe previously neglected motions, as well as actively therapeutic by recruiting neglected muscle fibers and the controlling neurologic pathways.

Especially when there’s a spinal issue, properly applied segmental manipulation can stimulate facet capsule and fascial proprioception, and recruit neglected muscle fibers controlling reflexive balance. Shifting the proprioception towards greater accuracy can propagate up and down the kinetic chain, which in turn and again, makes it easier to find previously forgotten subtleties of movement and posture.

An Opportunity to Individualize Your Care

For my colleagues in other professions using StrongPosture® BAM protocols, I find it’s more of a 50-50 proposition. Some physical therapists, massage therapists and trainers subscribe to the passive therapy first school of thought. Others use the BAM MUST vs TRY cueing to observe, assess and target areas to cue in other motor control exercises, or as a target for other passive therapies.

Bottom line. I’ve tried it both ways in many combinations. It comes down to the individual. At the end of the day it’s about helping the person by building personal agency through stronger posture consciousness.

PosturePractice Tip:

Create more engaging experiences by trying it both ways.

• Here’s what Visit #1 looks like:
  “Today, first we’re going to do (fill in your passive therapy of choice), then we’ll do your StrongPosture® work). Next time we’ll try it the other way. Pay attention so we can see what works best for your body”.
• Here’s what Visit #2 looks like:
  Reverse the order.
• Here’s what Visit #3 looks like:
  Assess progress yourself, and then ask the patient which seemed to work best for their unique body.

Try it over the next month and let me know what you find works best.

Motion and movement are very important for patients in the acute care setting. StrongPosture® is a skill set I use to address this with my patient base. The patients I see that are most challenging but benefit the most are those that have had prolonged bed rest due to their medical complications. These patients’ challenges mostly impact range of motion. StrongPosture® protocols include initiating pelvic tuck and diaphragmatic breathing during sessions with these patients as a starting point for improved movement.

“Breathing is the most important motion,” Dr. Steven Weiniger

“Breathing is the most important motion” and these techniques can easily be initiated with all our patients even at the lowest level and even when ventilated. As we work with the patient from bed mobility to sitting, we can engage more of their core in sitting balance.

Posture Principles in an Acute Care Setting

Balance in sitting can be challenging for many of the patients in my caseload. In the hospital, I float around to the ICU, cardiac, neuro, orthopedic, medical, surgery, and other patients. A great thing about acute care is our ability to be creative in our environment. Since we don’t have a clinic or gym to go to, we have to use what we have available in the patient’s room. My colleagues and I improvise ways to create a flat surface for the patient’s back while they are sitting with their feet flat on the floor.

We’ll perform a StrongPosture wall lean and use the same phrasing of arching and tucking including the diaphragmatic breathing. Some of our patient base is wheelchair dependent and suffer from pain and poor breathing due to their posture and with the education of StrongPosture we can assist them to “stand taller live longer.”  We also have higher level patients who frequently come to the ER for back pain and we use these techniques to look at their posture and educate them on exercises to provide relief.

Retraining Beneficial Patterns

With technological devices that can help patients in stance, we can assist people who have had prolonged bed rest to achieve better positioning to assist their posture. While the StrongPosture stork might not be appropriate when we first start working with these patients, other BAM Alignment exercises can be started and progressed to reinforce proper posture that can be continued in their care. These techniques train my patients to change their bad habits and move into easier and more beneficial patterns.

Patterns are hard to break when they are learned habits. People find that they save energy and have less pain with these posture exercises and begin to adopt better habits. Patients that have had prolonged bed rest usually develop patterns that are not good for their posture and their breathing. Retraining new positive patterns shows patients that their compensation techniques to avoid pain are not needed.

Inspiring Patient Compliance

Compensation is common for patients when they’ve completed their physical therapy sessions and can negatively affect the body structurally and physiologically. StrongPosture helps break improper compensation habits because of the strong emphasis on focus and control. For example, the sit-to-stand demonstration teaches patients to build a strong core, while decreasing the chance of falls. Additionally, patients see the value when they find they can breathe easier and perform tasks more easily.

Adaptations that cause the body to change over time can cause contractures and postural issues that lead to other medical problems. Therapists should incorporate evidence-based protocols which identify and address these longer term changes. For example, some patients require stair training prior to going home, and at that high level, incorporating the StrongPosture exercise with use of foam roll can not only strengthen their core but possibly prevent a physiological response such as increased respiratory rate or heart rate. Demonstrating to patients that they do not need to accept their body adaptation from having been bed bound is a powerful motivator to follow through with prescribed exercises at home.

There is great value in incorporating StrongPosture in the acute care setting whether it’s for employee health or a high or low-level patient. Even patients with medical complications or prolonged bed rest can accomplish an individualized plan to reap the benefits from having a strong posture.

Author: Evelyne Orlander, PT, DPT, CPEP is a physical therapist working in Hospital Based Rehab at Tampa General Hospital.

(1) 5 Posture Principles, Motion, Balance, Patterns, Compensation, Adaptation, Steven Weiniger, BodyZone, 2000.
(2) StrongPosture Rehab Protocol Training Manual, S. Weiniger, BodyZone Press, (2000, 2016).

To learn the StrongPosture® program get the Posture Rehab Exercise Program and take the online CE course. Take it to the next level with CPEP® Posture Specialist Certification!

When I ask people about their posture, the most common response is “My posture sucks”. It’s not surprising, because between looking at our devices and sitting, most people today spend the majority of their time with their body folded, rarely opening up to lengthen things fully and stand their tallest.

Studies show sedentary, sitting habits take a significant toll on posture, back pain and health.(1) Diving deeper than “I know it when I see it”- What does “better posture” look like, and why? It’s not the idealized manikins you see, the ones with theoretic dots on the ear, shoulder, hip and ankle because our bodies are different. We’re each subtly unique, which is the problem with solutions to fix posture to be “correct“.

Your posture might not be good, but it’s probably balanced

Sitting or standing, walking or running, watching TV or checking Facebook – if you’re not falling down, your posture is balanced. We’re using muscles and leveraging joints to stay vertical. So the question becomes: What do we see when objectively looking at an individual with functionally stronger posture? Towards vertical is good, but perfectly straight may not be right for that body.

Patient Posture Perception

Which brings us to the more important question- what does it feel like to them? When you try to sit or stand with good posture, does that align with what someone else sees when looking at you? Researchers who objectively aligned people to “ideal” sitting posture found perception didn’t line up with reality. Statistically significant differences were shown between someone’s perception of good sitting posture, and when someone physically and objectively aligned them into “good posture”⁠. (2)

Also and not surprisingly, most people’s habitual sitting posture appears far worse than the posture they assumed for the moment they focused on “good” posture.

These are two elephants standing (or sitting, or walking around) in the room of posture: Awareness and uniqueness. Our internal body awareness, and the actual patterns in which we’re aligning of our body mass in space, are not the same. To function, our physical body must balance- otherwise we fall down.

Posture is Unique

Here’s the bottom line. Everyone’s posture is subtly unique because bodies are shaped differently, and so they balance subtly differently. Which is why improving posture begins with connecting the feeling of “better posture” with how things are truly aligned, the objective reality of things function, the physics of bio-mechanics.

The core of biomechanics is the core… the muscles connecting and controlling the top of our body that sees and manipulates our environment, with the pelvis and lower extremity that gets us around. The key to functionally stronger posture is connecting our body perception more accurately to reality, and engaging accurate core control.

And the best way to begin is by focusing on each body mass, each PostureZone®, and focusing your attention to something objective, something external to your body. Beginning with how your balance your body.

Controlling body balance towards vertical is the beginning of looking at posture because posture is less about how it looks, and more about how it feels and functions. Appearance is a measurement, but we need to look at how that connects to function and control

Which is why we begin the process of retraining posture patterns with StrongPosture® Stork.

• Engage patients with posture rehab. 7 Steps to StrongPosture® is the online at-home program for patients that integrates education and exercise designed to blend easily into your workflow. Find out how you can offer the program to your patients and clients >>>
• Learn the complete rehab protocol and earn CE. Posture and Balance Assessment, Rehabilitation, and Motor Control Exercise >>>

1 Biswas et al (2015). Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: A systematic review and meta-analysis. Annals of Internal Medicine, 162(2), 123-32. doi:10.7326/M14-1651
2 Korakakis et al (2014). Sitting bodily configuration: A study investigating the intra-tester reliability of positioning subjects into a predetermined sitting posture. Manual Therapy, 19(3), 197-202. doi:10.1016/j.math.2014.01.001

I’d like to share a hospital-based physical therapists’ experience with chronic pain patients, and how she’s helping them to find the long neglected links in their body’s motion system to strengthen their kinetic chain with results like this:

1. “Ron”: A 32 yo electrician supervisor with chronic LBP who works out at the gym 5x/week and has excellent muscular definition. He started PT with perhaps the worst posture I had seen in several years for someone his age and he was completely unaware of this. After learning the StrongPosture Protocol (SPP) exercises, he stated that he felt empowered leaving the first session especially after seeing his before and after Posture Pictures with just completing Wall Tilts. He was shocked “how much better I can walk after doing these exercises with my core more engaged”. After several more sessions, his postural transformation is quite miraculous and he agrees as he has picture evidence.

Laurie Lackman is a  Physical Therapist with 34 years of experience who focuses on inpatient rehab of chronic pain patients at Tampa General Hospital. In her own words, here’s what Laurie had to say about her StrongPosture® training:

StrongPosture® Protocols can contribute to Increased Exercise Compliance, Improved Patient Satisfaction and a Reduction of Pain in the Chronic Pain and Headache Population

Having worked with the Chronic Pain population for over 20 years, I have routinely sought out various interventions in an effort to bring relief to my patients. These included Craniosacral therapy, myofascial release, Graston Technique, Microcurrent Point Stimulation, Therapeutic Neuroscience Education strategies for pain just to name a few (in addition to more traditional PT interventions). With each new technique that I implemented, I would see some benefit to my patients but nothing earth shattering. Additionally, the age-old problem of adherence to a Home Exercise Program (especially in the Chronic Pain population) has always frustrated therapists despite seeking out further education on various psychological strategies to attain buy in and compliance (such as motivational interviewing).  Acutely understanding that passive interventions alone are not nearly as effective as a combination of manual and active strategies in addressing persistent pain, I was very attracted to the Strong Posture philosophy.

After attending the Strong Posture weekend, it was a breath of fresh air! I loved the research based, systematic approach to dealing with weak posture that inevitably leads to chronic pain conditions. It really synthesized all the education I had received over the years into an easy to implement system that integrates balance, alignment and motion along with awareness and self-reliance into 1 approach that all of my patients can benefit from.

Once I returned to the clinic following the Strong Posture weekend, I immediately started to implement the protocols with both my persistent and acute pain patients. These patients were now “switched” from more traditional PT approaches, to the Strong Posture protocols which uniquely allowed them to compare and contrast both interventions. I felt that sharing many of their reactions would be very insightful and supportive of the Strong Posture approach.“

The reason Laurie got results boils down to the fact that in the human body, everything is connected… but you can only focus on one thing at a time. Mechanically, everything is linked together.

The effects of back pain on whole body balances was the thread in the StrongPosture® tapestry demonstrated by this week’s study from Noguiera et.al., Posturography Comparison and Discriminant Analysis Between Individuals With and Without Chronic Low Back Pain.

Conclusion:  For the people in the study, those with “chronic LBP had worse postural control performance than matched controls.”

Therefore, effective rehab must focus on the whole body. Also, complexity mushrooms when you add the effects of Mind on the Body, which in turn then grow exponentially when you factor in the interactions of the Body on the Mind. Standing with your torso erect doesn’t improve posture if you have to bend your knees to do so. Everything is connected, and efforts to change are limited by physics of our body, and the limits of our ability to focus.

Which is why another way to look at StrongPosture® Rehab is reprogramming the minds perception of the whole body, for her results from our “simple” exercises ,systematically applied to strengthen postural control.

2. “Kayla”: A 27 yo Muscular Dystrophy patient coming to PT for chronic LBP- she stated the SPP (strong posture protocol) exercises were “easier to incorporate into my exercise routine”, she really liked the “mental focus “ they required and she could tell that “they focused on my total core strength”.

Simplicity is the truth on the far side of complexity. The StrongPosture® protocols work because we focus on changing one thing at a time, in bio-mechanically logical sequences, in a framework to apply to any body, as a baseline for any rehab (and functionally strengthening posture all the rehab that’s necessary for many cases).

Especially for cases of debilitating, hard to diagnose problems like Complex Regional Pain Syndrome (CRPS) in highly educated people

3. “Deborah”: A 62 yo disabled MD with total body chronic pain including CRPS and she has been through MANY years of various PT interventions. She stated she found herself wanting to only do the SPP exercises and felt “very encouraged with the ball hug into leg lifts because these exercises make me feel in control without hurting” and she later stated “I feel better when I do them” citing all the exercises she had learned in the protocol. She was very surprised how much better she could balance with the Stork Peelback and this was extremely gratifying to her. As a result, she wanted to practice more. Seeing her Posture Picture and video walking progressions was extremely reinforcing to her and beneficial in combating her depression which is a significant barrier to her continued progress.

Systematically individualizing exercise for anyone is the strength of the StrongPosture® rehab protocols. The MUST vs TRY cueing of the BAM progressions let professionals customize StrongPosture® exercise for just about anyone doing rehab, and everyone interested in improving posture.

Nogueira, J. F., Carrasco, A. C., Pelegrinelli, A. R. M., Guenka, L. C., Silva, M. F., Bela, L. F. D. et al. (2020). Posturography Comparison and Discriminant Analysis Between Individuals With and Without Chronic Low Back Pain. Journal of Manipulative and Physiological Therapeutics.

StrongPosture Rehab Protocol Training Manual, S. Weiniger, BodyZone Press, (2000, 2016).

For more about StrongPosture® and to incorporate it in your practice get the Posture Rehab Exercise Program and take the latest training via the online rehab course, Posture and Balance Assessment, Rehabilitation, and Motor Control Exercise.

PART II- Connecting Perception to Reality: the Magic of the StrongPosture Framework

“Posture is HOW you balance your body.”  The 2nd Posture Principle^⁠1 Stand Taller Live Longer (Dr. Steven Weiniger)

Posture is the beginning point for locomotion, and as bipeds the imperative, the MUST, is to stay vertical.

Except for special cases like swimming, crawling and bungee jumping, for just about anything we physically TRY to do in life, we MUST stay vertical, balancing head over feet, with the torso and pelvis pretty much in the middle.

Balance is the interface between our internal perception of the body in space, and our ability to control and maintain that vertical position.  If our perception is more accurate, and our control more true, we balance.  If there’s an error between what we perceive, and our control of what we do, balance is less stable.

When the error between sensed position and motor control is too great, we fall down.

Functionally speaking, balance is the connection between incoming (sensory aka afferent) neurons of body position and outgoing (motor aka efferent) neurons controlling muscle contraction.

The Question of Balance

Our personal sense of body, and our sense of balance in particular, is an emergent sense, a neurologic construct.

On the sensory side, it’s synthesized on a moment to moment basis from visual, vestibular and proprioceptive inputs. On the motor side, it’s the precise skeletal muscle motor control required to maintain mechanical alignment with a net vertical vector force of zero. There’s a split-second coordination of sensory input from 3 sources with the sub-cortical firing of skeletal muscle fibers to keep the afferent input within an acceptable range translates as “keeping your balance”.

The astounding miracle is we do it without thinking!

The trade-off between aligning our body mass, position and motion to reflexively stay vertical is a dance with three postural elements: Balance Alignment, and Motion (BAM).

“The test is the exercise, and the exercise is the test.”  Vladimir Janda

All exercise is not created equal. A recent study in the Clinical Journal of Pain looked at perception and chronic low back pain (CLBP) and concluded there’s “a growing body of evidence suggesting that disturbed self-perception is a feature of CLBP. It is plausible that altered self-perception is maladaptive and contributes to the maintenance of the problem and may represent a target of treatment for CLBP.”^⁠2

An implication of maladaptive altered self-perception: Exercise is good, but for chronic low back pain exercising may perpetuate and aggravate both pain as well as disability. Which is the promise of motor control exercises (MCE), training motion in a specific controlled pattern.

A recent MCE metastudy compared 16 other studies of motor control exercises and found “In patients with chronic and recurrent low back pain, MCE seem to be superior to several other treatments”^⁠3 …including general exercise and spinal manipulation.

Strong Posture, Must vs Try, & Perception vs Reality, Biofeedback

StrongPosture® exercise protocols systematically focus attention with “MUST” vs “TRY” cueing to identify and strengthen the weakest point in an individual’s unique kinetic chain.

StrongPosture® exercise protocols systematically work to correct sensori-motor errors with biofeedback by focusing attention on a single BAM element of posture (Balance, Alignment, Motion) and a single PostureZone® (Head, Torso, Pelvis, Lower Extremity) at a time, and then aligning subjective perception of body position with objective reality.  Each exercise is performed perfectly to an individual’s ability, within their pain-free functional range.

Compensations of other PostureZone components are minimized by strictly requiring exercises be performed while keeping input from other elements constant with exercises arranged in 3 tracks corresponding to the 3 Elements of Posture:

• Balance track, focusing on aligning vestibular input with reality

• Alignment track, focusing on connecting kinesthetic with visually observed alignment of the 4 PostureZones

• Motion track, using a ball for proprioceptive focus to objective reality while moving with balance and alignment

Assessing and addressing posture by focusing on one element at at time (Balance, Alignment and Motion) allows objective functional measurement along an continuum of strength and accuracy, and addressing improvement by focusing on strengthening and correcting to objective reality. And then by precisely defining exercises and requiring adherence to objective references, protocols train a systematic focus on one kinetic chain link at a time.  And when rehabilitative exercises are protocoled with clear imperatives such as “you MUST do this”, and then “TRY to do that”, changes in ability to perform the therapeutic activity also become an objective measure to track improvement in functional posture control.

An inability to perform a specific progression can be diagnostic of asymmetric impediments to free motion, and suggest a therapeutic intervention such as spinal manipulation, muscle therapy or fascial treatment.

An example: restoring the potential to full range segmental motion by removing deep mechanical restrictions and facilitating neurologic control- the unique contribution of the chiropractic adjustment.

The systematization of correcting perception of balance, alignment and motion (BAM) to reality and then training these three postural elements tightly, towards symmetry, and towards that reality, explains the effectiveness many CPEP® posture specialists and other posture professionals have seen with chronic low back pain patients, as well as those suffering other NMS conditions.

For Part 1, see Reality, Perceptions and the Human Brain>>> to learn more on how mental maps are a construct.

¹ Stand Taller Live Longer: An Anti- Aging Strategy, Steven Weiniger DC, BodyZone Press, 2008

² Mislocalization of sensory information in people with chronic low back pain: a preliminary investigation.Wand, Keeves , Bourgoin, George, Smith, O’Connell, Moseley,  Clin J Pain. 2013 Aug;29(8):737-43. doi: 10.1097/AJP.0b013e318274b320.

³ Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis. Byström, Rasmussen-Barr, Grooten, Spine  2013 Mar 15;38(6):E350-8. doi: 10.1097/BRS.0b013e31828435fb

To integrate StrongPosture® in your practice get the Posture Rehab Exercise Program and take the latest online training.

People often ask me where StrongPosture® rehab and the PosturePractice model comes from.

Here’s the story.

The StrongPosture® protocols integrate precise postural exercise with bio-mechanic patient education. The system developed in early 2000 when I needed a way to integrate posture rehab and concepts in a busy clinic with multiple doctors and therapists.

Short-Duration Rehab Exercise

My vision was for patients to receive rehab individualized to their unique kinetic chain strengths and weakness, and consistently experience subtle strengthening and improvement from their “posture exercise professional”.  Plus, I wanted patients to receive consistent cueing during the short-duration exercise and clear communication of concepts, regardless if their session that day was from a chiropractor, massage therapist, trainer or an assistant.

In other words, after removing restrictions to motion (be it muscle, joint or neural patterning), I built a system to retrain that motion – towards symmetry, with control.  I also framed education to engage people with an understanding of how to move well, and why posture care is often a neglected factor in overall physical, mental and even social health, as well as performance. I wanted to tailor their posture retraining so each person experienced improvement in functional ability, regardless of who on our team taught them.

My work began with Vladimir Janda’s Czech School of Rehab, and concepts including kinetic chain and Crossed Syndromes. Additionally, back in the 1970’s when in college I studied yoga, and saw many parallels. So over many patients and trials of protocols, Janda’s work was blended with yoga concepts of mindfulness to more effectively communicate these ideas for each individual, which added the emphasis on precise control of breath, along with objectively accurate motion.

Mindful Somatic Training System

The vision developed into what I call a mindful somatic training system to empower patients to better care for their unique muscle imbalances. We trained people towards balance between overly strong muscles and previously neglected antagonists… and were blown away by how strongly they were invested with the results of our care.

Thus grew a web of interlinking and inter-dependent protocols combining attentional focus with tightly controlled and isolated motion, with often dramatic results for our patients. In addition (and to my surprise), their engagement with posture rehab and us as a group skyrocketed, as did staff morale and referrals.

Posture Principles

People were excited with their own accomplishments, and progressively learned to strengthen previously ignored weaknesses and asymmetric patterns of motion control. The excitement (and compliance) grew as we educated patients with the common-sense biomechanics concepts I developed – BAM (Balance, Alignment and Motion) and the 5 Posture Principles (aka the Principles of Posture).

Stand Taller Live Longer: An Anti-Aging Strategy is the book I published 10 years ago which encapsulated the basics of these ideas. Especially for people interested in learning more,  the book combined the StrongPosture® concepts and “bio-mechanics 101” posture principles with simple demos that really boosted patients ability to share our concepts with anyone else who should be concerned about postural health.  Which is everyone.

Subsequently, over the past decade interest in posture has mushroomed with aging Boomers slumping, Millennial’s bent over phones training “tech-neck”, and teen complaints of tech-related back and neck pain being reported at higher rates than ever before.  As research on the health impact of posture has multiplied, I’ve shared our work with thousands of health professionals, training many as CPEP®s (Certified Posture Exercise Professionals®) in the hands-on detail of functionally strengthening posture in a Posture Practice.

For 2019, we’ll continue the mission of training practitioners globally to help everyone stand taller to move, feel and be well.  If you missed the last one, register for our next free Posture Research webinar. If you’re already in the CPEP® network, it will be available on-demand in the new CPEP members area launching next month.

Steven Weiniger, DC
the Posture Expert | CPEP® Founder

Coming in Pt II:  The ACE Spiral of Awareness-Control-Environment: From PostureZone® App Referrals to Posture Care LifeHabits

For more about StrongPosture® and to incorporate it in your practice get the Posture Rehab Exercise Program and take the latest training via online course or hands-on seminar.

The term athlete brings to mind a person who participates in a specific sport or activity. Many practitioners like to make a point when marketing their company that “We Treat Athletes” with the hope that it appeals to a more active, healthy clientele.

However, the argument could be made that everyone is an athlete and one of the jobs of the practitioner is to determine their patients sport and how to best help them excel. The sport may be running or basketball, but it could also be gardening, playing with grandchildren, or being able to clean the house. The challenge comes when trying to integrate an exercise and rehab program that is functional across the spectrum of sports, activities and skill levels.

Common Thread: Addressing Adaptations

As an Athletic Trainer I know this is where the StrongPosture program holds a lot of value. It is applicable for high level athletes and everyday athletes alike. Everyone has adaptations that impact the way the body moves. These adaptations can alter the quality of motion in both large and small ways. Patients can decrease pain and increase function by becoming aware of their individual faulty movement patterns and beginning to control and alter the dysfunction that has been created.

A focused posture routine requires the everyday athlete to pay attention to the details.

• How is my pelvis moving?
• Where is my head?
• Are my shoulders back?
• Can I stand balanced on one foot?
• How are my feet aligned?

The biofeedback created by the wall or ball used in the StrongPosture® BAM (Balance, Alignment & Motion) protocols allow the patient to quickly identify the faulty movement and begin the process of correcting postural distortions through segmental movement. By improving balance, alignment, and motion with a focus on strong posture awareness, patients will move better and perform better in all skills.

Posture Awareness: Basic Alignment Exercise 

This short-duration, motor control exercise will align your perception of where your body is with objective reality. Try it on your own before teaching it to patients.

Align each PostureZone with a StrongPosture® Wall Lean

• Stand a foot away from a wall (back to wall)
• Lean back so your buttocks and shoulders touch the wall
• Keep your head level, eyes straight ahead
• Don’t look up! It’s okay if your head doesn’t reach the wall

The point of the exercise is to align your upper body and hips, and then to pull your head back into alignment as best as you can, while keeping your head level and eyes straight ahead.

• Take 5 slow breaths and TRY to press your head back towards the wall each time you exhale.

You may think your head is aligned over your torso and pelvis with ‘good posture’, but if you can’t lean comfortably against a wall with each zone touching the wall, something is out of line.

StrongPosture® is a systematic rehab protocol. Purchase the StrongPosture Program and take the latest training as an online course or hands-on seminar.

From high school sports to the pros, coaches and trainers know good form is important for athletes to perform well, as well as avoid injury so they keep on playing well. And for just about every sport you can name, bio-mechanically effective form begins with posture.

Posture is a whole body function, and function follows form.

Posture is a whole body function, and function follows form. Coaches and trainers agree posture is important for winning performance, but we live in a tech society that’s folding athletes – young and old alike.  In fact, a recent Baylor University study found college women spent 10 hours a day hunched over their devices (⁠1). The men fared slightly better, logging 8 hours a day on their phones (but video game time was not included in the study).

Off the Field and On the Phone

Players habits off the field in today’s tech society of smartphones, mobile devices and computers is why it’s essential to check athletes posture consistently, engage them to be more aware of their posture, and then train them proprioceptively towards standing taller in everyday life.

The sports are different, but a batter’s stance, a golfer’s address position, and a runner’s technique all start with their own unique posture. Posture is not just about strength, it’s control, and the perception of where the person’s body truly is when they’re trying to stand up straight and tall. For athletes – and for everyone else – a strong and proprioceptively accurate posture begins with the core.

Keep in mind all core training is not the same. A strong core and efficient Torso-Pelvis stabilization is key for any athletic training program, but each sport trains core strength, coordination and control specific to that sport. An effect that especially apparent for high level elite athletes.

A recent study by Barbado et al⁠ (2) compared the trunk stabilization patterns of high level judo practitioners, high level kayakers and recreational athletes. Their conclusion: “specific-sport training induces specific trunk stability adaptations”.

Torso-Pelvis (aka core) control shapes how you stand, and stance is the beginning of form. An athlete’s perception of their posture may be that they’re standing straight and tall, but an accurate posture picture against a grid often shows subtle asymmetries. These subtle errors between their perception and reality trains subtle asymmetry of core stabilization and posture control.

The best coaches watch tiny movement for clues about a players’ fatigue and potential for injury from weak stabilization and control. All trainers should observe the beginning point of where the athletes body is when they’re trying to stand tall. It’s the benchmark for what happens to them with fatigue or injury, as well as with training focused on strengthening posture.

StrongPosture® ACTION STEP 1: Take benchmark posture pictures at the beginning of training and again at the start of playing season. Posture injury pictures can also offer a point of comparison after rehab for safe return to play. Use the free PostureZone® app to assess symmetry of Head, Torso, Pelvis alignment over the center of pressure of the Feet.

StrongPosture® ACTION STEP 2: Incorporate StrongPosture® exercises targeted to each individual athlete to strengthen accuracy and symmetry of proprioceptive Balance, postural Alignment, and subtle Motion control.(3)

1 Roberts, J. A., Yaya, L. H., & Manolis, C. (2014). The invisible addiction: Cell-phone activities and addiction among male and female college students. Journal of Behavioral Addictions, 3(4), 254-65. doi:10.1556/JBA.
2 Barbado, D., Barbado, L. C., Elvira, J. L., Dieën, J. H., & Vera-Garcia, F. J. (2016). Sports-related testing protocols are required to reveal trunk stability adaptations in high-level athletes. Gait & Posture, 49, 90-96. doi:10.1016/j.gaitpost.2016.06.027d.
3 Weiniger, S, Posture Rehab Protocol Professional Training Manual, BodyZone Press, 2000-2016