June 29, 2025

Standing Tall

HI ,

What is going on here? There is some actual interesting neurology involved here. Posture is a function of the tone of the postural muscles. Postural muscles are different from regular muscles. They are always “on”. The nerves to postural muscles are always firing to some degree. These muscles are not for movement. These muscles are for holding your body steady. They never completely relax. How tight they are is called tone. The reason for this is because they are controlled by the same part of the brain that is responsible for us to be aroused and responsive to our environment.

I remember back in the early 80s I had a couple of competition bodybuilders as patients. They would show me pictures of their latest competition, and there was not an ounce of fat on them anywhere. They were solid muscle. Yet when they laid down on my table to be adjusted, their bodies were soft and squishy as though they were mostly fat instead of muscle. This taught me a valuable lesson. Conscious movement muscles can relax. They can let go and become totally soft and pliable. But when I am checking a patient's spine, I am feeling for tight spots in the muscles along the spine. I feel for spots where the normal spring to the vertebra when I push on them disappears, and instead the bone feels hard as a rock. This is where I know there is a subluxation, a spot that needs to be adjusted. The whole spine has a certain amount of tension, which is its normal muscular tone, and then there are spots that have seized up and don't allow normal motion.

What is the point of this story? The point is that the muscles along our spine are postural muscles and should always have a certain amount of tone to them. These are the muscles that are responsible for our standing tall. The kind of muscles that you can work out in a gym by moving weights or moving your body are not postural muscles. In fact, if you are moving a postural area, those postural muscles have to be inhibited to allow motion. They are for holding things still. They oppose motion in the joints they connect to. What does this mean – why should you care? Because it means that any kind of exercise you do to straighten up your back that involves movement won't work. You can build muscles that will enable you to consciously straighten up as long as you are concentrating on it. But the moment you stop thinking about it, everything will go back to slumped forward. There is a type of exercise you can do for postural muscles, which we will get to in a minute.

But first, a bit more neurology to help you understand why posture gets harder every year. Postural muscles are controlled by the oldest part of the brain – the brain stem, specifically a part called the reticular activating system. This area regulates your level of arousal and responsiveness to your sensory information. It controls how awake you are and how much attention you are paying to your environment. Part of this attention is what regulates your postural tone. Imagine you are crossing an open grassy area in the wilds of Africa. You stop to look and hear for any hungry lions prowling about. Your spine stiffens up, making you taller so you can see better. Your attention to every little sound, smell, and sight is turned up to the max to try to keep you safe. This is the system that is responsible for your posture.

Strong postural tone is the consequence of your body being in the present moment and ready to react or respond to whatever you encounter. Maybe that is a threat, but it might be searching for food or a mate. Good tone says you are ready for anything. You are engaged with life and ready for action. Compare this to what your body is ready for while you are scrolling through stuff on your phone. How engaged with the world of action are you while you are working on your computer (like I am right now)? As humans, our head is designed to be fully upright and busy scanning the environment. We are not designed to have our gaze fixated on something close to us more than briefly. As we do, our neck muscles pull our head forward toward whatever we are focused on. It is fine for a few minutes, but as a lifestyle, it damages our neck.

Now here is the unfortunate reality we have to deal with. As we age, the part of the reticular activating system that tells our spinal muscles to maintain good tone starts to degenerate. This area ages faster than the parts of the brain that control the muscles in the front of our body that like to pull us forward. Standing tall gradually becomes more and more difficult. Not only are the muscles getting weaker, but the drive to be present and participating in the moment also decreases. We are not as inclined to get up and go fight the battles with life. We settle back into our memories more and more instead of embracing life head-on. This should be giving you a huge clue about how to improve your posture – embrace life. Live life to its fullest! Engage in differences in order to wake up! Personally, the patients I know that have this attitude toward life also seem to “naturally” have better posture.

So, aside from skydiving, pickleball, and death-defying adventure sports, what can we do to help strengthen postural muscles? Since these muscles are all about holding us steady, we want to do a type of exercise that does just that. We want to get into positions that engage these muscles and challenge them to hold us steady for a length of time. That length has been studied extensively and has been found to be 10 seconds. Many Yin Yoga, a yoga of stillness, practitioners will hold positions for a minute or longer, but the research says that the max benefit is gained with simple 10-second holds. Additional time is just for the spiritual purification that comes from suffering.

In the gym, I use something called a Roman chair, commonly used for doing back extensions. But pulling up and down like is normally done does not work the postural muscles. Instead, I hang down and stretch out for 10 seconds, then raise up 30 degrees and hold for another 10 seconds, then up to 60 degrees for another 10 seconds, and finally up to 90 degrees for a last 10 seconds. I will do this protocol only two or three times.

For years I have been referring patients to the Foundation Training videos on YouTube. They do a really good job of teaching you how to exercise those postural back muscles at home without any equipment. This is especially true for those of you that experience low back pain that is across the top of the hips and does not go down your leg. This is a common problem with people that sit a lot like at work. The muscles that go from the front of your low back spine to your hips (the psoas muscles) shorten and tighten when you sit for more than 20 minutes. When you try to get up they pull the spine forward and pinch the joints. It is a strong set of postural muscles behind the spine (the multifidi) that prevent this spinal joint damage. We need these guys strong. I also recommend that if you have been sitting for a while that you stretch out straight for a moment before you get up out of your chair. This will lengthen those psoas muscles before they try to pull your spine forward.

Another simple one I tell patients is to simply raise their head up while they are brushing their teeth over the sink. You can feel the muscles in your low back close to the spine tighten up. Those are the ones we want to strengthen. These little postures need to become a regular part of your daily life. Fighting the gradual decline of the brain matter that provides the tone to these vital muscles is a vital endeavor till the day we die. Stand tall! Embrace life!

Take care,

David

Ellen

A week and a half ago Ellen had surgery on her left eye. She had a basal cell carcinoma on the lower eyelid and extending down into her upper cheek. The surgery took 10 hours because they had to do three rounds of cutting out samples and sending them to a pathologist to see if all the cancer had been gotten. Each round took 2 to 3 hours which meant a whole new round of local anesthetic four different times. She ended up with loosing the lower eyelid completely and a fair bit of her upper cheek. The surgeon had to make a skin graft from her throat skin to sew over the removed tissue and then sew her eye closed. She will get to stay this way for at least a month. Life is such an adventure! 

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"Positivity is built out of who you are, negativity is built out of what you have and don't have. There is no lack in who you are, simply unmanifest abilities. Conversely there are never enough possessions to fill the inner void. "

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