How is posture relevant to health and wellbeing?   

Most massage therapists, and most people in general, have opinions about this.  In fact, most have been taught specific answers to this question.  And if asked “What do we need to discuss to properly address this topic?” most people would say words like muscles, fascia, and balance.

But I propose that if one truly wants to understand how posture is relevant to health and wellbeing, then what one needs to primarily grasp is the psychological question of what drives all behavior.  And if that seems far afield from muscles, fascia, and balance, it’s because it is.  

Emotions and Feelings

To understand why we need to look at the root of behavior to address this topic, we must first examine how emotions and feelings work, and to do this, I invite you stand up and try the following.   

  1. Assume a position with your back rounded, your head and eyes down, and see how easy it is to feel sadness or grief.  
  2. Now assume a position with your back erect, your chest forward, and your head and eyes straight, and see how easy it is to feel sadness or grief.

Let’s try another one:

  1. Assume a position with your back erect, your head forward, your eyes straight, and see how easy it is to feel anger.  Maybe squint your eyes a bit too….
  2. Now assume a position with your back tilted to the side, your head down and tilted, your arms behind your back, and your eyes and eyebrows up, and see how easy it is to feel anger.

What did you notice?  Most people report that the first posture in each group makes it easy to feel the specified feeling, while the second posture makes it hard to feel that feeling.  

So what’s going on here?  We all know that we go into certain postures when we feel a certain way, but why aren’t we able to feel those feelings in certain postures?   

To answer this question, we need to take a look at the James-Lange theory of emotion, which states that our bodies are driving our feelings, not the other way around.  So instead of thinking that you smile when you feel happy, it’s more accurate to say that you feel happy when you smile.  But it’s not quite this simple either.  This has to be broken down further to really get what is going on.

Here’s a simple breakdown of what happens, sequentially:

  1. There’s an event, or stimulus. 
  2. The event is analyzed and a subconscious decision is made about an appropriate response (e.g. moving towards or away).  
  3. A signal goes out to change the posture or facial expression.  This subconscious signal is called an emotion or expression.  
  4. A signal goes back to the brain about the status of the body.  We call this a conscious feeling.  

So technically, the expression happens first, and then the feeling comes, but this is all so fast that we don’t notice the sequence most of the time.  We will say “I smile when I’m happy” and this isn’t wrong, but the more accurate rendition would be to say “I smile when I subconsciously recognize a positive event and very soon thereafter I have a conscious experience of a positive feeling”, which could be shortened to “I smile before I’m happy” if we define happy as a conscious feeling.

Understanding this sequence is the first step in addressing the relevance of posture.

Interoception and the Root of Behavior

The second issue to address is what’s driving all behavior, and the answer to that very big question, for our purposes here, is maintaining homeostasis, for which “feeling good” serves as a proxy.  This works via a process called interoception, whereby sensory signals from the body travel to the brainstem and eventually the posterior insular cortex to convey all sorts of things relevant to survival, from bladder pressure and hunger to blood pressure and temperature, and so on.  The anterior insula takes on similar functions that relate to social feelings.  

Altogether, the insula is involved in any kind of body sensation or feeling that you can think of and it’s communicating with other limbic structures (e.g. anterior cingulate, orbital-frontal) that play an enormous role in determining how to behave.  And those structures are guided by the organizing principle of what’s going to get the insula to provide a neural “thumbs up” about our system status.  

Personality and Posture

Next we need to look at the relationship between maintaining homeostasis and behavior.  A whole book can go here, but to put it briefly, each of us have adopted go-to strategies for dealing with cranky signals from the insula.  Maybe we eat food or drink alcohol or smoke a cigarette.  Maybe we exercise or watch TV.   In social contexts maybe we make ourselves large and in charge, or maybe we tell jokes, or makes ourselves small, or make ourselves adorable.  Whatever we do now, without even thinking about it, is something we “figured out” at a very young age as an effective way to adapt to the situation and ultimately reduce any unpleasant feelings.  This makes most of us rather predictable, particularly in unpleasant situations.  

If you’re going to be large and in charge, that body posture is different than small and adorable.  So already right there, posture is emerging for homeostasis, to feel safe in order to feel good.  

But that’s just the beginning.  If we go back to our posture exercise earlier, we see that certain postures can mask certain feelings, so we must also consider that many people have had painful experiences in their lives that create unpleasant feelings all the time, particularly if those events were from childhood.  So the insula directs an active campaign to manage those emotions through numerous means (e.g. alcohol, food, drugs, exercise, work, etc.) and one of those means that can be utilized most of the day is posture.  If grief is too intolerable, there’s a posture to block that.  If the anger is too much, there’s a posture to block that.  Those postures are adaptive because they make life tolerable.  And sometimes, during a massage session, the client lets go of those adaptive postures and are just left with the deeper feelings that their subconscious might not have even allowed themselves to feel before.  Some will (wrongly) think that “trauma is released” in these moments, but the point is that at this point we are not in posture Kansas any more, and we haven’t even touched on the topic of spinal pain reflexes, which is also a key part of the puzzle.  

So when a massage therapist thinks that there’s something wrong with a client’s posture that needs to be “fixed” or that s/he’s going to address things in terms of muscles, fascia, or creating “balance”, that client’s body is probably saying “you really don’t get me at all”.   So if we really want to “get” our clients, we have to dispense with the idea that posture is simply about balancing muscles and fascia or that something is broken and needs fixed and replace it with the view that posture emerges for psycho-emotional purposes to maintain a sense of feeling ok.  

Consequences of Masking

We need to consider that for those clients with a great deal of psychoemotional pain, these adaptations may be in conflict with what is best for the client physically.  After all, while a posture might block emotional pain, it’s still using extra energy and quite possibly stressing the body on a physical level.  In fact it’s quite likely that clients with more physical pain are the very ones who are using posture the most to mask psychoemotional pain, which calls for us to be even more compassionate and accepting for how their nervous system has organized itself to feel ok.  

So in stark contrast to the “balancing muscles and fascia” perspective, which tends towards subtly or not-so-subtly pathologizing the client, a complete understanding of posture that incorporates this understanding of psychology and homeostasis requires us to deeply incorporate compassion and acceptance into our practice.  


The usual approach to posture is to see it as the source of problems, as something that needs to be corrected and “brought into balance”.  But the reality is nothing close to this.  A better understanding of posture requires incorporation of homeostasis, interoception, and how we’ve developed habitual strategies to feel good, including somatic strategies that use posture to mask unpleasant feelings.  Masking behaviors may create more physical problems for the clients, so it’s likely that the people who seek out massage are masking emotional pain more than the average person.  This calls for a greater level of compassion and acceptance with our clients around the topic of posture and the need for the entire massage industry to evolve how the topic of posture is thought of and discussed.  

Mark Olson, Ph.D. LMT is the director of the Pacific Center for Awareness and Bodywork, a trauma-informed massage school in Hawaii that integrates neuroscience and somatic psychology into the bodywork training program.  For more information, see

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