Pain Free Performance — Posture Alignment Therapy

Live Pain Free!

Movement For Alignment

Knee Pain: How to treat, prevent, and live Pain Free with Egoscue Method

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Knee pain is a frequent issue that brings individuals into Pain Free Performance. Pain in the knees can often be diagnosed as arthritis, instability, weakness, or tearing of the supporting structures. In order to identify the root of the pain and not just treat the symptom, the first assessment needs to focus on the joint position of the knee that created the diagnosis.

During an initial assessment, it is important to palpate the joint position and identify muscular and structural imbalances. Clients with knee pain often present with knees that are rotated externally or internally from the hip. A kneecap (patella) or femur position (the position of the thigh bone from the hip) that is not straight creates an uneven distribution of load on the knee, ankle, and foot. The knee was designed to be a hinge joint and function by bending and straightening. If many of us are walking, running, and jumping with knees that are rotated, it is no wonder acute and chronic knee pain are frequently diagnosed and treated!

Our bodies are brilliant at compensating for muscular imbalances and changes in function. Clients with acute or chronic knee pain often stand with their knees bent in flexion to take pressure off the knee. This creates a cascade of compensations throughout the body. The hip begins to tilt, the spine is altered through rotation and flexion, and the ankle and foot begin to turn outward. Compensation for joint position and pain can lead to more issues down the road. When the joint position of the knee is rotated and out of alignment, individuals with knee pain who undergo imaging, such as an MRI or CT scan, may show a meniscus tear or cartilage degeneration. In our practice over the past decade and a half, many of these clients had been advised to have arthroscopic surgery that did not resolve their knee pain but instead made it worse. Recently, medical literature has supported this observation, stating that “for most patients with osteoarthritis of the knee, arthroscopic surgery offers little benefit” (Mounsey A, Ewigman B. Arthroscopic surgery for knee osteoarthritis? Just say no. J Fam Pract. 2009 Mar;58(3):143-145. PMID: 19284940; PMCID: PMC3183924).

So how do we treat knee pain? At our practice, we use postural alignment therapy, the Egoscue Method, to identify the root cause and imbalances creating pain and work toward lasting change in a functional body. This is accomplished through a whole-body assessment designed to reduce knee pain while enhancing overall mobility and function. The Egoscue Method does not just address the pain—it addresses the root cause of the pain.

The Evolution of our Practice

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Our clinic first opened in 2006 when our founder, Cindy, encountered a book that shifted her understanding of how the body experiences and resolves pain. At the time, Cindy was working in physical therapy when a client introduced her to Pain Free by Pete Egoscue. The book’s central idea—that the body functions as an interconnected system—offered a new perspective on therapeutic exercise and muscular compensation.

Trusting her intuition, Cindy began applying these principles with her physical therapy patients. The results were striking. Patients who had been preparing for surgical procedures were improving and, in some cases, no longer needed them. Encouraged by these outcomes, Cindy took a leap of faith and opened the first postural alignment therapy clinic in Central Virginia.

After completing her certification through Egoscue University in 2006, Cindy continued to deepen her belief that the body has an extraordinary capacity to heal when muscular imbalances and postural dysfunction are properly addressed. For more than 20 years, our practice has helped clients experience meaningful improvements in function, longevity, and overall quality of life—often allowing them to move beyond chronic pain.

As our understanding of the body has continued to evolve, so has our approach. While Postural Alignment Therapy remains the foundation of our work, we have thoughtfully incorporated additional modalities when they support the healing process. These include hands-on techniques such as Strain Counterstrain, as well as therapeutic technologies like red-light and infrared laser therapy.

Equally important to us is the process of assessment. Each client is evaluated individually through observation, movement analysis, and hands-on palpation. This allows us to understand the subtle compensations within the body in ways that standardized software or automated assessments often cannot capture.

In 2018, after more than a decade as Egoscue affiliates, we chose to continue our work independently at Pain Free Performance. This transition allowed us to expand the services we offer while maintaining the principles that have guided our practice since the beginning.

Alignment: Treating the Body as a Whole to alleviate Pain

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Healthcare today is focused on the parts. Our healthcare practitioners are specialized and focus on specific sites and no longer view the body as a whole. As a result, we are missing how each site impacts another directly.

With the Egoscue method, alignment matters. When the position of the head, shoulders, vertebrae, hips, knees, and ankles are in line the forces through the joints are distributed to allow movement with minimal effort. This is the ability to move freely and without pain.

When our body is not in alignment, our joints wear down and uneven load is placed on parts of our body that are not meant to bear the added weight. This dysfunction is often the root of pain.

Many clients find Egoscue after trying other modalities that are not addressing the compensation created by their tissues, muscles, and joints. When we see clients for the first time, their gait and the movement of their body tells the story of a system trying to fix its parts. In order to determine what is causing their neck pain, knee pain, or hip pain we must determine what body part positions are misaligned.

Our job is to release the muscular compensation and strengthen the correct muscles to bring the body into alignment. We do this through specific exercises targeted towards what is off in a client’s specific body. After each exercise, we use gait analysis and functional testing (like an arm circle or reaching to touch the toes) as tests to see how the body is changing. As things become in a better joint position, the body is noticeably moving more fluidly, straighter, and more balanced.

This is why we must consider the body holistically when pain is present. Often the site or location of pain is not the cause. Our goal is to identify the dysfunction and create an integrated muscular skeletal system where movement is freer and function is unlimited.

A Simple Trick to Test Your Alignment

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Many clients seek out our practice to reduce pain and regain their quality of life. 

Often, they are not aware that their body is out of alignment. 

When one aspect of the body is altered, it changes the function of the muscles and joints that surround that site. 

For most of us, our work week involves sitting at a desk in front of a computer. 

This position drives the shoulder forward, forcing the upper back to round, and bringing the head and neck into a flexed position.

In order to not develop chronic neck, shoulder, and back pain here is a simple trick to see if you body is aligned:

Stand vertically at the wall with the back of your head, shoulders, hips, and feet touching the wall.

In this position, is your head able to touch the wall? Or is there tension in your neck from bringing the head back?

For every inch forward that your head is from the wall, it increases the weight of your head on your neck by 10 lbs!

With the Egoscue method, we can reduce the forward head positioning and neck strain by getting to the root of the problem in the body.

How long does it take to create pain relief using posture alignment therapy?

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Most of the clients we see are in pain. These clients come to us for relief with their knee pain, back pain, hip pain, and shoulder pain. Oftentimes, our clients have been to chiropractors, physical therapists, doctors, massage therapists, and acupuncturists that have been unable to create a lasting change with their muscle and joint pain. This can be challenging for our clients because their journey for pain relief has already taken weeks and months before we meet our clients for the first time. 

 

In order to create lasting pain relief, as Postural Alignment Specialists that practice The Egoscue Method, we assess the muscular imbalances in their bodies. This begins through a complete health assessment and history to understand the patterns of movement (or lack of movement) that led to pain. We complete postural photos to see how their joint position aligns against a grid to understand how their joints are loading. This can reveal if an elevated shoulder and hip are leading to the back pain or if a forward head position is causing the shoulder pain. Finally, we complete a series of functional testing and gait analysis to determine what muscles are active or inactive that are resulting in muscular compensation and pain. 

 

When our clients leave their first postural alignment session, they can expect to feel a change in their body. This often results in a decrease in pain. If a client’s body has compensated for years, they might notice feeling “lighter” or “straighter” after doing their Egoscue therapy exercises. This is a sign that their body is becoming more functional and balanced. 

 

The work towards alignment and health takes time and effort. Our muscle memory begins to take effect in 90 days and is often the time our clients begin to notice less pain due to their enhanced alignment. Change is not always linear and might result in peaks and valleys. We encourage clients to remain focused on what is changing. Our cells and tissues are constantly adapting and we will continue to adapt new exercises and stimuli to create a change in the muscle structure. One of the great benefits of our bodies is that they are dynamic and constantly in motion. This is why the method works! Now, let’s get moving!

Moving into the New Year!

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A new year brings opportunity for new beginnings. Many of us look at January as a start date for change and for removing bad habits from our lives. What if we viewed this new decade as an opportunity to add something positive to our lives? This could be adding an Egoscue e-cise menu to your life to correct your joint position or choosing to do your Egoscue more regularly. When we add positive health choices to our life, even once a week, our body and our health change immensely.

In our culture, going to the gym the first month of the new year is a tradition for many. Many of us believe “moving more” is “exercising more”. This year, we’d like to encourage you change the way you think about movement. Moving more could be taking breaks every twenty minutes from sitting or standing at work. Take a walk around the office or out to the mailbox.  Moving more could be sitting on the floor to watch tv at night instead of collapsing into our couch or comfy chair. The more resistant surface of the floor encourages increased blood flow – seems crazy, but this is sooo good for your body! And, it’s so simple.

When we move in any which way, our bones our nourished and joints have enhanced flexibility. If your goal is to be pain free or enhance your health this new year, consider adding more movement to your life outside of the gym. Be creative. There are no rules to how you have to move just move as often as possible!

Alignment While Exercising

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Have you ever been told by a fitness instructor or a health care professional to tuck your pelvis under to protect your back?

Look in any anatomy book at the skeletal system and you will see that the lower back is designed to have a curve in it.  The curve of the lower back is there to absorb the “shock” of your body weight when you stand or move.  When you tuck the pelvis under you are decreasing the curve of your lower spine and taking away the shock absorber.  Doing this will eventually contribute to back pain. But that’s not all!

Our bodies work as a unit.  Everything is connected in one way or another.  A tucked pelvis can also create rounding in the upper back which can cause the shoulders to move forward.  A rounded upper back can cause the head to go forward.  Below the waist the tucked pelvis will change the way the leg muscles work.  The change in the work of the leg muscles due to a tucked pelvis will force a slight bend at the knees. Overtime the uneven pressure on the knees can lead to a wearing of the cartilage, inflammation and pain.

Anytime you change the design of the skeletal system it effects the system as a whole.  There are safe ways to exercise with or without weights that do not involve changing the natural alignment.  Use your Egoscue programs to align your body (get straight).  Then when you embark on a fitness activity (strengthen), allow the natural curve in your spine and keep your shoulders back while performing upper body exercises.  If you need additional guidance, we are happy to help.

Moving Toward Being Pain Free

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We often work with clients experiencing significant changes in their quality of life due to pain. Many are having pain for the first time and don’t understand why. They progressively and reluctantly remove the activities they love that seem to increase pain. Ironically this leads to no longer being able to sit, stand or move without discomfort. The catch is, even in pain, our bodies are meant to move. Ultimately, the body moves the way you move it or, doesn’t move because you don’t move it.

If you have been a cardio-queen, spending an hour doing the elliptical every morning and then go off to work sitting for eight hours, that’s a problem. Perhaps you’re a jogger and pound the pavement on the weekends but lay low during the week. Both of these scenarios can cause pain over time. Parts of your body and muscles are deprived of oxygen for all that time you are sitting or sedentary. Most people are out of alignment and can unwittingly create more dysfunction with activity. It creeps up on you and then one day, as our clients describe above, you are in pain for the first time. You have back pain, hip pain, foot pain, neck pain or shoulder pain and you don’t know what to do! You hurt, so you stop the morning exercise, the running, the elliptical. Inactivity is not the answer, but the right activity to correct your alignment is key to healing your pain.

At Pain Free, our job is to evaluate each client’s body, to diagnose what is truly causing the pain and reintroduce appropriate movement. This prescribed movement restores alignment, naturally removing pain which reunites people with the activities they enjoy! Let us join you on this journey back to moving well and doing the things you love to do.