I recently had a client, Leanne, who came to me after starting a new workout program and discovered she had very limited range of motion when lifting her arms overhead or to the side. This restriction affected her ability to properly perform certain weightlifting movements.
“I’ve known that my arm movement has been limited for a while,” she told me, “and I knew it’s been an issue. I’m finally ready to deal with it.”
The trainers at our local gym, Weight Tudor, wanted to avoid any further injury, so they referred Leanne to me for treatment. After assessing her posture, I discovered a severe case of forward rounding in the upper back, also known as kyphosis. This caused her shoulders to round forward, her head to sink down, and her chest and collarbones to cave inward.
“I worked at a desk for 30 years,” she said, “and I was never really in pain until recently. I’ve had constant shoulder and upper back pain, plus headaches. I started this workout program to lose weight and get moving because I know if I don’t now, I never will, but I don’t know how to get unstuck from this position.”
From the traditional massage therapy perspective, many well-intentioned LMTs would go straight to Swedish massage techniques to provide quick pain relief. Although that’s not necessarily wrong, given Leanne’s goals and her determination to feel better in her body, I knew that Structural Integration (SI) techniques would be the key to getting her lasting results, correcting her posture, and helping her meet her fitness goals.
What is Structural Integration (SI) and how does it differ from traditional massage?
SI focuses on balancing the body’s muscular structure through a combination of strength and stretching, creating more efficient and optimal pull on the skeletal system. One could say the biggest difference between SI and traditional massage is that SI begins with a detailed assessment of posture and movement, rather than a full-body approach focused on relaxation and pain reduction. Minimal massage oil is used in SI to allow for better grip on the skin, muscles, and fascia, which helps stretch and reorganize these tissues effectively.
To picture Leanne’s posture, imagine standing and letting your arms hang down while rounding your upper back and dropping your head forward— this is an exaggerated version of her alignment. You might feel a nice stretch at first, but if you stayed in that position constantly, those upper-back muscles would become weak and overstretched. This leads to discomfort because those same muscles are responsible for pulling the shoulder blades back and stabilizing the upper back in a more upright position. Meanwhile, the muscles in the front, like the pecs and anterior neck muscles, can become tight and shortened. If massage focuses only on the back, it actually reinforces this pattern rather than correcting it.
Core Principles: Postural Alignment & Movement Efficiency
Postural Alignment
Optimal alignment looks different for everyone—it’s not about perfect symmetry, but about balance and function. During our treatment sessions, Leanne and I discussed expectations and goals. I shared one of my favorite quotes by Judith Aston: “Balance is the successful navigation of asymmetry.” Perfect symmetry isn’t realistic or even necessary, especially since Leanne is now in her early 70s and has lived in this pattern for over 30 years. Our goal was to create as much functional balance and organization as possible based on her lifestyle, time, and goals.
Leanne wanted to become stronger and move better. As a woman who lives alone and values her independence, she wanted to ensure she could continue taking care of herself safely and comfortably. She also knew that in her current posture, she was more likely to fall or lose balance, which could lead to possibly being unable to catch herself.
Movement Efficiency
SI techniques aim to reorganize muscle and fascial layers by breaking down adhesions that restrict tissue glide. This often includes specific movements that involve active participation from the client.
For example, one exercise I used with Leanne involved her lying on her back while I gently held part of her pec muscle as she raised her arm upward until we reached a natural stopping point of tension. We would hold this position for two or three breaths before lowering her arm. Another exercise involved her lying face down while I placed my hands on her shoulder blade and gently guided it toward her spine as she actively contracted in that same direction. This “stretch and strengthen” combination retrains the nerves and muscles to contract through their full range of motion. Leanne would often say, “These muscles feel like they can breathe again!”
After five weekly sessions, Leanne’s ability to lift her arms overhead significantly improved. Her upper back and head alignment had noticeably lifted from the rounded position she was in. “I don’t have any pain, I can lift my arms up over my head, and my workouts have been much more comfortable!” she told me.
While we still have more work to do balancing her hips and abdominal muscles, Leanne is thrilled with her progress. She’s transitioned into biweekly sessions for the next two months, and we’ll reassess her posture and functionality again afterward. She’s also continuing the home stretches and exercises I gave her, which will reinforce the new, more balanced postural pattern we’re building together.
Her experience is best summed up with the words she used in her review after our sessions:
“I have suffered with Bowers Hump and weak shoulders. I would exercise then seek massage for pain. I was referred to Hannah. Within six weeks, her gentle therapy has me carrying myself more upright, and many notice it when they see me. I am accomplishing better use of my arms and shoulders and meeting some of my goals within this short period of time. I am excitedly looking forward to continued improvements in the future.”
It’s always inspiring to witness a client’s transformation. Not just in how they move, but in how they feel in their body again. With consistent, intentional work, Leanne is rediscovering her strength, alignment, and confidence, and that is the true mission of this work.