One of the most famous principles in the world of physical therapy and rehabilitation (coined by Karel Lewit) states: "He who treats the site of pain is lost." While this might sound extreme, it holds the key to long-term clinical success.

 

When a patient complains of shoulder or lower back pain, a novice therapist's instinct is to rush to the painful area. However, an experienced manual therapist knows that the pain is often the "victim." It is the area that is working too hard, stretching too far, or absorbing biomechanical loads it wasn't designed for. The true "criminal" usually hides in a quiet, stiff, and pain-free region that has forced the rest of the body to compensate for its dysfunction.

 

In this article, we will learn how to "deconstruct" a patient’s posture and movement. We will explore the mechanisms of compensatory strategies, learn to distinguish between structural and functional impairments, and provide you with the tools to become architects of movement in the Manual IL approach.

 

Chapter 1: Posture as a Life Story – The Bio-Psycho-Social Model

Posture is not just the alignment of bones; it is how the patient’s nervous system manages the body against gravity. It is influenced by injury history, work patterns (sedentary screen time), emotional state, and genetics.

 

At Manual IL, we divide postural analysis into two layers:

• The Structural Layer: Permanent changes in bones, discs, or ligaments (e.g., structural scoliosis). These are difficult to change manually, and we must learn to work around them.
• The Functional Layer: This is where the magic happens. These are patterns the brain adopted due to old pain or habit. Functional Kyphosis (slumped back), for example, may stem from a shortening of the anterior fascia and pectoral muscles. This is a reversible state that can be transformed using STB techniques and manual release.

 

Chapter 2: The Kinetic Matrix – Where is the Weak Link?

As noted in previous articles, the body operates as a chain of joints. Our diagnosis begins by identifying the "stuck" area.

Eyal Feigin emphasizes: "When a joint meant to be mobile (like the thoracic spine) becomes rigid, the body will seek movement in the adjacent joint (the neck or lower back)." During assessment, we look for hypo-mobility (lack of movement). If we find that a patient’s thoracic spine lacks rotation or extension, we already know their lower back is at high risk for compensatory hyper-mobility and pain.

 

Chapter 3: The STB Method & Soft Tissue Assessment – The Language of Tension

Giveon Peled teaches us to listen to the "tone" of the tissue. Manual palpation is critical. We aren't just looking for "knots" (Trigger Points); we are trying to understand the tension vector.

• Is the patient’s fascia "pulled" entirely to one side?
• Are there areas that feel "frozen" or dense?

 

For instance, in chronic low back pain, we often find immense tension in the Psoas muscle or Visceral Fascia. This tension pulls the spine forward (Hyper-lordosis). While the patient feels pain in the back, the treatment must begin at the front. Without releasing that anterior shortening using the STB method, any lumbar manipulation will be futile in the long run.

 

Chapter 4: Functional Screening – The Body in Action

Static assessment (standing) is only half the picture. At Manual IL, we advocate for dynamic assessment. Here are three key tests we teach in our workshops:

• Overhead Squat: The ultimate "informant" test. If the hands fall forward—thoracic stiffness. If the heels lift—ankle stiffness. If the knees collapse—gluteal weakness.
• Single Leg Stance: Testing pelvic stability. If the pelvis drops (Trendelenburg sign), the patient is likely compensating for Gluteus Medius weakness via the back muscles (Quadratus Lumborum), leading to unilateral back pain.
• Thoracic Rotation Test: A basic yet critical check for anyone suffering from shoulder or neck pain.

 

Chapter 5: The Treatment Hierarchy – Where to Start?

Once we identify the compensation pattern, the question arises: where do we begin? At Manual IL, we follow a proven workflow:

• Inhibition: Using STB techniques to lower the tone of short, overactive compensatory muscles (the hyper-vigilant "guards").
• Mobilization: Using manual therapy and HVLA techniques to restore motion to the "stuck" joints (the source of the problem).
• Activation: Gentle, specific strengthening of "dormant" muscles (areas under neurological inhibition).
• Integration: Teaching a new, balanced movement pattern that prevents a return to the old compensation.

 

Summary: The Therapist as a "Programmer" of Movement Patterns

The ability to distinguish between the source and the symptom is what separates a "technician of touch" from an expert manual clinician. Pain is the patient's teacher, but it often misleads the therapist.

 

When you understand The Great Compensation, you stop fighting the pain and start building health. By combining the biomechanical and manipulative expertise of Eyal Feigin with the diagnostic and healing touch of Giveon Peled, you gain the spatial awareness needed to solve even the most complex cases.

 

Ultimately, our goal is not just to "release the neck," but to restore the patient's freedom to move within their body without limitations or unnecessary compensations.

 

Want to learn how to identify posture and movement patterns in seconds? Want to understand the hidden links between joints and treat the root of the problem? Join our Manual Therapy course at Manual IL.