Doctors, Physical & Occupational Therapists are all taught to see and treat pain locally, I.E. Carpal Tunnel Syndrome as an issue at the volar wrist, and Tennis Elbow in the lateral elbow. Yet as with my trained Feldenkrais eye, I have learned that these diagnoses indicate where the symptoms appear, not where the true underlying cause resides. I’ve reached this conclusion after working with hundreds of clients presenting with overuse conditions over the past three decades.
Where the Real Problem Lies
More often than not, these problems originate far from the site of pain—within the pelvis, spine, ribs, scapula, and neck. I have observed that many clients with chronic neuropathic pain or distal symptoms (such as paresthesia, numbness, or bilateral hand and arm discomfort) are moving through the world as if wearing a straightjacket, limiting the movement around their thoracic spine. This means the mid-thoracic region, between T3 and T10 often lacks the segmented, differentiated movement needed for effortless fluid motion. When the ribs and vertebrae move as one rigid unit, the lumbar and cervical regions must compensate—twisting and rotating beyond what is biomechanically efficient. Given today’s stress and anxiety levels and less-than- ideal workstation setups, these poor movement patterns are becoming increasingly common.
For context, consider a simple movement: sliding your left hand down your left thigh or bending to pick something up by your left foot. In a well-organized system, the vertebrae and ribs on the left compress slightly while those on the right expand. But when the thoracic spine and ribs are restricted or metaphorically “glued” together, this coordinated movement is greatly reduced. The same principle applies to bending, reaching, and rotating. As another analogy, imagine holding a metal chain vertically and twisting the bottom link— Ideally, each link above would rotate incrementally. That’s how the spine should move during turning or twisting. Unfortunately, in many clients, the cervical and lumbar regions over-engage to pick up the “slack” of the mid and upper back region, creating strain, imbalance, and inefficiency. Consequently, the larger muscle groups and core stabilizers become unavailable to properly assist arm and hand movements. This forces the smaller muscle groups of the distal extremities to do more work than necessary, increasing strain on tendons, ligaments, and other structures— a direct pathway to overuse injuries.
The Role of the Scapula
Proper scapular function is another foundational element of upper extremity mechanics. The scapula should glide fluidly and synchronously with the gleno-humeral joint, clavicle, ribs, and spine. Yet often, I observe the inferior angle flaring away from the thorax—or, in other cases, a scapula so restricted that it appears almost fused to the thoracic wall. Both scenarios reflect a breakdown in coordination, often resulting in chronic over-activation of specific musculature such as the scalenes and upper trapezium. This occurs because the aforementioned structures are unavailable to properly assist with arm and neck movements— resulting in the “wrong” muscles working more than they should and hence placing abnormal directional forces on the scapula.
Over time, the arm becomes increasingly “disconnected” from the rest of the body, forcing the distal extremities to compensate and exert excessive effort. The outcome is heightened stress and strain on distal ligament, tendons, and muscles which may ultimately contribute to pain, fatigue, and reduced functional efficiency. In my clinical observation, tennis elbow often correlates with a flared inferior border of the scapula, a shoulder that is slightly rounded forward, and compensatory overuse of the upper trapezium. Such bio-mechanical inefficiency—combined with poor wrist postures (I.E. ulnar deviation, flexion or the hyperextension of the digits) creates the perfect storm for hand overuse symptoms to develop. If we treat solely at the distal site of symptoms, our therapy will be inherently sub-optimal as the true sources of the client’s issues remain unaddressed.
The Low Back and Neck
Another major contributor is habitual over-contraction of the back, thigh, and neck musculature—a topic I explore further in my companion article, “What Causes Neck Pain.” Traditional therapy approaches may focus on stretching or strengthening the back and neck, yet these interventions often fail to address the underlying issue. In most cases, the neck is overcompensating because the thoracic spine, ribs, and related structures are not contributing adequately to movement. It is crucial that treatment for most neck and overuse injuries prioritize neuromuscular re-education— helping the nervous system to relearn how to move in a more coordinated, efficient way.
Parasitic Patterns of Movement
Nearly every client I see is caught in unconscious movement habits that perpetuate strain and fatigue.
Common examples include:
• Restricted or shallow breathing and diaphragm inhibition
• Hypertonicity of the paraspinals and over-reliance of the posterior chain
• Co-contraction of finger and neck extensors
• Overuse of the toes & leg adductors as well as extraneous muscles around the hips
Parasitic movement patterns show up in everyday actions—standing up, walking, or reaching into the cabinet for a teacup—without conscious awareness. I use the term “parasitic” because such patterns drain energy and create unnecessary strain as the “wrong” muscles are being recruited for the task at hand.
A Gentle, Nervous-System-Led Approach
When I treat manually, my touch is soft, gentle, and precise. This isn’t just stylistic—it’s what the nervous system responds to best. A nervous system that feels safe can begin to release chronic muscular holding. Under the right conditions, tissues soften, and new movement options emerge. From there, I work—often without words—to facilitate the brain’s recognition of functional relationships among the ribs, vertebrae, scapulae, and pelvis. Each rib and vertebrae must be differentiated so the brain can refine its internal body map. Improved proprioception and sensory awareness leads to more efficient motor control and movement.
Awareness Is Key
Equally important is helping clients cultivate awareness of their own movement patterns—how they may unconsciously overuse certain muscles or move inefficiently. The encouraging news is that these patterns, often learned during times of stress or trauma, can indeed be unlearned. With practice and guidance, clients begin to move with greater ease, coordination, and intentionality.
Lasting Change Without Chasing Symptoms
At times, distal symptoms—such as neuropathic pain or paresthesia—begin to resolve even before I directly touch the hand. Still, I typically include gentle, intentional touch to the distal extremities near the end of treatment to help the brain integrate new movement patterns and to restore proprioceptive awareness of each part and it’s relationship to the whole. The results are often profound–extending beyond pain relief into a transformation of self-awareness, body image, and self-concept. Clients frequently report feeling more “put together,” aligned, and at ease within themselves.
A Call for a Whole-Body Approach
As we raise awareness of the effectiveness of the Feldenkrais Method in treating pain, I believe it to be equally as important to stress the importance of treating the body as an interconnected whole. When therapists treat the neuromuscular system in isolation, they risk chasing symptoms rather than addressing root causes. When therapy supports this whole-body integration, healing becomes not just physical but holistic— transforming how clients inhabit their bodies and their lives.
Shara Ogin, OTR/L, GCFP®, CEAS (Certified Ergonomic Assessment Specialist).
After more than 25 years in the medical field, as an Occupational Therapist, Ergonomist, and Feldenkrais Practitioner®, and over three decades of personal growth work with world-class teachers, Shara brings a holistic, full-body approach to healing.
She also offers office ergonomic consultations, mind/body retreats, and advanced training courses for medical professionals.
Website: https://holisticpainrelief.org/