The Effects of Posterior Tilt of the Ribs

From my treatment table: A blog series related to what I’m seeing in the bodies of my clients, and the treatments related to those findings.

In the last installment entitled “An overview of what I do” I explained the genesis of this work ( in a very precursory way) which I’m hoping gave you a general idea of the orientation used to assess and treat the body in this form of bodywork now known as Anatomy Trains Structural Integration.

In this installment I want to discuss an anomaly I’ve been seeing consistently in my practice which has significant ramifications for the well-being of any body- that anomaly is posterior tilt of the rib cage, also known as sway back posture.

This is an interesting anomaly in that it is created by a shortening of two major vectors of force in the human body – The Superficial Back Line and the Deep Front Line.

Let’s look at the Superficial Back Line first: (photo from Tom Myers’ amazing book ‘Anatomy Trains’)

The Superficial Back Line (SBL) runs from the soles of the feet up the back body to just above the eyebrows. Among other functions the SBL balances the lines of pull created by the musculature on the front of the body known as the Superficial Front Line (SFL).

It’s the SBL myofascial continuity which creates the curves in our spine. When we’re born we have been in fetal position for about nine months. Therefore we have been shaped like a ball, this shape is known as a state of spinal flexion. The fist curve in the opposite direction, known as extension, is developed by the baby lifting its head. This is known as cervical spine extension. The second curve created by the strengthening of the Superficial Back Line is the low back or lumbar curve, known as lumbar spine extension. This is developed as the baby develops enough strength in the arms and shoulders to push itself up from the surface it’s on.

When the SBL is in a state of hypertension it has the ability to wreak havoc on several bony structures in the body. Starting at the feet, it can be the cause of, or major contributing factor in, plantar fasciitis, Achilles‘ tendon issues, bone spurs, and claw foot to name just a few. In the knees it can be a major factor in a variety of issues including medial (inner) meniscus mal-alignment which often leads to tearing of the medial meniscus, as well as damage to the medial collateral ligament, which is historically the most common ligament injury for us humans. On the outer knee hyperextension in the SBL can cause or contribute to outer meniscus issues due to compression of the joint capsule and misalignment of the knee joint, as well as issues in the fibular head articulations which lead to pain in the outer knee or knee joint while running or hiking.
These are just a few of the knee issues caused by hypertension in the SBL.

In the hip area hypertension in the SBL often causes the pelvis to be posteriorly tilted due to the hamstrings being very tight which can be a challenge for the hip joint capsule as the posterior tilt of the pelvis means the joint capsule is not in ideal alignment for the femur (thigh bone) to articulate. This leads to uneven wear in the cartilage and potentially to hip replacement. These are just a few ways the malalignment caused by hypertension in the SBL cause hip issues.

In the back which is our main area of concern for this article, the hypertension in the erector spinea group, aka spinal muscles, creates a shortening of the whole spine, (think accordion when you push the air out), this can and does cause degenerative disease in the discs between the vertebrae. This is very important because in between each vertebrae is at least one nerve bundle exiting the spinal cord to deliver electrical impulses to the musculature, the most famous of these being the sciatic nerve which tends to exit between the 4th and 5th vertebrae of the lumbar spine, (think very low back).

This shortening also wreaks havoc in the neck, where it leads to compression of the cervical vertebrae. This compression is very harmful because the cervical vertebrae are where the neurovascular bundles which supply the shoulders and arms exit the spine. The cervical spine tension also contributes to head forward posture which leads to even more impingement of the nerve and blood supply to the shoulders and arms.

This visual shows the issue so many of us are dealing with.


This schematic shows the various nerve pathways exiting the whole spine.

The other main myofascial meridian that contributes mightily to ‘posterior tilt of the ribs’ is the Deep Front Line. This line is complex in that it has multiple potential pathways or vectors of pull within it. Here is the Deep Front Line, (from ‘Anatomy Trains’).

As you can see it’s more ‘volumetric’ than the other lines, meaning it encompasses whole muscle groups and areas within the body. In my practice I have found that this line more than any other is in need of loving attention. Even dedicated Yogis have issues in this line as it’s hard to access in a standard yoga practice. One has to understand it and have the intention of working with it in order to affect real change here.

The main DFL muscles involved in posterior tilt of the rib cage are the Illiacus, Psoas and Quadratus Lumborum. These muscles in addition to the shortened spinal muscles coordinate to pull the ribs down from behind thereby tilting the top of the ribs back. (See photo above titled ‘Sway Back Posture’).

When the ribs are tilted back, the shoulders are deprived of the foundation they need in order to function properly. The head tends to move forward or at least has that appearance, and the shoulders roll forward as well, (protraction of the shoulders). These two aspects of ‘posterior tilt of the ribs’ are what are so devastating about this anomaly. The nerve impingement caused by the head and shoulders being forward can leave us with headaches, shoulder, arm and hand issues.

The way to self treat for this condition is to lengthen your back body and your side bodies through stretching and to affect trigger point release through ball work. I love to use a knobby roller to get into the area just above my hip bones. This is a great way to treat Quadratus Lumborum in particular which is often a contributing culprit in a wide variety of low back syndromes.

Here are some hopefully helpful visuals of the muscles we’ve been discussing.

This photo shows the three main erector spinea muscles, Spinalis Thoracis, which is closest to the spine,  Longissimus Thoracis (highlighted), and Illiocostalis which is the muscle more distant from the spine. These muscles respond to trigger point therapy with a ball at the wall or on the floor. You roll the ball along the line of the muscle looking for particularly tender spots. When you find them, rest into those spots until they release.

I hope this info is of use to you. Please contact me with any questions or concerns related to this article.

An Overview of What I Do

What is it?

My work is primarily informed by Dr. Ida Rolf’s work known as “structural integration.” Structural Integration is what Dr. Rolf called the physical therapeutic work she developed over approximately 50 years of working on many different people. Her students coined the term “Rolfing” which she was not totally happy about.

When Ida Rolf died her students whom had been with her for a substantial amount of time had differing ideas about what the crux of the teaching was, and they split into different schools. Thomas Myers, developed “Kinesis Myofascial Integration” (KMI) as the flagship hands on training school utilizing the Anatomy Trains Myofascial Meridians, a revolutionary way of relating to the human body. Tom studied with Dr. Rolf in the 70’s. After 20 plus years of practicing “Rolfing”, developed the theory which later became the Anatomy Trains paradigm. While working with clients Tom noticed that when the feet were worked on, the hamstrings and spine were more relaxed and this led him to look for other connections or vectors of pull in the body that operated in the same fashion. He eventually arrived at 5 major lines of pull affecting our bony structure: Superficial Backline, Superficial Frontline, Lateral Line, Spiral Line, and Deep Front Line, along with the arm lines, and functional lines, (see These lines of pull along with their various fascial networks, affect all the major bony structures in the body including but not limited to the ribs, the legs, pelvis, the entire spine and arms.

He then did the anatomical dissections needed to prove the validity of that paradigm.

This work has as it’s premise that we are “tensegrity” ( a marriage of tension – integrity) structures, which means that our bones float in the muscles, and that trauma in one area can affect the whole structure. In order for the bones to be in good alignment, or pain to be resolved, the muscles have to be balanced around the bones, such that the joints can function with the proper balance of stability and freedom. This means that we seek an even tone or “palentonicity” in the whole fascial net; between the front and back, as well as the two side bodies.

Visual Assessment

I perform a visual assessment of the client’s standing posture as well as ask for various movements that relate to the aspect of the body I’m working with. Through these assessments I determine what treatment would be most beneficial.
For example, when a client comes in complaining of sciatica or pain in the low back which radiates down the leg, I know there is too much tension and a lack of fluidity in the back body, or Superficial Back Line in Anatomy Trains parlance. This excess tension is likely compressing the lumbar spine which is where the sciatic nerve arises from the spinal cord, ( between L3andL4 ). Often in this scenario the Sacroiliac joint (where the Sacrum meets the hip bone or Illium) is sublexated due to too much tension in the fascial network of musculature which affects that joint. That means the hip bone rides up onto the sacrum or vice versa causing pain in the low back. I can do a simple standing assessment to determine if that is the case, and if so I can do a Sacroiliac release to relieve that pain.

Also as part of this issue the Psoas and Illiacus which are antagonists of the Piriformis will be tight and tender. These are aspects of the Deep Front Line.

Treatment Strategy

I will address the Superficial Back Line, by working the layers of the back of the leg and sole of the foot from superficial to deep, separating the various layers that make up the back of the leg to bring ease of movement to as well as greater fluidity to the whole back of the leg thereby affecting the whole back body.

I would then tune into the buttocks which is where the Piriformis lives, working deeply into this muscle which lies atop the Sciatic nerve or has the Sciatic nerve running through it, depending on how you’re built.

Next, I would tune into the Illiacus and the Psoas to release the Deep Front Line aspects of this issue, looking for any other Deep Front Line aspect that needs addressing, such as Adductor Magnus in the inner leg. I work deeply and sequentially in a series of sessions designed to thoroughly address the imbalances in a way that can lead to a resolution of a long held postural pattern that is often the underlying cause of the chronic pain.

My treatments consist of myofascial release, somatic release, neuromuscular therapy, some Trager method, as well as cranial sacral used as an assessment tool.

Having the ability to read the body through a particular lens, in this case the “Anatomy Trains” lens, gives me a pathway for working with whatever I may find in the way of challenges facing the client. With a clear understanding of the vectors of pull affecting the various parts of the body I can often see, either with my eyes or my hands, the underlying causal factors creating the issue in the tissue. I feel very fortunate to have found this work and am indebted to Tom Myers for studying with Dr. Ida Rolf, Buckminster Fuller, and Moshe Feldenkreis. The way Tom took and developed what he received from them and the many other teachers he studied with along the way is a gift to the world.

I look forward to sharing this highly effective structural integration work with many more people! If this work looks like an avenue you’d like to explore please call me and we will set up an appointment.

How I Spend My Summers: Solitary Retreat Journeys & The Path That Led Me There

The great Sufi sage and poet Rumi, has a poem which perfectly captures why I am drawn to do Solitary retreat.

Seek the Wisdom that will untie your knot.
Seek the path that demands your whole being.
Leave that which is not, but appears to be,
Seek that which is, but is not apparent.

The knot Rumi speaks of, is the very deeply ingrained belief in a separate self. We all share this belief, and it’s at the heart of all the problems we face in the world today.

His Eminence Chagdud Tulku Rinpoche, my root Lama, whom I had the great privilege of living with and serving for two years, would tell us we were suffering from MeMineitis, a very serious disease in that it causes so much suffering.

The path Rumi speaks of, which demands your whole being is of course a very personal choice that one must make. For me that path has been Vajrayana Buddhism, and Dzogchen, with Hatha Yoga and Kashmir Saivism as adjunct aspects of the adventure.

I began my journey to an experience of Freedom at 15 when I experienced psychedelics for the first time. This began a lifelong inquiry into the nature of Reality and my place in it. I became a student of Swami Satchidananda at 16 which fostered my love affair with Yoga and its varied practices. At 19 I took refuge in the Mahayana vehicle of Buddhism as a Zen practitioner. At 21 I began an inquiry into Cristian Mysticism, which informed much of my parenting years until at age 40, disillusioned with my life as a householder, I picked up the book, “Gates to Buddhist Practice”, by His Eminence Chagdud Tulku Rinpoche and received a very powerful “Shaktipat” or transmission which changed my perception of reality forever. I knew in that moment I had found the Truth and the teacher I had been looking for my whole life, and that I must meet him and become his disciple. It turned out he was only 80 miles east of Arcata, where I lived at the time, in Junction City, at Chagdud Gompa Rigzdin Ling. I took refuge in the Vajrayana in 1996 with Rinpoche’s lineage holder Lama Padma Drimed Norbu, who is my current teacher, and began my journey on the very beautiful and powerful path of Vajrayana Buddhism.

I bring all this to the fore as a means of explaining that solitary retreat took me 19 years of dedicated practice to come to. One certainly doesn’t need to wait that long, but for me that’s how it unfolded. I do think it helped me immensely to have a lot of life experience and years of working through my “stuff” under my belt, as well as the blessings of receiving empowerment and teachings from many great masters including His Holinesss the Dalai Lama. These aspects of my life allowed me to drop into the practice of sitting in open awareness without a chorus of doubters within me asking questions like, ” why do I have to be alone?, what’s the point of all this?, this is boring, when are we going to do something interesting? “. Without a firm foundational understanding of the Path I had chosen, these voices could easily have distracted me from the fruits of the practice. I feel that my life experiences also helped me to understand the need for the involvement of ones entire being.

That brings us to “leave that which is not, but appears to be”.
Here Rumi is speaking of the process of withdrawal from “normal” life in favor of the ability to “seek that which is, but is not apparent”. For thousands of years people of many different traditions have left their normal lives to do retreat with the desire to uncover a deeper Truth. In Tibet, a three years, three months, three weeks, retreat is “de rigeur” for anyone seriously seeking enlightenment. Retreat gives one the opportunity to “leave that which is not, but appears to be” in order to experience “that which is, but is not apparent”. What is being spoken of as “that which is not, but appears to be”is our misunderstanding of our experience of Reality. This is alluded to in the Zen koan “nothing is as it seems, nor is it otherwise”. We know through the discoveries of quantum physics that what we see and experience as solid is actually not solid at all but filled with space. It is our doors of perception and the socially agreed to relationship to those perceptions that give us the experience of “solid” reality. Through spiritual practice it is possible to experience the source of all that we see as a dynamic display of Awareness itself. This experience is known as enlightenment, awakened mind or rigpa, (presence) in Dzogchen.

For most people, myself included, an experience of “that which is, but is not apparent”, is not enough to break the misunderstanding of reality, the fixation of separateness, and to cure”MeMineitis”.

It takes time, familiarization with the state of Awakened Mind to break our habit of thinking we are separate, and the belief in a “solid” reality. That’s why retreat is so important.

Retreat can take many forms. I did at least thirty group retreats of various sorts, as well as living at a Gompa, ( place of meditation) for two years while serving His Eminence Chagdud Tulku Rinpoche. Group retreats are a wonderful way to get your “feet wet” with the powerful experience of retreat.

Solitary retreat is a very different thing. You are with yourself 24/7 and it can be intense at times. There are a number of ways one can orient to solitary retreat. You can do a set routine of Sadhana, or spiritual practices, which can take many forms I can’t go into here, or you can simply be with yourself, which is the form I chose and which Lama Drimed suggested would be fruitful. No books, no screens, no recorded music, no teachings, just being with oneself in the present moment. My Guru let me know I could do Yoga, play my flutes, and enjoy artistic expression. Lama Drimed told me to be on the lookout for the inner critic, and the “should-er”, that voice that suggests what you should be doing right now. The main “mantra” Lama Drimed gave me was to ask myself this question often, “what would I do right now if I loved myself?”.

This question proved a very powerful one, as it brought me into relationship with my ability to love myself. It turns out, that to be able to accept and love oneself is crucial to the untying of the “knot” and the experience of that “which is, but is not apparent”.
“That which is, but is not apparent” goes by many names. The followers of Siavism would call it Siva or Parama Siva, the Krishnas, Krishna, Hindus might call it Supreme Consciousness, or Ram or Vishnu, Muslims would call it Allah, you get the point. In Dzogpa Chenpo or Dzogchen, it is known as Awareness, Awakened Mind, or Rigpa.

Awareness could be likened to the screen, so to speak, upon which the play of life is seen. That analogy falls short however because it’s two dimensional. It’s much closer to the truth to use the analogy of a holographic image. It’s three dimensional, arising in space, and its unique in that each piece of the image contains the whole image. The light is projected into space, so space is the container and the entrainer of the image. In Dzogchen, Awareness is likened to space. Space is incomprehensibly vast and everything we experience, including our every thought, is contained within it. Awareness and space are inseparable. In our normal lives the space/Awareness is forgotten in favor of the display. We love, or are challenged by the display, but the medium and creator of the display is Awareness, God, or any other label you want to apply to that which is beyond all labels. This medium, creator of the display, is the key to cure the disease of MeMineitis. It’s the great unifier, the “Canvass” so to speak, from which everything arises. So the path to experiencing the truth of that is to focus without focusing on Awareness/space, itself. The environment one chooses to practice this, is important at first.

The place I chose was very important to the realizations I’ve experienced. Lama Drimed found a yurt in a redwood forest (pictured above), not too far from his house, so I was able to drive a short distance to receive teachings from him and have him give course corrections as needed during the retreat. I also had good quality organic produce etc. a short drive from the yurt. I was self sufficient on every level, so this really helped with the nuts and bolts of my day to day existence. I would head to the store every 7 to 10 days to pick up supplies. This was an aspect of the retreat I feel helped me reintegrate back into my “ordinary” life after retreat. It showed me where I was at in terms of maintaining recognition of Awareness in the face daily activities. It also showed me how altered my mind had become through the meditation practices. This was very interesting to me, as I felt very high, almost like a marijuana high but different, clearer and deeper, with a sense of connection to everyone and everything around me. I didn’t notice it as much when I was by myself, as I gained familiarity with Awakened Mind and it became the “norm”.

Lama Drimed has taught, and demonstrates, that with time in retreat it is possible to live from Awakened Mind in ones daily life. To experience the Truth of the interconnectedness of all of life in an ongoing way. The timeless state of Awakened Mind is available within the time-bound experience we have each day, it’s just difficult to access. So that is why I have made the pilgrimage to my retreat cabin the last two Summers, and why I will make that pilgrimage again next year. Underneath the neurosis, the many layers of confusion, I found a truly blissful, spacious, carefree being whose most essential quality is Unconditional Love. We are all, at our essence, an embodiment of Unconditional Love. Spending time with realized beings gives one the opportunity to experience the Truth of that, and solitary retreat is an opportunity to experience one’s own innate inner Enlightenment, one’s Unconditional Lover. May all beings have that opportunity. May all beings awaken to the Truth of who they are in essence.