How Egoscue Works

I had a client in the other day and I thought her situation did a really nice job of clarifying how Egoscue works and how we look at the body, so I thought I’d share her situation with you.

Susan (not her real name) came to us with left foot pain. She had tried all kinds of things to make it better, including physical therapy, chiropractic, stretching, acupuncture, and drugs. Nothing worked and it was hurting more than ever.

One of the things I love about Egoscue is that it takes a comprehensive look at the body. Most people assume the problem is where the pain is, but that’s rarely the case. The pain is obviously telling us there’s a problem at that location (in this case, her left foot), but the core problem that is responsible for that pain is usually elsewhere. So, how do we figure that out? Let me walk you through an abbreviated version of the analysis portion of her appointment.

The first thing we teach new Egoscue therapists is NOT to treat symptom. Focus on the whole body, see the client’s posture as a whole and let it tell you its story. I wasn’t looking at her thinking “what kind of exercises can I give her to help her foot feel better”. No, instead I was looking at her body and asking myself “what is going on with her body as a unit?”

The first thing that jumped out at me was when she was facing towards or away from me it was very apparent she had an elevated right hip. It wasn’t a little higher than her left hip, it was a LOT higher, like a full inch. Now, I know from clinical experience that when a hip is that elevated, often the client will have trouble efficiently putting weight on that side. The hip is just so out of position that they can’t effectively ‘load’ it. Weight is designed to be carried evenly between the left and right sides of the body. In her case, just standing there, I could see a weight shift to the left.

So, I ask her to stand there and bend her right leg and lift the knee up to waist high and balance on her left foot. She can balance on her left leg (the symptomatic side) without a problem. I then ask her to switch and stand on her right side and she’s really unstable, having a lot of trouble finding a balance point. So now I’m REALLY suspecting this right hip elevation is a key factor in her left foot pain. But I want to see her walk first. So I ask her to walk to the other side of the room and back. She does, and guess what I see? She limps onto her left side, the painful side! Not in a dramatic way, but you can absolutely see it, and you can also hear it. Her left foot hits the ground harder than her right foot. I ask her if she can feel it and she says she can, kind of. Then I ask if she can hear it and she pauses for a minute and says “absolutely, no question.”

Then I ask her “so why would you limp ON to your painful side? Most people limp away from pain, not into it.” She thinks about that for a minute and says “I have no idea, but you’re right, that doesn’t make sense.” So I explain to her my thinking, that her right hip is so out of position that she is simply unable to load her weight evenly from left to right. Theoretically, that makes sense to her.

So that’s it, right? Her left foot hurts because her right hip is up, causing her to shift weight to the left, and we need to give her hip exercises to lower that right hip. Not so fast! First, we have to figure out why that hip is up. Maybe the problem IS with the hip and she needs hip exercises, but maybe something else is going on.

One thing we often see in our clinics is that a client’s upper body position has a profound impact on the ability of their lower body to be properly positioned and to work correctly. As I’m looking at Susan from a side view, what do I see? I see a pelvis that is tipped back on itself, an upper body that is rounded forward, shoulders that are hinged forward, and a head that is way in front of her shoulders. Her entire upper body is rounding into flexion. She’s basically dropping into a big ‘C’ curve. So I have her face me again and I put a thumb on top of each side of her pelvis right at her sides and I confirm her right hip is an inch high. Then keeping my thumbs there, I ask her to interlace her hands behind her head and pull her elbows back. Hard. She does and makes a little sound, like I’m asking her to do something really difficult. As she’s pulling her elbows back, guess what happens to her hip? It drops completely level with the left one! So now I ask her to walk across the room and back while she keeps her hands there and keeps pulling her elbows back. She does and now he’s loading her left and right sides evenly, no disparity. She can feel it and she can hear it. That sound difference from before is gone and she is blown away.

She says “so, the answer is I just have to walk around like this for the rest of my life, right?” and she laughs. I look her in the eyes and say “yep, that’s exactly the answer, but we need to get your upper body in that position without you having to do that to get it there.” She nods in agreement; she gets it.

What did the hands behind head test do? It took an upper (thoracic) back that was stuck in flexion and shoulders that were rounded forward and it artificially put them into a more extended position, closer to the blueprint of where they’re designed to be. Then we stepped back to see how the rest of the body changed. And what we saw was her hip dropped level and her walking normalized.

So what does it all mean? This: Susan has left foot pain. Her left foot hurts because she beats it up with every step because she puts more weight onto it than it should normally get. On top of that, as she keeps shifting weight onto her left hip, it’s gotten progressively tighter and tighter over time to the point that now the foot and knee no longer point straight ahead, but point out to the side. So not only is she putting more weight on that side than it’s habitually intended to receive, but the hip has gotten so tight that it’s pulled the foot out of position and now she’s lost normal heel/ball/toe function when her foot contacts the ground as she walks. Bottom line, she’s beating the heck out of that foot with every step!

Why does she put more weight there? Because the right hip is so out of position she can’t load her weight evenly. And why is the right hip out of position? Because her upper body is pulling it there! So, to help her heal her left foot and resolve that foot pain she MUST change the position of her upper back and shoulders!

Everyone else who tried to help her did so by giving her exercises for her foot. But as you can see, she could’ve done those exercises for the next 10 years and it wouldn’t have change the core issue, the position of her upper body. So we gave her a menu (a routine of exercises) designed to feed her upper body the extension demand it was screaming for, along with some exercises to help assist that hip into a better position and help it be stable there, and by the end of her session her hips were level and she was walking better than she had in years.

Now it won’t be a quick fix. She needs to do her exercises every day to retrain her body where it’s supposed to go, but if she does the work, her body won’t just temporarily get into a better position, it will stay and live there. And once that happens, the left foot pain will be a thing of the past.

Remember folks, the pain isn’t always where the problem is. In fact, it’s rarely in the same place. Your body works as a unit. If you assess and treat it like a unit, you’ll get great results. If you’d like help figuring out what YOUR body is doing, go to and enter your zip code to find your nearest Egoscue clinic. Then give them a call. I promise you, they will not try to sell you anything, they’ll just answer your questions and do their best to serve you.

If you have questions or comments about this post, please enter them below and I promise to respond. And pass this on to your friends and family. The more people who understand these concepts, the more people who can stop hurting. Let’s stop being afraid of pain, let’s stop trying to shut it up, and instead, let’s listen to it, learn from it, and then intelligently respond to it! If your body hurts, it’s asking for help. Are you going to ignore it, or are you ready to listen and act? The time to begin making things better is NOW!

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14 Comments on “How Egoscue Works”

  1. Janne Alasalmi Says:

    Thanks Rick for this great post! Keep ’em coming! Most educational for the folks trying to figure out what to do with all the aches and pains that intefere with everyday life.

    It’s always so cool to demonstrate this whole body linkage with a new client. It never gets boring :^)

  2. […] How Egoscue Works – by Rick Mathes […]

  3. jeff Says:

    Rick, thanks for a great post! A very useful and insightful walk in your clients shoes showing what the Method is all about. It also reveals the crucial role the client plays in the detective work pain often leads us to. One of the best examples of the chain reaction the body goes through when things start to go awry AND most importantly the journey back toward health. Thanks again to you and your client for sharing valuable experience for all to learn from.

  4. […] I had a client in the other day and I thought her situation did a really nice job of clarifying how Egoscue works and how we look at the body, so I thought I'd share her situation with you. Susan (not her real name) came to us with left foot pain. She had tried all kinds of things to make it better, including physical therapy, chiropractic, stretching, acupuncture, and drugs. Nothing worked and it was hurting more than ever. One of the things I l … Read More […]

  5. Great Post Rick.. The magic of the body never ceases to amaze me! I am going to pass it on. I know it will help many people. Keep up the great work Rick.

    I love our Egoscue Team. What a unique, caring group of talented people.. Makes me proud.. Do you want to pass me a tissue? thanks 🙂

  6. greg phillippi Says:

    Howard still lives! 🙂 Good to hear from you.

    Rick, it was a terrific post. It reminded me that I need to look a little closer at times. I want the person to feel better quickly and I often take shortcuts. Because of your post, I’ll be a bit more meticulous when looking at and assessing the posture. Hope you’re doing well.

  7. […] To read the original version visit Rick’s bog Ramblings from the Hill Country […]

  8. […] Final note, if someone would like to talk with a licensed Egoscue therapist but you don’t live anywhere near one of our clinics, we also do therapy by Skype. We introduced it a few years back and I was skeptical it could be effective, but I was wrong. Our skype clients do beautifully, and it allows people to get help regardless of where they live. All you need is an Internet connection and a webcam (and the free skype software). Every clinic does this therapy. So if you have more specific questions or are contemplating utilizing our approach at some level (whether it’s working from a book or getting personalized help), I’d suggest contacting the clinic closest to you geographically and then asking if you could do a free consult via skype with them so you can outline your issues, goals and concerns. Every clinic would be happy to do that at no charge. all the best. […]

  9. John Burden Says:

    It is a very awesome information. Thanks for sharing. St. Petersburg FL back pain

  10. But how do the Egoscue exercises work to change posture? I can’t find this answer even in Pete Egosuce’s books; Most of the exercises involve holding a posture with certain muscles loaded. Why does that change things? Is it about flooding the body with proprioceptors? What does it physically do that makes the body react with a better posture?

    • Rick Says:

      Well, the body utilizes the principle of ‘use it or lose it’. Often the body has stopped using a certain musculoskeletal function because of the motion patterns of the individual. So to put it simply, by putting the body in a position where we essentially ‘trap’ the musculoskeletal system and force the desired function to fire, without letting the individual’s body run back to its compensatory movement and stabilization strategies, we can then get that function turned back on.

      Some exercises are repetition based, some as described above are putting the body into a position and holding it for a length of time. For the latter, it can take time for compensatory muscle patterns to fatigue and ‘give up’ so that the desired function can re-engage. Once a muscle ‘wakes up’ and begins to fire, it will regain tone, hopefully regain normal length and tension, and as that happens its line of pull on the bones to which it connects changes. Remember, bones go where muscles tell them to go, so as a muscle changes length and tension, that will immediately impact the position of the bones it attaches to.

  11. Carole Says:

    So, what was the menu you gave her? I have all your books, I have had sessions with the Florida clinic, and have done lots of menus and I still have a high right hip. Pain in in the right lower back. I don’t have a C curve back.

    • Rick Says:

      Honest? No idea. That was several years ago.

      So regarding your high right hip, you did menus every day for 6 months and it didn’t change position?

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