Why Won’t The Pain Go Away?

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After nearly thirty years in clinical practice, I’ve noticed the question I hear most often isn’t “How do I manage my pain?” It’s “Why won’t it go away?”

After months of physical therapy for a stiff, aching upper back — the stretches, the foam rolling, the ice — Alice discovers nothing sticks. Exploring her anatomy from a new perspective, the real culprit reveals itself: it’s not in her upper back at all, but in her chest, where tight, shortened muscles have been quietly pulling her shoulders forward for years. The upper back isn’t the problem. It’s the casualty.

The place that hurts is rarely the place that’s actually broken. And more often than not, the real root cause isn’t an injury, an illness, or simply “getting older.” It’s a muscle imbalance.

Chronic pain has quietly become one of the defining health crises of our time. By some estimates, tens of millions of Americans live with it, and the toll shows up far beyond the doctor’s office — missed workdays, disrupted sleep, canceled plans, and the slow erosion of a life fully lived.

The Body Out Of Alignment

Despite the enormous variety of aches, strains, and chronic conditions people experience, most musculoskeletal pain shares a common origin: the body has drifted out of alignment. Certain muscles become short and contracted, while their opposing muscles become overstretched and weak. Over time, this tug-of-war pulls the bones of the skeleton out of position. The result is a body that is, quite literally, crooked.

This kind of mechanical imbalance is behind the large majority of the pain people carry through their lives — far more than any single injury or diagnosis.

Take rounded shoulders, one of the most common imbalance patterns. Hours spent hunched over a desk or a phone cause the chest muscles to shorten and tighten, while the muscles between the shoulder blades become overstretched and strained. Here’s the twist: those overstretched muscles often feel tighter than the shortened ones. It’s why so many people reach instinctively for a stretch across the upper back, when the true source of the problem has been sitting quietly in the chest the whole time.

That’s the counterintuitive nature of muscle imbalances — and why so much conventional treatment stalls out. You can stretch and strengthen the wrong side of the equation for years and never touch the source.

A Roadmap Back To Balance

The good news is that the solution is every bit as logical as the problem. A muscle that’s become too long and weak needs to be strengthened. A muscle that’s become too short and tight needs to be released and lengthened.

Restoring the body’s natural balance doesn’t require complicated procedures, expensive equipment, or a lifetime of pain management: it requires addressing the imbalance directly, at its source. People who had resigned themselves to a life of pain discover that relief is closer than they thought.

Start With Sitting

You don’t need a clinic to begin correcting muscle imbalances — you can start with something you do dozens of times a day without a second thought: sitting. Feet flat on the floor, the natural curve of the lower back supported, ears stacked over the shoulders. Small adjustments, practiced consistently, reduce mechanical load on the spine and give weakened muscles the chance to re-engage.

Here’s what that looks like in practice. Start from the ground up: feet flat, knees bent at roughly a right angle and no higher than your hips. If your chair or desk forces your knees up above hip level, your pelvis tips backward and the lower back’s natural curve collapses with it — so a footrest, or simply lowering the chair, matters more than people expect. From there, let the low back settle into its natural inward curve rather than rounding into the seat back; a small cushion or rolled towel at the small of the back can remind those muscles what the position is supposed to feel like until it becomes automatic.

Shoulders come next: instead of letting them slide forward and down toward the desk, draw the shoulder blades gently back and down, toward the rear pockets, which re-engages the very muscles between the shoulder blades that rounded posture leaves weak and overstretched.

Finally, the head: rather than jutting the chin toward the screen, slide it back so the ears line up over the shoulders, not out in front of them. Even a monitor set too low pulls the whole chain forward, so raising the screen to eye level takes one more source of strain out of the equation.

None of this needs to be held perfectly, and trying to hold any position rigidly for hours will only create new tension. What matters more is the reset: every twenty to thirty minutes, notice where your body has drifted and gently walk it back through the same checklist — feet, low back, shoulder blades, ears. Over weeks, that repeated cue is what retrains the weakened muscles to hold their own position instead of relying on the short, tight ones to do the work.

For a short walkthrough of how to sit correctly, watch this video. Your mother was right all along. Sitting straight is good for you!

Lee Albert, NMT, is a neuromuscular therapist and the creator of Integrated Positional Therapy (IPT), a self-care system designed to eliminate neuromuscular pain at its source. He is the author of Live Pain Free and Yoga for Pain Relief (winner of the 2018 IBPA Benjamin Franklin Gold Award), and has been featured in two national PBS specials. Learn more about his work at www.leealbert.com.

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