When Brian Bradley told Alexandra Giannini to crawl the perimeter of the carpeted meeting room, some observers may have recalled humiliations native to gym class and football fields. But Giannini didn't object.

Instead, the 29-year-old athletic trainer from Springfield shed her shoes, sank onto hands and knees, and circled the audience of about 40 fitness professionals. Then, still barefoot, she rose to her feet and paced back and forth, as she had prior to crawling. The crowd responded with approving nods. This time, Giannini, who suffers from a congenital defect in both hips that makes her feet point outward, walked with her feet pointing straighter.

"I wanted her to see that the most primitive exercise, like crawling, could get her to walk better," Bradley explained after the workshop, held in June at a hotel on P Street NW. "It reengaged her pelvis, which made her foot strike better. She felt more balanced, and that was just in one day. Imagine if she did the exercise every day."

Convincing people to engage in a regular program of peculiar-looking exercises is a big part of Bradley's mission. He is director of program development for the Egoscue Method, a 25-year-old therapy aimed at relieving chronic pain of the back, neck, shoulders and knees, as well as alleviating other ailments -- from headaches to bunions -- without drugs, surgery or manipulation.

Named after founder Pete Egoscue (pronounced ee-GOSS-kyu), a self-taught anatomical physiologist with a degree in political science, the Egoscue Method is an exercise therapy program that, like Pilates, Rolfing, the Alexander Technique and several other modalities, focuses on the role of alignment and posture in improved bodily function.

The Egoscue Method, which requires no equipment beyond a chair, an exercise mat or an empty expanse of carpet, involves individually tailored sequences of stretches and strengthening exercises meant to be performed for up to an hour a day. The program boasts clients in more than 85 countries; Egoscue has been embraced by National Football League standout Junior Seau and, late in their careers, by golf legends Jack Nicklaus and Arnold Palmer.

Most patients, however, are typical men and women between 40 and 70, such as David Hoagland of Potomac Falls. Back in 1989 while living in San Diego, Egoscue's home base, Hoagland experienced debilitating low-back pain. "It felt like someone had stuck a bayonet in my back," said Hoagland, now 52. "One doctor said I'd never run again. I couldn't live like that. Within nine months of starting Egoscue, I was back on the running track."

In addition to its San Diego clinic, Egoscue operates a smaller clinic in Stamford, Conn., and regularly takes its therapy on the road, setting up weekend clinics in or near major cities. The method also is finding its way into Washington area health clubs such as One-to-One Fitness centers in the District and Fairfax County, and Jungle's Gym in Burke.

Despite its spread, the Egoscue Method has not won the full support of medical experts or the fitness industry. Some orthopedic surgeons warn that while such therapy has merit, there are limits to how much it can achieve. Some personal trainers say the method is difficult for them to learn and the therapy too time-consuming or inconsistent with their prior training.

"We found holes in the Egoscue Method," said Christy DeNardo, fitness manager at The Sports Club/LA in the District, which recently scrapped a plan to institute a posture program based solely on Egoscue in favor of one that draws from techniques championed by several organizations, including the National Academy of Sports Medicine and the CHEK Institute, both in California. She said that some Egoscue exercise prescriptions were too long for clients to complete daily and that the approach wasn't backed by research.

Bradley points to the Egoscue Method's self-reported 94 percent success rate with its patients. He suggested that some fitness professionals may be frustrated because Egoscue does not merely require would-be postural alignment specialists to memorize exercises and then spit back the information on an exam. "It's not always a real good fit because we actually make them think about how to do something."

Still, Bradley did not characterize The Sports Club/LA decision as a negative development. "They weren't doing anything like this before. So even if they're doing a watered-down version (of Egoscue) now, someone is going to get well. And that's great."

A search turned up no studies of the technique. Pete Egoscue said he is aware of only one -- a 12-week program this summer at St. John's Riverside Hospital in Yonkers, N.Y. Bob Fanelli, clinical director of cardiac rehabilitation at St. Johns's, said final results are still being tabulated but that overall, the study's raw data showed Egoscue exercises to be a positive addition to cardiac rehabilitation programs. "In my opinion, [the Egoscue Method] is more effective than any modality that I've ever used as an exercise physiologist," he said. "Anything I can do to decrease the workload for my clients is good, because they're already compromised."

Asked why his method has not been the focus of more research, Egoscue suggested the scientific community lacked great awareness of the importance of posture, in general, or of Egoscue.

Back to the Blueprint

The concept behind the Egoscue Method is simple: The body has an original blueprint for standing posture. Picture the classic model of the human skeleton. Eight load-bearing joints -- two shoulders, two hips, two knees, two ankles -- all sit on horizontal lines that are parallel to one another and to the ground. If viewed from the side, the head, shoulders, hips, knees, and ankles are vertically aligned. The side view also depicts the S-curve of the spine, which enables the body to distribute weight evenly from head to toe and serves as an enforcer of the body's uniform structure and symmetry.

The problem is that most of us don't resemble the blueprint. Look in the mirror. Does one hip sit higher than the other? Do your feet point inward? Are your shoulders rolled forward?

Spend a minute in the company of an Egoscue therapist and you'll become painfully aware of your bad habits. Even standing with your weight resting mostly on one foot is a no-no.

The good news is that all of this is correctable. "The body is very smart," Bradley said. "You just have to give it the right stimulus."

For Egoscue, the stimulus comes in the form of more than 400 stretches and strengthening exercises. These Egoscue-cises, or E-cises, target muscles responsible for holding our bones in correct alignment, which prompts the question: How did we slip out of correct alignment in the first place?

That's easy, said Pete Egoscue. We stopped moving.

At the heart of the Egoscue philosophy is the belief that the human body was designed to move. Think hunters and gatherers. They ran, jumped, lifted and threw. Modern man, on the other hand, rarely treks deep into the woods to stalk his dinner. Rather, he sits at a desk, drives a car, orders takeout and clicks a remote. All these environmental changes, says Egoscue, have weakened the muscles charged with supporting our bodies and enabling us to move as we were designed to move.

Picture Imperfect

Even those who exercise regularly are not immune. Doris Matteau, a fit-looking 56, played tennis regularly until February, when she felt a pinch in her back while shoveling snow. "The next day I couldn't stand up straight," said Matteau, who lives in McLean. Her doctor put her on an anti-inflammatory medication, which allowed her to straighten up long enough to go skiing. That's when her right leg went numb. An MRI showed a bulging disk in her lower back. Her options? Surgery or physical therapy. She opted for eight weeks of physical therapy, with limited success.

Meanwhile, Matteau had begun performing E-cises she received online. By mid-June, she had returned to the tennis courts. In late June, she stopped by a traveling Egoscue clinic in Herndon to have her program reviewed and updated.

Forty-eight people attended the three-day clinic, held in a cleared-out conference room. Many suffered from some type of pain -- either in the lower back or in one or more joints. Each visitor underwent a 90-minute evaluation and treatment with one of three Egoscue-trained therapists. The fee for the first visit alone was $350; a package of eight individualized appointments, usually spread out over several weeks or months, cost $1,500. (Fees for online treatment are significantly lower.)

All appointments began with patients in bare or stocking feet and shorts; women wore a T-shirt or sports bra, men went shirtless. They assumed a normal standing posture while a therapist shot digital photographs from four views: left side, right side, front, and back. Next, a therapist conducted a "gait analysis," studying each individual for imbalances that occur while walking. Finally, E-cises were selected based on each patient's dysfunction. All exercises were to be performed between appointments, requiring up to an hour a day.

"In Egoscue, you get very intimate with your ceiling," said Barbara Lamborne, 46, of Lovettsville, while lying on her back with one leg resting, knee bent, on an inflated cube. She discovered Egoscue after undergoing hip surgery and seeing six orthopedic surgeons, one chiropractor and five physical therapists for persistent hip and back pain. The key to Lamborne's pain and Matteau's back problems, according to Egoscue therapists, are imbalances in their hips. Matteau's left hip was a bit elevated and Lamborne's left hip jutted out when she walked. Lamborne says the Egoscue treatment hasn't gotten rid of the problem, but it has helped.

Simply alleviating pain by injecting a drug, replacing a joint or resting an injury rarely corrects the underlying problem, said Pete Egoscue. He insists that most chronic joint pain -- barring disease, certain traumas or genetic defect -- results from alignment problems. Until correct posture is restored, ailments will continue to occur, if not in the same joint, then in another.

"If we understand [pain] and truly can interpret it properly, then the body responds, and it responds very rapidly," Egoscue said.

Posture-correction techniques do have merit, said John Klimkiewicz, chief of orthopedic sports medicine at Georgetown University Hospital. "You certainly do compensate to a large degree with your other joints when a single joint is affected."

Klimkiewicz maintains that an approach that considers posture would be most useful in treating overuse injuries, such as tendinitis, or pelvic imbalances where a specific injury is not involved. Even certain types of back pain may respond.

"Purely mechanical problems," such as severely torn tendons, would be best treated by surgery, he said.

Klimkiewicz sharply disagreed with some claims of Egoscue's advocates, though, such as their insistence that bunions are calcium deposits that can be eliminated by changing the way a person's foot strikes the ground.

"A bunion is a crooked toe," Klimkiewicz said. "You fix it by straightening it [through surgery], and the pain will go away." Other conditions he deemed not likely to respond to posture techniques include carpal tunnel syndrome and scoliosis involving a large degree of curvature. This view is not shared by Egoscue.

"You've got to be just a little skeptical," Klimkiewicz said. "Does this type of treatment have applications? Yes. Is it a panacea? No."

Straightening Up

Formerly hampered by low-back pain, Linda Miller, 59, of the District, faithfully engaged in E-cises -- not at a clinic, but during a recent visit to One-to-One Fitness on K Street NW.

Trainers at the gym sprinkled posture exercise throughout clients' workouts, whether or not they had a history of joint pain. Even weight-training exercises, such as biceps curls and shoulder presses, were monitored for correct posture.

"People like to view exercise as a benign entity that would be good for everybody," said Pat McCloskey, director of training at One-to-One and an Egoscue enthusiast. "But if people are getting strong in a crooked position, then they are strengthening a crooked position and just making things worse."

Most of the clients appeared to be over 30, in good health, and seemed to appreciate the focus on posture and corrective exercise. Miller, for instance, said she now understands what exercises to do if her back pain recurs, and she's more cognizant of maintaining correct posture in everyday tasks, such as lifting.

Fitness professionals who want to remain current are likely to integrate postural assessment and correction techniques, if not from Egoscue, then from another program, said Brenda Johnson, a personal trainer with a doctorate in physical education who draws from the Egoscue Method in working with clients at Jungle's Gym in Burke.

"It's not just about a great set of abs or a great set of glutes anymore. For the client to get the best value in terms of injury prevention and in terms of longevity, there's a need to learn to view the body as an integrated whole."


Dana Scarton's last fitness story for the Health section was about Heavy Hoops.

Pete Egoscue devised his therapy while recovering from a war injury.