When someone comes to me with shoulder pain, back pain, or recurring joint problems, I don't automatically assume the painful area is where the problem begins.
The body is an interconnected system. How you breathe, move, see, balance, respond to stress, and recover can all influence how you function physically.
As a CHEK practitioner, I use the CHEK Totem Pole to help determine what should be evaluated first. Developed by Paul Chek, this model organizes different levels of the body-mind system into a hierarchy, helping practitioners consider whether a problem in one area may be influenced by a higher-level control system.
The principle is straightforward: before focusing on a symptom, investigate the factors that may be contributing to it.
What Is the CHEK Totem Pole?
The CHEK Totem Pole is an assessment framework that organizes the body-mind system from higher-level influences, such as psychological state and basic physiological functions, down to the musculoskeletal system.
Rather than immediately treating a painful knee, shoulder, or back, the model encourages us to ask what else might be affecting how that area functions.
For example, recurring shoulder discomfort might involve local muscle imbalances or restricted joint mobility. But the assessment may also need to consider breathing mechanics, neck function, visual demands, stress, and the person's ability to stabilize their body during movement.
The Totem Pole provides a way to organize those questions and determine where to begin.
It is important to understand that the Totem Pole is a conceptual model, not a medically validated ranking of causes. Its value is in encouraging a systematic assessment, while clinical findings and appropriate medical evaluation guide decisions about an individual's care.
The Ten Levels of the CHEK Totem Pole
1. Psyche: The Person Behind the Symptoms
At the top of the Totem Pole is the psyche, represented by the white bird.
In practical terms, this level concerns a person's mental and emotional state, beliefs, motivations, and the choices they make every day.
Stress, expectations, coping strategies, and behavior can influence sleep, physical activity, recovery, and the experience of pain. Someone dealing with persistent stress may struggle to sleep well, relax their muscles, or maintain healthy routines.
When assessing a person, I consider their broader circumstances rather than looking only at their physical symptoms.
The model also uses the sun and moon to represent the balance between activity and rest, including the importance of circadian rhythms and sleep.
2. Respiration: How You Breathe
Breathing is essential to life, but it also plays a role in movement, trunk stability, and the body's response to stress.
I assess whether someone can breathe comfortably, expand their rib cage, and coordinate their diaphragm with their abdominal muscles.
Some people rely heavily on their upper chest and neck muscles when breathing. Others struggle to coordinate breathing with movement. These patterns may contribute to unnecessary muscle tension or make certain stabilization tasks more difficult.
Breathing assessment is particularly relevant when someone has neck tension, restricted rib cage movement, or difficulty maintaining core stability.
3. Mastication: The Jaw and Chewing System
Mastication refers to chewing. This part of the Totem Pole focuses on the jaw, temporomandibular joints (TMJs), teeth, and how the chewing system functions.
Jaw pain, restricted opening, clenching, and headaches may warrant assessment of the jaw and surrounding muscles.
The model also encourages consideration of eating habits and the choices people make about food.
However, jaw dysfunction should not automatically be assumed to cause pain elsewhere in the body. Symptoms involving the jaw or teeth may require evaluation by a dentist or another appropriately qualified healthcare professional.
4. Vision: How You See and Orient Yourself
Vision contributes to how we orient ourselves in our surroundings and coordinate movement.
Visual demands can influence head position, neck posture, and how we hold ourselves while reading, working at a computer, or using a phone.
For example, someone who spends hours looking at a screen may habitually position their head forward. Assessing their working environment, visual demands, and neck movement may help identify opportunities to reduce discomfort.
Persistent visual disturbances, eye strain, or double vision should be evaluated by an appropriate healthcare professional rather than assumed to be a postural problem.
5. Hearing, Listening, and Balance
This level includes the vestibular system, which contributes to balance, spatial orientation, and coordination with vision and sensory information from the body.
When someone has dizziness, balance difficulties, or problems coordinating head movements, these functions may warrant further evaluation.
The Totem Pole also uses listening as a broader concept: paying attention to symptoms, recognizing limitations, and responding appropriately to feedback from the body.
Balance problems can have many causes, so persistent or new symptoms may require medical assessment.
6. Upper Cervical Function and Adaptation
The upper cervical region includes the junction between the skull and neck and the upper cervical vertebrae.
Neck mobility, muscle function, and head control can influence how comfortably someone moves their head and performs activities that require looking up, down, or from side to side.
I assess neck movement and muscle function when appropriate, particularly in people with neck discomfort, restricted movement, or certain shoulder complaints.
The Totem Pole places this region at an important transition between the head and the rest of the body. However, it should not be assumed that an upper cervical problem is responsible for every musculoskeletal complaint.
7. Organs and Internal Health
The body's internal organs communicate with the nervous system and participate in complex physiological processes.
Internal health can sometimes affect musculoskeletal symptoms. For example, certain internal conditions can produce pain that is felt in the back, shoulder, or other areas.
Digestive problems, fatigue, and other persistent symptoms may also influence someone's ability to exercise, recover, and function comfortably.
This is why a whole-person assessment includes relevant health history and awareness of symptoms that may require medical evaluation.
The goal is not to assume that an organ problem is causing a muscle imbalance. It is to recognize when a complaint may involve more than the musculoskeletal system.
8. Emotions and Stress
Emotions can influence breathing, muscle tension, sleep, behavior, and the way we experience pain.
When someone is under sustained stress, they may have difficulty relaxing, recovering from exercise, or maintaining consistent health habits.
I consider stress and emotional well-being as part of the overall picture because physical function does not exist independently of a person's life circumstances.
This doesn't mean that pain is imaginary or that a person's symptoms are simply emotional. Pain is real, and its causes can be complex. Psychological and physical factors can interact without one invalidating the other.
9. The Sacrum and Pelvic Stability
The sacrum connects the spine to the pelvis and plays an important role in transferring loads between the trunk and lower body.
Pelvic control, hip mobility, and core function can influence how someone bends, lifts, walks, and performs exercise.
When assessing lower-back, hip, or lower-limb complaints, I may evaluate pelvic movement, core stability, and the coordination of the surrounding muscles.
For example, someone who struggles to control their pelvis during movement may benefit from targeted stability work and an appropriate progression of exercise.
The goal is to improve functional control—not to assume that every knee, hip, or back problem originates in the pelvis.
10. The Remaining Joints and Musculoskeletal System
The final level includes the rest of the musculoskeletal system: the shoulders, knees, ankles, elbows, and other joints and tissues.
These structures are essential to movement, but their function is influenced by many factors, including local strength, mobility, coordination, training demands, and recovery.
If someone has recurring knee pain, I assess the knee itself while also considering relevant factors such as hip function, ankle mobility, movement technique, and training load.
The Totem Pole reminds us to consider the larger system without overlooking the local problem.
A whole-body approach doesn't mean ignoring the painful joint. It means assessing that joint in the context of the person who uses it.
How I Use the CHEK Totem Pole in Practice
The practical value of the Totem Pole is that it helps organize the assessment process.
Rather than automatically prescribing stretching or strengthening, I consider which factors need to be evaluated first and which findings are most relevant to the person's symptoms and goals.
Depending on the individual, that process may include:
Reviewing health history, symptoms, sleep, stress, and activity levels.
Assessing posture, joint mobility, muscle function, and movement patterns.
Evaluating breathing mechanics, core function, and stability.
Identifying whether symptoms warrant referral to a medical professional.
Developing a targeted plan based on the findings.
The Totem Pole is a guide for asking better questions, not a substitute for clinical judgment or medical diagnosis. Its different levels are not proven to form a strict causal hierarchy, and the highest level does not necessarily explain every problem below it.
Why This Matters for Body Alignment
Body alignment is more than standing up straight. It involves how your joints, muscles, and nervous system work together to produce controlled, efficient movement.
But movement is only one part of the picture. Breathing, stress, sleep, general health, and daily habits can also influence how you feel and function.
My goal as a CHEK practitioner is to understand the person before deciding what their body needs. That means looking beyond symptoms, assessing relevant factors, and choosing interventions that address the individual's actual limitations.
The CHEK Totem Pole gives me a framework for deciding what to assess first, so I can make more informed decisions about how to help someone move and function better.
