(Published by South Bay Accent magazine in June, 2016.)
Most of us pay little attention to the topic of back pain. That is, until inevitably joining the unhappy eight out of 10 Americans who will suffer from some sort of back episode during their lives. Ask any of the millions of sufferers and the picture is grim, with spinal trouble turning everyday activities like sitting, standing, moving or sleeping into agonizing or impossible acts. Even just bending over to brush your teeth can become a painful challenge.
Back pain is one of the most common reasons for missing work, the leading cause of work-related disability, the number-two reason for doctor visits and a seeming black hole for our economy. One study reported that the direct and indirect costs of spinal distress amount to greater than $100 billion annually in the United States.
In the thriving South Bay where so many of us hunch over computers many hours a day, back pain is eating a big chunk out of our productivity. We flock to chiropractors, acupuncturists, physical therapists, physiatrists, neurosurgeons, orthopedic surgeons or anyone who promises relief while spending millions on pain meds, braces, pricey ergonomic chairs and other aids. But what’s the all-too-frequent outcome? Continuing pain and depression over how it seems to take over our lives.
But what if these standard approaches were all wrong? What if surgery and special chairs and lumbar cushions and treatments that encourage an s-shaped spine — considered correct by today’s professionals — were hurting rather than helping? What if relief all boiled down to emulating how more primitive people move? After all, back problems are scarce among these tribes.
This is the proposal of Esther Gokhale (pronounced go-clay), who’s been called “Silicon Valley’s posture guru,” “the back whisperer,” “the Michael Pollan of posture” and variations on this theme. Based in Palo Alto, Gokhale has been reintroducing clients to what she calls “primal posture.” And the results are astounding. She’s been profiled by the New York Times, ABC News, NPR, the Financial Times, Prevention Magazine, Woman’s Day, Men’s Journal and many more. Regionally, her techniques have been covered by the San Francisco Chronicle, KRON-TV, ABC’s San Francisco affiliate and others. She’s even done a TED talk on her posture techniques. Her 2008 book, “Eight Steps to a Pain-Free Back,” is an Amazon favorite and gets glowing customer reviews.
In her exotically, faintly accented voice, the tall, handsome brunette discusses her Gokhale Method — taught to students around the world by instructors in weekly classes — with the calm passion of an insider. “I have lots of sympathy for people who suffer because I’ve been there,” she explains. Although her fame has grown along with the countless successes among the close to 10,000 students who have taken her classes so far, she remembers every moment of the personal experiences that spawned this undertaking.
The daughter of a Brahmin-class Indian professional and his Dutch wife, Gokhale — a significant surname in Western India — grew up in Bombay, where she watched her nursing-trained mother explore alternative medicine approaches while caring for abandoned, often deformed kids as adoptees. Gokhale’s mother was also very observant of how many in the lower classes who had physically difficult jobs like spending hours stooped over while sweeping floors still seemed healthy and unimpaired.
Gokhale came to the United States to attend Harvard, then Princeton, graduating with a degree in biochemistry. Inspired by her insightful, compassionate mother, her career objective was to perform research in alternative medicine. By the time she met her husband-to-be playing ping pong at Princeton and they had later moved to California for his professorship at Stanford (he’s now chairman of the university’s math department), “I had had a couple of episodes with my back,” notes Gokhale. As is common, her pain resolved after a few weeks.
Living on the Stanford campus with her husband and working as an acupuncturist, she had no back issues until the late ’80s during her ninth month of pregnancy with her first child. Experiencing severe sciatic pain, “I was miserable,” she recalls. “I had a badly herniated disc and I tried a lot of alternative and conventional things. They didn’t work so I had surgery when my daughter was a year old.
“Then I was relatively pain free, although I could not lift or carry my daughter and was advised to have no more children,” explains Gokhale. “Within 12 months of my surgery, the pain returned and my doctors recommended further surgery. Instead, I decided to find my own path out of misery and to begin my own deeper research into the causes and treatments of back pain. I studied everything I could,” she recalls. This included movement-related programs like Feldenkrais, Alexander and the well-regarded Aplomb approach developed in France.
“Some of these techniques are inspired by people in indigenous cultures,” explains Gokhale. Remembering her mother’s observations about Indian laborers, “This made more sense to me than anything else.” She traveled “off the tourist track” to many primitive villages around the world “observing, filming, photographing and interviewing people who had no back pain” while utilizing her language skills — she speaks seven — and her natural warmth and charisma.
It was clear she was onto something. She saw older women in Western Africa who had spent years bending at a 30-degree angle for nine hours a day gathering water chestnuts pain free. She photographed primitive workers who were able to bow over to mold clay bricks by hand for their whole lives and have no negative physical impact.
At the heart of Gokhale’s many repeated aha moments during her travels was the natural posture of these villagers and how different it was from the “normal” spine position in the West. “We’ve lost the tradition of healthy posture that in a village is just yours for the taking,” she laments. “You’d be carried well and you’d be observing people who bend a certain way and you’d be mimicking them. We’ve lost that baseline but what’s worse is that our fashions point us the wrong way — toward an s-shaped spine. Ergonomic chairs and car seats create curve in the back rather than lengthening it. Also, we’re not that physical anymore.”
As more prosperous countries lost their village-influenced traditions, the tucked pelvis and resulting slump portrayed in then-modern fashions “did a bad number on people about a century ago,” explains Gokhale. As this s-shaped spinal posture made its way into society, parents thought it was proper “to exhort their kids to ‘sit up straight’ and ‘stand up straight,'” she notes. “There’s a sway that develops. Then people tuck their pelvis to get rid of the sway. You want to tuck the rib cage, not the pelvis.”
This unhealthy posture eventually became the new normal, alas. “It made its way into the medical profession,” reports Gokhale. “Now there are many layers of misconception.” This s-shaped spine and less-active lifestyles are the direct contributors to today’s back maladies, she believes, but achieving the s-shape is still what’s taught to chiropractors and physical therapists, who urge clients to attain this too-curved shape. Meanwhile, some of the avalanche of back pain in the West is also being treated by physicians through epidural spinal injections and costly surgeries so there are obvious financial incentives to continue this approach.
The spine on the left is from an anatomy book published in 1911 and shows what was considered normal then: a j-shaped spine. The spine on the right is from an anatomy book published in 1990 and shows the current “normal” spine, which has now become curvier and forms an s-shape.
As she studied and traveled, it was clear to Gokhale that having a j-shaped spine was the commonality among the healthy villagers she met so when she returned home, she started sharing posture techniques with her acupuncture clients and friends. The results were so powerful that this later evolved into the Gokhale Method classes, her book, DVDs and a variety of helpful aids. Even now, “People have trouble believing that the way you sit and stand will have such a big impact when so many prestigious, established methodologies have failed,” she says. “It’s our challenge to encourage people to give this a try.”
A common refrain among those who have taken Gokhale’s classes — “We call them students because it’s an education,” she says — is sorrow that they didn’t discover primal posture years earlier so they could have avoided so much pain. In the Bay Area, her approach has garnered testimonials from dozens of former “students,” including well-known figures like Joan Baez, You Tube CEO Susan Wojcicki, high-tech entrepreneur Donna Dubinsky, Oracle board member Ray Bingham, three time Olympian PattiSue Plumer, renowned author and professor Paul Ehrlich and many more.
According to Ehrlich, before the Gokhale Method, he had spent more than two decades suffering from back pain so bad that it often interrupted sleep and sometimes, “I was unable to walk more than 50 yards without squatting to relieve the pain,” he reports. Renowned runner Plumer successfully used the Gokhale Method after nothing else had worked for five years after an injury.
Among the many non-famous Gokhale students in the region is Palo Alto resident Pam Page, who reports she’s “always had a troublesome back,” which had long been addressed by muscle relaxers and other medication. Her need for relief was obvious. “It was awful,” she recalls. “There are times when you have to crawl rather than walk. My back hurt almost all the time.”
Around five years ago, Page was referred to Gokhale by an enlightened internist and she took the six-session class with her adult daughter, who had been a national swimmer but also suffered back pain. The results were dramatic and immediate. Page hasn’t taken any pain medication since and her daughter, after incorporating the spine-lengthening Gokhale techniques into her routine, was measured an inch and a half taller at the end of the six-week class.
Says Page: “It’s a discipline and you have to incorporate it into your daily life but it sure beats surgery. A lot of people think surgery is an instant fix but I know many who didn’t have great results. That’s like getting liposuction when you need to lose weight — it’s not gonna last.”
In a conservative profession not known for promoting alternative approaches, what’s most remarkable is the lineup of physicians who not only testify to the benefits of the Gokhale Method, but have referred hundreds of patients. Stanford pediatrics professor Dr. Harvey Cohen admits, “We have not served our patients with back pain well.”
There are even a few surgeons who support the notion of primal posture. According to Stanford neurosurgeon Dr. John Adler, “Every year, tens of thousands of patients undergo major back surgery without any benefit. By using Esther Gokhale’s novel techniques, many of these patients can avoid such needless and expensive medical procedures and quickly return to a pain-free life.”
Gokhale reports that “We get a lot of referrals and we’ve had over 300 physicians take the course.” One of many converts is Palo Alto Medical Foundation (PAMF) internist Dr. Jessica Davidson, who says that “Esther Gokhale’s vision of what makes a healthy back will be startling to most Americans because it’s so different from what we have always learned. With the adoption of even a few of Esther’s precepts, a life of bad habits can change to a life of healthy sitting and moving and therefore a life of less pain and more freedom.”
PAMF colleague Dr. Deirdre Stegman has referred more than 300 patients to Gokhale and states that “As one of my colleagues declared, I’ve become a true believer” in the Gokhale Method. Among her referrals was her 85-year-old mother-in-law, who had a withered left side from childhood polio, severe osteoporosis and arthritis and could only move bent over a walker. “Within one session, she was already sitting up straight and by the end of the program, she had learned to pick herself up from the floor unassisted in case of a fall,” says Dr. Stegman.
During the Gokhale classes, students are taught gentle techniques for sitting, walking, sleeping and bending based on the j-shaped spines exhibited by more primitive people. The positions and movements are subtle and sometimes quite involved in the case of what Gokhale calls glidewalking. But even incorporating just a few techniques such as contracting the gluteus medius muscles in the buttocks on each step can make a profound difference. According to Pam Page, “I can still have pain in the morning but as soon as I go out and do the glidewalking, it disappears.”
As for Gokhale herself, “I’m in the clear,” she reports. “I haven’t had a back pain or a twinge in over 20 years. I’m glad I didn’t have another surgery and found another way to get to the root cause of the problem.” Disproving the advice she got from physicians years ago, she had two more children after her first born — who earned her medical degree and is now doing an internship. All her children have excellent posture, of course, and her two youngest participate in competitive athletics.
At this point, she is on a mission. “My goal is very clear. I would like to make back pain rare. I’d like it to be strange, once again, for people to have lower back problems,” she says. To that end, her techniques are not only taught in classes throughout the world but she is a frequent guest at companies seeking to help their desk-bound employees better cope with the physical strains of white-collar jobs. Among the local companies where she has appeared are Google, Facebook, Oracle, IDEO and Varian.
Although there’s still a whole industry of back-related products, treatments, therapies and medical procedures imbued with the notion of achieving an s-shaped spine, Gokhale believes her approach can still win. “People need this,” she says. “It gives them the chance to hope because a lot of people have had their hopes dashed. That roller coaster (of dealing with back pain) takes a big toll on the system.”
Echoing the calm, encouraging, hopeful perspective she watched her mother display when caring for sick, abandoned children while Gokhale was a girl in Bombay, she is optimistic about the future. “Water finds its level,” she explains. “At some point, this will become fashionable.”
Five Tips for Better Posture and Less Back Pain
Try these exercises while you’re working at your desk, sitting at the dinner table or walking around, Esther Gokhale recommends.
- Do a shoulder roll: Americans tend to scrunch their shoulders forward, so our arms are in front of our bodies. That’s not how people in indigenous cultures carry their arms, Gokhale says. To fix that, gently roll your shoulders a little forward, a little up, a lot back and then down. Now your arms should dangle by your side, with your thumbs pointing out. “This is the way all your ancestors parked their shoulders,” she says. “This is the natural architecture for our species.”
- Lengthen your spine:Adding extra length to your spine is easy, Gokhale says. Being careful not to arch your back, take a deep breath in and grow tall. Then maintain that height as you exhale. Repeat: Breathe in, grow even taller and maintain that new height as you exhale. “It takes some effort, but it really strengthens your abdominal muscles,” Gokhale says.
- Squeeze, squeeze your glute muscles when you walk:In many indigenous cultures, people squeeze their gluteus medius muscles every time they take a step. That’s one reason they have such shapely buttocks muscles that support their lower backs. Gokhale says you can start developing the same type of derrière by tightening the buttocks muscles when you take each step. “The gluteus medius is the one you’re after here. It’s the one high up on your bum,” Gokhale says. “It’s the muscle that keeps you perky, at any age.”
- Don’t put your chin up: Instead, add length to your neck by taking a lightweight object, like a bean bag or folded washcloth, and balance it on the top of your crown. Try to push your head against the object. “This will lengthen the back of your neck and allow your chin to angle down — not in an exaggerated way, but in a relaxed manner,” Gokhale says.
- Don’t sit up straight!“That’s just arching your back and getting you into all sorts of trouble,” Gokhale says. Instead do a shoulder roll to open up the chest and take a deep breath to stretch and lengthen the spine.