|Injury Prevention | Yael Grauer
I first wrote about Esther Gokhale in the February 2010 issue, after reading 8 Steps to a Pain-Free Back and taking a Gokhale Method Foundations course, where I learned how to sit and walk and lay down again. Gokhale, a Harvard and Princeton-trained biochemist, studied the kinesthetic principles in tribal cultures where back pain is virtually nonexistent. She also studied ancient Greek statues, the natural movements of babies and photographs from the past, and meticulously synthesized all of the information she had found to create a system of movement that reestablishes the body’s structural integrity through healthy posture and movement. Since this system is so useful for pain-free living, I thought it’d be equally helpful for injury prevention, and so I turned to Esther Gokhale again for her to discuss common sports injuries through the lens of her life’s work.
I thought we could talk about how the work that you do can help people prevent injuries, so what we did was come up with five of the most common injuries that we think our readers would struggle with, and so I thought we could spend a little bit of time talking about each of them.
I thought we could start by discussing SLAP tears; tears in the labrum of the shoulder which throwers or people who just lift very heavy often end up with. What’s a good preventative measure for those?
I think there are several approaches, and the first is architectural. If the shoulder joint has optimal architecture to begin with, this helps reduce the risk of tear and other injuries too, arthritic changes for
example. If the bones are not sitting in juxtaposition, that puts stress in inappropriate locations. This induces calcium deposits and osteoarthritic changes, which can raise the risk of injury of various sorts.
Also, it’s best if the baseline length of the muscles surrounding the joints is healthy: not too short, not too long, but especially not too short. When they go to full extension, you don’t want the difference in length from baseline length to the final length to be too drastically different because that then increases risk of tear.
A very common example is hamstring tears. If the pelvis is tucked, the hamstrings adjust to a short resting length, and then when someone kicks a soccer ball without adequate warm-up, they are at high risk of injury or tear.
A lot of Africans and Brazilians and so on don’t warm up at all. It’s certainly not a notion in traditional cultures to do extensive warm-ups. They break into sport— gradually, slower at first and then more vigorously, or, in the case of capoeira pretty vigorously from the start. And the reason they get away with that I think is because the resting muscle lengths are already substantial so it isn’t as a dramatic a departure from the length they are used outside of their sport. Is this making sense?
Yeah, definitely. Because what I’ve always read is about how even if you have really good form in your sport it’s what you do in the 97% rest of the day that really matters.
That’s certainly my belief, though I haven’t really heard that anywhere. I always think that’s a very unusual notion. I think it’s very important and I have a name for that that I’ve actually trademarked; I call it downtime training. What you do outside your sport matters a great deal. The way you stand, the way you bend, the
way you walk and so on is either preparation for your sport or it compromises you in your sport.
Can you talk about the Stretchsit cushion, which I use a lot while driving?
We were talking about the discs and how you get hydration in the discs and good baseline disc health by stretching the spine. One simple way to stretch the spine is to stretchsit while you drive, watch TV or sit at your computer. The Stretchsit cushion facilitates that. For two seconds of effort, you get hours of gentle spinal traction happening in the background, - this way the discs are in good shape before beginning any sport.
The next one is, I think because we have a lot of readers that are lifters and they do a lot of twisting and turning motions, we get a lot of slipped discs.
Okay. I have a lot to say about that. First of all, along the same lines it’s very highly desirable for the baseline length of the spine to be healthy so that the discs are well hydrated and plumped up and not stressed from the start. If there is enough intervertebral disc space, the twists and so on are well tolerated. It’s the combination of compression plus twist that is detrimental.
So how do you get plumped up, well-hydrated discs and tall, adequate, intervertebral disc spaces? Well, once again, it’s your every day life that has a lot of influence over that. So if you’re sitting with a rounded spine or a swayed spine, your discs are compromised, either anteriorly compressed or posteriorly compressed. If you bend with a rounded back, again, you’re anteriorly compressing your discs. That’s a more dangerous compression, actually. And also if you don’t have enough muscle tone in your abs, then you’re letting your spine settle into itself. So it becomes a shorter spine and all the discs are somewhat dehydrated, compressed and stressed, and they start to have tears. In this case, the process of healing the discs is also compromised. Discs don’t have the usual capillaries and veins and arteries; they don’t have the usual kind of circulation. They depend on decompression to create a vacuum and suction in moisture into the discs.
And this happens as part of everyday life as a byproduct of breathing, but can only happen if your spine is well stacked. If the spine is well stacked then it can elongate with every inhalation. That then creates negative pressure within the discs, which then suctions in moisture and nutrients, which helps facilitate self-healing within the disc. You want that process to be intact before you even begin your sport, so that your discs begin in a healthy condition.
You also want to have adequate abdominal strength as well as deep back muscle strength to slenderize you and elongate you. Making your body tall in the face of stress is very important. This is the notion of the inner corset which is available as a free download on the website. You want that action to be happening so that with the addition of stress from your weightlifting or from impact when you jump, or from twisting and any kind of compression, your spine is protected. You want to have that extra length afforded to your body by the engagement of the deep abdominal and back muscles - the inner corset.
For the health of L5/S1, that should not involve rectus abdominus very much – rectus tucks the pelvis and distorts the L5-S1 disk, rendering it vulnerable to injuries. You want to respect the original shape of the spine, which I describe as J shaped rather than S-shaped, with not a tucked pelvis but rather an anteverted pelvis and tail out behind.
Do you think it’s ever because one side of the body is stronger than another?
Yes, but I don’t think the sideto- side distortions cause as much problem as the frontto- back distortions. I think the side-to-side distortions are much more recognizable to people. People usually come
in and they know about their scoliosis since that is a departure from what everyone else has, and so it’s more visible and more on the radar. But I don’t find that’s usually the biggest problem. I find that the biggest problem is usually the front to back distortions. And the up and down distortions; the compressions, the sways and the roundings, the lordoses and the kyphoses that cause the majority of the problem.
In extreme cases, of course, scoliosis is the problem. But in minor cases I think the side-to-side asymmetries, which all of us have to some degree being left-handed or right-handed, can be well tolerated. You know, many of our sports are asymmetric. You play tennis with one hand, you play golf with one hand and I think these can be well tolerated. For millions of years we’ve been throwing things and making stone tools with one hand and this has clearly been well tolerated.
We get a lot of rotator cuff injuries, a lot of people using their shoulders a lot—baseball players, football quarterbacks, volleyball players, shotput throwers, boxers, swimmers, pretty much everybody using a repetitive overhead motion or pulling motions…
Yeah, and here again I think the shoulder roll becomes a really important tool or technique to reposition the shoulder to have normal baseline architecture. I spoke
already about how, when the bones juxtapose well, they are not causing inappropriate stress, which leads to osteoarthritic changes. Bone spurs can dig into some of the rotator cuff muscles and so on and cause mischief, but it’s also true that when the shoulders are back in place that opens the brachial plexus. Architectural integrity for all those veins and nerves and arteries that constitute the brachial plexus right under the pectoral muscles allows good blood flow to and from not only the rotator cuff but also the length of the arms and that limits repetitive stress injuries and allows a lot of healing to happen on the fly. Little injuries happen as a part of everyday life and if the circulation is excellent then those are taken care of along the way, but if the circulation is compromised then you get a series of injuries and injuries that get out of hand and cause problems.
I should also say that the nerve distribution to the rotator cuff and the arm are important as well. In the case of repetitive stress injuries in the arm, tennis
elbow and golfer’s elbow and so on, consider that all the nerves that feed those areas arise from some place in the cervical spine. So the architecture of the cervical spine is also extremely important. You want to have length in the back of neck with the chin down, as opposed to the kind of curved neck shape that we’ve come to think of as normal and are inclined to support with cervical pillows and such. You want good shape and length in the neck for the sake of the nerve supply to the upper limbs and the rotator cuff. Okay, so the next one I had was the sacroiliac pain; pain in the sacroiliac area.
The sacroiliac joint is the large joint that consists of the entire connection between the sacrum and the ilium, which is part of the pelvis and that joins in a long line and has multiple ligaments crossing over it; it is usually held pretty firmly. But with a tucked pelvis, which is so common in modern culture, the entire joint is strained. The pelvis is tucked but the buttock muscles and so on pull back on the pelvis, and especially with twisting and so on, that’s exacerbated. So I’d say the pelvic position is very key in presenting sacroiliac dysfunction and pain.
What I describe as normal for the pelvis, as you know, is an anteverted pelvis with the tail behind, where the pubic bone is kind of dropped a little toward the floor between the legs, and this requires the legs to be externally rotated to a healthy degree. And then once the pelvis is anteverted and the behind is behind, then the sacroiliac joint is in a healthy architecture and can withstand twists and strains much better.
Nature didn’t design a very elaborate system to heal sacroiliac tears and there isn’t much blood circulation around that joint, because if we used our bodies well that would be a very rare injury. As it is, it’s a fairly common strain, and it’s slow healing because there just aren’t many blood vessels there. I personally like acupuncture to help get blood flow to the area, reduce inflammation and help healing. From a posture point of view this is the one situation in which I recommend to not antevert the pelvis so much, only as tolerated. A slight tucking can actually feel better. I also think its important to stabilize the joint with a sacral belt so as to not oblige the muscles in the area to remain tense at all times. That joint needs protection because movement in joints can be excruciatingly painful; going up stairs, turning in bed, etc. And so I’d recommend stabilizing the joint as it knits with the sacral belt and then, as tolerated, slowly reverting to having an anteverted pelvis to prevent future injury there.
I didn’t realize I had posture problems until I started lifting heavy things and getting injured. Do you think a
sport helps bring awareness to postural problems?
You know, a sport is an extra stress which would ordinarily be healthy, but if the baseline is problematic then it shows the cracks. So it helps you realize your distortions and posture deviations early in the game. Which is just as well, you know. Then you can change that before things have degenerated to an irreversible degree.
I can’t speak for all of our readers, but I know at times that I’ve been less interested in things from a health aspect and was far more concerned with getting better performance.
The thing about posture is that it does both, it improves your health and performance and appearance. It converges. I think of myself as a Taoist looking for a path where you don’t compromise one thing to benefit another thing. If you find a really deep truth, it helps everything. And I really think this type of posture improves performance and appearance and health. And that in itself is a compelling thing about it.
It’s the long game. At first you might not be lifting as heavy as your body readjusts to it, but in the long term you’d be sidelined less once you’re using your entire body in integrity; you’d perform better….
Okay, the last injury I wanted to discuss was patellar tendinitis.
Well, there it is very important to have a healthy architecture in the legs. The foot, the knee and the hip, they go together. One of the easiest ways to turn an unhealthy knee architecture around is to kidney
bean shape the foot. And I teach people to raise the heel ever so slightly off the floor, pivot the heel into the center of the body as they externally rotate the knee, knee out and heel in.
And that restores the healthy natural kidney bean shape you had as a child.
It also leaves the knees externally rotated, as well as the femurs externally rotated somewhat, so they fit in a more healthy position in the hip socket. Then the patella is riding on the tissues in a more healthy configuration and there isn’t the same risk, there isn’t same degree of arthritic change and inflammation and so on. The bursas and so on have been created for a particular configuration, so if you distort it with internal rotation of the knee which most people have then it’s no wonder that they get frequently injured. The kidney bean shaping of the foot not only restores normal architecture of the bones and the knee, it also frees up the blood circulation all through the leg, and that’s very important so that healing can happen efficiently.
Another measure that I think is very important is to have a softness in the tissues around the groin so that your femoral artery, vein and nerve can supply the leg in a much more healthy fashion, efficient fashion and not be obstructed. Again, little injuries happen all the time and you want to be able to heal them efficiently. A little angle between the torso and the leg is healthy. If you press on tissues vertically into your groin, you want to feel the same softness that you would feel in your elbow crease if you bent your elbow. You want to have your thoroughfares, like the groin, soft, so the blood circulation can actually function.
You know, one overall factor that I think is important in all these injuries is that the body be adequately hydrated. An obvious way is to drink enough fluids, but there’s another way in which we in modern society systematically strip the body of its natural moisture and that is with our bathing practices—we bathe with soap and we remove our body oils every day, and it’s pretty socially unacceptable to stop that practice. So the solution I think is to replace body oil with some moisture from the outside. And I think some of the commercial moisturizing practices, things like Lubriderm which have a lot of alcohol in them, long-term actually do more harm than good. The particular moisturizing agent that I find works like a charm is shea butter. We’ve actually started stocking it because I’ve asked my patients and students to work it into their entire body and we want them to be using large quantities and so we decided to import it directly and we’ve put it up on our website. It’s a way of moisturizing the tissue from the outside in, because if you strip the body oil, then it borrows moisture from underlying tissue. This then causes the deeper layers of body tissue to also be dehydrated.
We know for example with discs that dehydration is a critical factor in vulnerability to injury and how well they repair. Smokers, who are ultra-dehydrated, are much more prone to back injuries and disc herniation. So I have my students massage shea butter into their backs and around their injuries and really around their whole body, but especially around their injured sites, so at least those tissues have the moisture they need.
There’s a lot of research that has been done on shea butter. And you want to get a kind that is not solvent extracted and not rancid, and that’s pretty hard to find. We found a good source and are retailing it ourselves. The effects of shea butter are quite magical. A daily application for two weeks gives people entirely different skin. People come to me with menopausal papery-thin dried, cracked skin that in two weeks looks young, vibrant, and moisturized. It’s very impressive what it can do.
Very cool! I have to ask you about this because people ask about this all the time, about all the different shoes that are coming out that are supposed to mimic barefoot walking.
Oh, yes, all the new shoes I am still wrapping my brain around. I think as a country we tend to go from one extreme to another. We used have inches of cushioning in our shoes that turn out not to be so healthy because it fools the body into thinking it’s protected and then induces sloppy form and more injury. Now we’ve gone to running around barefoot on concrete. I think both extremes are problematic.
I think the most important thing is to have good form and to be using your muscles, sparing your joints no matter which shoes you’re wearing. And then which shoes are best for you I think really depends on the condition of your feet, how much muscle you have and how much ligament distortion (ligament distortion is irreversible). So if you’ve stretched your ligaments and your feet have grown two sizes it’s a different situation than if your ligaments are still intact. So there’s foot muscle tone, the state of your foot ligaments, your knowledge of how to use your feet, and how much of that is patterned in - how much you know to do and how much you habitually do - and how much attention you can pay to what you are doing, and what sort of surface you are running on.
You know, if you’re walking on beach and you can really pay attention to how you are walking it’s one thing, and that’s different than if you’re having a conversation with your colleague and walking around on cement. I think it’s a complex issue and I expect it’s going to get sorted; it’s going to get looked at in more detail just like with fat. Fat was bad, and then you
realized there’s good fat and bad fat, and it depends on what’s going on. There’s monounsaturated and polyunsaturated and it’s complicated. So I think that the feet too, it’s a little bit more complicated than either wear tons of padding or none at all. It depends on a few factors. So I counsel people individually on that.
I finally got Vibrams. I gave in.
I have a pair too. And I actually find them good to walk around in, although I question the five-toe thing. I think the whole yoga toes and spreading your toes apart is not particularly natural or desirable, but having a thin sole so you can actually feel the earth is wonderful when you have the threshold levels of muscle strength and ligament integrity and bandwidth to pay attention and knowledge and habits.
Well, and then also, I walk around barefoot most of the day and I wear sandals, so it’s not very different from what I normally would wear.
That’s true for me too. I grew up in India walking around barefoot a lot and I have always worked barefoot, and so it’s not very different for me, but I do appreciate having a little sole to protect me from pine needles and pebbles and glass and so on so that I can extend that habit outside, but I don’t recommend that across the board.
I read something on your message board where you said you wouldn’t recommend that for someone that didn’t have good gripping with their toes.
Again it depends on the state of your ligaments and your muscles and your knowledge and your habits and so on. You have to be able to grip the ground and push the ground back to go forward, and I describe that in the glidewalking chapter of my book, with each step you push back. There has to be some threshold amount of ability and that you know what gripping means and that you can do it and that you are able to pay attention and actually do it or have the habit. And then you can actually improve. And the surface needs to be reasonable - then you can actually build up some muscular strength in your foot and it’s very helpful But if you don’t have the above pre-conditions, there’s danger of further splaying your foot and losing what little ligament integrity you have and that’s not desirable.
For coaches or gym owners who want to help people, what would you recommend for them?
I would recommend that they take my free online class and look at my book and get some basic training themselves. Now we have teachers all over the world.
Or they could get some top people trained and then maybe develop a teacher within their own gym who will train people. It can’t be satisfying to see so many people injure themselves. They would lower that injury rate, improve the performance and their people would be happy with them as they are with me. People are really happy to discover these new insights and these new ways to improve performance, prevent injury and improve appearance. They love it. The whole movement is catching on. And so I think if they’re a gym owner they’re in a key position to spread the movement, and join the movement.
And for individuals?
We have steadily increased our offerings. We have online workshops - some are free and some have
nominal fees. We also have our course which they can request in their town; if we get eight people who are ready to commit to take the course we put the course on our calendar and website; in the lead time up to the course, we try to get an additional eight to create a second group to make it worth our while to travel. Each group consists of eight people and meets for six 90-minue sessions, usually over a weekend. We now have more than a dozen teachers available to teach and it’s rapidly growing. We’re really excited to be able to provide it, and we’d love for the gym owners to join that group or have a Gokhale Method Foundations teacher in their premise.
For more information on Esther Gokhale and the Gokhale method, check out her website.