research

October 16 is World Spine Day, which makes this the perfect time to share with you a fascinating piece of recent research about the human spine. 

In April I was contacted by Scott Williams PhD, Associate Professor at the Center for the Study of Human Origins, Department of Anthropology, New York University. He and his team of anthropologists had recently published a scientific paper— which concluded that understanding the spines of Neanderthals, a human ancestor, may explain the back pain experienced by humans today.

Who were the Neanderthals?

The Neanderthals populated Europe and Asia between about 400,00 and 40,000 years ago. Neanderthals became extinct, but are considered one of our most recent evolutionary ancestors. Research shows there is DNA evidence that they interbred with early human populations¹. 

The Neanderthals were adept hunters who controlled fire and made shelters, clothing, and artifacts. Wikimedia

The Neanderthal skeleton was shorter, and its bones heftier and more robust than those of modern humans. Rather than being a hunched “caveman,” recent research suggests their posture may have been entirely upright. Wikimedia

Comparing Neanderthal and modern spines

Examination of the bones of Neanderthal lumbar spines has indicated that they curved less in the lumbar area than modern human spines studied in the U.S. and Europe. Because a significant degree of lumbar curve has commonly been associated with the ability of bipedal humanity to stand upright, Neanderthals have long been assumed to have had an intrinsically different posture from modern humans. 

However, Professor Williams was able to come to a different conclusion because, like the Gokhale Method®, he realized that “modern” human posture itself has been subject to change in just the past few hundred years. 

Williams and his colleagues compared preindustrial to postindustrial spines of male and female modern humans from around the world against samples of Neanderthal spines. His samples included more than 300 spines—that’s more than 1,600 vertebrae.

Williams acknowledges that because lower back curvature is made up of soft tissues (i.e., intervertebral discs), not just bones, their spine shape cannot be known with certainty. “The bones are often all that is preserved in fossils, so it’s all we have to work with,” he adds. Nonetheless, the distinctions in spine formation that Williams and his team found strongly suggest different degrees of curvature.

What Williams’ research found about modern human spine shape

Williams’ research indicates that there has not been just a one-time dominant spine shape in modern humans, but that spine shape changed over the period of the industrial revolution. Overall, Williams found that spines in postindustrial people showed more lumbar wedging (which produces curvature) than did those in pre-industrial people. 

This illustration detail from Professor Williams’ paper shows increasing, unchanged, and diminishing angles of wedging towards the back of lumbar vertebrae (B). Academic.oup.com

Williams observes:

Past research has shown that higher rates of low back pain are associated with urban areas and especially in ‘enclosed workshop’ settings where employees maintain tedious and painful work postures, such as constantly sitting on stools in a forward leaning position. . . A pre-industrial vs. post-industrial lifestyle is the important factor.

Research fits with the Gokhale Method

In his paper Williams cited my book, 8 Steps to a Pain-Free Back, as it details how posture and spine shape have changed progressively since the industrial revolution. It explains that industrialization led to the break in transmission of traditional ways of living and working. For example, people have always sat to do tasks—but it’s how they sat that changed and caused problems. 

Human beings have always sat to do tasks, from nursing infants to decorating artifacts. The important thing is to sit well. Winslow Homer, Mending the Nets, 1882 (detail). nga.gov

Industrialization also resulted in new but mistaken paradigms of “natural” spine shape in furniture design, fashion, and even medicine. My book advocates for the J-shaped, pre-industrial spine rather than the  postindustrial, S-shaped spine, which causes lumbar compression, wear and tear, and pain. You can read more about spine shape here.

The Gokhale Method advocacy for the J-shape is based on observing that it remains intact in our children, largely in our track and field athletes, and consistently in adults living in non-industrialized regions or in traditional societies. And these people report significantly less back pain than the 80% of American adults who suffer incapacity with back pain at some point in their lives. 

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This illustration from 8 Steps to a Pain-Free Back shows the more recent S-shape spine (left) that would likely create “wedging” in the intervertebral discs and bones subject to extra curvature, and the earlier J-shape spine that does not have this compression (right) .

Conclusions about the Neanderthal spine and understanding modern back pain

Williams’ research concludes that the Neanderthals’ spines were significantly different from those of postindustrial people but not from pre-industrial people. By examining only the spines from modern people who lived in the industrialized world, past researchers have mistakenly assumed that the distinctions between Neanderthal and modern spine shape were due to evolutionary development rather than social and cultural changes. Williams says:

Diminished physical activity levels, bad posture, and the use of furniture, among other changes in lifestyle that accompanied industrialization, resulted, over time, in inadequate soft tissue structures to support lumbar lordosis during development. To compensate, our lower-back bones have taken on more wedging than our pre-industrial and Neanderthal predecessors, potentially contributing to the frequency of lower back pain we find in post-industrial societies. 

This illustration shows how angles of vertebral wedging contribute to spinal curvature. 

The idea that the lumbar spine of our Neanderthal ancestors was relatively straight is not so shocking to those of us who already recognize that it makes sense for bipedal spinal health. And the wedging of the postindustrial vertebral bones is a fascinating discovery, which shows the degree of adaptation possible within the human body, although it is clearly not preventing back pain! 

The evolution of humankind has been associated with changing posture in many versions of this cartoon. Pinterest

This fascinating research suggests an ancient and more natural way to be which, while preserved in some parts of the world, we’ve largely lost in our culture. But it can be and is being relearned. If you would like guidance on any aspect of your posture and spine shape, consider scheduling an Initial Consultation, online or in person, with a Gokhale Method teacher.

If you would like to find out more about how the Gokhale Method can help support you, sign up to join one of our upcoming FREE Online Workshops…

Reference:
¹ Scott A. Williams et al., “Inferring Lumbar Lordosis in Neandertals and Other Hominins.” PNAS Nexus 1, no. 1 (March 2022): pgab005, https://doi.org/10.1093/pnasnexus/pgab005.’

The single focus of many back pain interventions can be described as a “one-trick pony.” Image courtesy Nikki Jeffrey on Unsplash.

Many back pain interventions could be described as having a single, dominant approach: cortisone injections into inflamed tissue, insertion of acupuncture needles to open flow in meridians, “adjustments,” medications for reducing pain, etc. Of course, each of these interventions has complexity and nuance in theory and practice, but the vast majority of existing interventions have a single focus. To put it somewhat crassly, they could be described as one-trick ponies. And I’ve wondered if this is perhaps related to why most approaches to back pain are so ineffectual (see data on HealthOutcome.org).

A three-trick pony
In our method, we’ve never been less than a 3-trick pony, the three “tricks” being intellectual, visual, and kinesthetic ways of guiding the body’s architecture and movement patterns to a more primal configuration. Does this partially account for why we are outliers in effectiveness and efficiency in helping back pain sufferers? That’s not to diminish the core insight of our program, that there is a healthier, better way to be in our bodies and that the modern day conception of the body is skewed and contributes to decline. But additionally, our multi-faceted, coordinated approach helps this diamond in the rough be accessible, persist, and bring delight.

Unlike many other back pain interventions, our “pony” has more than one “trick” in its repertoire. Image courtesy Tobias Nii Kwatei Quartey on Unsplash.

One approach to back pain that I’ve always admired is the Alexander Technique. The Alexander Technique is similar to our approach in that it works on posture and movement patterns. But it uses kinesthetic input almost exclusively. The Alexander Technique’s “one-trick” approach lacks robust use of the images we employ in our teaching, book, website, and communications. Many students and readers also experience the intellectual framework of Alexander Technique to be abstruse and inaccessible. People tell me they feel good while they’re in an Alexander Technique lesson, but they go home and have no idea how to replicate what happened in the session.

Passively viewing images or hearing theories alone doesn’t reduce pain, of course, but alongside the kinesthetic learning, they form part of a rich and textured weave Gokhale Method students take home with them. This allows students to approach the goal of reduced pain from multiple angles simultaneously. I regularly get emails from students containing posture-related images. These students have absorbed the Gokhale Method filter and carry it with them. The method takes on a life of its own. What’s more, the good feelings are replicable outside of active instruction as they go about their life exercises.

Indigenous cultures — along with non-industrialized populations and young children — are amongthe groups we look to for inspiration and the body-knowledge which informs our method. Image courtesy Jason Rojas on Unsplash.

More “tricks”
Over the past five years, we’ve added a technological trick and a research trick to our quite talented pony’s repertoire; this has expanded the range of people who have access to our work and increased students’ trust that what they are experiencing is real.

One of our difficult-to crack nuts has been how to attract alumni to Continuing Education offerings so they can integrate techniques that require repetition and practice to remain rooted in their bodies long after their initial course has concluded. In the past year, we’ve intuited our way to several additional tricks that are addressing this challenge. The new pieces include music, dance, and art in a central role. These cultural pieces have always existed in our ecosystem, but now they are part of our core Continuing Education offering. Dance, music, and art make the weave of learning and integrating so much richer and more enjoyable. Additionally, we’re discovering a sense of community and joy building in our 1-2-3 Move program. People are naturally interested in each other, and including Q&A after each session allows that community spirit to build.

Central Asia is home to rich equestrian traditions, among them horseback falconry with golden eagles, horseback archery, and horseback gymnastics. As in our method, multiple elements combine to form a complex, impressive whole. Image courtesy Lightscape on Unsplash.

We’re also recently included exercise in our programming. It’s been wonderful to be led by a knowledgeable guide in the company of dozens of people online. This makes it fun to return.

We are delighted by the response to our new directions. And as we are always adding new enrichments, there is always more to come.

Stanford now lists the Gokhale Method Foundations course as an option for which Stanford staff can use their STAP (Staff Training Assistance Program) funds. I am thrilled that the educational institution closest to home (I live on campus) is the first to make my offering more available to their staff.

My avenues for bringing posture into Stanford are manifold, both through my family members and through hundreds of students and staff who have taken my courses. Healthy posture has been demonstrated to have a positive impact on those in close proximity, and I'm hopeful this effect will permeate the community over the years.  

My husband is a professor in the Math Department and is beaming out much better posture than he used to:

 
Brian White, Professor of Math at Stanford, was one of the early Gokhale Method guinea pigs (being my husband!). See him here bending with a straight back, and with his legs well-aligned and feet pointing outwards. 

My daughters Maya and Monisha did their undergraduate degrees in the school of engineering; Maya also did a Master’s degree in epidemiology. They participated in sports, where they influenced and taught some of their teammates:

Maya White (left, jumping), has a natural degree of pelvic anteversion which facilitates glute action and a powerful spring.

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Monisha White, who captained the Stanford Women's Ultimate frisbee team and lead them to win Nationals in 2016, coached some of her teammates in healthy posture. Here she shows healthy external leg rotation, posterior shoulder placement, and a J-Spine.

My son Nathan coaches the Stanford Men’s Ultimate Frisbee team. Learning hip-hinging has helped some of the team get rid of longstanding hamstring problems: 

Nathan White (second from right, standing tall) sets a good posture example as a coach of the Stanford Men's Ultimate Frisbee team.

I have taught hundreds of faculty, students, and staff how to have their behinds behind, and their torsos upright and relaxed: 

Olivia Page, one of many Stanford students who learned to hip-hinge, stacksit, and stretch-lie.

Now with Stanford STAP funds, enrollees will not have to pay out of pocket for their posture education.

The two courses offered on the weekend of April 28-30 both consist of the usual 6 x 1.5 hour lessons using 8 Steps to a Pain-Free Back as the text and the DVD, Back Pain: The Primal Posture Solution, as a reference (both are included in the price of the Stanford course). The courses still have some openings and are open to the public, though STAP funding is available only to Stanford staff.

It has long been a dream of mine to influence a mid-sized community to have lower rates of back pain and reap the benefits of healthy posture. There is a synergistic effect that happens when members of a community learn the familiar, but forgotten, language of primal posture. Human beings are known to mimic each other. We expect that having examples of healthy posture to mimic will raise the general wellbeing of the community, and that this effect will spiral in a positive direction. Also, Stanford is a self-reflective community that conducts research, formulates theories, and births products - a lot could happen in this rich milieu.

The Stanford Rodin collection is the second largest in the world and is chock full of examples of excellent posture.

We hope other educational institutions will be inspired to replicate Stanford’s offering for their staff, now that we have teachers all over the world who are able to satisfy such demands. Educational institutions often induce other types of institutions to follow their lead. We are hoping that banks, law firms, tech firms, and other entities will see the value in keeping their members healthy and pain-free, like Stanford has.

One recent Stanford study, Is crowdsourcing patient-reported outcomes the future of evidence-based medicine? A case study of back pain, examines the findings of the website healthoutcome.org, on which Postural Modifications (and the Gokhale Method in particular) are the top-rated intervention for lower back pain by a very large margin. The study finds that crowdsourcing results are similar to conservative research results, but involve much larger numbers of subjects at lower cost. Postural Modification as an intervention for lower back pain has not been studied by conventional means. As the prestigious newsletter The BackLetter put it in September 2015, “there is certainly a glittering opportunity for some enterprising young researchers to explore this area with sound scientific methods.”

For more information or ideas on how to bring the Gokhale Method to your institution, please contact us at [email protected].

When we first learn new information, we create shallow neural pathways in our brain that can quickly disappear. To retain information for the long-term requires reuse. Beyond the learning techniques referred to in Don’t Forget The Forgetting Curve (Part 1) (mnemonic devices, association, and multi-channel learning), re-engagement with the material is crucial in deepening the related neural pathways. Some aspects of re-engagement that play a big role in mitigating the effects of the forgetting curve are:

Repetition
Recall
The Halo Effect

Repetition is one form of engagement that is built into the Gokhale Method Foundations Course. Each technique is taught repeatedly in the course, and in multiple contexts. The most-repeated techniques in the course are:
Stretchsitting: we begin the course with this technique, repeat it whenever we prepare to watch slides, and use it to do our check-ins at the beginning of each lesson.
Shoulder roll: the simplest and easiest of our techniques, it is a part of stretchsitting, stacksitting, tallstanding, and glidewalking.

The shoulder roll is repeated throughout the Gokhale Method Foundations course

Butt-squeeze walking: Students learn this in Lesson 1, and return to it adding additional features in Lessons 3, 5, and 6.
Breathing into the back: This is a subtle but key concept that students meet in Lessons 2, 3, 4, 5, and 6. In spite of the emphasis and importance placed on this technique, it seems to get forgotten easily.

Repetition is crucial for kinetic experiences, as it establishes muscle memory and gets you comfortable with new movements or body positions. It builds physical patterns as well as mental ones (think about how an annoying pop song that plays repeatedly on the radio can get stuck in your head!)
 

Recall, or conscious remembering, is a type of re-engagement that is superior to repetition for certain learning experiences. Rereading your textbook after class constitutes repetition; taking a booster quiz qualifies as recall. A booster quiz might use multiple choice questions that ask you to think situationally about the subject to choose a best answer, or it might include short-answer questions that require you to think critically and apply your understanding of the learned concepts. The effectiveness of recall quizzes as booster events for memory is demonstrated in the graph below.  

The graph shows the difference in the amount of material remembered between two groups, one of which took time to reread the material, and the other of which took the same amount of time to answer questions asking them to recall the material.
 

‘Booster events’ in the hours, days, and weeks following learning dramatically impact how much you can recall on the subject matter, and for how long. Repeat booster events give you a bigger return for each consecutive effort.

Each green line on the graph represents memory retention after a booster event. The rate of memory loss decreases with each successive event.
 

“If your goal is to produce long-term retention, and if your goal is to produce behavior change, then what you do after training is more important than what you do during training.” Art Kohn, Professor, Portland State Univ School of Business, on holding corporate training programs.

Now you might think that to retain all the information you learned in the Gokhale Method Foundations Course, you will have to recall every topic covered. Luckily, this isn’t the case due to something called the halo effect. The halo effect shows us that recalling just a few ideas improves retention of the whole learning experience. Seeing the nubs of a Stretchsit® cushion can help remind you to traction the back against the backrest, which will help recall a shoulder roll, more expansive breathing in the chest, and a general feeling of wellness and being in “good shape.”

In the Gokhale Method, each technique you learn connects with other techniques, body parts, feelings... For example, rib anchoring not only lengthens your lumbar spine, but sets up a natural spinal self-massage accompanying the breath, delivering an overall feeling of well-being. It may also cue you to elongate your neck, adjust your pelvis, and shape your feet whether standing, sitting, or laying down. Any of these hooks can serve up the halo effect and benefit your posture and your wellness.

The rib anchor is a key concept in primal posture. Recalling it can trigger the halo effect, bringing about length in the lumbar spine, a shift in breathing pattern, and a sense of well-being.
 

Towards the goal of providing our students with better booster events, the Gokhale Method Institute is building some additional services:

1. An online complement to the Gokhale Method Foundations course, including mini-quizzes, a way to track progress, recaps, etc. We will call this the Posture Oasis. If you are a graduate of the course, you will be able to work and play in the Posture Oasis retroactively.

2. Geographically-based Chapters that will allow graduates of the Gokhale Method Foundations course to connect with each other for in-person study groups, review and online discussion.

Of course, we will continue to send you these bi-weekly newsletters and encourage you to attend Alumni Workshops and sign up for our Online University for graduates. For those who haven’t taken the Foundations Course yet, that’s a great place to start! We look forward to a society that has better posture, less pain, and great function!

Pop quiz: What posture technique(s) does the poised Burkina woman below remind you to do?

 
Burkina woman drying her laundry

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Notes: For more information on the history of the concept of the forgetting curve, you can read more here on Wikipedia. These research articles, “Benefits of Testing Memory. Best Practices and Boundary Conditions,” and “The Power of Testing Memory,” go into more depth about the forgetting curve and how to overcome it.

As a posture teacher, I am very aware of my students’ tendencies to forget the finer points of the Gokhale Method. The longer students wait between classes or refreshers, the more they’ve forgotten. Although there’s always room to improve our teaching methods, forgetting is and will always be a natural phenomenon that accompanies any kind of memory acquisition.

According to nineteenth century psychologist Hermann Ebbinghaus and his theory of the Forgetting Curve, people have a steady rate at which they forget material over time. After learning new material, we forget the majority of what we have learned within 24 hours; we forget even more in the following days.

The Forgetting Curve shows how much information we lose, on average, hours, days, and weeks after a learning event.
 

Normally, discarding much of what we learn throughout the day is an important task for our brains. Most of our memories are useful for the short term, but are not needed by the next day: it’s not crucial to remember what you wore to work last week or what time you walked the dog. To handle all the information you receive throughout the day, your brain purges most of its active memories in order to focus on crucial information. But your brain doesn’t always know how to distinguish the unimportant stuff from important material you want to keep a hold on.

From this article in Learning Solution Magazine on the forgetting curve, we learn that in training programs, “research shows that, on average, students forget 70 percent of what is taught within 24 hours of the training experience.” 90 percent is forgotten within a week. But we also learn that there are ways to let our brains know which information is important, and which isn’t.

Getting ahead of the curve

One method of priming information for long-term memory is through better presentation of material, including using mnemonic devices. Scientists and teachers alike have often found that presenting information using tools like rhyming, patterns, spatial or kinetic cues, or in otherwise relatable ways aids it in being more easily remembered. For example, when teaching tall standing, Gokhale Method teachers use the mnemonic device “three, three, and three.” The symmetry of remembering the steps in threes is a cue that groups related steps into very digestible amounts of information. This technique also helps trigger physical memory, since the three steps always follow in order and move sequentially. Can you recall the three sets of three steps for tall standing, in the feet, lower, and upper body? (Answer: kidney bean feet, feet facing out, weight mainly on heels; soft knees, soft groin, behind behind; ribs tucked, shoulders rolled back, neck tall.)

Many of us learned the mnemonic device ‘Every Good Boy Does Fine’ to remember the notes represented by lines on a music staff, and ‘FACE’ for the notes in the spaces.
 

Multi-channel learning or multimedia learning is another technique that often leads to better memory consolidation and recall. The redundancy principle teaches that presenting non-text images (like animations) at the same time as auditory text helps improve information absorption.

In the Gokhale Method Foundations Course, we present as much of our information as possible with accompanying images to demonstrate the concepts we discuss, and to link the auditory information with visual understanding. We are able to go further than is possible in most academic environments, and add in kinetic and social learning as well. The broad combination of input methods we take advantage of in the course—hands-on instruction, images of good and bad form, instructor demonstrations, repetitive practice, watching other students move and receive adjustment (which hones the eye), commenting on what we see and feel, using tools like a skeleton (sometimes) as well as posture aids like chairs and cushions, feeling our own bodies for physical cues, using anecdotes in addition to medical and historical support (to address the intellectual aspects of the course information)—creates a rich and layered foundation of knowledge to support comprehension and retention.

One reason this multi-channel learning is so powerful is the effect produced by associating newly learned information with previously stored information. This association enables and improves the process of moving information from short-term memory to long-term memory. When we connect something we learn to something we already know, we are actually building upon information retrieval pathways in our brains that we already have practice in accessing. This increases the likelihood that we will succeed in remembering this new information, because we can cue recall by accessing the previously stored information.

We love to take advantage of this association, both by providing the type of rich learning experience discussed above, which increases the chance that students can make personal connections between course info and fields they already have experience in, and by using familiar analogies to explain new concepts. When we talk about hip-hinging, we like to compare the movement to the drinking bird toy:

The drinking bird hinges at the hip without distorting his spine, just like we should! This image helps new students to understand the movement.
 

When we discuss stretchsitting, we often talk about hanging the back against the back support the way a picture hangs on the wall; in stretchlying on the back we liken our backs to a hammock that contacts the bed one segment at a time, lengthening all the while. Because these analogies are all based on memorable, simple images, they are very easy to both understand and to recall when a student returns to the subject to practice. They help trigger physical memory, because an association has been built between the physical and muscular sensation, and the already-stored image presented in the analogy.

In a future blog post, we will talk about a few more techniques that enable you to get a handle on the forgetting curve, and take charge of your own memory retention. We want you to get the most out of our offerings, so we continue to create tools and opportunities that help students engage with and  remember the techniques they learn.

Whether you have read the book, taken the course, or simply subscribe to this newsletter, what are some ways that help you remember to have good posture?