erector spinae

If you have had back pain, odds are that you have visited either a physical therapist or a chiropractor. They are the most frequented medical practitioners for all types of structural pain, and our teacher community has been enriched by both these (and many other types of) practitioners. For this post, I have invited Vera Baziuk, a chiropractor and Gokhale Method® teacher based in Edmonton, Canada, to join me for a Q&A. We would like to share with you how she sees the interface between chiropractic and our method. 

Gokhale Method teacher and chiropractor Vera Baziuk.

E: How did you first discover the Gokhale Method?

V: I was researching the best home exercises and stretches for certain patients for back pain relief. I felt that this was a missing component in chiropractic for fully resolving back pain. I stumbled upon an interview with you and Dr. Mercola. What you said in the beginning about the J-spine grabbed my attention. I immediately went to the Gokhale Method website and downloaded your book, 8 Steps to a Pain-Free Back

This was one of those career aha moments, when I know on an inner, deeper level, that something is right and what I need to be doing. I began looking into teacher training in November 2019, however, teacher training was not going to be possible with a three-month-old, and I still needed to take the Foundations course. Then COVID hit.

I took the online Elements course in the spring/summer of 2020, right in the middle of COVID, and waited for the announcement of teacher training. In fall of 2021, I gained in-person experience in a Pop-up class in Palo Alto. That weekend was amazing! I had never felt quite the stretch before as when Esther adjusted my stretchsitting. I shall never forget that initial amazing feeling of lengthening in my erector spinae muscles and ultimately the spine. I wanted everyone I knew to feel how good that felt. If I wasn’t hooked before, I was after that class! 

Gokhale Method teacher Sabina Blumauer guides a student in stretchsitting.

E: Were you initially skeptical about the Gokhale Method?

V: No, I wasn’t. The interview I heard between you and Dr. Mercola made complete sense. The book and Elements made a well-presented argument for the natural J-shape of the spine, supported by analysis of body mechanics, muscle contraction, and relaxation. Hundreds of photos showed how the spine looks when posture is done well in daily activities—and how things look when it is not. It became evident that poor posture was the real culprit to back pain. And that the posture pot of gold is still attainable at any age. 

E: Do you see any divergence between chiropractic and the Gokhale Method? 

V: The main thing I encounter, from fellow health professionals and patients, is confusion about healthy spine shape and pelvic position. 

For example, in conventional trainings, having an anterior pelvic tilt is equated with having an excessive lumbar lordosis. The Gokhale Method makes the important distinction between upper lumbar lordosis (undesirable) and L5-S1 angle (desirable). The Gokhale Method also uses more descriptive and “sticky” language when it comes to spinal shape—instead of talking about lordosis and kyphosis, we refer to J-spines, C-spines, and S-spines; this helps students understand what they need to embody more accurately and easily. This is explained and illustrated in detail in your book, and also addressed in a blog post on spine shape and another on pelvic angle.

E: Has the Gokhale Method complimented your practice as a chiropractor?

V: Incorporating the Gokhale Method into my practice is a natural fit because, ideally, there is an active and passive component to most healing. 

Passive care is when the chiropractor (or therapist) does something to you, like an adjustment, mobilization, TENS, ultrasound, laser, soft tissue therapy, or acupuncture. While these modalities can be effective in providing relief from pain, they often do not solve the root cause of the problem. Unfortunately, perhaps due to persuasive marketing, people often expect entirely passive solutions for their back pain. They begin to believe that a magic bullet for back pain relief exists.

Here I am giving a patient a chiropractic adjustment. This is an example of passive care, using diagnostic skills and clinical knowledge, plus hands on techniques, to effect change.

Active care consists of therapists providing tools to their patients/clients that they can use in their day-to-day lives to help them in recovery. These may be cryotherapy or heat, exercises to strengthen muscles and stretches to lengthen muscles, nutritional advice to improve healing, stress management tips, and general physical fitness recommendations. This active care component is critical in creating lasting, functional changes.

The Gokhale Method provides high quality active care. It is an educational intervention that teaches and empowers people to make gentle changes to their body 24/7, often with both immediate and cumulative benefits. I don’t know of any other intervention that does this so comprehensively and also includes the J-spine paradigm. 

E: So you see the Gokhale Method and chiropractic as working together? 

V: Yes, absolutely. The Gokhale Method helps chiropractic adjustments hold more effectively and chiropractic adjustments give people a welcome jumpstart on feeling better. 

Most people who come for chiropractic treatment have sustained a lot of damage over the years in their muscles, tendons, ligaments, discs, and joints, so experiencing a break from their cycle of pain is very welcome. But partial or repeated short-term relief from pain is ultimately unsatisfying, both for the patient and practitioner. The Gokhale Method offers ways of transforming the postural habits that caused the problem in the first place. I find that, given most people’s starting point, a combination approach restores function, gives long term relief, and improves comfort along the way. 

My Gokhale Method students find learning how to rest and sleep in comfortable, therapeutic positions makes an invaluable contribution to their recovery. Here I am teaching stretchlying.

E: What impact has the Gokhale Method had on your thinking about chiropractic? 

V: I feel like my eyes have finally opened. For example, revisiting my textbooks, I noticed that references to posture are minimal and often an afterthought. Dr. David Magee is a well-respected physiotherapist who has written numerous classic orthopedic and physical examination books that both chiropractors and physiotherapists still learn from today. I began to wonder why, in one of his books, Posture Assessment is Chapter 15 of 17? It should be Chapter 1! Nearly all musculoskeletal conditions are a direct result of poor posture. 

E: Do you discuss the subject of posture with your patients?

V: I now see my patients’ complaints through the Gokhale lens, with posture as the starting point. Looking at someone in the past, I could see their posture was not ideal, but I still dealt with their presenting complaint in parts, not as a whole. For the past year, I have switched my filter and now consider all musculoskeletal pain in relation to posture. 

When speaking to patients for the first time, I begin to paint the picture of what healthy posture looks like and how their current posture compares. We then explore options to solve the problem with some immediate pain relief solutions and a longer-term relief and prevention strategy—the Gokhale Method. 

Teaching my Gokhale Method students healthy bending not only enables them to avoid future back pain flare-ups and protect against damage, it also brings many other biomechanical benefits—such as natural length in the hamstrings and improved hip joint mobility.

For existing patients, I periodically offer observations on how their current posture is very likely contributing to a flare up or increase of pain from their last appointment. Many wholeheartedly welcome hearing more about the Gokhale Method.

E: Can you share a specific case where the Gokhale Method has enhanced the outcome for a patient?

V: In September of 2023, I met Kay Chui Lee, who is happy to share his journey. He was referred by a massage therapist, and presented wearing a cervical collar for an acquired torticollis (neck twist to one side). His posture was a significant C-shaped spine, with a very tucked pelvis and his hips parked forward. His erector spinae were perhaps the tightest I have ever felt. In addition, he had tight sternocleidomastoid, scalene, levator scapulae, and trapezius muscles. His gluteal muscular tone was weak. 

Kay Lee started as a chiropractic patient, and, to best serve his needs, I also encouraged him to enroll in the Gokhale Foundations course. He stopped wearing his cervical collar about halfway through the course. After the course, his neck and head rotation to the right had improved and there were times when Kay was able to look straight ahead. 

A combination of the Gokhale Method and chiropractic treatment is enabling Kay Lee to gradually become more upright. His head and neck are returning to a more natural, comfortable, and symmetric alignment. 

He walks daily, practicing what he learnt in glidewalking, and reports doing so without the fatigue he used to feel after a walk. He sleeps better and can manage his day with greater comfort. The texture in his erector spinae muscles is softening and he reports less pain with muscle work. To date, Kay continues with chiropractic treatment and there are ongoing improvements. I am hopeful that with alumni classes, online or in-person, he will continue to improve.

E: Thanks, Vera, for sharing how you are using chiropractic alongside the Gokhale Method. I am sure your insights will help both our students, and chiropractors and their patients, to embrace this complementary pairing with a new level of confidence.

Best next action steps 

If you would like to improve your posture, get started by booking a consultation, online or in person, with one of our teachers. 

You can sign up below to join any one of our upcoming FREE Online Workshops…

Choose your remedies carefully

There are many approaches to stretching tight back muscles that involve rounding the back. Though these exercises give temporary relief, we recommend against them because they threaten the spinal discs, nerves, and ligaments. They can also result in the back muscles contracting even more tightly to stabilize the area. 

Rounded stretching exercises increase existing upper back curvature (hunching) while pulling aggressively on tight soft tissues and ligaments. Our tissues respond better to sustained, gentle realignment to make healthy changes. Pexels

By contrast, the Gokhale Method rib anchor maneuver brings relief from compression without any negative side effects. It restores your spine to a healthy J-shape, preserving the spinal discs, nerves, and ligaments. Over time, this alignment encourages a more natural, relaxed baseline tone in your back muscles as well as better abdominal tone.

How your rib anchor works

Rib anchor describes the pivot of the rib cage around a horizontal axis at about breast height, bringing the lower border of the front of the rib cage in and down thus sending the back of the rib cage up and out. Since the back of the ribs are attached to the vertebrae, this pulls the curvy “necklace” of the lumbar spine into a flatter, longer arrangement. This means of tractioning the lower spine is a fundamental Gokhale Method technique for removing sway. It restores healthy length in the lumbar area, alleviating compression of the discs, nerves, and vertebrae.  

a.                                                          b.             

A forward pivot of the rib cage at breast height (b.) corrects for a tight lower back (a.), restoring lumbar length. Maintaining this orientation requires the abdominal muscles that anchor the ribs down to develop a healthy baseline tone.

The art of transmission 

Over many years of hands-on work helping students with their rib anchor, I became increasingly aware of an intuitive sequence of moves in what I was doing. My hands could guide a student to a pleasing endpoint, but what exactly I was doing fell short of verbal description and a conceptual framework. The gap between what we were doing and articulating in words showed up especially when our teachers got together for continuing education offerings, when questions and case studies were discussed. There was a need for new language, fresh insights, and deeper understanding. While teaching posture is both an art and a science, it is also a hallmark of our method that there be kinesthetic, visual, and intellectual understanding of our process; this takes the right words and analogies.

A fresh analogy for the rib anchor

For a very long time, we’ve taught three things that need to happen to help most people find a healthy head position. It’s a combination of: 

1. Pivoting around an axis from ear to ear
2. Lengthening the neck through relaxing certain muscles and recruiting others (especially the longus colli)
3. Shearing the head and neck gently back               

1.                                         2.                                       3.

Gliding the rib cage home follows a similar pattern:

1. Pivoting around an axis that goes from side to side through the chest at about breast level (this being the main component of what I’ve described as rib anchor so far)
2. Relaxing the erector spinae and other muscles and recruiting the deep abdominal and back muscles (inner corset) to create additional length in the back, as described and included in our teachings
3. Shearing the ribcage backward relative to the pelvis. This is the movement that I’d been intuitively weaving into my hands-on ministrations that previously wasn’t well described

When students aligned their ribs by only pivoting the rib cage, I could see that it sometimes resulted in an awkward movement that did not integrate the rib cage into the torso quite right. Adding, and even better with practice, integrating this element of shear, transformed their outcome and experience. 

We can describe the shear element, for both the head and the rib cage, as analogous with backing your car into its garage: 

An analogy that is true and versatile

Neat and easy parallels can, of course, be seductive but false. However, here we have a really useful and accurate analogy of what needs to happen. Deploying your rib anchor to come into a healthier orientation usually feels somewhat strange at first—especially if you have spent years actually leaning backwards from your waist—but this new analogy is already helping our students to enjoy a more buoyant uprightness, and less of a leaning forward sensation. 

This “backing up” of the ribcage can be tailored to affect different levels of the spine, as appropriate for each person. And while every body is a unique landscape known only to its owner, a teacher’s guidance is always available to help you map it out sooner. 

a.                                                          b.             

 
This girl (a.) stands with her lower back swayed. Her rib cage is angled back, and she can feel her lower front ribs popping up under her hands. She gently but firmly presses on her ribcage to “back it into the garage” and into a healthy alignment (b.), removing the sway in her lower back as she does so. 

Best next action steps

If you are new to the Gokhale Method, are resuming your posture journey after a little while, or struggle with your rib anchor, book a consultation, online, or in person with one of our teachers, who will be happy to help.

You can sign up below to join one of our upcoming FREE Online Workshops. . .

This blog post explains how some common yoga injuries occur and how applying the principles of healthy posture to yoga postures replaces this scenario with movements that are good for your body.

Yoga postures and back pain

Growing up in Mumbai, India, my Dutch mother was a student of BKS Iyengar and the Satyananda yogis, and keen for me also to learn yoga asanas, or postures. I practiced, and, being reasonably athletic as a child and already trained in Indian classical dance (Bharata Natyam), did not find it particularly difficult to choreograph the back bends, forward bends, and twists that were asked of me. I became a yoga model, demonstrating postures alongside visiting swamis’ presentations to induce the audience to sign up for upcoming yoga courses.

This photograph shows me teaching yoga as best as I knew how in 1979, standing with a sway in my back (and putting excess flexion into my student's neck).

Aged 15, I came to the United States as an exchange student and proceeded to go to college here. It was while doing a yoga pose in college that I first experienced a significant back episode with severe spasms. A few years later I injured my back while windsurfing; this time it took five days of bed rest to recover. I did weight training to strengthen my back, and returned to normal activity. 

When nine months pregnant with my first child, my back problem resurfaced with an onset of sciatica. After my baby’s birth, it grew worse, leading to surgery for a large disc herniation at L5-S1 a year later. Within another year the pain had returned. I declined a second surgery, and instead deepened my quest to understand the causes of back pain and how best to resolve it. 

An MRI scan done in 1987 revealed the cause of my sciatica and severe back pain—a large herniation at L5-S1.

Yoga postures require healthy posture

I learned from my life experience, as well as that of key teachers such as Noelle Perez, that in the industrialized world we do not use our bodies well. As our posture has deteriorated, traditional ways of performing everyday tasks in sitting, standing, and bending positions have become distorted. These damaging postural patterns are now deeply embedded in our culture and have even been unwittingly carried through into therapeutic activities such as yoga. 

How is it that yoga asanas, developed to bring strength, flexibility, and relaxation to the body, are now causing frequent injury? This question has been the subject of much media coverage in recent decades, including the provocative New York Times article in 2012, How Yoga Can Wreck Your Body¹. From a Gokhale Method® perspective, the primary problem is that poor posture in the population at large, including yoga students, combined with misguided conventional wisdom shared by yoga teachers about what constitutes good posture, has created a perfect storm. 

I came to realize that much of the flexibility I had as a young yoga model came from the wrong places—it was achieved at the expense of my lumbar discs and nerves as I compressed them to sway back, round forward, and twist. Let’s take a look at how yogis are likely to be causing themselves injuries and how using the Gokhale Method to apply the principles of healthy posture will avoid them:

Back bends

A large group of yoga postures are backbends. Bending backwards is something that is generally done extremely poorly in our culture, with most of the bend occuring around waist level. This puts a great deal of pressure on discs, nerves, and soft tissue in an area of the lumbar spine already compressed by tight erector spinae (long back muscles). This shortened baseline length is due to poor posture and furniture, part of our culture’s paradigm shift away from a healthy spine shape. You can read more about spine shape in my blog post What Shape is Your Spine? 

Many versions of Warrior pose, or Virabhadrasana in Sanskrit, are taught with a significant bend in the upper lumbar spine or thoraco-lumbar junction. This is especially a problem when one or both arms are lifted, encouraging the ribs to pop up. Pixabay

Even mild sways perpetuate tight muscles in the lumbar area and correspond with a lack of healthy articulation at L5-S1, the lumbosacral junction. Pexels

Gokhale Method teacher Lang Liu shows how anchoring your rib cage prevents swaying and encourages healthy articulation at L5-S1. You can read more about our approach to this pose in my blog post Why Keep the Body forward in Warrior I 

Forward bends

Many yoga postures contain some form of forward bend. This can be standing, sitting, symmetrical or asymmetrical, with the legs together or wide apart. Regardless of these permutations, from a Gokhale Method perspective, the key point is to make bending healthy and avoid the damage that comes with rounding the back, distending the spinal ligaments, and pinching the front of the discs.

Standing forward bends (Uttanasana) are often taught with legs straight. This leaves most students in our culture, who have tight hamstrings, straining towards the ground with their shoulders pulled forward. It also rounds the back, distending the spinal ligaments and pinching the front of the discs. Hanging off the lower back is also aggravating for the sacro-iliac joints and soft tissue in the area. Pexels

Bending the knees softens tight hamstrings allowing a lower bend to the floor—but this student is still rounding her torso to reach over her pelvis and legs to reach the floor. Pexels

This man is using blocks to reach the floor. He is still rounding his back, and severely compressing his neck to try and look ahead. Pexels

Unfortunately this well-meaning mother is teaching her daughter poor bending form. This is especially regrettable as young children naturally tend to bend healthily by hip-hinging. Pexels

In seated forward bends yoga students often hunch forward. This compounds any rounding already established in the upper back, and forward rounding of the shoulders. Her head also strains forward, chin up, compressing the back of the neck. Pexels

Gokhale Method teacher Cecily Frederick hip-hinges in a standing forward bend. Her pelvis rotates forward around the femoral heads (tops of the thigh bones that form part of the hip joints). Her spine remains long, rather than rounding. 

Twists

In twisting postures (Parivrtti), it is especially important that your movement is not concentrated at a particular level of the spine, but is well distributed. Levering into a twist by pushing or pulling with the arms or legs can cause a twist to concentrate at any vulnerable point. Typically people will twist most in the mid-spine at T12-L1. Here the more axially mobile thoracic spine meets the lumbar area, where the orientation of the facet joints limit rotation. This is likely to result in disc bulging or even herniation at this junction, pinching of the nerves, and undue stress on the bony spine.

This woman is twisting mostly at the waist. Pexels

This seated twist shows tucking of the pelvis. There is considerable rotation at the base of the shoulder blades as the yogini levers with her arms against a fixed pelvis and legs. Wikimedia

A lying twist with one knee reaching the floor and the opposite shoulder remaining there is an extreme rotation for most people. It will often compromise healthy posture. In this case the woman is using her forearm and tucking her pelvis slightly to get her knees down. It is better to prioritize  healthy movement over achieving the “correct” shape. Pexels

Gokhale Method teacher Clare Chapman in a lying twist. Allowing the pelvis to rest back and the thighs to separate avoids tucking and encourages more rotation in the hips. 

We recommend that you initiate twists using the muscles of the torso’s inner corset, especially the obliques. The inner corset is explained in detail in Lesson 5 of my book 8 Steps to a Pain-Free Back. Using these muscles means that the lumbar spine is protected while the muscles originating in the thoracic area and connecting to the pelvis power the rotation. Engaging the inner corset also lengthens the spine avoiding the common pitfall of imposing rotation on top of flexion (rounding) or extension (swaying) or any other kind of compression. 

Twists should mainly occur and be appropriately distributed in the joints best designed for them—the ankles (standing twists), hips, the thoracic spine, and the neck. Small amounts of rotation can contribute from elsewhere, but pushing beyond natural limits anywhere by applying force is a recipe for injury and pain.

Before executing yoga bends or twists, we recommend that you first learn the basics of the Gokhale Method® in our in-person Foundations Course, Pop-Up courses, or online Elements. These courses teach you how to bend back without swaying, and how to bend forward in a way that profoundly benefits rather than damages your body. The Gokhale Method Online University has many offerings for Alumni which explore additional movements such as shearing and twisting in ways that are healthy.

If you are a yoga practitioner who suffers from recurrent bouts of back pain or strain, have stopped practicing due to injury, or have been put off even trying yoga, then a solution is at hand! 

It has long been my ambition to offer yoga classes with healthy posture. I am delighted that one of our most experienced and accomplished teachers, Lang Liu, will offer regular Tuesday and Thursday Gokhale Yoga classes, ​​7:00 am (Pacific Time), starting April 21, as part of our Alumni Gokhale Exercise program. 

We look forward to seeing you there.

Gokhale Method teacher Lang Liu looks forward to seeing you in the Gokhale Yoga class.

References:

¹ William Broad, “How Yoga Can Wreck Your Body”, New York Times Magazine, Jan. 5, 2012,
https://www.nytimes.com/2012/01/08/magazine/how-yoga-can-wreck-your-body.html 

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…