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As we approach International Women’s Day on March 8, I would like to share a few observations regarding gender and health made over the past three decades of teaching posture. 

Does gender affect back pain?

Back pain and the posture distortions behind it are very democratic—people of all ages, activity levels, geographic locations, and gender are affected by cultural postural distortions. That said, some modern posture guidelines and expectations are gender-specific, and some of them affect women disproportionately. We will discuss posture guidelines for men another time. In this post, I’d like to address some of the messaging that is relentlessly addressed towards women and girls, and the consequences of this messaging. 

In our society back pain affects people across all social groups. Different groups can be affected disproportionately in particular ways. Image from Pexels

Fashion and posture

I think it’s fair to say that women are more subject to fashion and to its extremes than men. 

Conformity to fashion, and rebellion against it, has women, more than men, stuck with uncomfortable, biomechanically unhealthy, and impractical garb. Examples are: 

• High heels that deform the feet and prevent mobility
• Tight clothes that distort body alignment and restrict range of motion
• Eating lightly to be thin and retain teenage proportions 
• Encouraging women and men to unduly judge women by their appearance

 
Most fashion role models for women encourage an emaciated, weak physique, a tucked or forward pelvis, internally rotated legs, and forward shoulders and head. Images from X, Pixabay

One of the most damaging distortions perpetuated by the fashion industry is tucking the pelvis. This pose exploded onto the scene in the 1920s, and has been a look ever since. Perhaps a reaction against corseting and “stiff” pre–World War 1 fashions, it encouraged a relaxed but slouched posture, with a tucked tail, rounded shoulders, and forward head. 

This 1920s portrait shows the new “relaxed” posture which translates as tucking the pelvis, rounding the back, and jutting the head forward. (Photo of Eileen McCahon, New Zealand). Image from Unsplash

While tucking the pelvis is a problem for everybody vis-à-vis spinal health, when it comes to pelvic organ health, women have much more to lose! In addition to the rectum, which is at risk of prolapse in all genders, women are additionally at risk for a prolapsed uterus, vagina, and bladder, as well as urinary incontinence. Women also have a more vulnerable pelvic floor due to the stresses of pregnancy and childbearing. The wider female pelvis is also at higher risk of instability, with this effect amplified by the pregnancy hormone relaxin.

An anteverted pelvis (left) gives optimal support to internal pelvic organs and the connective tissues that hold them in place. A tucked pelvis (right) makes us more vulnerable to organ prolapse.

Pregnancy and the nursing of babies can bring with it yet more musculoskeletal challenges. The extra weight requires additional strength and resilience throughout the body. For example, weak abdominal muscles cause the spine to be pulled into a compressive sway, dangerously loading the spinal discs and nerves. While nursing and caring for an infant, it takes a strong inner corset and posture wisdom to lift, hold, and carry an infant well, or these actions too can cause significant damage. 

Several of our teachers, including myself, came to the Gokhale Method for solutions to pregnancy-related trials. These past blog posts reflect some of our experiences: Esther Gokhale and Julie Johnson, Esther Gokhale and MommaStrong, Esther Pohl, Janine Farzin. 

This young mother in Burkina Faso (left) is using her inner corset to remain tall, stable, and relaxed while carrying on her head with her baby on her back . Gokhale Method teacher Esther Pohl (right) found that traditional posture principles really work, and carried her second child much more comfortably.  

Outside of the physiological and anatomical considerations mentioned above, in my experience women are also disproportionately raised to be “good girls” and people-pleasing, and to conform to current social norms. Postural examples would be: 

• Craning the neck forward to signal empathy and attentiveness
• Turning the legs inward to be “modest”, which forces the pelvis to tuck, cultivates internal rotation of the legs and feet, and compromises circulation to the lower body
• Sitting and standing in ways that diminish size and surrender space, such as rounding the shoulders and stooping.

Body language and fashion norms for women often result in posture that diminishes their size, space, and sometimes, self-confidence. Image from Pixabay

Unless we have been subject to protection from poor posture by exposure to a strong and healthy postural tradition, we are likely to have acquired at least some of these disabling habits. When women set out on a journey into healthy posture it often awakens indignation as they gain awareness of the reasons for some of their aches and pains. This reaction can act as a useful spur to positive action. A healthy strategy going forward is about repairing the situation—and celebrating being an active woman enjoying a pain-free body. 

Aline was able to start making many empowering posture changes during her weekend Gokhale Foundations Course, and continues her journey of discovery.  

On March 12, 12 p.m. PST, my colleague Julie Johnson and I will be offering a special free online workshop called Women’s Empowerment Through Posture. Join us to discuss the issues raised by our many thousands of female students over the years—some of them mentioned here, and many more besides. 

We are excited that this workshop is the kick-off for a brand new Women’s Empowerment Through Posture campaign. For those joining our free online workshop live we will also have a special offer and will be unveiling a brand new offering! 

Best next action steps 

If you are new to the Gokhale Method, 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…

Podcasts are one of my favorite media. It’s hard to reimagine a time when you couldn’t take your pick and enjoy their entertaining and compelling content. Over the years I have been invited to be interviewed for many podcasts about the Gokhale Method®, and for this blog post I would like to introduce you to three of my favorites, which I hope you will now enjoy if you haven’t done so already.

My Body Odyssey

A recent interview was for the Fluent Knowledge series, My Body Odyssey. Fluent Knowledge introduces their audience to experts who convey knowledge on important issues, topics, and trends in wellness, neuropsychology, media, and politics. It was a pleasure to discuss the root causes and solutions of modern back pain with them. 

Artwork by Emily Crocetti for Esther Gokhale podcast with My Body Odyssey for Fluent Knowledge

For the podcast I introduced Fluent Knowledge to my friend and advocate of the Gokhale Method, Dr. D.J. Kennedy, Professor and Chair of the Department of Physical Medicine and Rehabilitation at Vanderbilt University Medical Center, who you can hear in the brief audio clip below.

The podcast is an elegant production, weaving the Q&A between the interviewers and myself, along with Dr. Kennedy’s commentary and that of back pain contributors, in a well-constructed and informationally rich blend that is easy to listen to. I particularly like that it covers both the Gokhale Method’s respect for the ancient roots of healthy posture, and our engagement with modern science and technology to confirm and augment the efficacy of our teaching.

My cohosts were Brittany Thomas and Robert Pease, and it turned out that Robert was one of the 80% of Americans who suffer back pain. Hearing back from Robert recently, I am delighted to share that he is already experiencing substantial improvements by implementing Gokhale Method techniques: 

Fluent Knowledge also featured a complimentary blog post with an interesting timeline of posture pioneers which you can find here.

Screenshot from fluentknowledge.com

Listen to the My Body Odyssey podcast:  on Apple on Spotify  

Hypermobility Happy Hour

My second podcast pick goes back to June 2020 and a talk with Kerry Gabrielson, founder of the Hypermobility Happy Hour. Kerry’s podcast grew from her own experience, and is dedicated to discussing hypermobility conditions, including Ehlers-Danlos Syndrome (EDS). 

Artwork from Hypermobility Happy Hour

We talked about how COVID-19 had necessitated further development of our online teaching, giving rise to our Elements course. Kerry was quick to appreciate its potential for widening access to the Gokhale Method and enabling a greater impact on our runaway U.S. back pain statistics with a relatively low-cost, noninvasive approach.  

One of the challenges we both appreciated was the roller-coaster of raised and then crushed hope that many back pain sufferers ride. Musculoskeletal problems can be especially unpredictable for people with hypermobility conditions, and stabilizing the joints through healthy postural alignment, and knowing the techniques to get there, are key.

I was pleased to offer HHH listeners some practical posture guidance—how to engage their inner corset, the column of muscles in our torso that protects our spine from compression and jarring:

Since the podcast, we have been able to update Kerry on the launch of PostureTracker™, our 2-sensor Bluetooth wearable and app. I am particularly excited about its applications for people with hypermobility. For example, they can be particularly prone to hyperextension in the knee joint in standing, walking, and running, but PostureTracker™ can catch this in real time, giving users visual, audio. or vibration feedback and allowing them to self-correct. Kerry and I look forward to future conversations.

                 
PostureTracker™ will alert wearers when they inadvertently hyperextend their knees (a.). With Gokhale Method techniques and know-how they can then correct this habit and return to a safe range of motion (b.), preserving healthy knee joints.

Listen to the Hypermobility Happy Hour podcast:  on Apple    on Spotify    on SoundCloud

So Frickin’ Healthy 

My third podcast is Back in the Game, a podcast for So Frickin’ Healthy, hosted by Megan J. McCrory and Danna Levy Hoffmann. For this podcast I was joined by Gokhale Method teacher Julie Johnson.

Artwork from So Frickin’ Healthy

I experienced a serious episode of back pain while pregnant—in Julie’s case, her back pain started after giving birth to twins. If your posture is not as healthy and your structure not as robust as it might be, the extra stress of pregnancy or birth can be “the straw that breaks the camel’s back.” 

It is worth saying here that in pregnancy our structure has to contend not only with the additional weight of a baby (or two), but also the effect of increased relaxin. Relaxin is the hormone which helps loosen muscles and ligaments in the pelvis so it is ready for birthing, but it can also bring greater mobility throughout the body. This can leave a pregnant woman especially vulnerable to back and joint issues, including flat feet. And if you already have hypermobile joints, you can all too readily find yourself in extra trouble. 

Fortunately, as I, Julie, and the many Gokhale Method Alumni can testify, by aligning our bodies well and avoiding the pitfalls of poor posture it is possible to get “back in the game,” active, and pain-free once again.

Listen to the So Frickin’ Healthy podcast:  on Apple    on Spotify   

Spread the word

If you would like to let friends and family know about the Gokhale Method approach to back pain, please share our podcasts. 

Catch our new podcasts in the “In the News” section of our free newsletter Positive Stance (subscribe). You can find all our podcast recordings here on our website. 

Best next action steps for newcomers

If you would like insight on your posture, consider scheduling an Initial Consultation, online, or in person.

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

Why is it not a routine practice for podiatrists to observe their plantar fasciitis patients’ stance and gait? Let’s consider how a broader approach that considers the way people stand and walk could improve treatment outcomes for plantar fasciitis patients—and also help prevent recurrences.

The main factors in foot health

In my experience, the top three influences on the health and performance of the human foot are the architecture and orientation of the foot and leg, the way a person stands, and the way a person walks. Of course, shoes also play a big role in foot health (you can read more about this here), but while truly healthy posture can do a lot to compensate for poor shoes (extreme styles excepted), the best of shoes cannot make up for poor posture, stance, and gait. 

These African fishermen all show healthy external rotation in their legs and feet. Pexels

Internal leg rotation mechanically disadvantages our structure, and offers poor support to the feet and legs. Pexels

What gives rise to foot problems

We frequently work with people whose foot problems have been created or made worse by poor postural habits. While there can be a genetic predisposition to foot problems, frequently, what appears to be a genetic trait is actually the result of mimicking those closest to us—the person with bunions has replicated their parent’s poor posture or poor shoe choices which, in turn, caused their bunions. 

Let’s consider what can go wrong in the feet when standing. In a common modern stance where the hips are parked forward relative to the feet, the body’s weight lands excessively on the smaller, more delicate structures of the midfoot and forefoot. The ligaments that bind the bones in the feet together may no longer be able to do their job in preserving the shape and healthy function of the foot. 

 
How you stand affects your weight bearing and the forces going through your feet. This man has parked his pelvis forward, shifting his weight off his heels and onto the more delicate forefoot. Pexels

Plantar fasciitis

Plantar fasciitis is one common problem that results from faulty weight distribution overwhelming the foot ligaments. Other problems may include calcium deposits (bone spurs) at points of stress, nerve damage such as in Morton’s neuroma, inflammation such as in sesamoiditis, and stress fractures. 

Plantar fasciitis affects the strong, fibrous attachment that runs from your heel bone to the ball of your foot, supporting the medial and lateral arches. The ligament-like tissue becomes irritated and inflamed, making it painful to bear weight or use the foot, especially on initial standing. 

Plantar fasciitis occurs when the connective tissue on the sole of the foot becomes inflamed. Pexels

Treatment of conditions such as plantar fasciitis is often limited to local solutions. A common treatment for plantar fasciitis is to stretch the plantar fascia with exercise, manual therapy or by wearing night splints. This has some protective merit as it reduces the degree of tearing that can occur under the body's weight. Another measure that can offer relief is foot rolling with iced water bottles. 

After observing the shape of the patient’s foot, a podiatrist might prescribe an orthotic. The most conservative treatment with orthotics simply reflects the shape of the foot and aims to prevent further deterioration of the foot’s structure. Somewhat more sophisticated orthotics are designed to exert corrective forces on the foot, such as lifting a sunken arch. 

A root-cause solution is to learn how to stand and walk well. Instead of band-aid stretching and orthotics to compensate for weak muscles and poor body mechanics, this approach will lead to a strengthening of the foot muscles, an overall shortening of the foot, and appropriate weight-bearing on the foot at all times. When students come to us with orthotics, we encourage them to think of the orthotic as a training device that reminds the foot to practice what it needs to do, as well as being a prop for as long as they need it to do some of the lifting for them. 

Once the foot muscles have learned to grip around the contours of an arch support the foot can go beyond resting passively as shown here.

Learning to activate the feet is especially beneficial for anyone with “flat” feet. It’s also important for women during pregnancy, since both the additional weight of a baby and the hormone relaxin increase any tendency to ligament laxity. 

Key components of Gokhale Method® training in our in-person Foundations course, one-day Pop-up course, and our online Elements course will enable you to make profound and lasting changes for your feet. You can learn how to:

• Place much of your body weight on your heels. These are large, dense bones with a cross-fiber construction that are well suited to load-bearing compared with the comparatively delicate forefoot with its longer, thinner bone structure.
• Kidney-bean shape your foot, keeping its structural integrity. 
• Use your foot muscles to interact with the ground, providing stability and propulsion. 
• Coordinate your foot action with the external rotation of the leg and activation of the glutes.
• Antevert your pelvis, stack your spine, and align your upper body as part of healthy standing and glidewalking.

We pay a lot of attention to the feet in all our courses. Here I am showing a student how to kidney-bean shape their foot.

Is hi-tech the answer to foot problems?

Computer technology has enabled podiatrists to measure foot shape, weight bearing, and biomechanics with a precision that was previously unattainable. There have been exciting advances in clinical 3D scanning and modeling, and the use of sensors to measure real time movement and weight distribution. There is also an increased biomechanical understanding of how gait interacts with foot function. 

However, the medical model of foot and gait health continues to arrive at conclusions based on abstract reasoning instead of tried and true historical and anthropological evidence. It therefore continues to encourage modern distortions like a “straight” foot and “straight ahead” feet. We would love to see a shift in the medical perception of healthy feet and gait that weaves in ancestral wisdom. 

The Gokhale Method has developed two wearables that help refine students’ stance and gait. The five-sensor SpineTracker™ wearable is used by many of our teachers in a classroom setting to allow them and their students to monitor and track real-time changes in spinal shape during gait. The two-sensor PostureTracker™ is a consumer product that enables students to refine their stance and gait at home, work, or leisure. 

  
The PostureTracker setting Piston Walking can tell you if you are successfully straightening your back leg while walking (a) or not (b); this is relevant to the healthy function of your feet. 

Free Online Workshop: “Fix Your Feet”

On Wednesday, May 24, 1pm PT, we will be offering a Free Online Workshop, Fix Your Feet. If you would like to volunteer for a mini-consultation in this workshop, please email teamesther@gokhalemethod with a brief description of your foot condition. If you would like to support friends and family who suffer from foot problems, please feel free to email them.

Best next action steps for newcomers

If you would like insight on your foot issues and posture, consider scheduling an Initial Consultation, online, or in person.

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