lower back pain

Since the pandemic we are delighted to have resumed teacher training and welcomed 12 new teachers to the Gokhale Method community in Europe and the U.S. We are also steadily growing our roots in the Southern Hemisphere. Below, Australia-based Teacher Tegan Kahn shares the story of how and why she decided to train.

One New Year’s Day many years ago, I made a resolution to “have better posture.” This was back before I had kids; when I had time and energy to devote to grand plans! But, like most New Year’s Resolutions, it fizzled out pretty quickly. For several days, I reminded myself every hour to sit up straight and pull my shoulders back. But because I didn’t know how to be tall and regal without holding myself stiffly, my efforts just made me more uncomfortable and tired than remaining in my perpetual slouch.

Me on New Year’s Day twenty years ago at age 16. Slouching was my default. I felt it was impossible to maintain “good” posture for more than a few minutes at a time. 

Me slouching at 22. Another beautiful dress spoilt by poor posture!

I used to experience all kinds of pain and dysfunction in my body: lower back pain, upper back strain, jaw tightness, shin splints, IT band tenderness, tight hamstrings, lactic acid buildup, and dodgy knees, to name a few. Even gentle massage on some parts of my body, such as the backs of my upper arms and lower legs, caused me to leap off the table. 

Despite attempting to stand up straight for this “before” photo, by the time I took the Gokhale Foundations Course in 2016 I was starting to develop a dowager’s hump (at the ripe old age of 28). I wonder what my posture would be like now had I continued on this trajectory.

One day when I was having my twice-weekly massage for typing-related forearm tendonitis (a repetitive strain injury covered by workers’ compensation), my massage therapist told me I had little crunchy crystals of lymphatic fluid along the lower left border of my rib cage. I had known for a long time that my lymphatic system was sluggish, but so slow-flowing that the fluid had crystallised was a bit of a wake-up call! 

That discovery led me to tumble down the YouTube rabbit hole of lymph and fascia research, where I stumbled upon Esther Gokhale’s TEDxStanford talk. It is hard to overstate how great an impact that six-minute video has had on my life. The slide Esther presented showing a J-shaped spine next to an S-shaped spine blew my mind. I had studied anatomy at university during my biology degrees but it had never occurred to me that my textbooks might have been based on incorrect assumptions. 

The illustration that immediately convinced me of the sound logic behind the Gokhale Method. If you’d like to learn more about it, consider reading our blog  What Shape Is Your Spine?

The logic of Esther’s presentation was so arresting I felt a bit dumbfounded (and a touch indignant) that I had never heard this information before. I set about reading and watching anything Gokhale Method-related that I could get my hands on. I was extremely fortunate that the original, and only Gokhale Method Teacher in Australia at that time, Michelle Ball, was offering a Gokhale Foundations Course in my home city of Canberra a mere three months after I watched the TEDx talk. I felt like the stars were aligning. 

I was already convinced by the theory and evidence basis of the Gokhale Method, but I was yet to see first-hand the ramifications of implementing it. My mum, who had been left with daily pain following a serious car accident before I was born, attended the Foundations Course with me. When she turned to me at the end of the first lesson and said, “this is the longest I've sat without pain in 30 years,” I was doubly sure that this was something I wanted to be involved with in a big way. In fact, Michelle may recall that even on that first day of the Course I was already asking her what the steps were for becoming a qualified Gokhale Method Teacher.

At that time, I was also struggling to find motivation to return to my job as a science writer for a university following my maternity leave—while my work had a worthwhile indirect impact, I was having trouble justifying being away from my little son to do work that wasn’t directly and palpably making a difference to people. Perhaps it was the sleep deprivation, or the deep well of support from my mum, that led to me booking the three of us (myself, mum, and my by-then-14-month-old) on flights to San Francisco to begin the week-long intensive training with Esther, the start of the qualifying process. Looking back, it seems kind of a crazy undertaking, but I’m glad I did it, as I’ve rarely been more sure of wanting to do something.

I feel extremely grateful to have gained the know-how to help preserve my kids’ naturally healthy posture. Although, with their J-spines still mostly intact, they are more often good posture role models for me than the other way around! 

Training with Esther was bliss. I was so fortunate to be in company with the beyond lovely Kathleen O’Donohue and Tiffany Mann, my fellow trainees. Every day we explored a wide variety of subjects relating to teaching the method and then practised our new skills on a willing Foundations Course cohort. I just loved the depth and nuance that’s involved in rolling someone’s shoulders to just the right position for them (and of course seeing the change in their facial expression when they realised it was now easy and comfortable to maintain healthy shoulder architecture!). Esther’s knowledge and expertise were awe-inspiring, and it was a jam-packed journey. One day we toured the Cantor Arts Center at Stanford University, analysing the posture of the sculptures; the next day she ordered in some Chinese food for our lunch (and when she ordered over the phone in fluent Chinese, I thought: “of course Esther speaks Chinese—what can’t she do?”)

Myself (second from left), Esther (second from right), and my fellow teacher trainees Tiffany Mann (right), and Kathleen O’Donohue after practising our hip-hinging while picking kale in Esther’s garden.

When I returned to Canberra with my head full of knowledge, I leapt straight into my case studies (my husband was the first and patiently continues to be my guinea pig all these years later), and was proud to become a fully-fledged Gokhale Method Teacher once my peers and Esther had reviewed the videos of my teaching and given their valuable advice and support. My enjoyment of teaching hasn’t lost its lustre. I love interacting with people from all walks of life, adapting my teaching style and my hands-on help to their particular bodies and personalities. I love seeing them smiling in their “after” pictures (hardly anyone smiles in the “before” pics!), and am always on a high when someone tells me how the techniques have improved their lives, in little and big ways. Although I have passed through the initial uncertainty of my early teaching experiences (it can be hard to believe what you’re doing will produce astounding results when all the health information around you is based on an entirely different paradigm of healthy human spinal shapes), I still sometimes feel the need to “pinch myself” when a student makes a particularly marked transformation in their posture and pain levels. 

I feel very privileged to be able to pass on this life-changing wisdom, and Michelle and I are excited to get this work to as many people who need us as we can. Some of our wonderful students have expressed interest in becoming Gokhale Method Teachers, too, and Esther is planning to come all the way to Australia to train them if there is enough interest. We wait to welcome them with open arms to work collaboratively on our mission to make back pain rare around the globe.

If you or someone you know are interested in hearing more about Gokhale Method teacher training with Esther Gokhale in Australia, please reach out to [email protected]. 

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 to find out how the Gokhale Method can help you.

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

I’m a longtime cyclist, former elite-level mountain bike racer, and Gokhale Method teacher. Learning and applying Gokhale Method techniques helped me reduce lumbar strain caused by unhelpful posture habits I used to employ while riding. I continue riding to this day, along with my whole family — now free of lower back pain.

Riding a bike can be a fantastically fun way to get away from devices, boost energy, and practice healthy posture, all in one...and of course we always want to wear a helmet, and ideally have our shoulders more posterior than this rider does! Image courtesy Ümit Yıldırım on Unsplash.

In my humble opinion, bikes are the most perfect exercise equipment of all time. This is especially true for the COVID era! What else serves as a human-powered vehicle that allows you exercise as it transports you to various destinations, all the while engaging your senses and doing no damage to the planet? Furthermore, it is something you can do by yourself or with your family or friends, while still maintaining social distance and is, perhaps most importantly, done outdoors. The wheel base between two bicycles is around 6 feet, so riding with others can be done safely. Add Gokhale Method techniques to the mix, and you’ve got a recipe for full-body health.

This rider is wearing a helmet, always recommended! Also, her shoulders stay posterior, with a nice give/relaxation in her arms, and her head rotates on its axis. Her behind is not tucked; her tail appears to be behind her. Image courtesy Victor Xok on Unsplash.

Freshen up your routine
While many of us are sheltering at home, and/or working from home, fresh air and movement are vital to our health and well-being, perhaps even more so now than ever! And when more of our time than usual is spent indoors due to lockdown restrictions, experiencing the outdoors more intimately, through our senses observing the horizon and peripheries and making judgements about traffic and road conditions, as well as minute adjustments that occur as a result, can be really invigorating and refreshing and provide a wonderful reset to the stresses of daily life.

The roads are quieter these days, with less traffic than before the pandemic. This makes it an ideal time to dust off your bicycle, put some air in your tires, and if it’s been a while, visit your local bike shop for a tune-up. Or perhaps think about increasing the riding you do! You definitely want to make sure your bike fits you well; a good fit will help with comfort and safety.

My daughter Wilhelmina Brown, age 5. She hasn't been formally taught how to sit (this photo was taken before I knew better myself), but since she is not yet spending hours in school, she still sits well, with her lovely J-spine intact. Image courtesy Ken Richardson.

Adjusting seat height to support healthy posture
If you are unsure about the right fit, or if you feel too stretched out or too cramped in your torso when on your bike, consult a bike shop. People who work in bike shops love bicycles and want more people to enjoy them too! Your seat wants to be high enough so your leg has only a slight bend at the 6 o'clock position, with the knees not coming up too high either. You want to feel safe and balanced when you are stopped and standing over your bike, with at least a couple of inches of clearance or standover height. Bike shops will be able to guide you about specific bike components — the seatpost and stem, for example, can be adapted to better fit and support the rider. You can also read our founder Esther Gokhale’s blog post on choosing a bike style to support your posture while riding if you’re thinking of picking up a new 2-wheeler.

The changing season brings with it more comfortable riding weather than even a few weeks ago, whether you’re in the Northern Hemisphere or the Southern. And air quality is thankfully improving in the West. There’s never been a better time to saddle up and hit the road!

Cycling is a great way to experience community while maintaining social distance and practicing healthy posture. Win-win-win! Image courtesy Ahshea1 Media on Pexels.

This is the first post in a 3-part series on cycling and posture: stay tuned for more to come! For more information on Tiffany’s teaching in the Boston area, contact her here.

Studying and teaching yoga has been part of my life for several years. However, after learning the Gokhale Method, I approached the well-known yoga posture “downward-facing dog” (Adho Mukha Svanasana) in a new way.
 

Hip-hinging with my even spinal groove visible — GOOD! Image courtesy Cecily Frederick.

In the Gokhale Method Foundations Course, I learned how to hip-hinge and keep my spine from flexing when bending. I wanted to maintain about the same spinal shape in my “downward-facing dog” pose as I had learned when hip-hinging. This spinal shape, with an even spinal groove from the lower to the upper back, meant that my intervertebral discs, nerve roots and spinal ligaments would be protected during bends, and my hip joints would be used in a healthy way.

Also informing the adjustments I made to my downward-facing dog was receiving detailed feedback about my spinal shape from the new SpineTracker wearable device developed by the Gokhale Method Institute. This technology is available to participants of the new Pop-up Course and in private lessons with participating teachers.
 

Here, I’m wearing a set of SpineTracker sensors on my back to determine my lumbar spinal shape. Image courtesy Cecily Frederick.

Here is an example of the SpineTracker feedback for a hip-hinge. To contextualize, each dot is the location of a sensor.

SpineTracker snapshot of my spinal shape while hip-hinging — GOOD!

Although many yoga practitioners hip-hinge in their “downward-facing dog” posture, I had a habit of slightly flexing my lumbar spine in this pose.
 

The practitioner in this version of "downward-facing dog" pose shows a slightly flexed lumbar spine, putting the lumbar discs under strain. Image courtesy Form on Unsplash.

After many years of spinal flexion occurring with most hip flexion, I had developed chronic low back pain. Not all spinal flexion is easy to see (or feel internally), as my former downward-facing dog form, demonstrated below, shows.
 

Here I am in downward-facing dog with some lumbar spine flexion and hip flexion (knees straight, heels down) — BAD! Image courtesy Cecily Frederick.

To heal my irritated back, I began revisiting the way I approached this yoga posture. It was a worthy project since this pose shows up frequently in my yoga practice and yoga teaching sessions.

First, I needed to learn how to stabilize my overly mobile lower back and ease into deeper flexion in my hips. Luckily, hip-hinging practice had helped me learn how to achieve both of these goals. Then I needed to transfer this skill to one common yoga pose: downward-facing dog.
 

In this photo, I’m in downward-facing dog with my spinal groove visible (knees bent, heels up) — GOOD! Image courtesy Cecily Frederick.

Here’s another view of my downward-facing dog, wearing the SpineTracker sensors on my back (knees bent, heels up) — GOOD! Image courtesy Cecily Frederick.

The upgraded downward-facing dog pose creates an even spinal groove which I’m able to feel with my fingertips — GOOD! Image courtesy Cecily Frederick.

A great way to capture the shape of the spine in a complex yoga pose is to take an image with the SpineTracker device. The SpineTracker sensors stick directly to the skin over the spine and are able to give detailed information about the spine’s shape (and your hands can stay on the floor).

SpineTracker snapshot of my spinal shape in upgraded downward-facing dog (knees bent, heels up), more spinal extension — GOOD!

For comparison, this SpineTracker snapshot of my spinal shape in unmodified downward-facing dog (knees straight, heels down) reveals noticeably more spinal flexion than in the upgraded form — BAD!

In my upgraded downward-facing dog pose: no spinal flexion, heels up, knees bent — GOOD! Image courtesy Cecily Frederick.

To refine my downward-facing dog pose, I needed to:

1. Learn how to hip-hinge from a Gokhale Method teacher
2. Come to a hands and knees position (“dog pose”) with a J-spine
3. Lift hips into downward-facing dog position without changing spinal shape and gently pull hips back, away from hands

Things that might also help if you have shortened hamstrings and calf muscles and/or internally rotated femurs:

1. Keep knees softly bent and kidney bean shape the feet to allow the pelvis to settle well
2. De-emphasize dropping heels to the floor
3. Allow the pose to feel awkward at first (but not painful)

One additional advantage to structuring a downward-facing dog this way is that the pose becomes a great way to lengthen the entire spine, which can make other yoga poses healthier and more accessible. Yoga is one of many topics addressed in the Online University content for alumni.

Is there a yoga pose that causes you some back discomfort?

In the 1990s, Ofer Ben-Shachar suffered a leg injury. Doctors recommended he get surgery, estimating they would have him back running marathons within weeks. Before going under the knife, Ben-Shachar wanted to find data on this surgical option to see how effective it really was. However, the little research he could dig up was confusing and inconclusive. Frustrated, he succumbed to the assurances of his confident surgeon. What happened instead was so debilitating, it took him five years before he was able to drive a car again (you can read more about this story here). He vowed that one day he would create a website to help people get the kind of information he wished he had had at the outset.

After selling a successful startup, Ben-Shachar was able to follow through on his promise and funded a venture that he has named HealthOutcome.

Health Outcome homepage showing the highest and lowest rated solutions for Lower Back Pain

The website reads, “To [Ofer’s] surprise, no one from the medical community (his doctor, the hospital, or his insurance company) contacted him to learn about the result of his surgery.” Ben-Shachar goes on to say, “There is no meaningful data on medical treatments or surgery outcomes available to patients or physicians." Despite over 51 million surgeries (750,000 of them back surgeries) performed annually in the US, there was little to no patient-reported outcome data available to patients. "We are actively addressing this void of outcome data with a platform built to capture the voice of the patient.”

Data on medical outcomes has been limited and is not always trustworthy

In response to this lack of information, HealthOutcome has democratized treatment outcome data by collecting crowdsourced ratings and reviews. People need to hear from each other, not just in anecdotes, but in numbers. Ben-Shachar explains, “after 80 reviews are submitted for an intervention, we see the rating stabilize, which is in itself a sign of validity. The scale of the studies we are doing here is beyond anything happening in clinical trials. At 1/10,000th the cost per patient, we pool unbiased results from the public and are reflecting important truths about what works and what doesn’t.” There is truth in numbers, and the website has gotten the attention of a group of Stanford researchers who have recently published an article about the site "Is Crowdsourcing Patient-Reported Outcomes the Future of Evidence-Based Medicine? A Case Study of Back Pain", showing it to be a valid tool for measuring medical outcomes.

In the Evidence-Based Medicine triad, ‘relevant scientific evidence’ can now be bolstered by crowdsourced outcome data

Researchers note that the findings on HealthOutcome are consistent with the findings from randomized controlled trials, while the numbers are vastly greater than can be achieved from a randomized controlled trial (RTC). Furthermore, HealthOutcome allows for people to rate treatment success many months or years later, giving a better picture of the longevity of an outcome. For most surgeries, doctors perform little or no follow-up, and controlled trials are limited in that they cannot check back in on the trial patients one, two, three years later to see how their condition has progressed.

The Gokhale Method Institute recognizes the need for research on our program, but has had to face the reality of how difficult it is for a small organization to gather ‘pure’ data, in the form of an RTC. These trials are expensive and take specialized knowledge and a specialized cast of characters to design, implement, analyze, and publish.

This figure shows the change of mean values of the number of check-marked pain-related questions from the Roland Morris Pain Questionnaire due to Gokhale Method Foundations course.

In our journey for scientifically sound data, various studies have been conducted on the Gokhale Method. A San Jose State University study showed increased vitality and increased hamstring flexibility from taking the Foundations Course. An ongoing in-house study has shown remarkable changes in the frequency of back pain that students experience before the course, at completion of the course, and four weeks after completion. These studies, though highly encouraging, fall short of the RTC standard.

Enter HealthOutcome with reliable and valuable data!

HealthOutcome, with its overwhelming validation of the Gokhale Method and Postural Modification, was therefore a very welcome recent discovery. Lower back pain is one of the conditions the site has highlighted and...drumroll…Postural Modifications wins by a landslide margin! While most treatment options on the site differ by only 0.1 or 0.2 points (on a 0–5 rating scale) from the next best treatment option, Posture Modification stands head and shoulders above the next best treatment: compare a rating of 3.7 for Posture Modification with 2.9 for Yoga, with over a thousand reviews between them.

The Gokhale Method had been added to the list of interventions on the site, and we’re very proud to have a 4.6 out of 5 rating. With less than 500 reviews, our treatment doesn’t yet make it ‘above the fold.’ However, this excellent rating is a huge deal for the Gokhale Method, for back pain research, and for the public.

The Gokhale Method needs more reviews, but it is quickly becoming the top-rated solution on the Health Outcome website

This site is a tremendous service to us all, and I hope it flourishes and expands to cover an increasing number of conditions. There has long been a need for an efficient, trustworthy way to collect reviews of available treatment options, both to help patients gather the information they need to make informed medical decisions, and to help inform medical professionals (who have little time to research new treatments for every condition and to compile detailed treatment reviews) of the variety and efficacy of the options available for their patients. There is also a great need for a platform that non-clinical treatment options, such as posture modification and exercise regimens, can use to efficiently gather data, learn how effective their programs are, and share this news. The Gokhale Method is very excited to be able to see quantifiable validation of what we hear from our students every day, and to share our success with a larger audience.

I hope as readers of this article, you will share your experience after taking the Gokhale Method Foundations course on HealthOutcome if you were suffering from either lower back pain or neck pain.

Having some asymmetry in our bodies is natural and by no means a problem… for example, the majority of us are either strongly right- or left-handed, and if we play soccer we soon discover that we have a preferred foot, too! This study shows that pelvic obliquity (often caused by legs of a slightly different length) is present in equal measure in people both with and without Lower Back Pain, and doesn’t seem to be a contributing factor to the problem of back pain.

A famous example of someone who had a big leg length discrepancy was Bruce Lee. It didn't hold him back very much! To quote him, "I became a martial artist in spite of my limitations. My left leg is almost one inch shorter than the right.  That fact dictated the best stance for me – my right foot leading. Then I found because the right leg was longer, I had an advantage with certain types of kicks, since the uneven stomp gave me greater impetus.”

Bruce Lee, who had almost a 1" leg length discrepancy, managed to go far nonetheless.

It is a good bet that having a dominant side is not a significant problem for humans, or we would likely have evolved to be more ambidextrous!

Pete Sampras showing great form. Playing tennis is a very asymmetric activity, but amateurs and professionals alike don't suffer from it in any obvious way.

As long as our bones and joints stay well aligned and our postural muscles are strong, moderate amounts of muscular asymmetry doesn’t seem to be problematic. However, if our posture and movement patterns have been poor, we are much more likely to develop shears or twists in our bodies, and suffer injury or uneven wear in the joints. Joints or muscles that remain unused because of pain or weakness can degenerate or atrophy, hindering the development of a strong postural base.

Because of this, it is worth observing our everyday movements. If you favor one side to the extent that one side of you becomes strong and the other noticeably weaker, or one side is flexible and the other stiff or uncomfortable, applying the Gokhale Method can help redress the balance:

Stretchlying on a Different Side
If it is suitable for your back, give a little more attention to stretchlying on your less favored side, where it is likely that your back muscles are tighter and shorter.

Stretchlying on your less favored side can help even your body out. 
 

Fine-tune Your Hiphinge

Make sure that:

1. Your weight is evenly distributed between your feet

2. Each knee is bent the same amount

3. Each thigh is externally rotated to the same degree

4. Most importantly, check that your pelvis and torso remain central and that you are not listing to one side.

Be sure that as you bend, your knees point in the same direction as the feet, and that you don't list to one side.

Glidewalking
When practicing your glute squeezes for glidewalking, usually by raising a leg behind you, it can be helpful to complete more reps on your weaker side. Same with the inchworm exercises for gaining foot strength.

Try to even out unevenness in the strength of your feet by doing more reps on the weak side.
 

Steps and Stairs
Make sure you do not always climb up steps and stairs with the same leg first. Alternate which leg you start with, and focus on pushing off from behind with the foot.

Alternating which leg you begin climbing stairs with helps eliminate a possible cause of muscle imbalance.

You may also notice that a movement flows well in one direction, and feels awkward in the other direction (for example, opening a door with your non-dominant hand). Practice switching sides from time to time. Beginning with a blank slate will help you reexamine and improve your movement pattern. Being somewhat ambidexterous can improve your overall muscular strength and be helpful in sports and everyday life; it can also help chart new and helpufl neural pathways in your brain.

Do you have activities in your life that are very asymmetric? Have they caused you problems or have you navigated them just fine?

Join us in an upcoming Free Workshop (online or in person).  

Find a Foundations Course in your area to get the full training on the Gokhale Method!  

We also offer in person or online Initial Consultations with any of our qualified Gokhale Method teachers.