pelvic anteversion

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…

Next time you are in the dentist chair, spare a thought for your dentist’s posture and the postural demands of their job. Doing dental procedures shares many challenges with other surgical procedures, such as having to maintain a steady position for long periods, maintain a clear line of vision, and hold and manipulate tools with precision. Working in the oral cavity of a conscious patient is a pretty significant challenge. 

Dental professionals place many physical demands on their structure. They can be regarded as “occupational athletes.” Image from Pexels

Dental personnel and health

Unfortunately, these demands take a toll. Of adults in the U.S. general population, 13.8% experience significant neck pain; among dentists, that figure is a staggering 67%. Dentists and other oral health practitioners (OHPs), including dental nurses and hygienists, also report suffering from above average incidences of lower back pain, headaches, shoulder problems, and work-related tendonitis, bursitis, and carpal tunnel syndrome. Such problems can make life miserable, both in and out of the dental office. Some OHPs are forced to abandon a career they have spent up to eight years training for. Of dentists taking ill health retirement, 55% cited musculoskeletal disorders as the cause.

The Gokhale Method for Dentists and Oral Health Practitioners

Since 2008, well over 100 dental workers have sought out the Gokhale Method® to help them solve their posture puzzle and get out of pain. They are both welcome and in need of what our courses (in-person Foundations, one-day Pop-up, and online Elements) offer. Given their particular professional needs, we are now working with some of our dentist and hygienist alumni to develop a special Gokhale Method offering for oral health practitioners. 

This will be a tailored training delivered at dental offices, clinics, and teaching hospitals. The goal is  that oral health practitioners learn the posture tools they need to future-proof their careers.

An introductory workshop for oral health practitioners with Gokhale Method teacher Julie Johnson was recently received with great enthusiasm at a dental practice near Stuttgart, Germany. 

Dental practice team members, Bridget, Amy, and Julie, practice seated hip-hinging with teacher Julie Johnson. The Gokhale PostureTracker™ wearable gives biofeedback—and they’re having fun!

From a dentist’s perspective

One of Julie’s recent Gokhale Foundations students is Warren Blair, an American dentist living and working in Germany who, though counting himself fortunate to have had relatively few serious musculoskeletal aches and pains over his four decades of practice, understands the value of the Gokhale Method. 

Warren Blair, D.D.S., M.S.D., is a specialist in periodontology, implantology, microsurgery, and endodontics—and a student of posture!

Warren shared many things about the ergonomics of dentistry with us, both from the dentist’s and patient’s perspective:

The physical aspect is a problem—all dentists have problems. Some are in their mid-thirties and they're walking around crooked because they have a charley horse (muscle spasm). I periodically stretch the muscles around my back and shoulders, or pull away from my microscope eyepieces to reset. Doing the Gokhale Foundations I have learned that posture is key to the solution; having healthy posture early on in the profession will prevent future problems, but if problems with your musculoskeletal system do crop up then you can do something about it by changing your habits and adopting the principles of healthy posture.

Warren confirmed that dentists are taught not to round over their patients, and to work with their knees wide, but admitted that these positions are not always easy to maintain on the job. Learning and preserving healthy postural habits is especially difficult given that many dental workers, like most people in our culture, will, unfortunately, be approaching their training from a poor posture baseline. 

Healthy posture is an ecosystem

The basic instruction that trainees receive is not nearly as nuanced or integrated as the movement patterns taught in the Gokhale Method. In typical modern western fashion, we are all given stand-alone instructions, e.g., “don’t round when you bend.” The hip-hinging bend taught as part of the Gokhale Method is part of a whole movement pattern, involving nestling an anteverted pelvis, getting the femurs out of the way of the pelvis, anchoring the rib cage, engaging the inner corset, keeping the shoulders posterior, and maintaining a healthy neck position. Altogether, these elements give dentists the resilience needed for sustained bending, even with some variety of twist.

This practitioner is maintaining her J-spine, with her behind behind and her back tall and relaxed. This is a healthy baseline for sitting and forward bending. Image from Pexels

Posture instructions given in isolation don't translate very effectively into practice. However, as part of a holistic education that pays attention to the way we do everyday life activities, posture training becomes transformative. For example, walking well, both in and out of the office, is a natural reset for a tight psoas muscle. Learning to stacksit allows your breath to mobilize your back. Sleeping positions, done well, can enable you to heal damage and inflammation. 

Learning the Gokhale Method at work means you immediately put posture into practice in your profession, and sets up many opportunities for colleagues to support one another. If you are a dental or medical professional and would like to know more about how the Gokhale Method can help you and your team, please email: [email protected].

If you would like to support your dentist, send them this invitation to one of our free online workshops. 

Best next action steps 

If you would like to improve your posture, for work or leisure, 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…

 

The best art often communicates on many levels. The Walking Men 99™ exhibit is a great example. It consisted of a frieze of pedestrian crossing icons, photographed and assembled from around the world. At human scale, they mingled with passersby on the sidewalk. 

Walking Men Worldwide™ is a series of public art installations by artist Maya Barkai, which was launched in Lower Manhattan in 2010-2013 (Walking Men 99™), and was followed by a series of installations around the globe. www.walking-men.com

From a posture perspective, signage featuring pedestrians offers us an overview of how modern urban people perceive, represent, and execute walking. Some lean back in line with the front leg, others lean forward in line with the back leg; some land with a bent front knee, others land with a straight knee; some have a straight back leg as the front leg lands, others do not. No other mammal on earth shows such variation in its locomotion!

Does variation in gait matter?

In traditional rural villages across Africa, India, and South America, when I study walking, I see a more uniform walking pattern. This holds true across different cultures, ages, and occupations. Intriguingly, this gait is also shared by our young children, and can be seen in antique photographs, paintings, and sculptures of our ancestors. It results in a uniquely smooth, elegant, powerful walk that is rare enough, it merits a special name, glidewalking. 

Glidewalking describes the healthy and efficient human gait pattern shared across different generations and cultures.

Glidewalking is very different from the various stomps, shuffles, totters, bounces, and other strategies that people in modern urban societies bring to their walking. Any type of walk can get us from A to B, but anything short of what our bodies are designed for is likely to be inefficient and, over time, destructive. Twisting, swaying, slumping, or jerking the spine with every step causes compression, inflammation, damage, and degenerative processes. Suboptimal gait biomechanics are also largely responsible for our epidemic of knee, hip, and foot problems, which include cartilage wear and tear, joint arthritis, and plantar fasciitis.

Take a closer look at walking

In the Glidewalking chapter of my book, 8 Steps to a Pain-Free Back, I included a variety of pedestrian traffic signs to show how they can reflect and promote different gait patterns:

Taking a fresh look at pedestrian crossing signs—from a posture perspective. (Page 170, 8 Steps to a Pain-Free Back)

Most public signage reflects our confusion about walking. Signs often depict walking with either both legs bent, or both legs straight at the same time, or some other compromised configuration.

These airport signs show weight aligned on the front leg and little effective propulsion from behind.

Straighten out your walking

A good first step (literally!) is to learn to straighten your back leg fully. This has numerous benefits: 

• pushes the ground back strongly to propel you forward
• encourages you to lean a little forward rather than backward 
• encourages glute contraction 
• encourages healthy pelvic anteversion
• encourages your back heel to stay down and your foot to be active for longer
• stretches your calves
• is nature’s stretch for the psoas

We recommend you start practicing by walking uphill, or pushing a rolling chair or shopping cart, which makes all of the above benefits easier to find in your body. 

This sign in the Philippines shows healthy walking form, with the torso angled slightly forward and the leg behind straight. Image from Bonifacio Global City

Unfortunately, this guy is not doing such a good job… Image from Angela Bayona(Toggear.com

Notice how these animated walking figures differ…but both have a straight back leg.

 

Take a step in the right direction 

Over the decades we have worked out how best to guide students through the process of improving their gait. Deeply ingrained poor walking habits can be replaced using tried and tested techniques in a step-by-step process.  This is covered in all of our beginning courses: our in-person Foundations course, one-day Pop-up course, and our online Elements course. 

Alumni can sign up here for our next Advanced Glidewalking Course, starting Monday, June 03, 12:00 p.m. PST and give your walk the green light!

Best next action steps 

If you would like to improve your walking, 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…

I frequently get questions about what makes a good office chair. Of course, some office chairs are primarily fashioned for style and aesthetic appeal. In general, I would say these may be easy on the eye, but, over time, hard on the body!

 This office chair sparkles with 1960s retro-chic. However, its markedly concave seat will internally rotate your legs, encouraging malalignment in the hips and knees, and flat feet. Its straight backrest leaves no space for your behind, encouraging you to sit on your tail and tuck your pelvis. lakeland-furniture.co.uk

Ergonomic chairs

People often ask my opinion on how various ergonomic chairs on the market might help them. This makes sense given the rising prevalence of back pain¹. “Ergonomic” means that something is designed primarily for the health, comfort, and protection of users, and among the specific chairs people ask me about, the Herman Miller Aeron Chair tops the list. To answer efficiently, I like to compare and contrast it with the chair I designed, the Gokhale Method Pain-Free™ chair, as this embodies the posture principles confirmed by my research and experience. 

The Herman Miller Aeron Chair. hermanmiller.com

The Gokhale Method Pain-Free chair.

Even though they are both designed to be “ergonomic,” they are clearly very different. The Gokhale Method Pain-Free chair reflects the paradigm shift that underlies the Gokhale Method® philosophy. This makes the chair quite different from every other office chair on the market.

How chairs shape your spine

The Aeron chair has been designed following the conventional wisdom of the S-shaped spine, the “S” being formed by alternating lumbar, thoracic, and cervical curves. Over the last 100 years or so, this shape has become the received knowledge learned by physical therapists, medics, and designers, resulting in chairs whose contours support a significant curve in the lumbar area, and accommodate a thoracic curve in the upper back. From a Gokhale Method perspective this excessive curvature is the primary cause of disc bulges and herniations, nerve impingements, muscular spasms, and the degenerative conditions that cause back pain. 

The Aeron chair is based on the concept of significant lumbar and thoracic curvature being desirable.  hermanmiller.com

The Gokhale Method advocates a J-shaped spine, which is the shape we see in infants and young children, in historical artifacts and photographs, and which still persists in non-industrial societies across the world. The J-spine is especially relevant when sitting upright, where, due to an anteverted pelvis, the behind is behind and the vertebrae of the spine can stack more vertically. We call this stacksitting.

No tensing the back muscles to get upright, no collapsing into a slump—and no alternating between these two problematic positions, which is a common strategy to try and relieve the discomfort they cause. Just comfortable, healthy sitting. You can read more about spine shape here.

Sitting upright at your desk

Both the Herman Miller Aeron Chair and the Gokhale Method Pain-Free chair have a waterfall front (where the seat pan front angles downward), which is ideal for upright sitting. If you know how to arrange your legs and trunk well, this will facilitate pelvic anteversion and all the good things for your spine and general health that come with it. Pelvic anteversion is central to the Gokhale Method and is taught in our in-person Foundations Course, Pop-up courses, or online Elements Course. 

The seat pan of the Aeron chair features a waterfall front in a mesh fabric. Some users may find the adjustment lever under the seat is too close for easy operation when the seat is tilted forward for stacksitting.  hermanmiller.com

I designed the seat pan of my chair using a combination of materials that give optimal support for sitting. The sitz bones need to experience a firm foundation for the pelvis and spine above, but they also need to be padded for comfort. In my experience this combination cannot be equalled or improved on by a single material or mesh fabric.

The seat pan of the Gokhale chair combines materials for optimal support and comfort.

Note that the metal backrest support is curved to accommodate the behind behind, another feature that helps in anteversion of the pelvis. 

To further aid stacksitting the Gokhale Method Pain-Free chair seat pan also has four soft, textured, rubbery nubs sewn into its front edge. These provide grip which help keep your pelvic position, and prevent any slipping off the chair. 

The Gokhale chair seat pan features four nubs which help you to stacksit for upright working at your desk.

Our seat pan is also slightly convex to facilitate external rotation of the legs and feet—that is, it encourages them to gently turn outward. This brings healthy alignment of the hip, knee, and ankle joints, and also the foot arches. A mesh fabric, pulled taut, cannot support external rotation in this way. 

Stacksitting with healthy external rotation of the legs. 

Armrests

Many office chairs come with armrests. It is healthier for the shoulders, which are very mobile joints, not to be continually fixed in position by armrests, however adjustable. Far better to learn to shoulder roll, which encourages range of motion and optimal arrangement in the joint. Shoulder rolls also help adjacent problem areas such as the trapezius muscle, neck, and upper back, and improve circulation to the area. A well-connected shoulder can support the weight of the arm effortlessly as you do your tasks.

Arm rests also create the significant problem of not being able to come close in to the keyboard, thus encouraging rounding of the shoulders. The absence of arm rests allows an almost cockpit like feeling of being surrounded by the desk and keyboard with no temptation to migrate the shoulders forward.

Backrests—traction trumps lumbar support

The Y-shaped feature at the back of the recent models of the Aeron chair has a support for the base of the spine which can be used to support the sacrum in mild anteversion. It also has a lumbar support which is less aggressively curved than that of earlier models. While these are considerable improvements, the mesh back of the Aeron chair is still not able to provide therapeutic length to the spine through traction, as the Gokhale chair does, or space for posterior shoulder placement. Nor does the backrest easily accommodate our trusty Stretchsit® Cushion. 

A contemporary Aeron chair features support for the base of the spine (sacrum) and lumbar area.  hermanmiller.com

The Gokhale chair backrest provides therapeutic length to the lumbar spine with soft, built-in nubs for traction.

Beyond supporting a healthy J-shape in your spine, ideally a backrest would also help tease out any tension in the lumbar area. The Stretchsit Cushion success in improving back shape and reducing back tension has inspired the same successful features in our Pain-Free chair. With a little know-how, these soft textured nubs in the backrest can give you hours of therapeutic traction at your desk, reducing pressure on your spinal discs and nerves, and improving circulation in the surrounding tissues. We call this stretchsitting. 

Are adjustable chairs better?

As consumers we have become increasingly familiar with hi-tech products that we can adjust and customize to meet our individual needs and preferences, and the Aeron chair reflects this throughout its design. 

The Gokhale Method Pain-Free chair requires just one adjustment, and that is the gas lift height adjuster. This is key to the use of the chair, which is designed to be raised for stacksitting so the thighs and pelvis can angle downward, and lowered a little for stretchsitting against the backrest so that the feet can still meet the floor well. The lifting mechanism comes in three different heights, and there is also our Petite Gokhale Method Pain-Free™ Chair, ideal for both smaller people and smaller spaces. 

The Petite Gokhale Method Pain-Free chair gives a range of working heights, and a foot ring. 

Foot rings

One additional feature on our Petite Gokhale chair is a foot ring, which gives more options for foot and leg placement, and prevents legs from dangling and pulling the pelvis into a tuck. It also avoids the constriction to circulation which may occur if the thighs hang over a seat edge.

A foot ring helps take care of the lower body—an area often overlooked in conventional office chairs. 

From a Gokhale Method perspective, adjustments for spinal curves or arm rests are simply not required once the basics of healthy posture are understood. Better to address these fundamentals before going all out on the bells and whistles. This means there’s less to go wrong—with your chair, and your body!

Sitting well is a partnership 

Almost every employer who wants to demonstrate care for their executives finds themselves purchasing a Herman Miller chair. Yet within the budget of an Aeron chair they can buy a Gokhale chair and treat their employee to a one day Pop-up Course or six-lesson Group Foundations Course in the Gokhale Method where they will learn postural skills that last a lifetime.

Healthy sitting is a partnership. It takes a good chair on the one hand, and good posture on the other. With the Gokhale Method Pain-Free™ chair and the Gokhale Method you have the perfect combination.

References:

¹Janet K. Freburger et al., “The Rising Prevalence of Chronic Low Back Pain,” Archives of Internal Medicine 169, no. 3 (Feb. 2009), 251–58, doi: 10.1001/archinternmed.2008.543

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…

Rediscovering ancestral posture can be fun! In our online 1-2-3 Move program we have had several “Show and Tells” during which participants share old family photographs. The inspiration for healthy posture and positive change that these pictures bring to their descendants, as well as to the online community, is powerful. 

Here I am showing a photograph of me with my extended family in Holland. The tailoring of the traditional costumes we wore helped us to sit and stand with open, relaxed, and upright posture.

In Part 1 of this series we looked at the upper body. Here we are going to consider what our forebears can teach us about healthy alignment for the lower body—specifically, what needs to happen with the pelvis, legs, and feet. 

Ancestral photographs provide compelling evidence for what is taught in the Gokhale Method and can be a posture lesson in themselves. For example, in the print below it is striking that everyone is sitting on an anteverted pelvis, with externally rotated hips and legs, and feet angled outwards.

This group portrait shows how people sat with an anteverted pelvis, external rotation in their hips and legs, and feet pointing outward. It is one of several spare antique photographic prints donated by the Mendocino County Museum to the Gokhale Method Institute’s collection and also featured on the 1-2-3 Move exercise program. 

Pelvic anteversion 

Pelvic anteversion is the natural and healthy position for the human pelvis, in upright sitting and standing. “Anteversion” means the pelvic rim settles at a slight forward angle, rather than the “neutral” or “level” position which is often taught as ideal today. Most people in modern societies “tuck” or “retrovert” the pelvis in the opposite direction to anteversion, and consequently get into various kinds of trouble.

Anteversion is the pelvic angle you still see in historical artefacts, in our infants and children, and in populations throughout the non-industrialized world that suffer far less back pain than we do. This is explained and illustrated in detail in my book, 8 Steps to a Pain-Free Back. Below are just a few examples.

Antique statues, infants, and people in more traditional cultures all show a naturally anteverted pelvis. 

Legs externally rotated 

Pelvic anteversion is natural for our species, but was more prevalent prior to the 1920s, when traditional posture was still preserved and people had good role models. The prevailing dress codes of past times were also more conducive to healthy posture and movement patterns. For women, long, wide skirts allowed the legs to widen and the pelvis to settle well. In shorter skirts women tend to turn the knees inwards because of moral codes. Tight skirts and jeans will also tend to limit the range of movement in the hips in a way that traditional clothing does not. (Note: there is a healthy way to antevert the pelvis even when the knees are close together, but this takes a little more education and training.)

Pelvis nestled

A well-trained eye can also discern from a photograph the deep nestling of the pelvis between the leg bones that takes place when the legs are externally rotated. This nestling enables people to sit more forward on their sitz bones in an upright but relaxed position (below left). With the more common tucked pelvic position of modern times, a person is left with two equally unhealthy options for the torso: relaxed and slumped (below center) or upright and tense (below right). 

We have forgotten how to be upright and relaxed to the extent that when we look at old photographs with upright people, we mistakenly imagine that they are stiff and must be exerting a lot of effort to be upright.

Feet pointing outward

If you are lucky enough to have full-length family portraits you will see that the feet are angled outward in standing. This arises naturally from having external rotation in the hips. The current conventional wisdom that the feet should be parallel interferes with the healthy alignment and function of the lower limbs and pelvis. Without external rotation, feet are more likely to pronate (roll inward), knees to collapse inward (knock knees), and the pelvis will not articulate well with the heads of the femurs (hip joint). Students have reported much improvement in hip bursitis and impingements in the groin from gently progressing external rotation over time using Gokhale Method techniques. 

1-2-3 Move participant Linda Grande shares a photograph of her grandparents, taken around 1916, who emigrated from Sicily and met in Brooklyn. They both show beautiful posture, including outward pointing feet.

Finding external rotation

Our 1-2-3 Move Alumni exercise program gives participants further practical posture experience as well as sharing compelling history and theory. Below is a short video clip in which I introduce and teach a traditional Indian dance (Bharata Natyam) movement, which I learned as a child in Mumbai. Like most traditional dance forms, it encourages external rotation of the hips, legs, and feet. Dance is an excellent way to learn new movement patterns and make them feel familiar. Try this move for yourself! 

Traditional dance forms such as Bharata Natyam encourage external rotation of the hips, legs and feet.

The Gokhale Method® approach to posture and movement is always holistic, supports good habits, and develops healthy alignment that protects joints and soft tissues from injury. You can find out more in one of our new FREE Online Workshops. If you would like an expert one-on-one assessment of your posture and especially your lower body alignment, you can arrange an Online Initial Consultation or take an in-person Initial Consultation if you have a Gokhale Method Teacher near you.

In our part 1 blog post on the topic of bikes, we went over how to find the right frame for you. The next important step is to find the right seat for your body and your bike, since without a decent seat you may be uncomfortable, or may find it challenging to have healthy posture. Your seat should distribute your weight across regions comfortably; it should have padding, but not so much that it lacks support and stability; it should be set at an angle that allows your pelvis to antevert (that is, tip forward relative to the angle of your spine.) A good seat is crucial whether you prefer to be upright and stacksit, or if you prefer a racing style with a hiphinge. Here’s what you need to know about bike seats to find the right one for you:

Seat shape and angle: On most bike seats, it’s possible to change not just the height, but the horizontal position and the tilt of the seat. Make these adjustments carefully on any bike you plan to ride regularly. A small difference in the seat position can have a big difference on your posture as well as your comfort.

The angle of your bike seat—because it makes anteversion uncomfortable or because it tilts you too far forward or backward—may be causing you to tilt your pelvis in a direction that doesn’t allow for good back positioning. Many people prefer bike seats that carry most of their weight on their sitz bones (further back) rather than on the tissues under the pubic bone (further forward), because there are fewer sensitive nerves endings around your sitz bones. So if the front of your seat is tilted too far up (as in the image above left), this can encourage you to tuck your pelvis in an effort to relieve pressure on the pubic bone. And if the seat is really tilted too far up, it forces you into a tuck because of the backward slope of the seat—picture this as the opposite of the wedge you would use to facilitate stacksitting. If you try to sit on your bike with an anteverted pelvis (more angled than the angle of the hiphinge you need to reach your handlebars), and your seat causes you discomfort, you may need to angle the front of the seat downward.

Too much downward tilt is also problematic. If your seat makes you feel as though you are slipping forward off it when you antevert your pelvis, you will need to tip it back more so that you stay comfortably in place without having to brace all your weight against your handlebars. If your seat is tilted forward so that it doesn’t sufficiently ‘cradle’ your pelvis at the right angle, you may also be tucking in an effort to get your bottom further back on the seat.

It is possible that after playing with your seat to find a comfortable middle-ground, you will discover you need a new seat altogether. You should look for one that accommodates the shape and size of your sitz bones and carries your weight in the least-sensitive areas when you are properly hiphinging on your bike. Some seats are wider and may cause chafing against your thigh; you may need a cutout in your seat to relieve pressure under your public bone. To find a seat that matches your body, you may need to do a lot of testing!

Note that many newer “comfort” seats have a huge amount of padding and can amount to sitting on a small mound, rather than distributing your weight and ‘cradling’ your bottom. This extreme amount of padding can actually make it harder to comfortably antevert your pelvis:

Because these seats fall away from a padded peak, your weight is not well distributed; to find a comfortable spot for the pressure to land, you may end up tucking your pelvis so your sitz bones take all the force.

Older “saddle” style bike seats may appear too firm, but they can cradle your pelvis, distribute your weight comfortably, and promote stacking.

The slightly bowl-shaped curve of these seats provides lift in the back like a wedge, but catches your from sliding forward with the projection in the front.

Firmness and fabric covering on the seat will also make a difference in your riding experience. A slippery fabric may cause you to always be sliding around; a squishy seat may feel most comfortable at first, but end up chafing or lacking support. Finding the ideal seat is best accomplished through a lot of testing and laps around the block, so we recommend you find a very patient bike shop attendant to help you with this selection. You may need to purchase several seats so you can test them out on longer rides over several days before returning the rejects.

In addition to the more standard styles found in most bike shops, there are also many kinds of specialty seats available online which may work best for your needs and preferences:

Both of these seats provide a nice bowl shape that can support anteversion and comfortably distribute weight. Personal preference will dictate whether these fit your body, and enable a proper range of movement and a stable seat while on your bicycle.

Getting moving: When it’s time to actually get on your bike, how should you do it? The most gentle way to mount your bike will be to start by straddling the frame in front of the seat. Try doing this next to a railing or wall where you can brace yourself for balance, and move slowly while engaging your inner corset.

This young girl shows the ideal way to start your ride—straddle the frame and tallstand to align your pelvis and spine.

If you are not adept at swinging one leg through the air, or your balance isn’t what it used to be, a bike frame that dips very low in front (like comfort bikes) may be necessary to make getting on and off your bicycle easy. Make sure you can easily step over your frame without hurting your back or losing balance.

 

This comfort cruiser is ideal for maintaining a relaxed upright posture, and has a low bar in the front that makes getting on and off the bike a breeze!

Before you get up your seat, perform a shoulder roll and slowly reach your arms to your handlebars, to make sure you maintain good shoulder positioning with your elbows close to your sides, and no slump in the upper back. Keeping your shoulders in position may deepen the amount of bend you need to sit with, which will dictate how anteverted your pelvis should be.

When you get up onto your seat, you will have to perform an advanced hiphinge/stacksit, one that is done by bringing your hips back and up, rather than your torso down (while moving and balancing!). As you stand up on your pedals, make sure you start with a straight back, engage your rib anchor, and then slowly deepen your hiphinge as you move your hips back and up onto the seat, keeping your sitz bones out behind you.

Start hiphinging as you stand up on your pedals, before moving your bottom onto your seat.

The motion is similar to hiphinging before lowering down onto a chair for stacksitting:

As your lift yourself into your bike seat, you will need to hiphinge to some degree, more or less depending on the style of your bike and how upright it allows you to be.

If you need to adjust while you are on the move, you can make sure you are properly anteverted by lifting your bottom up a little and repositioning your sitz bones even farther behind you.

As you ride, you can lessen the work of your back, shoulder, forearm, and wrist muscles by keeping as much weight in your seat as possible, rather than supporting yourself on your handlebars. If you have experienced wrist or arm pain, you should consider a frame and seat that allows you to stacksit, since being fully upright will save your wrists from unnecessary stress.

Engaging your inner corset as you ride will also protect you from bumps and jostling. Because you will be in motion, manually checking your position or looking in a mirror is likely impossible, so you will have to rely on your proprioception and your body’s comfort levels to judge how well you are maintaining your posture. But like with everything else, practice makes perfect; with some repetition and regular breaks, you can soon master the Gokhale Method on two wheels!

Do you have any experiences to share about bike seats?

 

 

Most people, when they ride a bike, tuck their pelvis so the rear portion of their sitz bones rests on the seat. Then they lean over to reach the handlebars causing a lot of spine curvature. With the additional tension created from pushing the pedals and holding the handlebars, and the bouncing and jostling from the road, riding a bike this way can be a painful and harmful activity.

Many modern bike riders look like Mr. Bean when they ride a bike, sitting with an unnaturally curved spine.

Each of these modern-day bikers has a rounded spine and craned neck. Image courtesy John Matrix at bikelist.org.

With a few adjustments, riding a bike can be a harmonious and healthful activity. By using hiphinging and stacksitting, and by making sure you have the right bike and the right settings, you can enjoy this way of exercising and getting around. Here are the key things to look for in a bike frame:

Bike style: In some areas, road bikes and touring bikes—styles that require a deep bend to reach the handlebars—are very common. In other places, cruisers, hybrids, and flat-foot ‘comfort bikes’ are the norm. Pick a style that works best for you, but if you experience back pain, an upright model will likely more comfortable and conducive to good posture.

An additional advantage of an upright bike is that you won’t need much hamstring flexibility and back strength to maintain a J-spine. An upright bike allows you to stacksit on your seat with an easily maintained healthy neck position.

This comfort cruiser is ideal for maintaining a relaxed upright posture. It also has a low bar in the front that makes getting on and off the bike easy.

Shailene Woodley rides a bike with close-swooping handle bars, which make it easy to ride upright with the shoulders back.

This woman from yesteryear demonstrates an excellent J-spine on a ‘comfort’ frame that allows her to stacksit and easily keep her shoulders back.  

Here Kim Kardashian rides an upright with cruiser handlebars. With a slight hiphinge, she is able to maintain healthy spine and neck alignment. This position doesn’t require great hamstring flexibility; it does requires slightly more work than stacksitting.

For those who prefer a more aerodynamic racing style, you will need to do a deep hiphinge. It can be challenging to find a seat that allows for appropriate and comfortable pelvic anteversion. I will write more about bike seats in an upcoming sequel post.

To get closer to a racing position with your torso more horizontal, you will need a pronounced hiphinge to maintain a straight spine. This woman hiphinges quite a bit, but stops short of ideal and therefore has a slightly rounded lumbar spine. Ideally, you pivot your head upwards on the neck rather than crane the neck to look ahead (more on this in a future post). 

Frame size: For good bicycling posture, you will need an appropriately sized bike frame that allows you to maintain a relaxed shoulder and neck position, and allows you to touch your feet to the ground from your seat. The handlebars need to be within reach without your shoulders pulling forward. 

With a little effort, you can find just the right size and style frame to keep you straight and pain-free!

With With good posture and a good bike fit, biking is a pleasure to observe and experience.

The more upright you can be on your bike, the less work you will have to do to maintain your J-spine.

Children often maintain a J-spine on bikes without too much trouble. Children’s bikes are rarely designed for aerodynamic racing, but rather for ease of learning on.

A frame that is too small can cause you to scrunch up, tuck your pelvis, and round your spine. A frame that is too large can pull your shoulders too far forward to reach the handlebars. When your handlebars are in the wrong place and you rest a lot of weight on them, you may create shoulder and neck tension from bracing yourself continuously.

This rider’s bike is too small for him, resulting in a tucked pelvis and rounded spine.

If you are exceptionally tall, you may find it difficult to find a frame that is tall enough to fit you. If you need to lift your seat to its max to create enough legroom for yourself, consider also lifting your handlebars. There are extensions that can be attached to the stem of the handlebars, to bring them closer or farther away, as well as to add height. Your frame needs to be long enough to comfortably reach between seat and handlebars without hitting your knees or scrunching your torso.

This tall rider is having trouble fitting onto a too-small frame—the distance between the handlebars and seat is too short for his torso to fit without buckling at the spine.

For smaller-than-average adults, it is sometimes difficult to find a petite frame that allows you to lower the seat enough to reach the ground, without this causing the handlebars to be uncomfortably out of reach. Again, there are adjustable stems available for handlebars that are shorter than average, or can tilt the handlebars closer to you. With many bike seats, you can also adjust the seat position horizontally, and it may be easier to slide the seat closer to the handlebars than to bring the handlebars closer to the seat. Just make sure that your seat isn’t so far forward that pedaling becomes awkward or uncomfortable.

How well does your bike fit you? What has your experience been riding different kinds of bicycles? How good is your posture when you ride? Please do share!

 

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.

Josephine Baker dances the Charleston

The knee bone is "connected"
to the gluteus medius

 Can you sing "Dem Dry Bones"? If you don't know the spiritual by name, I bet you can intone at least some of the lyrics:

…the foot bone's connected to the leg bone, the leg bone's connected to the knee bone, the knee bone's connected to the thigh bone...

Beyond the direct structural connection between the "knee bone," or patella, and the "thigh bone," or femur, is another connection that will be of particular interest to athletes and other individuals afflicted with or susceptible to patellar femoral pain syndrome (PFPS), a disorder often referred to as "runner's knee." And this is the connection between the knee and the gluteus medius, the muscles situated above and toward the outer sides of the much larger gluteus maximus muscles. 

How to locate the gluteus medius

 

If you read my Samba Your Way to Beautiful Glutes post or joined my Samba webinar in November, you'll know how to locate these paired muscles, and you'll appreciate at least some of what they do. (If you'd benefit from a refresher, click and scroll through the Samba post, where you'll find a 6-point list.) 

 Gluteus medius muscles, pelvic anteversion, and knee health

This Burkina baby was patterned to
externally rotate his legs as he was
carried on his mother's back

According to modern conventional wisdom, it's considered normal for young children to have inward-turning knees, which are expected to straighten out by about age 7. What I've observed in village Africa and other nonindustrial cultures is that because children are carried on their caregivers' hips and backs, children's legs are externally rotated from the very youngest ages.

In contrast, in the US and other modern industrial cultures, the  internal rotation of the legs is often maintained into adulthood. 

Internally rotated legs
are common in modern
industrial cultures, even
in adulthood

Because the gluteus medius muscles are external leg rotators, strengthening these muscles can counter internal leg rotation, helping  the kneecaps to align and track better. (To check the tracking of your patella, sit down, place your palm over one of your knees, and then flex your leg to feel and follow the triangular kneecap glide up and down along the end of your femur.) Strong gluteus medius muscles are important because people whose "glute mēds" are underdeveloped are at increased risk of knee and other lower-limb injuries, including patellafemoral pain syndrome. Preventing PFPS, or managing its painful symptoms if the problem has already occurred, are just a couple of reasons why--when you stand, walk, and run--you want to use your glute meds and externally rotate your legs.

In addition to promoting knee health, external leg rotation 
also facilitates an anteverted pelvic position and a
well-stacked spine

Gluteal muscle activity and patellofemoral pain syndrome (PFPS)

Knee pain is nothing new; this Greek votive
relief for the cure of an injured knee
dates back to 100-200 AD

If you've ever felt a dull, aching pain under or around your kneecap where it connects with the lower end of your femur, you may have experienced patellar femoral pain, especially if the pain occurred when you were sitting for a long stretch of time with your knees bent, or you were kneeling, squatting, or walking up or down stairs.

And, if you have been diagnosed with PFPS, you're not alone. Gluteal Muscle Activity and Patellofemoral Pain Syndrome--A Systematic Review, which was published earlier this year in the British Journal of Sports Medicine, confirms the connection between the knee and the gluteus medius. By synthesizing electromyography (EMG) measurements of the gluteus medius muscles during a range of functional tasks as reported in 10 case-controlled studies, all of which evaluated EMG activity of the gluteus medius, the authors strove to elucidate the relationship between gluteal muscle activity and PFPS. Among their observations and conclusions:

In a nutshell, if you have good strength in your gluteus medius
muscles, your knees will be in better shape.

• Patellofemoral pain syndrome is one of the most common presentations to sports medicine practitioners; of 2500 presentations to sports medicine clinics 25% of all injuries were PFPS
• Individuals with PFPS exhibit reduced gluteus medius and gluteus maximus muscle strength
• Growing evidence supports the efficacy of gluteal muscle strengthening for PFPS and gluteal-muscle strengthening programs have been associated with positive clinical outcomes

Walking is connected to healthy knees

Walking is something most of us do a lot, although according to the 2010 study Pedometer-Measured Physical Activity and Health Behaviors in US Adults, the 5,117 steps Americans typically take each day are not enough--and in fact represent thousands fewer steps than those taken by our counterparts in Australia (9,695 steps), Switzerland (9,650 steps), and Japan (7,168 steps). But even if  we step just 5,000 times a day, if we engage our gluteus medius muscles with each step, that's still a lot of repetitions to help "re-architecture" our legs and minimize the risk of PFPS. 

           
Ancient Greek coin features Apollo (with anteverted pelvis!                      

The pelvis serves as our postural foundation, and one of the keystones for healthy postures is to allow the pelvis to be anteverted. When your pelvis is anteverted and your "behind is out behind you," then the whole pack of muscles that includes the hamstrings, the gluteus maximus, and the gluteus medias can work to advantage, strengthening themselves, inducing circulation in the appropriate places, and bearing stress.

 

Eadweard Muybridge's 'human male walking'
demonstrates strong gluteal action
in the rear leg

 

This rear view of the
subject above shows his
healthy external leg
rotation

 

Beyond this, the relationship between external leg rotation, pelvic anteversion, and the action of the gluteus medius is cyclic. In order for the gluteus medius to be in a position of mechanical advantage, some degree of pelvic anteversion is required. And, if we are to believe the observations summarized in the British Journal of Sports Medicine review, strong gluteus medius action relates to a diminished risk of PFPS.

The interconnectedness between external leg rotation, pelvic anteversion, and strong gluteus medius action is beautifully illustrated in the detail of Muybridge's "animal locomotion" photo and "film" to the right. 

"Dem Dry Bones"

Bottom line, the knee bone is connected to the thigh bone, but it's also connected to the gluteus medius, and this is a fairly direct connection because these paired muscles externally rotate the legs. Finally--not just because the lyrics are right on point with this lesson, but because he plays and sings so artfully and with such a great sense of fun--I hope you'll listen to Fats Waller's wonderful take on "Dem Dry Bones." 

 

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.

 

Image Credits: Josephine Baker Dances the Charleston, Wikimedia Commons; The Bath, Charles Degas, Wikimedia Commons, Public Domain; How to Locate the Gluteus Medius, Esther Gokhale; X-ray of "Knock Knee," Biomed Central, Wikipedia; The Spinal Cord, Bruce Blaus, Wikimedia Commons; Greek Votive Relief Knee Injury, Marie-Lan Nguyen, Blacas Collection, Wikimedia Commons; Female Jogger, Mike Baird, Creative Commons; Human Male Walking (animation), Eadweard Muybridge, Wikimedia Commons; Animal Locomotion, Eadward Muybridge, Wikimedia Commons;  AncientGreek Coin: Classical Numismatic Group, Inc, Wikimedia Commons