pain management

Before I settle in to recount my back pain story, let me fetch my Gokhale Pain-Free™Chair. This is the chair I now use for all my writing, and that’s important, as I am an author of mystery short stories, and spend many hours composing at my desk. Pain-free, I’m now glad to say.

Since retiring from over four decades as a trial lawyer, I write about The Sleuthing Silvers, Barb and Bernie. This image is from my website, sporting my detective shades. www.thesleuthingsilvers.com

I’ve had back problems for many years and coped with it by going to any number of orthopedists, chiropractors, physical therapists, and neurologists. In my experience, doctors (general physicians) can’t do much for ordinary mechanical back pain, other than advise on painkillers.

That management worked for some 25 years, and then I started having chronic pain that wouldn’t respond to my usual formula and go away. I was becoming somewhat desperate as it affected my whole life. I was grumpy enough by nature before the pain started, but became much more grumpy after! 

My rheumatologist, who I’d seen many times, said, “Well, you might want to read this book.” I had never read a self-help book for my health—I just generally don’t believe in them—but I was so desperate that I went ahead and bought Esther’s book, 8 Steps to a Pain-Free Back. 

I actually liked the subtitle, “Remember When It Didn’t Hurt.”  You do remember how when you were younger, even if you had back pain, it would be a little bit better each day. You could count on it being better tomorrow, and then soon you would be fine. That certainly wasn’t happening.

Esther’s Book was the only self-help book I ever bought—reluctantly.

I was cynical going into this work, and admit I had a very negative attitude. I had already made some of the arguments against working with my posture that were anticipated in the book—you’re too old for this, it’s too far gone…Yet I have come around to endorsing all the amazing testimonials I read in the book. Because I live in the same location as Esther, I actually know many of the doctors and patients quoted in the book who experienced transformational results with the Gokhale Method.

So I read the introduction. That’s what really did it for me—it’s so persuasive, and it’s so simple—it’s something you then want to do. So I started to antevert my pelvis. After months of pain, I woke up the next day and felt noticeably better. I thought, well, this must be a mistake. The following day I was substantially better, and the next day after that I was pain-free and have been ever since. 

I was just blown away by this, and so read the whole book that explains the Gokhale Method. Esther focuses on her subject like a laser beam. I got the impression she knows the spine as well as anyone on earth. I wanted to meet Esther Gokhale, and as we both live in Palo Alto, I was able to do that and take the six Gokhale Method Foundation's Course lessons. 

The in-person  Gokhale Method Foundations' Course originated in Palo Alto and is now taught by teachers in many parts of the globe. Our online Elements course makes the Gokhale Method accessible to students the world over. www.maps.google.com

When we met, even Esther was surprised by my body’s rapid positive response to the Gokhale Method. She explained to me that I had actually been lucky to have gotten positive results having immediately anteverted my pelvis. Attempting to antevert the pelvis to start with is not recommended as most people have some stiffness at the L5-S1 joint and are therefore likely to sway higher in their lumbar spine as they try to get their behinds behind them, creating even more compression in that area. Alternative techniques, designed to first bring healthy length into the lower spine, are advised as an initial phase. It seems I was lucky—one of a small percentage of people with sufficient protective stiffness in my lumbar area to avoid any sway and additional damage.

(a.)                                           (b.)

Most people will inadvertently sway their backs when trying to stand or sit upright with their behinds behind them (a.). This tightens lower back muscles and compresses the lumbar vertebrae and discs. To avoid this, the Gokhale Method first teaches techniques to elongate and stabilize the spine (b.). 

Anteverting my pelvis made a huge difference to me. I had been doing all the wrong things to my spine, such as sleeping in a fetal position, but soon I learned how to sleep, sit, stand, and walk without compressing my spine. In fact, I could now decompress my problematic area around L5-S1. I came to understand how much of our modern furniture puts us into compressive shapes that tuck the pelvis under, pinching the L5-S1 disc and causing it to bulge back toward the nerves. 

An anteverted pelvis preserves the wedge-shaped L5-S1 disc (a.). A tucked pelvis cannot accommodate this and the lower discs will suffer undue pressure and bulge toward the nerve roots (b.).

When I first showed up for the lessons, I explained that I thought the introductory chapters said it all, and that the rest of it was somewhat repetitive. But I was wrong. Every chapter will give you a little something that may look inconsequential, but the magic is in the detail! And even though I was doing very well with the book, the precision adjustments and personal coaching I got from having the lessons made a huge difference.

These things were so simple, made such sense, and worked. Even while I was so thrilled to have found this work, I also felt very angry that nobody else had been able to tell me these things. I have seen umpteen specialists over the years, and no one ever mentioned the Gokhale Method. The upcoming Randomized Control Trial that has apparently been funded entirely by satisfied students will hopefully put the Gokhale Method on their radar. I would like to see the Gokhale Method become a prominent part of every doctor’s prescription for back pain.

It makes sense that changing your posture can make a huge difference to structures as sensitive as your spinal nerves. Just a millimeter either way can determine whether you get agony, or relief from back pain. I also appreciate the wider health benefits of making these posture shifts. I’ve noticed that my organs work better, and my breathing is better. 

I now realize it’s not sitting that’s the problem. The issue is the furniture you choose and how you sit. The Gokhale Pain-Free Chair helps me to stretchsit, decompressing my lower spine.

My understanding of the relationship between breathing and the inner corset is much clearer from having had the lessons. Reading the book did not make it clear to me how muscle tone in the abdominal wall would act to resist any ballooning outward when breathing, and translate into healthy movement in my back with every breath. What Esther calls our “inner massage therapist.” Lessons enabled me to get that. 

I used to get tired and sore standing in line for just a few minutes. More recently, after about 10 minutes in that situation I thought, “Hey, something’s different, I should be tired by now,” and I realized that standing with my weight in my heels, my body aligned as I learned from the Gokhale Method, I felt fine! Cumulatively these details really work. 

Enjoying pain-free time with my granddaughter and her American Girl Tea Party puzzle.

When I first read the chapter on glidewalking, I thought I needed a PhD in mechanical engineering to understand it! But in the lessons, you get it bit by bit, and the teacher gives exactly what the student is ready for. When I was younger, before I had had so much back pain, I loved to walk—I would walk 40 minutes every day. Then I had a hip replacement in 2018, and since then I have had problems. Esther showed me how my left gluteus medius was weak, and had likely caused my piriformis (a deeper external hip rotator) to overwork and cause other problems. 

I’ve been keen to improve my walking. Here I am hiking in the Tahoe National Forest, California.

This is a quote I can relate to: “Nature has placed mankind under the governance of two sovereign masters, pain and pleasure. It is for them alone to point out what we ought to do, as well as to determine what we shall do.” Anglo-American philosopher of law and social reformer Jeremy Bentham, 1748–1832. Portrait by Henry William Pickersgill (d. 1875). Wikipedia

I’m in the early days of my journey and I’ve only finished the course recently. I’m tempted to declare myself “cured” and move on—I can bike ride, swim, and ski without any pain. I’m hopeful that I’ve mastered and internalized what I need to know and keep doing to get on with my life. But I will stay in communication—I can set up an appointment anytime if I need to—all I want is to remain pain-free. I’m so grateful to the Gokhale Method and all who are associated with it. It has changed my life. 

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. . .

The American College of Physicians (ACP) has just issued new Clinical Guidelines for the non-invasive treatment of non-radicular lower back pain (pain that does not radiate from and is not caused by damage to the spinal nerve root).

Since the last guidelines were issued in 2007, the ACP has dramatically revised the medical solutions commonly offered for back pain. Many interventions that were once routinely administered to back pain patients, having proven to be ineffective or counterproductive for back pain, are no longer part of the guidelines for doctors. Surgery, cortisone and nerve blocking injections, X-rays, and MRIs are all discouraged in back pain cases where they used to be a part of standard care.

A lot of the what used to be standard of care for back pain is no longer recommended.

The new guidelines issued last month also discourage the use of pain medications as a treatment for back pain. The recommendation is based on extensive data showing that pain meds (whether over-the-counter, prescription NSAIDs, or opioids) are ineffective in back pain treatment. Strong painkillers may help to mask symptoms, but do little to actually treat the cause of pain. As painkiller addiction has become a serious large scale problem, it is commendable that the ACP has taken this bold move to discourage the overuse of a common but ineffective and potentially harmful intervention.

The new ACP guidelines discourage the use of pain medication to treat back pain.

What is sadly missing in the guidelines is an enthusiastic endorsement of any intervention. Physicians and patients are advised to try non-drug therapies, but this is followed by the lukewarm statement “physicians should select therapies that have the fewest harms and costs, since there were no clear comparative advantages for most treatments compared to one another.”

In 2017 mainstream medical practice, there is still no satisfactory understanding of the root causes of back pain, nor robust treatment to eliminate it. I dream of a future when randomized controlled trials (RTCs) validate what Gokhale Method students and teachers experience, and what our recently collected data and the data on healthoutcome.org suggest. Imagine if the Gokhale Method became part of standard protocol for back pain! Here are some key ways that would play out:

1. The ACP guidelines correctly recommend that people resume “normal everyday activities” as early as possible. This would take on a whole new meaning! Often, people develop their aches and pains from the ways they slump-sit, round-bend, jerk-walk and so forth. How could sending such a person back to their “normal” everyday activities constitute a sensible measure? The Gokhale Method would help these people transform their slump-sitting and arch-sitting into stretchsitting and stacksitting. They would learn to hiphinge not round-bend, and glidewalk not jerk-walk. Previously injurious everyday movements become comfortable and therapeutic. Now life becomes a gym and a playground, and the recommendation to do "normal" activity makes eminent sense to the back pain sufferer.

Bending is a healthy everyday activity if and only if one has good form.

The recommendation to do exercise, yoga, and other augmented activity would become a more robust recommendation. With Gokhale Method principles integrated into exercise and yoga, there’s less risk of injury and more leveraged benefits to be had.

Yoga done wth good form bestows many benefits; yoga done with poor form can result in injury.

2. Some medical interventions, that went through cycles of being over-used and then booted out, may well have a new role and relevance when used to supplement a robust postural re-education program. Medical science will continue to improve in determining which interventions work in which circumstances. Pain meds, spinal injections, and even surgery have more of a place as palliative or auxiliary measures if they facilitate new learning which gets to the root cause of the problem. They provide a window of opportunity to learn new posture ways without acute pain and symptoms getting in the way of being able to concentrate and function.

Coupled with posture training, a lot of medical interventions for back pain acquire a new role and relevance.

For example, if someone gets spinal surgery but then goes back to their old habits, their pain is likely to come back, and the surgery may be deemed ineffective. But if instead they use the temporary pain relief from surgery to learn new habits from the Gokhale Method, their pain is less likely to return. In that case, the surgery will have been part of a more integrated and ultimately successful approach.

Similarly a more circumspect use of pain meds could facilitate learning new posture ways, getting to the root of pain, and, in turn, eliminating the need for pain meds.

The Gokhale Method doesn’t just combine well with wise medicine, exercise or therapeutic interventions, it can redefine them. For that reason we’re looking forward to being adopted into standard care guidelines one day—wouldn’t that be lovely?

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