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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.

Stanford now lists the Gokhale Method Foundations course as an option for which Stanford staff can use their STAP (Staff Training Assistance Program) funds. I am thrilled that the educational institution closest to home (I live on campus) is the first to make my offering more available to their staff.

My avenues for bringing posture into Stanford are manifold, both through my family members and through hundreds of students and staff who have taken my courses. Healthy posture has been demonstrated to have a positive impact on those in close proximity, and I'm hopeful this effect will permeate the community over the years.  

My husband is a professor in the Math Department and is beaming out much better posture than he used to:

 
Brian White, Professor of Math at Stanford, was one of the early Gokhale Method guinea pigs (being my husband!). See him here bending with a straight back, and with his legs well-aligned and feet pointing outwards. 

My daughters Maya and Monisha did their undergraduate degrees in the school of engineering; Maya also did a Master’s degree in epidemiology. They participated in sports, where they influenced and taught some of their teammates:

Maya White (left, jumping), has a natural degree of pelvic anteversion which facilitates glute action and a powerful spring.

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Monisha White, who captained the Stanford Women's Ultimate frisbee team and lead them to win Nationals in 2016, coached some of her teammates in healthy posture. Here she shows healthy external leg rotation, posterior shoulder placement, and a J-Spine.

My son Nathan coaches the Stanford Men’s Ultimate Frisbee team. Learning hip-hinging has helped some of the team get rid of longstanding hamstring problems: 

Nathan White (second from right, standing tall) sets a good posture example as a coach of the Stanford Men's Ultimate Frisbee team.

I have taught hundreds of faculty, students, and staff how to have their behinds behind, and their torsos upright and relaxed: 

Olivia Page, one of many Stanford students who learned to hip-hinge, stacksit, and stretch-lie.

Now with Stanford STAP funds, enrollees will not have to pay out of pocket for their posture education.

The two courses offered on the weekend of April 28-30 both consist of the usual 6 x 1.5 hour lessons using 8 Steps to a Pain-Free Back as the text and the DVD, Back Pain: The Primal Posture Solution, as a reference (both are included in the price of the Stanford course). The courses still have some openings and are open to the public, though STAP funding is available only to Stanford staff.

It has long been a dream of mine to influence a mid-sized community to have lower rates of back pain and reap the benefits of healthy posture. There is a synergistic effect that happens when members of a community learn the familiar, but forgotten, language of primal posture. Human beings are known to mimic each other. We expect that having examples of healthy posture to mimic will raise the general wellbeing of the community, and that this effect will spiral in a positive direction. Also, Stanford is a self-reflective community that conducts research, formulates theories, and births products - a lot could happen in this rich milieu.

The Stanford Rodin collection is the second largest in the world and is chock full of examples of excellent posture.

We hope other educational institutions will be inspired to replicate Stanford’s offering for their staff, now that we have teachers all over the world who are able to satisfy such demands. Educational institutions often induce other types of institutions to follow their lead. We are hoping that banks, law firms, tech firms, and other entities will see the value in keeping their members healthy and pain-free, like Stanford has.

One recent Stanford study, Is crowdsourcing patient-reported outcomes the future of evidence-based medicine? A case study of back pain, examines the findings of the website healthoutcome.org, on which Postural Modifications (and the Gokhale Method in particular) are the top-rated intervention for lower back pain by a very large margin. The study finds that crowdsourcing results are similar to conservative research results, but involve much larger numbers of subjects at lower cost. Postural Modification as an intervention for lower back pain has not been studied by conventional means. As the prestigious newsletter The BackLetter put it in September 2015, “there is certainly a glittering opportunity for some enterprising young researchers to explore this area with sound scientific methods.”

For more information or ideas on how to bring the Gokhale Method to your institution, please contact us at [email protected].