Primal Posture for Modern Pain? The Gokhale Method of Walking, Sitting & Bending

Esther Gokhale

I was raised in India. My father’s Indian, my mom is Dutch. And my mother was an Indophile, so she was really very immersed in the culture, and in particular, very impressed by people who lived close to the ground. 

Robert Pease (co-host)

Esther Gokhale, creator of the Gokhale Method of primal posture, a system for relieving for back pain and other issues by adopting traditional forms of walking, sitting, and bending. 

Esther Gokhale

The vegetables and fruit sellers and the street carrying very large loads on their heads without any problems. And she would point these things out to us kids.

Robert Pease (co-host)

Esther created the Gokhale Method three decades ago after a surgery and many other therapies failed to heal her own back pain while pregnant with her second child.

Esther Gokhale

You know, here I am in my twenties falling apart. There’s something very wrong with this picture. 

Robert Pease (co-host)

Thirty years later, over 20,000 individuals have learned to sit, walk, bend and also sleep more efficiently by adopting the Gokhale Method- which now offers a Posture Tracking app.

Esther Gokhale

We’ve used another wearable five sensors that go on the back to help people know what the shape of their spine is and how it’s changing over time. 

Robert Pease (co-host)

Stanford University is embarking on a long term study of the Gokhale Method. That’s after hundreds of doctors, nurses and PT’s have learned the system and recommended it to  patients, most often for back pain. So we’ll speak to a spine specialist who’s also trained in the  fundamentals of the Gokhale Method.   

Dr. Kennedy

D.J. Kennedy. I am a professor and chair of the Department of Physical Medicine and Rehabilitation at Vanderbilt University Medical Center

Robert Pease (co-host)

And Dr Kennedy introduces the method to his medical students

Dr. Kennedy

I think she paints a picture that makes a lot of sense intuitively. And she’s also going about trying to get the data to prove it.

Robert Pease (co-host)

Esther Gokhale and the Gokhale Method on My Body Odyssey, a show about the rewards and challenges of active lifestyle. And a close look today at the primal posture system which may  be positioned for wider adoption in our modern medical system. I’m Robert Pease here with Brittany Thomas.

Brittany Thomas (co-host) 

Hey Rob. Good to be here. And I’m interested to hear more about Esther’s story, because she’s clearly an expert on posture and movement, and she also has her own story of back issues.

Robert Pease (co-host) 

Yeah, back issues really triggered the method. She was in her twenties, she’s pregnant with her second child and decides against a second back surgery. Because the first one didn’t help her.

Brittany Thomas (co-host) 

Hmm. Yeah, I can’t imagine being pregnant, in serious pain and moving slowly, and thinking, ‘No, I got this’.

Robert Pease (co-host) 

It does take a lot of confidence to do that. So I asked Esther, where did that confidence come from?

Esther Gokhale

Well, couple of things. You know, positive things and negative things. I mean the negative things: I had exhausted all the possibilities that I knew about, conventional and alternative. You know, I had done one surgery, in addition to physical therapy, chiropractic, acupuncture, massage, yoga, stretching, strengthening, checking my head, you name it. I had tried it. And here I was, in big trouble all over again.

Brittany Thomas (co-host) 

So I know from the last episode, Esther’s not an MD or a PT, but she does have a science background, right?

Robert Pease (co-host) 

Yeah, she does have, I guess you would say, a science foundation, an academic background. And she must have built on that in developing the method.

Esther Gokhale

I also happen to be savvy in anatomy. I took anatomy with the Stanford medical students and I know that, you know, you’re weakening the structure. You’re having to, to get to the site, you have to remove some muscle tissue and you’re carving away bone and you’re weakening the structure with every subsequent surgery.

Brittany Thomas (co-host) 

Growing up in India, Esther studied classical dance and practiced yoga and developed body awareness. And she also observed the people around her.

Robert Pease (co-host) 

Yeah. And that came from her mother, who she describes as an Indophile. She was actually Dutch, they were living in India. She pointed out the slightly-built people carrying not very slight loads without great effort. And that came back to her in this period of back pain when she’s unable to even lift her infant child.

Esther Gokhale

And I also was drawn to methods that study other cultures, you know, because of that early upbringing, because of my mother’s perspective. And so I was drawn to things like Alexander Technique who made notes of indigenous, of Aborigines, footprints and such.

Esther Gokhale

And most especially Noel Perez, who did a lot of work with Iyengar, whose body is like “textbook correct” for teaching this posture method from. I was very influenced by her work. I immersed myself in studying her method and made progress. And then my own background is very scientific. I was trained in biochemistry at Harvard and Princeton, and logic and science is very important to me. Both because, you know, when things become a little cultish or metaphysical, that doesn’t hold water the same way for me. 

Brittany Thomas (co-host) 

I’ve heard of Iyengar from yoga practice, but I don’t know much about Noel Perez.

Robert Pease (co-host) 

Yeah, we had to do a little research there. Perez was an early student of Iyengar. He’s the teacher in India who made yoga safer, more accessible by breaking postures down into simpler parts. There’s also quite a bit of blanket folding involved. But anyway, that was in the 1920s and 30’s. Perez later directed the Aplomb Institute in Paris for several decades promoting “spinefullness”, or functional posture, to its clients.

Brittany Thomas (co-host) 

So would you say that yoga is a part of the Gokhale Method? 

Robert Pease (co-host) 

I guess I would say they’re really different methods. But maybe common principles. I’m no expert. I did read her book “Eight Steps to a Pain-Free Back” some years ago and just reviewed it again. And that title sounds like so many other self-help books, but it’s really a remarkable book, still in print after 15 years, it’s sold 300,000 copies. 

Brittany Thomas (co-host) 

Yeah, it’s a beautiful book with lots of images and she talks a lot about body wisdom. There’s this one photo I really like of a baby, she’s being carried by her mom in a backwrap, and she’s almost absorbing from her mom that posture, and learning right away in life what good posture is.

Robert Pease (co-host) 

Yeah the book’s part anthropology, part biomechanics. I also went to an introductory workshop that Esther taught at the Kripalu Institute, the Yoga Center. And that was something like the Gokhale in-person elements course offered by certified method teachers. Small groups of people working on these core techniques: glide walking, stretch lying and hip hinging.

Brittany Thomas (co-host) 

“Glide walking” sounds kind of fun. How would you describe it? What is glide walking?

Robert Pease (co-host) 

Well, I would describe it by analogy. If you think about how is sprinter comes out of the blocks, and the way the legs accelerate to the side… or the way a skater accelerates…glide walking’s, a little like that. Don’t walk linear, don’t walk like a stick figure. Glide to the right and then to the left

Brittany Thomas (co-host) 

Sounds kind of like a superpower. I’m gonna try to glide walk all the way to work today.

Midroll 

Robert Pease (co-host) 

All of the Gokhale Method’s principles- like glide walking, stack sitting, hip hinging- they’re introduced in the Gokhale Method online fundamentals course. Or through classes or consults in person with a certified teacher. But in both cases, the method doesn’t throw a lot of new postures or exercises at you like yoga does. Like physical therapy does. The focus is everyday positions, everyday movements. 

Brittany Thomas (co-host) 

So focusing on sitting and standing and walking can add up to hours of reconditioning every day. Like basically you’re doing one of those things all day long. Does the Gokhale Method address just back issues, or other problems as well?

Robert Pease (co-host) 

Other issues too. There’s a lot about hips. They do emphasize the sort of interconnectedness of the body, but back pain is the most common. So, I played a clip about back pain from one of our protagonists, Larry, we met up at the Nordic Ski Marathon in Craftsbury Vermont.

Brittany Thomas (co-host) 

I remember Larry. Really enthusiastic guy, maybe in his fifties. He loved cycling, tennis, cross country skiing, but had back spasms too

Robert Pease (co-host) 

Like I do. And they’re absolutely miserable. We talked to other people at other events who have them– head of the Charles Regatta, tennis tournaments. They’re not uncommon and also not very well understood. But everyone describes something very similar to Larry.

Larry

Well, you know, it’s sort of outta nowhere. What happens is you, if my body’s in such a way, all of a sudden I can feel my back went outta whack. And I have a problem. And it just, sometimes it just takes a week to get better, and sometimes it just gets worse. 

Brittany Thomas (co-host) 

And what was Esther’s take on Larry?

Robert Pease (co-host) 

Well first off, she said there’s a lot we don’t know about backs.

Esther Gokhale

You know, he’s just pointing out how much is in the unknown when it comes to musculoskeletal stuff. You know, he uses language like “comes out of nowhere”, and “the back went out of whack”, and “one week to get better, sometimes it gets worse”. You know, there’s just a huge territory of unknown and that’s at every level in modern industrial society. Even our medical practitioners- 85% of lower back pain is because of, what’s the euphemism? “Non-specific” back pain, yeah.

Robert Pease (co-host) 

And we don’t learn much from those office visits. But Esther’s feeling is that Larry’s spasms may not be so mysterious

Esther Gokhale

It just indexes how little we understand about the musculoskeletal system. You know, muscles just seemingly out of nowhere go into spasm. Well, I’m gonna venture that it’s not out of nowhere, that they have very good reason to go into spasm. And very often, what they’re doing for us is preemptive, you know, like protection. You know, we don’t know what’s going on, we’re flinging our bodies around this way and that. But the brain gets messages, ‘Whoa Nelly, this is coming really close to pinching some nerve or squeezing some disc. Let’s protect our dude by spasming, you know, so that we stop him in his tracks because otherwise he’s gonna do some real damage.’”

Robert Pease (co-host) 

Yeah, lying on the floor for a week, that is pretty good protection. 

Brittany Thomas (co-host) 

That sounds rough. She’s also making an important point there about different types of pain. Some pain’s caused by injury and some to prevent further injury. Bodies are wise that way. Or… at least sometimes. 

Robert Pease (co-host) 

Yeah… and that “some of the time” is really critical because the body doesn’t always speak up, some serious issues go unannounced. That’s very much the case with Yogi Jess from our season one episode. She’s the yoga teacher with thoracic outlet syndrome or TOS–that’s a life threatening condition with no painful symptoms.

Brittany Thomas (co-host) 

I first learned about TOS from Jess. It’s where the top rib and the clavicle can pinch a vein and cause a blood clot.

Robert Pease (co-host) 

And a blood clot can cause an embolism or a stroke. It’s rare but potentially really serious. TOS often affects people with hypermobility, like yogis or swimmers, as Jess was in college. Or baseball pitchers. We played this clip for Esther where Jess receives, first of all, the bad news that she does have TOS. And, secondly, the recommendation from her doctor to remove her top rib.

Yogi Jess 

And I was like, ‘Well don’t I have muscles that attach to that? Isn’t that kind of important?’ He is like, ‘Yeah, but they’ll be fine… unless you need to take a really big, deep breath’. I’m like, ‘Well I’m a yoga teacher and I go on big hikes. So yes, that’s important to me.’

Robert Pease (co-host) 

Esther has a very similar mindset to Jessica regarding surgery when it’s presented as a first and only option. 

Esther Gokhale

So someone like Jess, I mean I think she is lucky that she was warned ahead that a deep breath would be a problem and that that, you know, sort of gave her pause. Because I think just having surgery, you know, already gives a lot of pause, right? There’s a lot of potential downside. There’s risk, there’s scar tissue that can form, and you really do wanna explore every other option before you do surgery, in my view. 

Brittany Thomas (co-host) 

There’s some similarities between Esther and Jess’s stories. Esther decides against that second back surgery and develops the Gokhale Method. Jess also decides against surgery and manages the issue through her own yoga practice and some PT. 

Robert Pease (co-host) 

But we really have to say don’t try this at home without all the knowledge and body awareness that Esther and Jess have. And we should also disclaim here, obviously most surgeries are necessary and helpful. Many are downright miraculous. But as both Jess and Esther point out, there’s always some damage in the process of cutting and stitching. 

Brittany Thomas (co-host) 

And there’s another similarly here. Jess didn’t just focus on the small area around the top rib to lessen the friction. She looked at her entire posture, which is exactly what Esther recommended.

Esther Gokhale

Now you know, Jess being a yoga teacher, has unusually many pegs in her brain to learn new things and to do explorations to address particular muscles and relax them and so on. I wish she had our knowledge of what to do lower in the body, in the pelvis, for example, that would set the upper body up for success. Where she wouldn’t have to be constantly paying attention to relaxing a certain muscle or pulling the upper body back. You know, she really needs to pay attention to the entire body and understand why this happened in the first place.

Robert Pease (co-host) 

Over several decades of instruction, Esther Gokhale has observed the importance of alignment regardless of a person’s age, flexibility or fitness level 

Esther Gokhale

Even in yogis, even in ballet dancers, even in athletic people, the physics of the building block stack is wrong when the pelvis is tucked. 

Brittany Thomas (co-host) 

It makes a lot of sense stacking from the ground up, thinking about the foundation of the body. And just sitting here now, I’m sort of thinking more clearly about how I’m sitting, to untuck my pelvis. Esther calls it ‘stack sitting’. Rob, tell us about that. What is stack sitting?

Esther Gokhale

A very important part of stack sitting is to position your pelvis well… 

Robert Pease (co-host) 

The thing that helped me from reading the book, from going to the workshop, is to sit like  babies do 

Esther Gokhale

You want it tipped forward or anteverted… 

Robert Pease (co-host) 

With the butt behind you, as a firm foundation for the upper body. So there’s no slouching but also no tension.

Esther Gokhale

One way to achieve that is to use a wedge.

Brittany Thomas (co-host) 

And Esther also talks about imagining that you have a tail. 

Esther Gokhale

Your tail out behind you.

Brittany Thomas (co-host) 

So you’re sitting, you have a tail, and you need to leave space for it and not smush it. I’m imagining like a good fluffy tail, like a fox. 

Robert Pease (co-host) 

Yeah, these images or analogies are helpful. But it is a bit of work to undo our bad habits, to stop slouching or tensing. And it might seem like too much to people who wanna get better immediately. So I asked Esther, is a major challenge for the method was offering a solution that might take weeks or months?

Esther Gokhale

So it’s rarely months that people have to wait to feel better. Sometimes weeks, you know, but usually the improvements are right from the beginning, incrementally, and quite rapid. So I would call this a pretty quick fix. It’s not like swallowing a pill and it’s not like lying on someone’s table and being operated on, you know. So it’s not that quick a fix, but it’s a pretty quick fix.

Robert Pease (co-host) 

Dr. D.J. Kennedy was a competitive weight lifter and strength coach prior to medical school. He knows a thing or two about getting results. And he confirmed that a large number of his patients do tend to get fairly quick and positive results from the Method

Dr. Kennedy

What I would say from all of my therapy-based techniques: the data is very consistent and the people that get better get better fairly quickly. So physical therapy, six to eight visits, meaning you shouldn’t need 30 visits. The Gokhale Method, same thing. For the vast majority of people, if you do not notice improvement in a few weeks time frame, the given technique, in isolation, is probably not what is needed. 

Robert Pease (co-host) 

It also helps that a lot of Doctors and PTs are recommending the Gokhale Method. That helps with credibility and also compliance, or just sticking with the plan.

Esther Gokhale

That is our most important referral source. We have been very conscientious about keeping the respect of the physicians by not overclaiming, by not doing shrill marketing and promising the moon. And so we’ve succeeded, you know, and it starts in the localities where we have teachers, where physicians begin to hear from random patients that, ‘YeahI tried this and this helped.’”

Robert Pease (co-host) 

The Gokhale Method has a network of teachers throughout the U.S. and a dozen countries. It’s been based in Palo Alto since its inception. That’s an area better known for disruption, but it has been receptive to this approach with a long tradition behind it.

Esther Gokhale

And so here in Palo Alto where I’ve been busy for over three decades, we have over 500 physicians who have taken the course, their families have taken the course, they have referred patients. I have been invited to train whole groups of physicians because physicians suffer just like everybody else, if not more, because they have to bend. You know, surgeons have a very tough job.

Brittany Thomas (co-host) 

It’s encouraging when medicine accepts something from outside the mainstream that just works really well, as happened with, you know, acupuncture, meditation, Pilates. But I don’t think we can say that that’s yet happened for the Gokhale Method on the same scale.

Robert Pease (co-host)

That is certainly true. There is this large network of teachers, there are doctors recommending it, but it’s not yet covered by insurance, it’s not yet standard med school material. But there are two developments worth watching. First off, there’s an effort to create wearable technology to reinforce the method, and that’s called the Posture Tracker.

Esther Gokhale

The bigger things are that we have invested in wearables, you know, in technology. So we have, for example, two sensors that go in a variety of pairs of location that then students learn to calibrate. You know, as they’re sitting at their desk, if they start to slump, then they will hear from their app. They can either see or hear or feel a vibration to just reinforce what they know to be correct posture. So that’s, that’s, it’s cool.

Robert Pease (co-host) 

And secondly, this tracking technology has triggered interest from Stanford University in conducting a longitudinal study of the method and its efficacy.

Esther Gokhale

And we’ve published research on that. That actually got the attention of the Stanford Chief of Physical Medicine and Rehab, who’s the principal investigator on the randomized controlled trial coming up. 

Brittany Thomas (co-host) 

Let’s hope we can report on the results of that Stanford study, and also test drive the Posture Tracker… So I’m not just hunched over my phone all day. But first I need to work on my glide walking. 

Robert Pease (co-host) 

And I need to work on that and hip hinging and stack sitting. I might need to take a hiatus here from the podcast. But, here’s the really interesting point: a relatively new approach to injury and limitation, a very new technology for avoiding pain, and they’re inspired decades ago during Esther’s childhood in India through the observations of her European mother. 

Esther Gokhale 

And we also traveled to all kinds of places in India, tribal cultures, village cultures, and she would always point out the amazing part of that culture, you know, how physically capable they were. So that made an early impression on me. 

Robert Pease (co-host) 

Many thanks to Esther Gokhale for speaking with us and to the Gokhale Method team with help on resources. There are Gokhale Method teachers throughout the U.S. and other countries More information at gokhalemethod.com. And Esther’s book, “8 Steps to a Pain Free Back”, is highly recommended. There’s a link to the book in our show notes and an excerpt in our latest newsletter on our website, mybodyodyssey.com. Many thanks as well to Dr. DJ Kennedy of Vanderbilt Medical School for his expertise and his openness to anything that will help the many millions of us with back pain.

Brittany Thomas (co-host) 

Next up on My Body Odyssey, we’ll be following up with Generational Gene one year after our first episode. Gene’s a super busy guy: a school superintendent, a doctoral student, a family man and avid cyclist, who often says he’s pedaling to save his life. With a family history of diabetes and cancer, Gene gets checked regularly, and he knows it’s important to encourage loved ones to do the same. 

Gene

You know, I’ve also been able to tell other people, and it’s good, I think particularly for African American men, something that, you know, is more prevalent in, you know, in our community. And again, we talk about opportunity and access to resources. You know a lot of our health disparities are, you know, are related to societal inequality, right? And so we have to work a little bit harder to make sure that people have access to opportunity, but also, like, to advice and to kind of knowledge about it. 

Robert Pease (co-host) 

We hope you’ll join us for that episode, tell a friend or two about My Body Odyssey, and leave us a review on Apple Podcasts. We’re always open to feedback here and suggestions. You can send those via our social media or through our website, mybodyodyssey.com. Thanks for listening from the whole team here at My Body Odyssey, which is a Fluent Knowledge production. Original music by Ryan Adair Rooney.