Esther Gokhale, Posture Pioneer, and The Roots Of Modern Pain

Primal posture includes bending, sitting, and standing with good spine alignment

Our latest episode with Esther Gokhale, of the Gokhale Method, has us thinking about primal posture for modern pain. Through this process, we learned about walking with more glide, stacking our spine when we sit, and hinging at the hips when we bend. Esther Gokhale created the Gokhale Method to improve posture and reduce pain based on her personal experience. 

Gokhale was pregnant with her second child and had back pain that was so intense that she was unable to lift her first child — even after a first surgery for back pain.

“Something was wrong with this picture,” Esther told us. She also vividly recalled observing the impressive posture of local laborers when she was a child growing up in India. Have we lost the traditional wisdom of everyday movement that’s protected us from the scourge of back pain? The Gokhale Method aims to restore that wisdom with a modern twist, using a Posture Tracker app and other tools to encourage better walking, sitting, bending, and sleeping. 

“We are marvelously designed creatures. We have inherent grace and strength, like every other creature on the planet. We have evolved to sit, walk, run, jump, climb, carry, and even dance without pain . . . Why, then, do so many people in our culture suffer back pain and other musculoskeletal ills? The problem is that we arrive on the planet without a user’s manual . . . And the culture in industrialized societies has not been teaching or supporting us very well. If we have pain and musculoskeletal problems, we need to look first at the laws of nature we are disrespecting, the blueprint for our skeletal structure we are disregarding, the pieces of our genetic code we are ignoring.

Esther Gokhale in 8 Steps To A Pain-Free Back

What causes back pain?

“There’s just a huge territory of unknown and that’s at every level in modern industrial society,” Esther Gokhale explained in our interview. “Even our medical practitioners [say] 85% of lower back pain is because of — what’s the euphemism? Non-specific back pain… It just indexes how little we understand about the musculoskeletal system. You know, muscles just seemingly out of nowhere go into spasm,” she said.

But Gokhale thinks that there probably is a specific reason why a muscle spasms: “Very often, what [muscles] are doing for us is preemptive, 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, so that we stop him in his tracks’.”

Modern Life and pain

The structure of modern, industrialized society — the reliance on screens, the sedentary lifestyle — promotes poor posture that can make muscles spasm more often. Joseph Pilates, creator of the Pilates Method, was also critical of how industrial culture promotes unhealthy development. In The Complete Writings of Joseph H. Pilates, with William John Miller, Pilates writes:

“In addition to physical maladies such as malformation in arms or feet, weak bodies, or other diseases and conditions, man commits flagrant faults in a child’s upbringing. These include…

  • Forcing children to walk when they are not strong enough to control their physical movements
  • Forcing children to remain physically inactive when they are inclined to be physically active
  • Forbidding older children from climbing trees or jumping fences when their natural inclination is to do so
  • Forcing children to remain quiet when they crave activity…”
A carpenter stands with primal posture tall and erect

Gokhale had a similar epiphany about the way modern societal norms deprive humans from their natural, healthy physical tendencies. In her book 8 Steps To A Pain-Free Back Gokhale writes:

“This carpenter from Burkina Faso pressed me to take his photograph. I hesitated because I do not usually take posed photographs, but I am glad I took this one. Notice that his shoulders are aligned toward the back of his torso. His neck is elongated without much curvature and, as a result, his chin angles down. His belt is lower in front than in back, reflecting a pelvis that is tipped forward and a sacrum that is angled back. His chest is ‘open’. His breast bone is more horizontal than vertical; and his rib cage is flush with the contour of his torso. Even though he works on a low table for much of the day, he does not stoop forward or hunch his shoulders at all.”

So, how do we get our bodies back to existing how they were designed to?

A brief timeline of posture pioneers


Alexander Technique

The Australian Actor Frederick Matthias Alexander developed this technique because he believed patterns of excessive tension originated from the head and neck, leading to muscular strain throughout the body. He concluded that faulty movement habits led to decreased kinesthetic perception. He developed a system of hands-on assistance as well as verbal cues to help clients stop their physical habits and move in a freer, more efficient manner.
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Mesendieck System

Bess Mesendieck, an American physician and gymnastics teacher, developed a physical education paradigm that she claimed to both correct and prevent physical ailments. Her particular concern was the improvement of women’s posture and muscle structure.
The focus of Mesendieck’s bodywork was on perception of posture and movement. She thought that if you repeat exercises regularly and learn to integrate them into the movements of your daily life, they will become a habit that prevents problems. Mesendieck was one of the few women who combined the ideas of women’s rights activists with her system of movement. “Think for yourself!” was her motto.
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Feldenkrais Method

Devised by Israeli engineer and physicist Moshé Feldenkrais in the mid-20th century, the Feldenkrais Method claims to re-organize connections between the brain and body. The method teaches “kinesthetic awareness” so that participants notice what feels good in their bodies and what doesn’t. Feldenkrais said, “We move according to our perceived self-image.” According to Feldenkrais, by expanding your perception and increasing awareness, you will become more mindful of your habits and tensions and develop new ways of moving.
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Iyengar Yoga

Developed by B. K. S. Iyengar, this technique utilizes yoga as an exercise and emphasizes detail, precision and alignment in its postures. Iyengar pioneered the use of props such as cushions, benches, blocks, straps and sand bags, which allow beginners to experience asanas (yoga postures) more easily and fully than might otherwise be possible without several years of practice. Props also allow elderly, injured, tired, or ill students to experience the benefits of a wider variety of asanas via fully “supported” methods requiring less muscular effort.
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McKenzie Method

The McKenzie Method was developed in the late 1950’s by Robin McKenzie, a physical therapist in New Zealand. He noted that extending the spine could provide significant pain relief to certain patients and allow them to return to their normal daily activities. With the McKenzie method, physical therapy and exercise are used to extend the spine to help “centralize” the patient’s pain by moving it away from the extremities (leg or arm) to the back. Back pain is usually better tolerated than leg pain or arm pain, and Mckenzie believed that centralizing the pain allows the source of the pain to be treated rather than the symptoms.
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Noëlle Perez-christiaens: “Spinefulness”

Created by Noëlle Perez-Christiaens, the Perez method of “Spinefulness” stems out of Iyengar Yoga. Perez began by traveling to India in 1959 at age 33 to study with the famous yoga teacher, B.K.S. Iyengar. Perez studied x-rays of the spines and learned that people in less industrialized countries who carry weight on the head have a “natural arch” at the base of the spine, and their joints are aligned vertically. She changed the way she practiced and taught yoga as a result of these discoveries. “Whether people are from the East or West, the tensions are there. Tensions are not stretches. If the stretching is good, relaxation is bound to be complete. A half-hearted stretch gives a half-hearted relaxation.” – from Iyengar’s book that she edited, Sparks of Divinity.
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Gokhale Method

Esther Gokhale, posture pioneer and modern innovator, developed her method of posture-as-pain-relief in the 1990’s after experiencing crippling back pain during her first pregnancy, despite having already undergone surgery. As a young girl growing up in India, she helped her mother, a nurse, treat abandoned babies waiting to be adopted. She then studied biochemistry at Harvard and Princeton and acupuncture at the San Francisco School of Oriental Medicine. Using what she learned about healing and about biomechanics, Gokhale developed a specific posture-based program that aims to eliminate back pain by correcting poor posture, reinforced by modern living.
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Posture Pioneers who Inspired Gokhale

We all stand on the shoulders of giants (but do we stand correctly?). Gokhale is no exception; she was drawn to methods that study other cultures, like the Alexander Technique, which made notes of indigenous (Aboriginal) footprints. She admired the work of Noȅlle Perez, who studied under Iyengar. Gokhale immersed herself in studying Perez’s method, which, along with her experience studying science, helped her develop her own method. “My own background is very scientific,” she told us. “I was trained in biochemistry at Harvard and Princeton. Logic and science are very important… because when things become a little cultish or metaphysical, that doesn’t hold water the same way for me.”

Esther Gokhale, posture pioneer, treats a supine patient
Dr. D.J. Kennedy, pain and posture expert

“Our discs are kind of like wheels on a car and you can abruptly blow out a tire. That happens, [and] that’s an acute disc herniation. You can gently let the air out over time and get a flat tire. That’s kind of a disc bulge. And what predisposes to that? There’s a lot of things. What kind of car are you driving? How are you driving? What accidents do you have? But also, are the wheels aligned appropriately?”

-From our interview with Dr. DJ Kennedy , who recommends the Gokhale Method to his physiatry students at Vanderbilt Medical School

The Modern Back Pain Pandemic & The Cost of Treatment

Back pain is a leading cause of missed work for Americans; the numbers are staggering. Here are some stats that we thought might be of interest:

  • Americans spent $134 billion from 1996 to 2016 on treatments for neck and lower back pain — more than for treatments for diabetes or heart disease. As of 2017, lower back and neck pain cost Americans $88 billion a year.
  • The figure for low back and neck pain tops $380 billion when combined with other musculoskeletal ailments such as rheumatoid arthritis and other joint and limb pain.

Many of the back pain treatments covered by insurance (and therefore accessible to the average American) are reactive. Doctors commonly prescribe a pain pill, such as an opiod. But opioids often cause more problems than they solve. In January of 2020, in response to the opioid crisis, the Centers for Medicare and Medicaid Services (CMS) announced a decision to cover acupuncture for Medicare patients with chronic low back pain. However, insurance coverage for acupuncture is inconsistent, and there is little published data concerning coverage in most states.

One survey of 45 commercial, Medicaid, and Medicare Advantage health plans found that only one-third of plans covered acupuncture, suggesting most patients pay for acupuncture entirely out of pocket. When insurers did cover acupuncture, cost sharing was higher than other non-pharmacological interventions, and insurers tended to cover few indications and clinician types. Chiropractic insurance coverage is generally considered an ancillary benefit. A health plan may cover this benefit as an optional “rider” added onto a major medical plan, or there may be certain restrictions to this benefit.

Meanwhile, Americans desperately need alternative medical treatments for back pain.

I did refer [the Gokhale Method] more when I was in California because it was there and insurance wasn’t an issue. A lot of people that lived in the Bay Area could simply afford going to these classes. In Tennessee, any out-of-pocket experience is very challenging for a lot of my patients. That’s why I’m really hopeful that some of this data will get it where we can have this authorized through insurance. But we do need data to show that.”

Dr. DJ Kennedy , Professor and Chair, Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center
State of pain in the US illustrated by a bar graph of percentage of US adults who experience back pain

People that have reflux take reflux medicine. People that have high blood pressure take high blood pressure medicine. The medicine for your back, for most people, is doing some form of exercise. And I think that having the right posture throughout that is actually one of the things that can augment the process.”

Dr. DJ Kennedy , Professor and Chair, Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center

How Does The Gokhale Method Work?

lllustration of Ether Gokhale, pain pioneer's correct posture and painful modern ways of standing

The Gokhale Method emphasizes the importance of pelvis positioning — or, as Gokhale describes it, an “anteverted pelvis”. The common “neutral pelvis” is actually mildly tucked and does not allow the for correct lumbo-sacral angle and stacking of the spine, says Gokhale. A markedly tucked (retroverted) pelvis leads to a tense, compressed lumbar area and to slumping.

The Gokhale Method promotes strong core muscles, an anteverted pelvis, and a “shoulder roll” (where one rolls the shoulder back as far as one can and then gently slides the shoulder blade down along the spine).
If you master these things, according to Gokhale:

  • Sitting will be comfortable, either with a backrest when you place your back in therapeutic traction (stretchsitting) or without a backrest, when you stack your spine on a well-positioned, anteverted pelvis (stacksitting).
  • Sleeping will be comfortable and provide hours of restorative traction, whether lying on your back or side (stretchlying).
  • Standing will be a resting position for most of the muscles of the body with the weight-bearing bones vertically stacked over the heels (tallstanding).
  • Bending will involve hinging at the hip rather than the waist, exercising the long back muscles and sparing the spinal discs and ligaments (hip-hinging).
  • Actions that challenge spinal structures, such as carrying or twisting, will involve deep layers of muscles in the abdomen and back (inner corset) to protect the spine.
  • Walking will be a series of smooth forward propulsions, challenging the muscles of the lower body and sparing the weight-bearing joints throughout the body (glidewalking).

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…It’s not that quick a fix, but it’s a pretty quick fix.”

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

“In relearning these everyday actions, you will reposition and reshape your shoulders, arms, neck, torso, pelvis, hips, legs, and feet the way they were designed to be. You will develop a high level of confidence in and sense of control over your well-being.
Once you have learned the basic principles, you integrate them into all positions and movements. Your everyday activities will once again become therapeutic.”

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