Education

Teaching the Method

A deep pool of knowledge

Esther Gokhale, Founder

Esther Gokhale, Founder

We have an amazing pool of teachers, and I’m extremely proud of every one of them. They have diverse backgrounds and bring all kinds of knowledge, experience, and sensitivity to our Method, which benefits us all–teachers and students, alike. We are constantly tweaking and improving our offerings. Every month we get together via regularly scheduled, continuing-education teleseminars, where I or another expert in a specific area makes a presentation, followed up with a lively discussion. In addition, we stay in regular communication via what we have dubbed the “Teacher Water Cooler.” This is a private collaboration, a place where one teacher might write, “I just reviewed the intake form for ‘Student Y,’ who has this unusual syndrome, plus this and this and this. Any ideas how I might adjust my approach?” Another teacher might offer, “I ran into a cool educational tool the other day,” or, “Check out this interesting video on YouTube, and tell me what you think about its point of view.” So we teachers benefit from an ongoing and very dynamic interaction and, once a year, we gather together for a weekend of hands-on work.

A Gokhale Method Teacher who played a very helpful role in in the early days of our organization, when we most needed assistance, is Roberta Cooks, MD, who helped create a support group for teachers, as well as the teacher peer-review form that established standards against which we could begin to measure and improve teacher skills. She also tackled various writing and editorial projects, pitching in on the ever-evolving teacher training manual, which is now huge, because it covers all aspects of the training in great detail.

A physician who trained as a psychiatrist, Roberta spent much of her medical career in the museum industry, creating health-related exhibitions. Currently she is one of our most active teachers, regularly offering Gokhale Method Foundations courses and one-on-one sessions in and around Philadelphia, where she lives, as well as in New York City; Boulder, Colorado; and in Boca Raton and Fort Lauderdale, in South Florida.

Recently, I checked in with Roberta. Here’s some of what she had to share….

Roberta Cooks and the Gokhale Method–the early days

Roberta Cooks, Gokhale Method Teacher

Roberta Cooks, Gokhale Method Teacher

“Esther was teaching and fine-tuning the Gokhale Method on her own for a long time. Somewhere around 2008, she had arrived at the point where she knew it was important to have more people learning and teaching the Method, and she began to bring on teachers, a few of us at a time. I was one of the first, one of a group of seven or eight. Some of us stayed at Esther’s house, where we worked late into the night, doing our homework and brainstorming ways to boost our own training. Another teacher, Kathleen Marie, and I were especially interested in pursuing this, and—under Esther’s tutelage—we took next steps. On her own, Esther had developed a teacher training manual, but we began to build on this, with the goal of standardizing excellence. Esther was chock full of ideas, of course, but didn’t have the ‘bandwidth’ to develop them all.

As a physician, what particularly struck me when I first read Esther’s 8 Steps to a Pain-Free Back was the side-by-side comparison of the spine—the anatomical drawing from a 1911 anatomy book contrasted with a 1990 illustration.

The 1911 anatomical drawing of the spine, on the left, shows a less arched lumbar spine and a less tucked pelvis than the 1990 drawing on the right; the left spine illustrates what's going on inside the straight-sitting Maryland Governor and Congressman, above

The 1911 anatomical drawing of the spine, on the left, shows a less arched lumbar spine and a less tucked pelvis than the 1990 drawing on the right; the left spine illustrates what’s going on inside the straight-sitting Governor/Congressman, just below

Seeing these images, both from American anatomy books, prompted the thought: “This is the ‘black hole.’ No one knows what to do about the huge problem of back pain, so why aren’t we looking back into our own medical textbooks and reflecting on the early photographic record? Why aren’t we acknowledging this pertinent and poignant information?” And I felt I needed to convince other physicians of the common-sense truth of this core element of the Gokhale Method, which of course is only one piece of the evidence that supports Esther’s work.

The healthy stacksitting posture modeled by this Maryland Governor and Congressman is typical of our 19th-century forebears

The healthy stacksitting posture modeled by this Maryland Governor and Congressman is typical of our 19th-century forebears


Museumgoers have been known to try to console Duane Hanson's 1977 'Man On A Bench,' his disconsolate, slouching, vinyl and polychromed body is so hyper-real

Museumgoers have been known to try to console Duane Hanson’s 1977 ‘Man On A Bench,’ his disconsolate, slouching, vinyl and polychromed body is so hyper-real

The dance connection

I dance Tango. In fact, it’s through dance that I first found Esther. My Tango teacher was handing out copies of Esther’s 8 Steps to a Pain-Free Back to anyone in the class who had back pain. Pain wasn’t an issue for me, but at the time my sister was experiencing problems with her shoulders, her hip, and her feet. Nothing she was doing was working, so I read Esther’s book and was sufficiently intrigued to seek Esther out. I took a Gokhale Method Foundations Course with Esther and was very impressed by her work and teaching style. I saw how her Method helped students with a variety of health issues and backgrounds. At the end of the course I spoke with Esther and we really hit it off. So I decided to become a Gokhale teacher by going through the teacher training course.

Tango is a "gildewalking" dance

Tango is a “gildewalking” dance

Argentine Tango is a walking dance that has a lot in common with the glidewalking we do in the Gokhale Method. Just as practitioners of the glidewalking technique engage the gluteus medius muscles by sending the back heel into the floor to propel themselves forward, so dancers of the Argentine Tango take the same basic actions. Perhaps you can see in the video just below that in propelling myself forward with the heel of my back foot and my back leg and my engaged gluteus medius muscles, I’m communicating a strong message to my partner to move backwards. My shoulders are rolled back, my rib anchor is engaged, and my partner, who is following, receives most of my ‘information’ from my chest.

So dance was one of the ways Esther and I connected, although “her dance,” as you perhaps know from an earlier blog post and a Gokhale Method online workshop, is the Samba.

Argentine Tango, San Telmo Plaza Dorrego, Buenos Aires

Argentine Tango, San Telmo Plaza Dorrego, Buenos Aires

My writing, medical, and museum background

In addition to Tango, I’ve always been interested in self-education and preventive medicine. And I’m a writer; I’ve written a children’s book. These interests, together with my psychiatric medical training and my background designing health-related museum exhibits, are relevant to teaching the Gokhale Method. What’s wonderful about the posture work is not only what we teach, but how we teach it! The Method is so clear and practical. And it’s multisensory, which is essential because we want what we teach to become part of peoples’ bodies. The multifaceted approach is very similar to what I do when designing medical exhibits, where the challenge is to take difficult-to-understand information and make it visual, aural, and very hands-on. I know–and Esther and all our Gokhale Method teacher colleagues well know–that people learn in different ways. That’s why the rich, multimedia training we offer is so effective. Not only is it common-sense practical and intellectually clear, it’s also tactile.

I’ve been designing museum exhibits for a number of years–for example, the first big traveling exhibit on HIV/AIDS, as well as an exhibit on the brain, the heart, and–as shown in these photos–‘the universe inside us’–the cells. What I’ve observed about health education in museums is that people come to theses places, which are much more neutral settings than a medical office or a hospital, absolutely hungry for information. This seemed particularly true with the brain and AIDS exhibits, and I think this is because many people feel frightened or intimidated by medical settings, which makes it difficult for them to process what they’re being told.

One of the projects I directed and developed was the Maryland Science Center's permanent and traveling exhibit 'Cells: The Universe Inside Us'

One of the projects I directed and developed was the Maryland Science Center’s permanent and traveling exhibit ‘Cells: The Universe Inside Us’

I share these pieces of my professional biography, because the diversity of my experience provides a great foundation for the Gokhale Method work at hand.

Hands-on, highly visual, and interactive exhibits like the one shown here offer a multisensory learning experience--this is what the Gokhale Method offers, too

Hands-on, highly visual, and interactive exhibits like the one shown here offer a multisensory learning experience–this is what the Gokhale Method offers, too

 

Healthy posture can positively impact the universe inside us

Healthy posture can positively impact the universe inside us

The mind-body connection–wellbeing and healthy posture

I have seen some very positive psychological changes in people I’ve taught, and the improvement in the outlook of many of my posture students is one of the reasons that I find teaching the Gokhale Method to be so satisfying and joyful. Research has shown that there are biochemical advantages to being physically open, with shoulders rolled back and chest open–as opposed to standing with arms crossed and shoulders hunched–and my own experience confirms that posture can be a complementary wellness approach to psychological conditions. And what surprised me initially–and what I still find delightful, today–is how quickly these positive effects so often happen!

It’s not unusual when I’m teaching the Foundations Course for one student to say to another as early as the second day, ‘You look like a completely different person.’ In a class I just taught in Florida, a massage-therapist student who had participated in the free class and returned to the Foundations Course, told me: ‘After I learned the shoulder roll and then worked with my clients, I felt so much more open to the world.’

Might stretchlying, with shoulders rolled back and chest open, alter this fellow's sense of wellbeing?

Might stretchlying, with shoulders rolled back and chest open, alter this fellow’s sense of wellbeing?

Again, even though I’m not working directly on the psychological state of my posture students, I see positive results that are in the psychological realm. People with healthy posture tend to have a more positive body image. Practicing healthy posture, which requires us to be present in the moment, can also be an effective way of quieting the mind.

Yet another thing I know from my teaching of the Gokhale Method, as well as from my own experience as an individual with rheumatoid arthritis, is that by having a better understanding of my body and by knowing how to protect my muscles, joints, and skeletal system to prevent pain–all these things give me actual greater control over my health. This is such a rich topic, because I also know, both professionally and personally, that feelings of helplessness–a loss of control over one’s life–represent one of life’s biggest stressors!

Small groups

Another strength of the Gokhale Method is that classes are taught in small groups, which to my way of thinking is a wonderful way to teach people, many of whom are not comfortable with their bodies, or are feeling frightened or are in pain. Not only does the small-group approach enable teachers to do hands-on work with each individual, it encourages students to learn from one another, and to form a kind of community. The Method is a practical, step-by-step educational model, not a medical model, and in a small group this becomes a very powerful way to learn.

The rewards of teaching the Gokhale Method

When, as a prospective teacher, I signed on for Gokhale Method teacher training, I first needed to take the Foundations Course, and then I needed to find someone willing to work with me. I chose my cooperative sister!  At the time, she was having difficulties with hip, shoulder and foot pain. She had been going to health professionals for several years with no relief. ‘I was at my wit’s end,’ she said, when we recently reminisced about this. ‘It was so amazing to me that, after years of getting no relief through the usual channels, learning this method from you–my sister–could make such a positive difference.’

With most of her hip, shoulder, and foot problems resolved over the course of my teacher training, she was able to go back to biweekly Jazzercise classes that she still enjoys today. After working with my sister, I taught two people at once, then four people, then six–until I graduated my way up to teaching small-group classes.

My sister was my first student! Here, when we were pre-teens, it seems I was already encouraging her to roll back her shoulders

My sister was my first student! Here, when we were pre-teens, it seems I was already encouraging her to roll back her shoulders

A teacher-centric organization

While the 8-step fundamentals of teaching the Gokhale Method have remained essentially the same, Esther has ensured that teachers’ skills, energy, and time are leveraged by technology, and that the company stays cutting-edge. For example, teachers now use an iPhone app that makes it possible for us to take before-and-after pictures of our students and upload them in real-time to the private, secure, student-portion of the Gokhale Method website. Uploading these images straight from the classroom triggers an email to the student, so that as students walk out the door after completing a Foundations Course, an email alerting them to private (for their eyes only) class photos is waiting in their inbox.

Instant  access to these before-and-after photos is a powerful tool for students, in part because so many enter the classes wondering, ‘How am I ever going to change in such short period of time?’ And, with the before-and-after photos, they can see what a difference the training has made, even if they’ve taken an intensive course over a single weekend. The before-and-after photos also remain a valuable tool for students long after they have completed the coursework.

Also advantageous to both students and teachers is the ease with which student histories are privately, securely, and  instantly shared via the Method’s electronic educational record. This allows for uniformity across Gokhale Method training and continuity for students. Just now, for example, I taught a student in Florida who had been taught by my fellow-teacher Kathleen, which means that prior to my meeting with her I could access private information about her case and be prepared.

Also hugely helpful is the student intake form. When students sign up online or call the Palo Alto office, they complete a form that provides teachers with need-to-know information. This creates a link between individual students and teachers prior to their meeting. Gokhale Method teachers have access to only their students’ intake form, although, via the Teachers’ Water Cooler, we can reach out to our colleagues for additional expert input on unusual or particular cases. In these ways–and more–technology makes us stronger. We have the support of the entire teacher community, including Esther. And of course there are advantages to teaching–and learning–in a franchise where there is uniformity of high standards.

To sum up, I love being a teacher of the Gokhale Method, because it gives me back so much. To help people get to the root of their pain and posture problems, without imposing risks–to make such a difference in peoples’ lives by putting the practical power to heal into their own hands and teaching them to problem-solve significant challenges in their lives–well, it’s just incredibly rewarding.

If you are interested in learning more about what’s involved in teacher training, please check in with us at teachers@gokhalemethod.com. The Gokhale Method Institute is not able to satisfy student demand in a number of places in the US, Canada, and abroad and would love to have more qualified teachers join us.”  – See more at: http://gokhalemethod.com/blog/56476#sthash.dpLoglOm.dpuf
Here, I help a Gokhale Method student anchor his ribs

Here, I help a Gokhale Method student anchor his ribs

Inclined to teach?

If you are interested in learning more about what’s involved in teacher training, please check in with us at teachers@gokhalemethod.com. At present, the Gokhale Method Institute is not able to satisfy student demand in a number of places in the US, Canada, and abroad, and we would love to have more qualified teachers join us.”

If you are interested in learning more about what’s involved in teacher training, please check in with us at teachers@gokhalemethod.com. The Gokhale Method Institute is not able to satisfy student demand in a number of places in the US, Canada, and abroad and would love to have more qualified teachers join us.”  – See more at: http://gokhalemethod.com/blog/56476#sthash.2CM0onMl.dpuf
If you are interested in learning more about what’s involved in teacher training, please check in with us at teachers@gokhalemethod.com. The Gokhale Method Institute is not able to satisfy student demand in a number of places in the US, Canada, and abroad and would love to have more qualified teachers join us.”  – See more at: http://gokhalemethod.com/blog/56476#sthash.5inZDSEu.dpuf
If you are interested in learning more about what’s involved in teacher training, please check in with us at teachers@gokhalemethod.com. The Gokhale Method Institute is not able to satisfy student demand in a number of places in the US, Canada, and abroad and would love to have more qualified teachers join us.”  – See more at: http://gokhalemethod.com/blog/56476#sthash.2CM0onMl.dpuf
If you are interested in learning more about what’s involved in teacher training, please check in with us at teachers@gokhalemethod.com. The Gokhale Method Institute is not able to satisfy student demand in a number of places in the US, Canada, and abroad and would love to have more qualified teachers join us.”  – See more at: http://gokhalemethod.com/blog/56476#sthash.5inZDSEu.dpuf

 

Teaching the Gokhale Method is incredibly rewarding--it gives so much back

Teaching the Gokhale Method is incredibly rewarding–it gives so much back

 

If you are interested in learning more about what’s involved in teacher training, please check in with us at teachers@gokhalemethod.com. The Gokhale Method Institute is not able to satisfy student demand in a number of places in the US, Canada, and abroad and would love to have more qualified teachers join us.”  – See more at: http://gokhalemethod.com/blog/56476#sthash.dpLoglOm.dpuf
If you are interested in learning more about what’s involved in teacher training, please check in with us at teachers@gokhalemethod.com. The Gokhale Method Institute is not able to satisfy student demand in a number of places in the US, Canada, and abroad and would love to have more qualified teachers join us.”  – See more at: http://gokhalemethod.com/blog/56476#sthash.dpLoglOm.dpuf
If you are interested in learning more about what’s involved in teacher training, please check in with us at teachers@gokhalemethod.com. The Gokhale Method Institute is not able to satisfy student demand in a number of places in the US, Canada, and abroad and would love to have more qualified teachers join us.”  – See more at: http://gokhalemethod.com/blog/56476#sthash.2CM0onMl.dpuf

 

Image Credits:
All photos and video of Roberta Cooks, MD, courtesy of Roberta Cooks
Maryland Governor and Congressman Thomas Swann, public domain, Library of Congress

Duane Hanson’s ‘Man on A Bench,’ Wikimedia Commons
Three photos of Maryland Science Center Exhibit, Assemble, courtesy of Roberta Cooks
Buenos Aires Argentine Tango, Helge Høifødt, Wikipedia
Psychotherapy Session, Wikimedia Commons

 

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Mike King’s Incredible Journey

A quote from one of my cherished Gokhale Method students captures the before of his posture-improving, pain-eliminating journey with me:

“I was a managing director at a telecommunications company supervising a lot of people, but there would be days when I’d put in my time lying on the floor in my office–to take pressure off my spine. At first colleagues would walk in and do a double-take, but gradually they become accustomed to my having to stretch out the floor while I worked. This had become my new normal.”

Another quote offers a glimpse of the happy hereafter, in particular, the adventurous life this man has been leading since we concluded our regularly scheduled, one-on-one work together, in 2008. 

“My wife and I just came back from a trip to Machu Picchu and the Galapagos. All the climbing of the Inca ruins and the walking over the lava fields of the islands went so very smoothly I never had even one issue of back trouble. Believe me, I could not be happier.”

The remarkable fellow is Mike King of San Ramon, California, and I was thrilled when he agreed to share his dramatic journey into and out of debilitating back pain.

What follows is Mike’s “travelogue.”

"Esther, I never thought I would ever again be able to do something like this. Thank you, thank you, thank you."

“Esther, I never thought I would ever again be able to do something like this. Thank you!”

The “back story” to my back story

“I’m 75 now, and if I look at the kinds of things I did in my life that contributed to what turned out to be debilitating back pain, it includes putting myself through college by working in a truck service station, working on very large and very heavy tires, using pneumatic wrenches to take them off and put them on. It was physically awkward and very taxing work. I also played football in high school and college and was involved in several car accidents. These were among the contributing factors.

“The first signs of trouble appeared in 1974. Especially when I did yard work or any other manual labor I would be very achey; I would really feel it. But it wasn’t a big deal back then, because I could get through these episodes by popping anti-inflammatories and easing up on the manual labor. The pain wasn’t yet chronic.

“But by the late 1980s my back problems intensified. The pain would last longer, and it would be more restrictive in terms of what I could do. For example: I’ve always been someone who’s been in the gym; I enjoyed working out, and I ran. But when back pain began to catch up with me, I had to quit running and cut back on working out. My life began to change.”

From bad back to worse

“In the 1990s I was doing a lot of international business travel, which meant frequent long flights and hotels with strange beds. This was at a time when I was becoming severely physically limited–when not only  was something like yard work out of the question, but walking had become a chore.

“Yet another issue was pain-related sleep deprivation, which of course exacerbates the difficulties of any challenging situation. And when my back problem became chronic–when I saw how much of my lifestyle I was having to let go–I became terribly discouraged. Feeling uncomfortable after a workout is one thing, but when disabling pain comes at you all at once it’s pretty hard to take. So, out of desperation, in June 1998, I saw my first neurosurgeon.”

The diagnosis

“Long story short, the neurosurgeon ran a number of tests and did a number of scans and diagnosed extensive sciatica due primarily to damaged L4 and L5 discs impinging upon nerves radiating out from my spinal cord. And his recommendation was surgery on my lumbar spine.

Contrast the herniated lumbar disc impinging upon the spinal nerve, at bottom, with the healthy disc, at top

Contrast the herniated lumbar disc impinging upon the spinal nerve, at bottom, with the healthy disc, at top

“By this time I was in serious pain and walking with a cane, and in desperation I agreed to have surgery–a laminectomy and a discectomy, which basically involve the carving out of some bone to get to the damaged discs that were protruding out and pressing in on spinal nerve roots.

Two surgeries: the good–and the bad & ugly

The bad

“When I came out of the first surgery–even after a longer than normal period of recovery–it became apparent that I was in worse shape than when I went in. It’s not like I was looking for a miracle, but I was expecting some relief because the neurosurgeon had painted a rosy scenario of a positive outcome. Instead, the surgery was a failure.”

The ugly

“At one post-op visit my wife, who was extremely concerned, explained to the neurosurgeon that I was feeling discouraged because I was still in terrible pain and still so debilitated. And the neurosurgeon turned to her and said, ‘Well, that explains why he’s not getting better. He’s not getting better, because of his attitude.’

“Jan looked at him and said, ‘No. He’s discouraged because the surgery didn’t work, and you’re not taking responsibility for it.’

"In desperation, I agreed to have surgery."

“In desperation, I agreed to have surgery.”

“So we quickly moved on, but of course by that time the damage had been done.”

The good

“Nine months later, in April 1999, I had a second back surgery, basically to clean up the results of the first failed surgery. And though I came out of that with the usual post-back surgery kinds of issues, I felt sufficiently well to travel on business to Hungary just one month later. And I got eight good years out of that second procedure, because it was done well and because I was very careful about what I did and got better at reading the warning signs. Once again, I was able to travel, work out in the gym, enjoy my life. So that second surgery turned out to be a really good thing–for a while.”

Back surgery number 3?

“In late 2006, early 2007, my back pain returned, but this time I now had foot drop, a condition that can occur when herniated spinal discs in the lower back impinge on spinal nerve roots. Because foot drop made it hard for me to walk and keep my balance, it prompted a visit to a third neurosurgeon, who–as he showed me X-rays and MRIs–identified a number of discs causing my problems, specifically: L3-L4, L4-L5, and L5-S1. But when he said, ‘You’re looking at major spinal fusion,’ I said to myself, ‘I’m not going to have a third back surgery. I’m not going to put my body through this. I’ve got to find another way.”

"Adriaen Brouwer's 'The Back Operation,' 1636, captures only some of the pain of my surgical interventions."

“Adriaen Brouwer’s ‘The Back Operation,’ 1636, captures only some of the pain of my surgeries.”

Identifying with the man from la Mancha

An impossible dream?

“To say I became preoccupied with a need to feel better is an understatement, because when you’re in pain and desperate for relief, you will find all sorts of people who claim they can heal you. For me, the experience was like going through a smorgasbord line, trying countless alternatives, none of which worked and some of which actually hurt me. And I began to view my quest as a sort of impossible dream to find a way to take care of my problem, without submitting to spinal fusion. 

“I’m not a student of Cervantes, but as I got deeper into my quest the classic tale of Don Quixote began to resonate. As you no doubt know, the story centers on an idealistic but confused man’s wanderings to do good works.  An indomitable inner will and extraordinary determination propelled him on his journey, despite real and imagined obstacles he encountered at every turn. And it occurred to me that people who suffer from debilitating back pain follow a similar path. While perhaps not as delusional as Don Quixote, we’re forever searching the Internet, gathering the latest information on surgical and nonsurgical approaches; we’re able to recite the definition of chronic pain; we try heat and then we try cold; we try pain blockers, anti-inflammatories, and muscle-spasm medications. We visit neurosurgeons, orthopedic surgeons, chiropractors, naturopaths, homeopaths–every imaginable alternative practitioner.  We seek second opinions and third opinions, and then, because we’re still hurting, we seek more.

"Don Quixote's indomitable spirit inspired me."

“Don Quixote’s indomitable spirit inspired me.”

“I put a lot of miles on my car and paid a lot of fees, in search of a solution, but my quest was really wearing on me because I was beginning to believe there wasn’t an answer. And as the prospect of fusion surgery loomed ever larger, and as I could see life as I once knew it slipping away from me, I grew more concerned.  Until one night, I plucked up a copy of Costco’s magazine.”

A serendipitous discovery

“Deep inside the magazine, I found a small article linking posture to back pain. It was very brief, with almost no detail, but after I read it I thought, ‘Hey, this something I haven’t tried!’ Of course I was more than a little skeptical that the approach developed by Esther Gokhale, with its focus on posture, could have a significant effect on my back pain, but I was determined to check it out. So I gave Esther’s office a call and signed up for a 1-hour free session.”

"It was just incredibly serendipitous how I came to discover the Gokhale Method."

“It was just incredibly serendipitous how I came to discover the Gokhale Method.”

“Later, when I got to know Esther, I asked, ‘Was Costco selling  your book?’ It wasn’t. The story just kind of appeared, and the fact that I would find it–and jump on it–was just incredibly serendipitous.”

What’s posture going to do for me?

“By the time I met Esther I was walking with a cane and getting through the day on a heavy-duty dose of Vicodin; I was not in good shape. So when my wife and I attended the one-hour introductory session, my mindset was: ‘This is kind of weird. What’s posture going to do for me?’ But when the session concluded and a man in the back of the room stood up and said, ‘I just have to tell you something, Esther. I’m a neurosurgeon, and you’ve done more for a number of my patients than I could ever do with surgery,’ I thought, ‘Bingo, this is what I needed to hear.’

Esther_Gokhale_Mike_King“On the spot I signed up for the Gokhale Methods course, opting for six private sessions with Esther. And I bought a copy of her book, 8 Steps to a Pain-Free Back. The amazing thing—and even I have trouble believing this–was that  I literally could feel a positive change after each session. At our first meeting, I learned how to sit. Now that may seem like a very simple thing to do. (I know I certainly thought it was,  because I’d been sitting for a lot of years and it never occurred to me that I should be doing this any differently.) But it soon became apparent that I had a lot to learn, and that I was going to have to do some serious reprogramming of old habits. And for six weeks I worked really hard, learning and practicing Esther’s techniques.

“As I progressed through the six classes, Esther helped me understand the big picture of her program. One of the nice aspects of the Gokhale Method, I should add, is that it’s not something you need to go back and re-enroll in every month–or even every six months (although for a while, I greatly benefited from quarterly ‘tune-ups’). Instead, you learn techniques that you can easily practice in the course of your daily life.”

Reclaiming my life

“I finished the course in 2008, so it’s been five years. And at age 75  I’m enjoying life and doing everything I want to do. One thing I hugely enjoy is being out and about with my camera, finding things to photograph, and–since working with Esther–I’ve done wonderfully well when I travel. My wife and I are just back from China; last year we hiked around Machu Picchu and the Galapagos; the year before we explored southern Africa–and next year I’m returning to Africa. We’ve seen so many amazing things and I’m grateful to the Gokhale Method for helping me regain the mobility I need to do all this–I’m grateful to Esther and her method for enabling me to (quite literally) reclaim my life.

 

"Freedom from back pain means freedom to travel. Here I am in Tiananmen Square."

“Freedom from back pain means freedom to travel. Here I am in Tiananmen Square.”

 

Photo Credits:
Mike King, Machu Picchu, 2012:  Jan King
Herniated lumbar discs: Wikimedia Commons
Surgeon: Wikimedia Commons
“The Back Operation,” Adriaen Brouwer: Wikimedia Commons
“Don Quixote,” Honoré Daumier: Wikipedia
“Getting Back to Our Roots”: Screen shot from The Costco Connection
Esther Gokhale and Mike King from
Back Pain: The Primal Posture Solution video: gokhalemethod.com
Mike King, Beijing: Jan King

Pregnancy and back pain

I’m reaching out to pregnant women today, because I’ve been reflecting on a clinical study that captures the scope of the problem of lower back (lumbar) pain in expectant mothers and because I have all too vivid memories of how lower back and sciatic pain affected me when I was nine-months pregnant with my first child. This crippling pain continued for a year, at which point I had back surgery that provided only temporary relief. This painful chapter in my life is what started me on my path to understanding the causes and treatments for back pain.

Lower back pain and pregnancy–it’s a problem!

Jozsef_Rippi-Ronai_Female_Back_NudeIf you’re pregnant and have lower back pain, you’re not alone.

A 2004 study (Low back pain during pregnancy: prevalence, risk factors, and outcomes) published by Yale researchers in the American Journal of Obstetrics & Gynecology found that nearly 70% of the 645 pregnant women responding to a 36-question survey reported lower back pain during their current pregnancy.

The researchers also found that:

  • Pregnant women who have experienced lower back pain prior to their current pregnancy (e.g., during their periods, during a previous pregnancy, prior to ever becoming pregnant) are particularly susceptible to lower back pain
  • Lower back pain disturbed the sleep of 58% of study respondents
  • Lower back pain negatively impacted the daily lives of 57% of the women surveyed
  • Two-thirds of women surveyed in this study did not share back-pain problems with their pre-natal caregivers and–if and when they did–only one-quarter of  these caregivers recommended any kind of treatment

Because I know that lower back pain in pregnancy is a manageable and in most instances a preventable problem, it’s of course best if women who plan to become pregnant prepare their bodies for the dramatic physical, musculoskeletal, and hormonal changes that lie ahead. This, as the study confirms, is especially important for women with a history of back pain.

But because so many expectant mothers are–at this very minute!–experiencing lower back pain and, in many instances, not seeking or receiving help, this is the topic I’ll focus on now.

The lumbar spine is the region of the spine between the rib cage and the pelvis

The lumbar spine is the region of the spine between the rib cage and the pelvis

Body stressors during pregnancy

I’ll start by stating the obvious: During pregnancy a woman’s body undergoes a number of changes, many that are inherently stressful. These of course include:

  • Extra weight
  • A shift in the center of gravity
  • The impact of of the hormone relaxin on ligaments

If, as we consider the lumbar region of the body, we reference the very pregnant Mandy in the photo just below, we can begin to imagine why lower back pain can be a problem for some 7o% of expectant mothers.

Mandy at 39 weeks + 4 days

Mandy at 39 weeks + 4 days

By allowing the weight in her expanded belly to pull her lumbar spine into an exaggerated arch, Mandy is shifting her center of gravity forward, with the result that not only is there too much arch in her spine, there’s too much weight on the front of her feet. To counter the arching of her spine and to lengthen and flatten the lumbar region, Mandy would need to use her internal oblique muscles to rotate her ribcage forward. This action, which is vital to proper alignment of the spine and good posture, is what I call “anchoring” the ribs. (Rib anchoring is discussed in greater detail and demonstrated in the video, below.)

What’s healthy about Mandy’s posture is that she is anteverting, or tilting forward, her pelvis. An anteverted pelvis helps prevent lower back pain because it allows for a natural stacking of the vertebrae, as well as a healthy alignment of the spine over the legs.

Extra weight

Anatomy-of-Human-Gravid-Uterus-Exhibited-in-Figures-by-WilliamHunter01Where Does the Extra Weight Go During Pregnancy? (WebMD helpfully breaks this down.)

  • Baby: 8 pounds
  • Placenta: 2-3 pounds
  • Amniotic fluid: 2-3 pounds
  • Breast tissue: 2-3 pounds
  • Blood supply: 4 pounds
  • Larger uterus: 2-5 pounds
  • Stored fat for delivery and breastfeeding: 5-9 pounds

   Total: 25-35 pounds

Extra weight and foot structure. I’ve know for a long time that weight gain from pregnancy (in concert with the effects of the hormone relaxin) impact the feet and can increase a woman’s shoe size by half a size or more, so it was interesting to review results of a study published in the March 2013 issue of the American Journal of Physical Medicine & Rehabilitation. The study, Pregnancy leads to lasting changes in foot structure, reports that for 60% to 70% of the 49 participants, their feet became longer and wider and, on average, the height and rigidity of their arches significantly decreased. Study authors also observed that the loss of arch height seems to be permanent, and that the first pregnancy may have the most significant impact on the feet.

Center of gravity

Ecuadorian_Figure_of_a_Pregnant_Woman_-_Walters_Art_MuseumWith pregnancy comes a shift in the center of gravity that can be compensated for with good movement patterns and by engaging the internal oblique muscles, which run along the side of the abdomen at about the level of the waist. These muscles can be used to flex the thorax forward and prevent the lower back from arching.  (The thorax is the part of the body between between the neck and the abdomen.)

By rotating the ribcage forward and, once again, lengthening and flattening the lower back to “anchor” the ribs, even women well advanced in their pregnancy can maintain a comfortable center of gravity.

Shifting the weight back solidly on the heels is also a good thing, because it counters distortion in alignment, while also offering the advantage of not overspreading the feet, which can result in loss of structure.

Relaxin

Pregnant women need to take especially good care of their ligaments because the hormone relaxin, which is produced by the ovaries and the placenta and which helps prepare the expectant mother’s pelvis for delivery, also works to remodel other soft tissues, cartilage, and ligaments in the body. As a result, pregnant women are at risk of losing structure–for example (and as described above), in the feet.

Gokhale Method teacher Janine hiphinges in Chicago

Gokhale Method teacher Janine hiphinges in Chicago

Lower back pain and pregnancy–some solutions!

Authors of the “Low back pain in pregnancy” study, cited above, also make the point that lower back pain can start at any point during pregnancy. This means that whether a woman is one-month pregnant or on the cusp of giving birth, she may be experiencing pain in her lower back pain–pain the Gokhale Method helps address.

The good news is that by making adjustments women at every stage of pregnancy can prevent lower back pain from occurring, or–if pain is already an issue–take real steps to manage this pain.

Six tips

  1. Anchor your ribs
  2. Engage your inner corset
  3. Hinge your hips when you bend
  4. Stack your weight over your heels
  5. Engage your gluteus medias muscles when you walk
  6. Stretchlie on your side with supportive pillow

While the suggestions I outline in this post can begin to make a difference, much more can be gained from enrolling in the Gokhale Method Foundations Course, watching the DVD Back Pain: The Primal Posture Solution, and reading (and repeatedly referencing) 8 Steps to a Pain-Free Back. (‘Where to learn more’ details are provided at the bottom of this post.)

1. Anchor your ribs

With regard to the rib anchor, it’s important to know that the ever-growing baby is potentially pulling the mother’s back into an arch. An expectant mother who gives in to this pull will be increasingly swaying her back, which can cause lower back pain and other problems.

Anchoring the ribs involves keeping the lower border of the rib cage flush with the abdomen. This lengthens the back and helps to frame and lengthen the . By engaging  as the baby gets bigger, the expectant mother not only reduces the risk for lower back pain, she also gets very valuable abdominal muscle exercise during pregnancy. This not only negates the problem of lower back pain, it makes pregnancy an opportunity to strengthen abdominal muscles, rather than a liability to lose muscle tone.

Keeping abdominal muscles nicely toned before during and after pregnancy perhaps even more ties in with engaging the inner corset, which is at the core of Tip Number 2.

Frank_De_Klein_Coloring_Creative_Commons

2. Engage your inner corset 

Anchoring the ribs and periodically engaging the inner corset–that is, contracting the deep muscles in the abdomen and back to lengthen and support the spine–is the ticket to well-toned abdominal muscles before, during, and after pregnancy. No matter how pregnant a woman is, these muscles can be entirely engaged, which is especially beneficial, given that the usual abdominal exercises–for example, lying on the back and doing crunches–are not recommended.

© Gokhale Method

© Gokhale Method

Inner-corset muscles should not be engaged all the time, however. Instead, pregnant women (and everyone else!) will benefit from contracting deep back and abdominal muscles, off and on, over the course of the day.

3. Hinge your hips when you bend

Everybody needs to hip-hinge when they bend, but this is especially important for pregnant women. This is because lowering the body by bending with the knees and curving the back (as is so common in our culture) puts added stress on the spinal discs at a time when the discs are already being challenged by the additional weight of the pregnancy.  Keep in mind that the front of each disc in the curve being formed when the back is bent is compressed, pushing the contents of the discs backward, toward the spinal nerves. All authorities agree that this is a risky direction to distort the spine.

The features of hip-hinging especially important for pregnant women are to get the legs externally rotated and set apart in a wide stance, so that when they hinge forward, there’s room for the belly to settle between the legs. In other words, the legs have to be out of the way, so that the belly can settle between them. If the the knees are not externally rotated, but facing in, then the thighbones will interfere with the torso settling.

Gokhale Method teacher Janine hiphinges in Chicago

Gokhale Method teacher Janine hiphinges in Chicago

Because so much bending is involved in motherhood, a very good time to master hiphinging is before and during pregnancy. Doing so will prepare the expectant mother for all the bending that is to come.

4. Stack your weight over your heels

Positioning the pelvis so that it’s slightly tipped forward (anteverted) allows for a natural stacking of vertebrae without muscle strain. Vertebral stacking is important for everyone, but a for a pregnant woman carrying extra weight and with an altered center of gravity, it’s really essential.

Not only does healthy stacking yield good posture that leaves spinal discs decompressed, it also protects ligamental integrity. Ligaments already loosened by the hormone relaxin are less likely to be taxed when bones are correctly stacked. This will also help protect the feet, which–as noted above–are at risk of losing structure.

5. Engage your gluteus medias muscles when you walk

Engaging the gluteus medius, the muscle located in the upper, outer quadrant of each buttock, helps prevent lower back pain

Engaging the gluteus medius, the muscle located in the upper, outer quadrant of each buttock, helps prevent lower back pain

Our “glutes,” or buttocks, are made up of three major muscles: the gluteus maximus, gluteus medius, and gluteus minimus. Located in the upper, outer quadrant of the buttocks, the gluteus medius is the “middle” muscle, the one that moves the leg to the side and rotates the thigh.

Gluteus medius weakness–a study. Because engagement of the gluteus medius plays such an essential role in a healthy kind of walking I have dubbed ‘glidewalking,’ and because this muscle also plays an essential role in healthy, pain-free posture, I was very interested to learn that researchers at the University of Iowa Department of Orthopaedics and Rehabilitation conducted a study that found a strong correlation between lower back pain in pregnant women and weakness of the gluteus medius.

Specifically their 2009 pilot study, Association between gluteus medias weakness and low back pain during pregnancy, found that “pregnant women with gluteus medius weakness were roughly 6 to 8 times more likely to have low back pain than those without weakness.” The findings confirm what I have long known from my own research and practice–that strengthening and regularly engaging the gluteus medius is really key.

6. Stretchlie on your side with supportive pillow

Stretchlying on the side–that is, lying with a lengthened back, anteverted pelvis, and knees slightly bent–represents an opportunity to restore healthy architecture during sleep and reinforce the neural pathways that will help create muscle memory for a healthy J-shaped spine (as opposed to a curved C-shaped spine or an over-arched S-shaped spine). Not only does stretchling on the side decompress discs and improve circulation when the expectant mother is at rest or asleep, it also helps create muscle memory for an anterverted pelvis and lengthened spine when she’s up and about. For women unaccustomed to what good posture feels like, healthy muscle memory can be hugely helpful.

Because the extra weight in the belly tends to pull the expectant mother’s spine out of alignment, tucking a soft pillow in under the belly will help her resist the pull of gravity and maintain a neutral position. During pregnancy, anything that spares pull on the skin, muscles, flesh, ligaments, and spine, is a very good thing.

When pregnant and stretchlying on the side, it's important to tuck a soft pill in under the belly

When pregnant and stretchlying on the side, it’s important to tuck a soft pill in under the belly

Model this!

Pregnant women experiencing lower back pain might help themselves by taking posture cues from this illustration:

This very pregnant figure models very nearly perfect posture

This very pregnant figure models very nearly perfect posture

The image above captures very nice pregnant posture. The woman’s back is not significantly arched, her spine is more or less J-shaped, and her shoulders are rolled back.

Where to learn more?

Maternity_Curves_Sean_McGrathThe six-session Gokhale Method Foundations Course helps people, including pregnant women, improve their structure and function as they engage in everyday activities. 

While my book,  8 Steps to a Pain-Free Back, is most helpful when it’s read in its entirety, the following pages expand on the tips outlined in this post:

  • Rib Anchor: 39, 84, 140, 198
  • Inner Corset: 110,-127, 144, 153, 162-163, 190
  • Hiphinging: 150-167
  • Stack your weight over your heels:46-47, 138, 142
  • Engage gluteus medius muscles when you walk: 168-194
  • Stretchlie on your side with supportive pillow: 94-109

The DVD Back Pain: The Primal Posture Solution also features relevant training, including segments on:

  • Stretchsitting: Use the back of your chair to decompress your spinal discs and transform sitting into a healthy, therapeutic activity
  • Inner Corset: Learn to engage your deep back and abdominal muscles to protect your spine
  • Hip-hinging: Protect your spine and knees by learning to bend at the hips
  • Stacksitting: Learn how to sit anywhere without slouching, pain or tension
  • Tallstanding: Stack your bones well and prevent wear and tear
  • Stretchlying: Decompress your spinal discs and nerves while you sleep
  • Glidewalking: Learn to walk in a controlled series of forward propulsions that spares the joints

Image Credits:
The Happy Mother, Johann Anton de Peters, Wikimedia Commons
Lumbar Region of the Human Skeleton, Wikimedia Commons
Female Back Nude, Jozsef Rippi-Ronai, public domain
Mandy at 39 weeks + 4 days, Danielle deLeon, Wikimedia Commons
Janine hip hinging, Courtesy of Janine Farzan, Chicago
Equadorian figure of a pregnant woman, Wikimedia Commons
Pregnant woman seated on bench, Peter va der Sluijs, Wikimedia Commons
Gokhale Moment, Rib Anchor, © Gokhale Method
Gluteus Medius, Creative Commons
Model Maria Pesotskaya resting on her side, Anna Kosali, Wikimedia Commons
Pregnant Woman Facing Right, public domain