Pain

“Knee bone con-nect-ed to the…”?

Can you sing “Dem Dry Bones“? If you don’t know the spiritual by name, I bet you can intone at least some of the lyrics:

…the foot bone’s connected to the leg bone, the leg bone’s connected to the knee bone, the knee bone’s connected to the thigh bone…

Josephine Baker dances the Charleston

Josephine Baker dances the Charleston

Beyond the direct structural connection between the “knee bone,” or patella, and the “thigh bone,” or femur, is another connection that will be of particular interest to athletes and other individuals afflicted with or susceptible to patellar femoral pain syndrome (PFPS), a disorder often referred to as “runner’s knee.” And this is the connection between the knee and the gluteus medius, the muscles situated above and toward the outer sides of the much larger gluteus maximus muscles.

The knee bone is 'connected' to the gluteus medius

The knee bone is ‘connected’ to the gluteus medius

If you read my Samba Your Way to Beautiful Glutes post or joined my Samba webinar in October, you’ll know how to locate these paired muscles, and you’ll appreciate at least some of what they do.

How to locate the gluteus medius

How to locate the gluteus medius

Gluteus medius muscles, pelvic anteversion, and knee health

According to modern conventional wisdom, it’s considered normal for young children to have inward-turning knees, which are expected to straighten out by about age 7. What I’ve observed in village Africa and other nonindustrial cultures is that because children are carried on their caregivers’ hips and backs, children’s legs are externally rotated from the very youngest ages.

This Burkina baby was patterned to externally rotate his legs as he was carried on his mother's back

This Burkina baby was patterned to externally rotate his legs as he was carried on his mother’s back

In contrast, in the US and other modern industrial cultures, the  internal rotation of the legs is often maintained into adulthood.

Internally rotated legs are common in modern industrial cultures, even in adulthood

Internally rotated legs are common in modern industrial cultures, even in adulthood

Because the gluteus medius muscles are external leg rotators, strengthening these muscles can counter internal leg rotation, helping  the kneecaps to align and track better. (To check the tracking of your patella, sit down, place your palm over one of your knees, and then flex your leg to feel and follow the triangular kneecap glide up and down along the end of your femur.)

Strong gluteus medius muscles are important because people whose “glute mēds” are underdeveloped are at increased risk of knee and other lower-limb injuries, including patellafemoral pain syndrome. Preventing PFPS, or managing its painful symptoms if the problem has already occurred, are just a couple of reasons why–when you stand, walk, and run–you want to use your glute meds and externally rotate your legs. 

In addition to promoting knee health, external leg rotation facilitates an anteverted pelvic position and a well-stacked spine

In addition to promoting knee health, external leg rotation facilitates an anteverted pelvic position and a well-stacked spine

Gluteal muscle activity and patellofemoral pain syndrome (PFPS)

If you’ve ever felt a dull, aching pain under or around your kneecap where it connects with the lower end of your femur, you may have experienced patellar femoral pain, especially if the pain occurred when you were sitting for a long stretch of time with your knees bent, or you were kneeling, squatting, or walking up or down stairs.

Votive_relief_Asklepios

Knee pain is nothing new; this Greek votive relief for the cure of an injured knee dates back to 100-200 AD

And, if you have been diagnosed with PFPS, you’re not alone. Gluteal Muscle Activity and Patellofemoral Pain Syndrome–A Systematic Review, which was published earlier this year in the British Journal of Sports Medicine, confirms the connection between the knee and the gluteus medius. By synthesizing electromyography (EMG) measurements of the gluteus medius muscles during a range of functional tasks as reported in 10 case-controlled studies, all of which evaluated EMG activity of the gluteus medius, the authors strove to elucidate the relationship between gluteal muscle activity and PFPS. Among their observations and conclusions:

  • Patellofemoral pain syndrome is one of the most common presentations to sports medicine practitioners; of 2500 presentations to sports medicine clinics 25% of all injuries were PFPS
  • Individuals with PFPS exhibit reduced gluteus medius and gluteus maximus muscle strength
  • Growing evidence supports the efficacy of gluteal muscle strengthening for PFPS and gluteal-muscle strengthening programs have been associated with positive clinical outcomes
In a nutshell, if you have good strength in your gluteus medius muscles, your knees will be in better shape.

In a nutshell, if you have good strength in your gluteus medius muscles, your knees will be in better shape.

Walking is connected to healthy knees

Think about it: Walking is something most of us do a lot, although according to the 2010 study Pedometer-Measured Physical Activity and Health Behaviors in US Adultsthe 5,117 steps Americans typically take each day are not enough–and in fact represent thousands fewer steps than those taken by our counterparts in Australia (9,695 steps), Switzerland (9,650 steps), and Japan (7,168 steps). But even if  we step just 5,000 times a day, if we engage our gluteus medius muscles with each step, that’s still a lot of repetitions to help “re-architecture” our legs and minimize the risk of PFPS. 

The pelvis serves as our postural foundation, and one of the keystones for healthy postures is to allow the pelvis to be anteverted. When your pelvis is anteverted and your “behind is out behind you,” then the whole pack of muscles that includes the hamstrings, the gluteus maximus, and the gluteus medias can work to advantage, strengthening themselves, inducing circulation in the appropriate places, and bearing stress.

Ancient coin features Apollo (with anteverted pelvis!)

Ancient coin from Caulonia features Apollo with anteverted (ie, tipped forward) pelvis

Beyond this, the relationship between external leg rotation, pelvic anteversion, and the action of the gluteus medius is cyclic. In order for the gluteus medius to be in a position of mechanical advantage, some degree of pelvic anteversion is required. And, if we are to believe the observations summarized in the British Journal of Sports Medicine review, strong gluteus medius action relates to a diminished risk of PFPS.

Eadweard Muybridge's 'human male walking' demonstrates strong gluteal action in the rear leg

Eadweard Muybridge’s ‘human male walking’ demonstrates strong gluteal action in the rear leg

 

Muybridge_Strong_Gluteus_Medius_Action

The interconnectedness between external leg rotation, pelvic anteversion, and strong gluteus medius action is beautifully illustrated in the detail of Muybridge’s “animal locomotion” photo and “film” above.

“Dem Dry Bones”

Bottom line, the knee bone is connected to the thigh bone, but it’s also connected to the gluteus medius, and this is a fairly direct connection because these paired muscles externally rotate the legs.

Finally–not just because the lyrics are right on point with this lesson, but because he plays and sings so artfully and with such a great sense of fun–I hope you’ll listen to Fats Waller’s wonderful take on “Dem Dry Bones.”

 

Image Credits:
Josephine Baker Dances the Charleston, Wikimedia Commons
The Bath, Charles Degas, Wikimedia Commons, Public Domain
How to Locate the Gluteus Medius, Esther Gokhale
Burkina Baby, Esther Gokhale
X-ray of “Knock Knee,” Biomed Central, Wikipedia
The Spinal Cord, Bruce Blaus, Wikimedia Commons
Greek Votive Relief Knee Injury, Marie-Lan Nguyen, Blacas Collection, Wikimedia Commons
Female Jogger, Mike Baird, Creative Commons
Human Male Walking (animation), Eadweard Muybridge, Wikimedia Commons
Animal Locomotion, Eadward Muybridge, Wikimedia Commons
Ancient Coin from Caulonia: Classical Numismatic Group, Inc, Wikimedia Commons

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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

 

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

My quest for a “just right” chair

Thoreau had three chairs

Thoreau had three chairs

American philosopher-poet Henry David Thoreau wrote in the “Visitors” chapter of Walden, his 1854 account of his life in a cabin he built on the edge of Walden Pond, near Concord Massachusetts:

“I had three chairs in my house; one for solitude, two for friendship, three for society.”

I’m a fan of Thoreau, and I favor simplicity. And although I have more than three chairs in my house, I have just one type of chair that has become “go-to seating” for most solitary and social activities–not just for me, but for family members, friends, and co-workers. The chair is the Gokhale Pain-Free™ Chair, and I designed it myself.

Pain-free sitting, at home and at work

If you were to stop by my house today you would find five Pain-Free™ Chairs arranged around our dining room table–a table that has served my family well, not just at mealtimes, but throughout days and nights as a communal work station/library/coffee shop. To some extent I credit this comfortable arrangement for regularly enticing my two daughters home from nearby college and grad school; they continue to be drawn to this familiar setting, in part because it’s such a comfortable place to sit.

And if you were to pop into our nearby Gokhale Method Institute office you would see that every member of my staff sits in this very same type of chair, not because it’s required or because they feel obliged, but because this is their preference. Before the Gokhale Pain-Free™ Chair came to market, our office was furnished with relatively high-end task chairs (Herman Miller and Soma Ergonomics, among others). But when given the option to stay with the chair they had or to switch, everyone opted for the Pain-Free™ Chair.

Keeping it simple

“Simplicity is the law of nature for men as well as for flowers” is something else Thoreau wrote, and I subscribe to this philosophy. Tipping my hat to Thoreau, I would add that simplicity is also the law for chairs–or at least one of the laws. Too many chairs feature gratuitous, even counter-productive, features. It’s not so much that–as Goldilocks observed–the chairs are “too hard” or “too soft,” it’s that many oblige sitters to tuck the pelvis into a retroverted position, a position that leads to tense low-back muscles, slumping, and–over time–problems with spinal discs, hamstrings, and even the pelvic organs. Such repercussions can of course cause discomfort or pain.

Like Goldilocks, I sought a chair that was "just right."

Like Goldilocks, I sought a chair that was “just right.”

Simplicity was also a guiding principle when I set out to design my chair, in part because when the Pain-Free™ Chair was just a gleam in my eye I interviewed a chair repairman who came to our office to repair the same chair twice; it was one of the relatively high-end task chairs with perhaps one too many features.

Steering clear of bells and whistles

In search of a "just right" chair

In search of a “just right” chair

One valuable insight shared by the repairman was that he saw a direct link between chairs with a lot of features and chairs with a lot of dysfunction. This was especially true of chairs that recline via levers and were owned and operated by men. Men like to recline more than women, he observed, and while men apparently like to employ all available bells and whistles, they don’t necessarily read operational instructions first!

Reclining is of course a legitimate position (and in fact I’m beginning to think about designing a high-backed chair with headrest that reclines), but the desire to lean back becomes more urgent when a person is uncomfortable. If a task chair is designed to enable upright sitting and really support a person, then there’s no need to recline.

The rationale for my chair

Even among high-priced chairs design flaws are common. The challenge, as I saw it, was to design a simple chair that transforms sitting into a healthful activity that actually feels good.

Gokhale Pain-Free Chair

Gokhale Pain-Free Chair

Above all, I wanted to create a chair that promotes the natural stacking of the vertebrae without muscle strain, a chair that would enable two healthy ways of sitting–stretchsitting and stacksitting, techniques demonstrated in the video, below, and more thoroughly explored in the Gokhale Method Foundations course, my book 8 Steps to a Pain-Free Back, and the DVD Back Pain: The Primal Posture Solution. 

Again, the goal was to keep it simple and incorporate only those elements that absolutely matter:

  • Traction on the seatback
  • Seatpan with a downward slope
  • Adjustable seat height
  • Elimination of armrests
  • Highest quality materials

The Gokhale Pain-Free™ Chair

My chair, with its respectful-of-the-human-skeleton design, offers a healthful–even therapeutic–alternative for people committed to good posture who want to simply sit without pain. And these are the features that make a difference:

Traction on the seatback

Stretchsit nubs

Stretchsit nubs

Whether people have an upright and tense “S” spine (swayed), a relaxed and slumped “C” spine (rounded), or a compressed “I” spine (collapsed), stretchsitting is an easy way to regain some natural length. For this technique to work, people need a “grippy” support to meet the midback. Located higher than a lumbar support, but lower than the shoulder blades, soft Stretchsit® nubs built into the backrest of the Pain-Free™ Chair enables sitters to “hitch up” the spine and gently stretch the back. This, in turn, decompresses spinal nerves and discs, which not only feels good, but allows stressed-out discs to rehydrate and absorb nutrients from surrounding tissues and renew the process of self-repair.

Also, because the seatback stops short of the shoulder blades, it’s easy to roll open the shoulders for a relaxed position that promotes healthy circulation in the arms and better breathing.

Seatpan with a downward slope

It’s not good to sit the same way all day. Whereas stretchsitting allows for a sustained stretch and is well-suited to relatively passive tasks, stacksitting is generally more versatile because it enables us to reach for what we need and move around. Because we derive different benefits from stretchsitting and stacksitting, and because each lends itself to different tasks, I designed the seatpan of the Pain-Free™ Chair to enable both types of  sitting and make it easy for people to move back and forth.

The seatpan promotes healthy stacking

The seatpan promotes healthy stacking

While the back of the seatpan is flat, the front half, which features “grippy” rubberized patches, slopes downward. This design anteverts the pelvis, tipping it slightly forward to allow the vertebrae to stack easily and naturally and enable the back muscles to completely relax. Again, healthy stacking promotes healthy breathing, which in turn provides a gentle and revitalizing spinal massage.

The flat half of the seatpan, which allows for sitting back in the chair and stretchsitting, prevents the combination of anteversion and stretchsitting, which together would introduce sway in the lower back.

The seat cushion made of top-quality memory foam is really comfy. I designed this so that when people with underdeveloped glutes (something quite common in our culture) take a seat, they will not be the least bit aware of the hard board beneath the cushion–even if they stay seated all day.

Adjustable seat height

In Thoreau’s time people had sufficiently flexible hamstrings to sit comfortably and with naturally stacked spine on chairs of any height. Because people today tend to have less flexible hamstrings, a hydraulic lift helps. My own preferences is to raise the seat a little higher when I’m stacksitting, because this facilitates the downward sloping of my thighs and healthy anteversion of my pelvis. I lower the height of the seat when I stretchsit.

Take a look.

Elimination of armrests

Why did I opt not to include armrests when I designed the Pain-Free™ Chair? Too often, armrests prevent people from moving in close to their work surface. When we sit upright and relaxed with our shoulders rolled back and well hung, we can move our arms freely, without straining.

Highest quality materials

Thoreau's cabin

Thoreau’s cabin

It’s no exaggeration to say that chair is as well constructed as it is designed. I chose each part–steel, wheels, hydraulic lift, memory foam, and GREENGUARD-certified fabric–for its top-notch quality and durability…which brings me back to the spirit of Walden and the philosophy of Thoreau:

“There is some of the same fitness in a man’s building his own house that there is in a bird’s building its own nest.”

When I sit in the chair I’m proud to have designed and now share with others, I think I know what Thoreau meant.

Photo Credits:
Henry David Thoreau, 1861, Wikimedia Commons
The Three Bears, Arthur Rackham, Wikimedia Commons
Goldilocks, Swift’s Premium Soap Products, 1916, public domain Gokhale Pain-Free™ Chair (and details of the chair), © Gokhale Method Pain-Free™ Chair Tutorial, © Gokhale Method
Thoreau’s cabin from the title page of the first edition of
Walden, Sophia Thoreau, public domain, Wikimedia Commons