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"8 Steps to a Pain-Free Back" - A Book Review

Esther Gokhale is an acupuncturist and yoga instructor who studied biochemistry at Harvard and Princeton Universities, and also learned acupuncture at the San Francisco School of Oriental Medicine. She grew up in India, and during her youth she helped her mother, who was a nurse, treat abandoned babies that were waiting to be adopted. Gokhale published "8 Steps to a Pain-Free Back in 2008, as a way to put into book form the postural teachings that she has been using with clients for many years, many of whom work in Silicon Valley. We have had a copy of this book sitting in our office bookshelf for many years, but only recently did I decide to read it cover to cover. This book will change the way you think about and approach how you sit, stand, walk, and even lie in bed.

The beginning part of the book lays the foundation for the lessons that come later. There is a great description of how a healthy spinal column should look. The vertebrae should be "stacked" upon one another with a minimal curvature, rather than the S-shape we have come to accept. In fact, there is an illustration that contrasts a spinal column as detailed from a 1911 anatomy book with a spine taken from a book published in 1990. The difference is striking; the more recent illustration has a much more elaborate curve than the illustration from the early 20th century. In a healthy spine, the pelvis should be anteverted (tilted slightly forward) in order to maintain the proper wedge shape of the disc between L5 and S1. As Gokhale says, "The ideal shape of the spine is a gentle, elongated curve, not an exaggerated "S" curve. Pronounced curvature should only occur at L5-S1 at the base of the spine." Exaggerated spinal curvature can distort and compress vertebral discs, which may lead to numbness, pain, and injury. One interesting element that I had not considered was how cultural norms affect the construct of what is considered good posture. This can be understood by looking at pictures in the book showing models and advertisements, clothing, shoes, and even how modern furniture is designed. You can see the difference when you look at images from indigenous cultures or even pictures of Americans from the late 19th or early 20th century. A great number of these photos show far better posture than many of us currently display.

The first of the author's lessons details what is called stretchsitting. During this lesson, we learn the proper way to sit, how to lengthen your spine (which eases compression of the vertebral discs), and how to perform shoulder rolls in order to remedy hunching. This involves shrugging your shoulders and then rolling them comfortably backward and forward. As Gokhale describes, "Shoulder rolls influence the architecture of the area just beneath the pectoral muscles. This area, called the brachial plexus, is a major thoroughfare for nerves and blood vessels supplying the arms. Hunching the shoulders compromises the architecture of this area, affecting blood supply to and from the arms, and nerve functions in the arms." If you suffer from strange arm pain or frequently have cold hands, this can remedy the problem. The good news is that practicing stretchsitting, as with the other lessons in the book, requires little more than a folded towel and chair.

Another important lesson covered in this book is stacksitting. Once again, we learn about the significance of pelvic positioning, and why it is critical to tilt the pelvis slightly forward. People that slouch have a tendency to tuck the pelvis, and as a result, the surrounding structures become accustomed to this. As Gokhale says, "The muscles and ligaments in the groin area as well as the hamstring muscles, tend to be short and tight, while the muscles in the buttocks tend to be weak and underdeveloped." The author details the differences in the shape of the low back, from swayed (a lordotic curve in which the low back muscles are tight), to rounded (a kyphotic curve that causes the discs to bulge), and finally a straight (ideal) shape where the muscles are relaxed and the discs are decompressed. Stacksitting involves some of the same concepts that were discussed in stretchsitting, and requires a folded towel (to help antevert the pelvis), sitting back deeply in a chair, and working to sit tall so that the vertebrae stack on top of one another to alleviate disc compression. Gokhale shows how to take stock of your posture in the mirror before performing the lesson (with reference pictures to guide you), and also how to assess the spinal groove in your lower back. At the end of the lesson, she describes how you can gauge improvement and what you can do if you feel pain or soreness in the lower back while you perform the exercises.

Tallstanding is one more lesson that I found valuable. Standing in an anatomically correct and comfortable position involves not just the alignment of your spine and pelvis, but also the positioning of your knees and feet. People who are uncomfortable standing for reasonable lengths of time often have problems with their knees and feet as well as their lower back. When standing, the knees should remain soft rather than locked; this prevents wear and tear on the knee, hip, ankle, and foot joints. Gokhale also talks about restoring the natural "kidney bean" shape to the foot. Fallen foot arches result from weak tibialis anterior muscles (the muscles on the front of the shin), as well as muscles of the foot. There is a great section in this chapter about foot anatomy, and if you look at the bones of the foot you can see that most of the weight when we stand is designed to be born by the heel bone. The heel is the largest bone of the foot, and the bones toward the front of the foot are smaller and more delicate. The highlights of tallstanding involve shifting most of your weight onto your heels, keeping your knees soft (not locked, and not bent), maintaining an anteverted pelvis, and allowing your vertebrae to stack on top of one another. The use of a mirror in this particular lesson is very helpful.

I like the fact that each one of these lessons builds upon what is learned in the previous lesson. Gokhale says that if extreme pain or discomfort is experienced, then certain lessons can be skipped for the time being until the subject becomes a bit stronger or the pain subsides. Also encouraging is that the author makes repeated reference to the importance of neutral head position. As most of you know, this is something that is emphasized during Total Results workouts, and is absolutely critical for the safety of the neck structures. If there is a point of contention I have, it is with many of the exercises detailed in the appendix section of the book. Several of the exercises involve unilateral movement which unevenly load the pelvis and spine; these I would avoid. Some of these exercises might provide minimal benefit to a person that is extremely deconditioned, but they are neither desirable nor necessary if you strength train regularly.

The lessons and strategies discussed in "8 Steps to a Pain-Free Back" are a useful adjunct to regular Total Results workouts, especially if you suffer from regular or even intermittent lower back pain. Just the extra awareness gained in terms of how you stand, sit, lie, and walk is worthwhile. I recommend this book to all Total Results clients and anyone else that wants to attain or maintain healthy posture.

Posted July 22, 2021 by Matthew Romans