Lost Posture: Why Some Indigenous Cultures May Not Have Back Pain
Editor's note, June 10: We have added an acknowledgement of several sources that Esther Gokhale used while developing her theories on back pain. These include physiotherapy methods, such as the Alexander Technique and the Feldenkrais Method, and the work of anthropologist Noelle Perez-Christiaens.
Back pain is a tricky beast. Most Americans will at some point have a problem with their backs. And for an unlucky third, treatments won't work, and the problem will become chronic.
Many ancient statues, such as this one from Greece, display a J-shaped spine. The statue's back is nearly flat until the bottom, where it curves so the buttocks are behind the spine.
Believe it or not, there are a few cultures in the world where back pain hardly exists. One indigenous tribe in central India reported essentially none. And the discs in their backs showed little signs of degeneration as people aged.
An acupuncturist in Palo Alto, Calif., thinks she has figured out why. She has traveled around the world studying cultures with low rates of back pain — how they stand, sit and walk. Now she's sharing their secrets with back pain sufferers across the U.S.
About two decades ago, Esther Gokhale started to struggle with her own back after she had her first child. "I had excruciating pain. I couldn't sleep at night," she says. "I was walking around the block every two hours. I was just crippled."
Gokhale had a herniated disc. Eventually she had surgery to fix it. But a year later, it happened again. "They wanted to do another back surgery. You don't want to make a habit out of back surgery," she says.
This time around, Gokhale wanted to find a permanent fix for her back. And she wasn't convinced Western medicine could do that. So Gokhale started to think outside the box. She had an idea: "Go to populations where they don't have these huge problems and see what they're doing."
[Added June 10] So Gokhale studied findings from anthropologists, such as Noelle Perez-Christiaens, who analyzed postures of indigenous populations. And she studied physiotherapy methods, such as the Alexander Technique and the Feldenkrais Method.
And the original post continues ...
Then over the next decade, Gokhale went to cultures around the world that live far away from modern life. She went to the mountains in Ecuador, tiny fishing towns in Portugal and remote villages of West Africa.
"I went to villages where every kid under age 4 was crying because they were frightened to see somebody with white skin — they'd never seen a white person before," she says.
Gokhale took photos and videos of people who walked with water buckets on their heads, collected firewood or sat on the ground weaving, for hours.
"I have a picture in my book of these two women who spend seven to nine hours everyday, bent over, gathering water chestnuts," Gokhale says. "They're quite old. But the truth is they don't have a back pain."
She tried to figure out what all these different people had in common. The first thing that popped out was the shape of their spines. "They have this regal posture, and it's very compelling."
And it's quite different than American spines.
If you look at an American's spine from the side, or profile, it's shaped like the letter S. It curves at the top and then back again at the bottom.
But Gokhale didn't see those two big curves in people who don't have back pain. "That S shape is actually not natural," she says. "It's a J-shaped spine that you want."
In fact, if you look at drawings from Leonardo da Vinci — or a Gray's Anatomy book from 1901 — the spine isn't shaped like a sharp, curvy S. It's much flatter, all the way down the back. Then at the bottom, it curves to stick the buttocks out. So the spine looks more like the letter J.
"The J-shaped spine is what you see in Greek statues. It's what you see in young children. It's good design," Gokhale says.
So Gokhale worked to get her spine into the J shape. And gradually her back pain went away.
Healthy spines in the Western world: The J-shaped spine is often seen in photographs from the late 19th and early 20th centuries.
Then Gokhale realized she could help others. She developed a set of exercises, wrote a book and set up a studio in downtown Palo Alto.
Now her list of clients is impressive. She's helped YouTube CEO Susan Wojcicki and Matt Drudge of the Drudge Report. She has given classes at Google, Facebook and companies across the country. In Silicon Valley, she's known as the "posture guru."
Each year, doctors in the Bay Area refer hundreds of patients to Gokhale. One of them is Dr. Neeta Jain, an internist at the Palo Alto Medical Foundation. She puts Gokhale's method in the same category as Pilates and yoga for back pain. And it doesn't bother her that the method hasn't been tested in a clinical trial.
"If people are finding things that are helpful, and it's not causing any harm, then why do we have to wait for a trial?" Jain asked.
But there's still a big question looming here: Is Gokhale right? Have people in Western cultures somehow forgotten the right way to stand?
Scientists don't know yet, says Dr. Praveen Mummaneni, a neurosurgeon at the University of California, San Francisco's Spine Center. Nobody has done a study on traditional cultures to see why some have lower rates of back pain, he says. Nobody has even documented the shape of their spines.
"I'd like to go and take X-rays of indigenous populations and compare it to people in the Western world," Mummaneni says. "I think that would be helpful."
But there's a whole bunch of reasons why Americans' postures — and the shape of their spines — may be different than those of indigenous populations, he says. For starters, Americans tend to be much heavier.
"If you have a lot of fat built up in the belly, that could pull your weight forward," Mummaneni says. "That could curve the spine. And people who are thinner probably have less curvature" — and thus a spine shaped more like J than than an S.
Americans are also much less active than people in traditional cultures, Mummaneni says. "I think the sedentary lifestyle promotes a lack of muscle tone and a lack of postural stability because the muscles get weak."
Everyone knows that weak abdominal muscles can cause back pain. In fact, Mummaneni says, stronger muscles might be the secret to Gokhale's success.
In other words, it's not that the J-shaped spine is the ideal one — or the healthiest. It's what goes into making the J-shaped spine that matters: "You have to use muscle strength to get your spine to look like a J shape," he says.
So Gokhale has somehow figured out a way to teach people to build up their core muscles without them even knowing it. "Yes, I think that's correct," Mummaneni says. "You're not going to be able to go from the S- to the J-shaped spine without having good core muscle strength. And I think that's key here."
So indigenous people around the world don't have a magic bullet for stopping back pain. They've just got beefy abdominal muscles, and their lifestyle helps to keep them that way, even as they age.
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Transcript
ARI SHAPIRO, HOST:
Today in Your Health - back pain. Most Americans have a problem with it at some point. For a third of people in this country, treatments won't work. The problem becomes chronic. There are a few places on Earth where back pain hardly exists. These tend to be cultures that are far removed from modern life. One woman at the epicenter of modern life in Palo Alto, Calif., thinks she has figured out why these traditional societies have such healthy backs. NPR's Michaeleen Doucleff reports.
MICHAELEEN DOUCLEFF, BYLINE: After she had her first baby, Esther Gokhale couldn't even bend down to pick up her child.
ESTHER GOKHALE: I had excruciating pain. I could not sleep at night. I was walking around the block every two hours. And I was just crippled.
DOUCLEFF: Gokhale had a herniated disc. Eventually she had surgery to fix it. But a year later, it happened again.
GOKHALE: And they wanted to do another surgery. And, you know, you don't want to make a habit out of back surgery.
DOUCLEFF: Gokhale is a smart woman. She has a degree in biochemistry from Harvard, and she's a licensed acupuncturist. This time around, she wanted to think outside the box, and here's what she came up with.
GOKHALE: Go to populations where they don't have these huge problems and see what they're doing.
DOUCLEFF: Gokhale went online and searched through medical studies, and she found something intriguing - several studies of traditional populations reporting very low rates of back pain. We're talking about people who live far away from modern life. Now, most of us would've stopped there - at doing research on the web - but not Gokhale. She went to the mountains in Ecuador, to tiny fishing towns in Portugal and to the remote deserts of West Africa.
GOKHALE: Like, I went to villages where every kid under 4 was, you know, like, crying, frightened to see someone with white skin. They'd never seen a white person before.
DOUCLEFF: Gokhale took photos of people who walked with water buckets on their heads, collected firewood or sat on the ground weaving for hours.
GOKHALE: I have a picture in my book of these two women who spend seven to nine hours every day, bent over, gathering water chestnuts. And they're not spring chickens; they're quite old. But the truth is that they don't have back problems.
DOUCLEFF: She tried to figure out what all these different people had in common, and the first thing that popped out was the shape of their spines.
GOKHALE: They have this regal posture, and it's a very compelling.
DOUCLEFF: And quite different than American spines. Here's an experiment. Take a friend and have them stand up and turn to their left so you're looking at them in profile. If they have what we think of as good posture, then their spine is shaped like an S. It curves at the top and then back again at the bottom. This is what's drawn in medical books. But Gokhale didn't see those two big curves in people who don't have back pain.
GOKHALE: That S-shaped spine is actually not natural. It's a J-shaped spine that you want.
DOUCLEFF: In fact, if you look at drawings from da Vinci - or a "Gray's Anatomy" book from 1901 - the spine isn't shaped like a curvy S. It's much flatter almost all the way down the back. And then at the bottom, it curves to stick the butt out, so it looks more like a J. It seemed to her that this J shape was key to a pain-free back, so she developed a set of exercises to get her spine into the J shape. And gradually, her back pain went away. Then Gokhale realized she could help others. She wrote a book, set up a studio in downtown Palo Alto.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED WOMAN: And so without further ado, welcome Esther from all of us here in Silicon Valley.
(APPLAUSE)
DOUCLEFF: The day I caught up with her, she was giving a workshop at one of the biggest law firms in the world - Jones Day in Palo Alto. About 50 workers dressed in khakis and pencil skirts came to learn how they could sit at their computers for hours without hurting their backs. Gokhale brings a volunteer to the front to demonstrate the most common problem - the way we hold our shoulders.
(SOUNDBITE OF ARCHIVED RECORDING)
GOKHALE: Now, if we look at you from the front view, we can see that the portion of her hand that faces forward is mostly her knuckles and not so much the thumb.
DOUCLEFF: Americans tend to scrunch their shoulders forward so our arms are turned in. That's not how people in indigenous cultures carry their arms.
(SOUNDBITE OF ARCHIVED RECORDING)
GOKHALE: And we're going to show you a very simple way of addressing this.
DOUCLEFF: Gokhale gently takes the woman's shoulders, pulls them up, pushes them back and lets them drop, like a shoulder roll. And then the woman's arms dangle by her side.
(SOUNDBITE OF ARCHIVED RECORDING)
GOKHALE: This is the way all your ancestors parked their shoulders. This is a natural architecture for our species. So it behooves us all to explore this.
DOUCLEFF: Her list of clients is impressive. She's helped YouTube CEO Susan Wojcicki, Matt Drudge of the Drudge Report, and she's given classes at Google, Facebook. In Silicon Valley, she's known as the posture guru. Doctors in the Valley refer hundreds of patients to her, and they put her method in the same category as Pilates and yoga for back pain. But there's still a big question - is she right? Have people in Western society somehow forgotten the right way to stand? Praveen Mummaneni knows spines intimately. He operates on them three times a week and co-directs the Spine Center at the University of California in San Francisco. Mummaneni says scientists don't know yet why some traditional cultures have fewer problems with back pain. Nobody's done a systematic study or even documented the shape of their spines.
PRAVEEN MUMMANENI: I'd like to go and take X-rays of indigenous populations and compare it to the Western world. I think that would be very helpful.
DOUCLEFF: But Mummaneni says there's a whole bunch of reasons why postures of Americans and the shape of their spines may be different than indigenous populations. For starters, Americans tend to be much heavier.
MUMMANENI: If you have a lot of fat built up in your belly, it can tend to pull your low back forward.
DOUCLEFF: And that would curve the spine?
MUMMANENI: That could curve the spine. And people who are fairly thin probably have less curvature.
DOUCLEFF: And, thus, a spine shaped more like a J than an S. Mummaneni also points out that Americans are much less active than people in traditional cultures.
Do you think that that sedentary lifestyle could have an effect on the spine shape?
MUMMANENI: I think the sedentary lifestyle promotes a lack of muscle tone and a lack of postural stability because the muscles get weak.
DOUCLEFF: Everyone knows that weak abdominal muscles can cause back pain. And, in fact, Mummaneni says that might be the secret to Gokhale's success. It's not that the J shape is the ideal one or the healthiest. It's what goes into making the J shape that matters.
MUMMANENI: And you have to use muscle strength to get it to look like the J-shaped spine.
DOUCLEFF: So Gokhale has somehow figured out a way to teach people to build up their core muscles without them even knowing it.
MUMMANENI: Yes, I think that's correct. You're not going to be able to go from the S to the J without having good core muscle strength, and I think that's a key here.
DOUCLEFF: In other words, indigenous people around the world don't have a magic bullet for stopping back pain. They've just got beefy abdominal muscles, and their lifestyle helps to keep them that way even as they age. Michaeleen Doucleff, NPR News.
SHAPIRO: At NPR's "Goats and Soda" blog, you can find Esther Gokhale's five tips for better posture and less back pain. Transcript provided by NPR, Copyright NPR.
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