What if back-pain relief was just a few steps away? Esther Gokhale’s work with posture and movement finds that just changing the way you sit, stand, lie down, and walk can eliminate your back pain. 

Esther grew up in India helping her mom treat orphaned babies and she studied biochemistry at college. Later, she became a licensed acupuncturist. So when her own pain and herniated disc issues emerged, it motivated Esther to study how people move. 

“There were some seeds already sown in my brain that ‘there's something going on with people who live close to the ground that makes sense and that works.’ And so when this horrible thing happened to me, it resonated for me to study techniques that changed the way you use your body,” Esther says.

Esther developed and trademarked the Gokhale Method, an eight-step plan to adjust your back’s curvature and movement from an S or C-shaped curve to a J-shaped curve. Esther found this technique by studying the common thread between ancient cultures and today’s primal cultures:

“If you go to your museums and you look at the Greek statues, they're doing exactly what these Ubong guys are doing, they look the same. And so why would that be? Well, the simplest explanation is that it is natural. That's why they converge on the same form. And we in modern times have just lost our way.”

In this episode, Dr. Lakhia and Esther talk through modern and ancestral movements, and what you can do right now to start moving more primally and, ultimately, relieve your back pain.

Read the Full Show Notes on our website BackTalkDoc.com. 

💡 Featured Expert 💡

Name: Esther Gokhale

What she does: Esther used her crippling back pain during her first pregnancy to propel her interest in vanquishing back pain for all. Her Gokhale Method focuses on using posture and movement to bring the body back to a state of pain-free living. 

Company: Gokhale Method Institute, Inc.

Words of wisdom: “You often develop your passions in response to some humongous challenge that you're faced with. And if you manage to be successful in getting past that, you have acquired a lot of knowledge, skill, and insights.”

Connect: LinkedIn | Book 

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Welcome, you're listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health. Brought to you by Carolina Neurosurgery & Spine Associates, where providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.

Welcome to another episode of Back Talk Doc. Again, I am Sanjiv Lakhia and I'm a board certified physical medicine and rehabilitation specialist, otherwise known as a physiatrist. I am a DO by training. And for those of you listening for the first time, welcome to the show. It is my passion to bring to you all things related to spine care and help you make an informed decision about the health of your back. And as many of us who get into this field, in addition to being on the clinical side, I've had my own personal challenges with my back. And about two years ago, when I was maybe laying on the ground wondering what's going wrong, I came across a blog online that mentioned several great books that could be helpful. And one of them was titled 8 Steps to a Pain-Free Back, by Esther Gokhale. And I found it to be fascinating. And Esther has graciously agreed to come on this show today and talk to us about her method and share her knowledge with you. So Esther, welcome to the show.

Such a pleasure to be connected in this way.

Absolutely. Again, thank you for taking the time. I want to introduce you to the listeners with your bio here. Again, her name is pronounced Gokhale. And you were involved in integrative therapies all of your life. She grew up in India, helped her mom, a nurse, treat abandoned babies waiting to be adopted. This early interest in healing led her to study biochemistry at Harvard and Princeton, and later acupuncture at the San Francisco School of Oriental Medicine.

After experiencing crippling back pain during her first pregnancy and unsuccessful back surgery, Esther began her lifelong crusade to vanquished back pain. And she studied at the Aplomb Institute in Paris and years of research in Brazil, India, Portugal, and elsewhere, led her to develop the Gokhale Method, which is a unique systematic approach to help people find their bodies way back to pain-free living. And her book, 8 Steps to a Pain-Free Back, has sold over 300,000 copies and been translated into 10 languages. She's put together DVD programs, products, just has an entire enterprise around her passion to help you feel better. She's taught at corporations like Google, Facebook, presented at TEDx in Stanford, and also has helped trainers of the San Francisco 49ers, other Stanford sports teams. And really, you have just done so much with your passion and your knowledge, and I'm super stoked to get into this topic with you today. So once again, thank you for coming on.

Such a pleasure.

All right. So I want to start out by allowing you some time and space to kind of elaborate on your story a little bit. We're definitely going to get into your eight steps that you've come up with in your protocol.

Sure.

I think your background is just fascinating and I know you're a licensed acupuncturist. But talk to the listeners about your journey and how you got to where you are today.

Well, I had severe problems with my back, and you often develop your passions in response to some humongous challenge that you're faced with. And if you manage to be successful in getting past that, then often, you have acquired a lot of knowledge and skill and insights, and that's what happened. So it started in the ninth month of pregnancy with my first child and I had a very severely herniated, L5/S1 disc. And I couldn't carry a cooking pot, let alone my baby. And I also couldn't sleep at night. I had trouble sleeping more than two hours at a stretch. Then I would wake up and spasm and then I'd have to walk around the block to work out that spasm, and then that would start the cycle over again. So it was not really livable and I'd already tried every conventional as well as alternative technique that I knew of.

You name it, I tried it. Physical therapy, chiropractic, acupuncture, massage, me checking my head, stretching, strengthening, yoga. So it was a lot and nothing was really giving me a result. And I didn't want to use meds because I was nursing my baby. And so I just suffered and kept casting my net wider and wider and eventually decided to have a laminectomy discectomy. That seemed to be logical. And it did help. But then a year later I reherniated that same disc and they wanted to do another surgery on me. And I'm still in my mid 20s at this point and things are looking bleak. I had already been recommended not to have anymore children because I had various bulging discs and a problematic back. And they didn't have to tell me that because I just had been through hell. It was like putting an ice pick in my back with pain, going down to my toes. And I didn't want to repeat of that.

So anyway, here I was, and then I was being recommended a second surgery. And long story short, by casting my net wider and wider and finding things that made sense in terms of changing the way you live in your body, the way you use your body, so there are several techniques like that, including Alexander Technique and Feldenkrais to some extent, and especially a plank. And so this resonated with me and my background because my Dutch mother made a habit of observing the locals in how they eat, in how live in. She admired poor village people, how beautiful their teeth were, how well they could manage their bodies and squat for hours. Our sweeper could finish our whole house squatting. Then she, as a rather stiff Dutch person, had no way of doing that. And she would always point things out and told us this way and that, sent us off to yoga camps.

And so there were some seeds already sewn in my brain that there's something going on with people who live close to the ground. That makes sense and that works. And so when this horrible thing happened to me, it resonated for me to study techniques that changed the way you use your body. And anyway, by using the techniques, by doing the things that I've written about in my book, 8 Steps to a Pain-Free Back, I managed to get out of pain entirely. I did not need that second surgery. And it has stayed this way for now, 30 years. No aches, no pains, no twinges, no nothing. And I went on to have two more children, trouble free. And now, I have the incredible pleasure and privilege of passing on what I've learned to other people who are also finding themselves very empowered and able to navigate what used to seem like impossible pain and dysfunction and fear, and just a general lowering of your pilot burner in how you approach life. So it's been wonderful, miraculous really, for me and for many people now.

I can hear the passion in your voice and thank you for that story. I got to say, we're going to link to your website, a Gokhale Method, which is GokhaleMethod.com.

Yeah. People in the early stages tried to convince me to change the spelling of my last name, but I can't. You, as a fellow Indian know that, that is a common Indian name. It was Mahatma Gandhi's mentor. And you just can't mess with that, right?

That is correct. You got to step into who you are. But we're going to link to that in the show notes. And if you're listening, you have to pick up her book. I have to say your book, what strikes me about the book are the pictures. The text is great, but the pictures tell me everything. And just for me personally, when I look at the pictures and I compare it to what I look like in the mirror, there's my problem. And I really am fascinated about it.

Yeah. Well you know, you're an expert. By the way, my favorite students are the physicians. And I have many of them. Kaiser's hired me to teach entire groups of physicians, our beginning course. And I've been invited to give talks and physician retreats at Sutter Health and at Stanford and at UCSF. And this is the best because the physicians are not looking for magic bullets and ozone pills and whatever else sometimes the general public is hoping will help them. They are data driven, they are logic based. They know about evidence-based medicine. And yeah, this is unusual kind of evidence, so far, in that it's anthropological and historical and pretty logical. We don't yet have a randomized control trial, but that's about to change. But the physicians resonate with the arguments and it's compelling. And so really, those are my favorite students because then they also spread it to their patients. And that's our biggest referral sources, the physicians themselves.

Especially because most of us docs are broken in some way with our own health. So we don't practice what we preach. So we're happy to have people like you to help save us.

Also, you guys are very busy. So you don't have time to do one hour of this and one hour of that and do your little meditation and then do your exercises and have alone time and then group time. And so with posture, you change it, it takes zero time. It takes zero instruments or equipment and you're doing it all day long. So it's perfect for physicians or busy people in general. So that's another fit. And you guys have to bend over patients, especially the surgeons. They're bending for hours and hours. They get into big trouble and they retire early. And we show how to change that. Bending can be an exercise, a light exercise, instead of a pain in the butt.

Maybe we'll have you come out. We have the largest neurosurgical practice, I believe, in the country.

Really?

For sure. Yeah.

Well, try us. Try us.

Absolutely.

We're itching to do this.

It's great. And I know you're going to jump into your eight steps, but page 19 really struck me. It's a picture of, I'll say this wrong, but the Ubong tribesman.

Yeah.

It's just amazing.

I know.

In fact, before our call, I was watching your Ted talk that you did at Stanford, and I think you put this picture up in your presentation. So I really like, and I think people listening right now, I want to emphasize what she just said is that her approach is built into your day versus, and we have a wonderful physical therapy department at our group. We have multiple physical therapy locations in the greater Charlotte area, and they do a tremendous job with people. But yes, one of the pushbacks I get from patients is that, "I don't have the time to do a 30 minute core strengthening program," et cetera. And what you're talking about is reprogramming how you move your body and how you do simple things like sitting, standing, walking, and laying down. So I'm going to let you run with that. If you want to lead with that into your eight steps, please go ahead.

Yeah, yeah. There's all this opportunity. Every step you take could be a rep, a rep for the gluts, a rep for every foot muscle. And it's not that you have to do some contrived thing to make that happen. But rather, you have to learn how to walk naturally. And then you just automatically get all these benefits. And nature designed us around these actions. We are dependent on them. If you don't do them, there isn't any way a sane person can make up for the 5,000 missing reps. Who's going to go to the gym and squeeze their glutes 5,000 times, which is what you'd get if you were taking the recommended 10,000 steps every day, with good form. So you kind of have to do it right, because if you don't, then there's this huge gap that cannot be filled in a gym or with an exercise regimen.

And then you're doing some little half-ass regimen, pun intended, and you're not going to get where you could get if you were just walking right. Bending right is another rich mother load of opportunity from multiple exercises that take no time. You just have to learn to bend right. So you get a hamstring stretch, you get glute max stretch, you get rhomboid strengthening, you get erector spinae muscle strengthening just from bending right. And all of these hamstring stretches and such, they're happening throughout the day. It's peppered through your day. And that is so much more powerful than doing some little thing for or five minutes in the morning, and then just tucking your pelvis, letting your hamstrings adapt to a short resting length, never getting the full throttle stretch that they would get if you were hip hinging, as we call our bending technique that we teach everyone, that your ancestors used to do, that your counterparts in places like where the Ubong tribesmen live and in indigenous cultures.

And also young kids. That's pretty compelling right there. You have these very disparate populations, young kids, indigenous people, ancestral populations. If you go to your museums and you look at the Greek statues, they're doing exactly what these Ubong guys are doing, they look the same. And so why would that be? Well, the simplest explanation that is natural. That's why they converge on the same form. And we in modern times have just lost our way. We have diverged from these ways and we are doing random stuff and we are damaging certain parts of us, under using other parts and it's a bit of a mess. As you know, as a doctor, people show up and they have a multitude of musculoskeletal problems and then they get depressed and they get overweight because now they can't exercise because it hurts and they're injured and it's a downward spiral.

And one of the things that I pride myself in having put together is a good, efficient, effective order in how you want to make your changes. Because it's one thing to say, "Oh yeah, those Ubong guys have really juicy derrieres, like really toned glutes, let's put that in place." But if you start there, you can, again, like I said, the way to do that is to relearn walking. But if you start with that, you're in danger of overstretching your psoas muscle with every step you take, if it was a tight muscle.

So you have some prereqs to make it safe, to make it effective. You have to first learn how to elongate your spine and stabilize it and such. And then you can work on toning up your glutes. So it's nuanced. The order is important, the way you do it is important. For example, if you're walking with your feet out ahead, which is what many people are taught, then you're not going to be inviting gluteus medius into action so much. And it could be piriformis is doing a lot of the job. And now you got piriformis entrapment problems and such, and not to mention bursitises, IT band problems, just from having the whole leg oriented wrong. So what we like to do is cover all bases. But teach in a nuanced way, teach in the right order and then the results are spectacular.

Yes. And I'm just going to, Esther, for the listeners, I'm going to go through the table of contents so they get a general sense of what you're talking about in your book. Right in the beginning, you have an orientations section that talks about sequencing the lessons based upon your situation and kind of setting proper expectations. And then the lessons, the titles, are stretch sitting, stretch lying on your back, stack sitting, stretch lying on your side.

Correct.

Lesson five is using your inner corset. Lesson six talks about how to stand properly. Lesson seven is the hip hinging. Then you finish eight is glide walking and then some optional exercises. I will tell you clinically, as a spine specialist, the number one thing I see or history element that I hear is that I got a knife in my back when I bend over. So from your lens, and I know you touch on it about the hip hinging, can you elaborate on why you think that's happening and maybe talk to listeners about some simple things that they can be aware of?

So we teach hip hinging well into our beginning courses because we first want students to elongate their back and strengthen their back and then remodel their back to make it more J-shaped rather than S-shaped or C-shaped or melted into yourself, I-shaped. And once they've got that J-spine, now, and that by the way is a big part of what we teach is that we got our paradigms wrong. The S-shape, our paradigm is faulty in my view. We want to go back to this earlier older J-spine paradigm that you find in older anatomy books and is actually correct. And once you get that, then you want to take that J-spine into bending, into exercising, dancing, yoga poses, whatever you do. So already, before we bend, we have straightened out a lot of these curvy-wurvy contours throughout the spine. And then we maintain it.

And as you bend, that shape is kept. So I never like to teach people, as a first lesson, how to bend because they have to first improve their spine length, strength, and shape. And then hip hinging is extremely powerful. And when we get to that lesson, I sometimes put it this way. I say, people who bend well will almost certainly not have a back problem. And people who bend poorly will almost certainly have a back problem. So it's almost that simple. Not quite, you have to learn all these other things. But bending is where a lot of people, as you said, get a knife in their back, end up in the emergency room and there's high drama there.

And it's because most people round their backs when they bend. So when you have a rounded back, if you can visualize what's happening on the inside, it's that the vertebrae are kind of pivoted so that they are close to each other at the front edges, the anterior part of the vertebrae is approaching too closely. And that pushes the discs and their contents backwards. And backwards is the most dangerous direction because it's right behind the discs that you have the spinal nerve roots.

So whereas discs are just mechanical devices, more or less shock absorbers, once you damage them, once you get their 20 some fibrous layers of outer material damaged, and you have the inside goop, and the texture of that depends on your age. But once you have that inside stuff, the nucleus pulposus as you know it's called, pressing backwards and escaping, you got a herniated disc. Now the same disc that was just kind of a inert mechanical shock absorbing device has become like a misguided missile. Now, this stuff is pointed right at the nerve roots. And if you're unlucky, it can cause havoc, as it did in my case, like completely upend your life. It's hard to navigate around the kind of pain that happens when your nerve roots are impinged by extruded disc material. You can't escape it. And nature didn't do that much to solve the problem because it wasn't expecting that human beings would suddenly develop a fashion of rounding their backs every time we bend. For all our prehistory, we've been bending in certain ways which have been passed down. It's like an unbroken kinesthetic thread of wisdom passed down.

You watch your grandfather in the field when you grow up in a village. Your grandmother is informing the way that you were held as a baby. And it's wordless. It's not articulated, there's no manual. And so that's one of our problems, we're born without an owner's manual, a user's manual. And so we're just making it up as we go, and the culture hasn't served us. And as we've transplanted here and there, we've lost this kind of unbroken, kinesthetic wisdom, thread, and we're doing things in really problematic ways. And then sometimes, the fashion creates some crazy way of being in your body, like how the fashion models slink on the walkways and the pelvis is stuck way out front and they're slinking, led by their hips. Well, that's just totally not natural.

Our behinds are called behinds because they're meant to be behind. And so sticking the hips forward, it's a very unnatural thing and it causes all kinds of problems. And these models, when they're in their twenties, they can get away with that kind of stuff. But this doesn't age well. So we have to really establish, more clearly in our culture, which way is up. What is the natural shape of a human's body and a human's spine? And then we have to reinforce that in our anatomy books, in our fashion, in our furniture design. Right now, everything is designed to this wrong paradigm. Like we've got lumbar supports and all of our car seats. Our ergonomic chairs are designed to support, if not create an S-shaped spine, right? And that's the wrong shape.

I think explains, in part, why things are getting worse, not better. We're slinging, depending on who you read, $300 billion a year in back pain. And things are not getting better. Now the teenagers have back pain at rates that were unheard of a generation ago. So we just have the wrong paradigm. We are spending money in the wrong ways. And we need to get simple and look at the basics of how a human being was designed to move and be in their body.

Two simple things that you write about that resonated with me, if someone's listening and is just saying, "Well, what can I do right now?" One of them, I really like, is the idea of doing the posterior shoulder roll instead of trying to squeeze your shoulder blades together.

Yeah. That is the simplest thing we teach. And it's so effective because you just do this little shoulder roll, little forward, one shoulder at a time, moderate amount up and then quite a bit back. But do don't do it by pressing out the rib cage, just the shoulder moves. And then letting gravity just settle, the soft tissue, where you have taken it. So it's a little forward, moderate amount up by, a bunch back, and then let gravity just slide it into this new place that's actually an old place. And what you'll discover is that this is stable. Do it on the other side, too. Little forward, moderate amount up, lots back. Let it just gently peacefully glide into its new knot and ratchet back a notch or two and you'll find that it just stays there.

And that makes it practical and it also is what makes it healthy. Because by pulling back, you're using muscles like the rhomboid muscles. And where they attach, on the upper back, gets inflamed, gets sore. And now whether you're slumping forward from pulling the muscles at that attachment or yanking the shoulders back and inflaming these attachments, either way, you are going to be in pain and trouble.

Yeah. Excellent. I like it, because you're emphasizing proper positioning that's also relaxed versus strain.

Exactly.

That's great. Because it's a lot of times you feel strained, like sucking in your belly and squeezing your shoulder blades back. That's only going to last for about 10 seconds for most of us.

Exactly.

So this is a great cue.

And then we give ourselves psychological baggage by thinking we should be more disciplined and keep squeezing our shoulders back. And that's just totally the wrong direction.

The second cue that you talk about that I like is to untuck your tailbone.

Yeah.

And you showed a picture in your Ted Talk of an infant in a car seat and it made me cringe. I never thought of it that way. But so much of our furniture and the way we sit promotes this tucking of the tailbone and then you lose the benefit of the wedge shape, L5/S1 disc, which, oh, by the way, is the most injured lumbar disc that we encounter every day in the office. I should make that my license plate. It's just so prominent, the disc herniations and problems, and you mentioned it too. So untucking your tailbone and doing the shoulder roll are two very simple cues I think people can get started with right away.

Well, the second one, I actually don't like to start people with, if they have a back problem. Because if they have, for example, an L5/S1 disc herniation or significant damage there, sticking your bum back can further pinch off the herniation. That's one possible complication. And also, you don't want to tense up your back muscles to push your bottom back. That's a bad way to make this happen. And so what I prefer is that people get there behind to be behind by toning their glutes, which happens in learning to walk well. But before you learn to walk well, there's some prereqs like maintaining length and stability in the upper lumbar area. So that's where we like to start. So for example, stretch sitting, I love that as a beginning point, and stretch lying. And those are simple enough, we have videos on our website, on our YouTube channel, to help people get started because those are relatively safe. You still have to be gentle. You still have to be attentive.

If your body says no, if it barks at it by having pain, we have to respect. Some people think, "Oh, you should just work through pain." But that makes no sense. I always explain to my students that nature took eons to design the phenomenon of pain. So it behooves us to listen, not just disregard the pain or shut it down or so, but try to learn what is this about and then learn to do things differently. But in any case, as long as people are gentle, stretch sitting, stretch lying, relatively easy. They pack a big punch and you get hours of traction for a couple of seconds of effort. And that helps decompress the spine and rehydrate the discs and take away the impingement of the nerves and things like that.

I just received my stretch sitting cushion.

Oh, good.

And I used it for the first time this morning, on my way to work in my car. Because when I talk to my guests, I want to do research so I can be authentic.

Cool. I hope we sent it to you as a gift. We should have.

I don't know. I think I just ordered it. It's fine. The gift is you coming on the show and sharing your knowledge. But it's interesting, and I want to be respectful of your time, but I'd love for you to talk a little bit about your thoughts regarding this type of cushion. And again, we'll put a link to the video on how you describe the Stretchsit Cushion and how to use it.

Sure.

But give me your thoughts about this type of cushion, which you've created.

Versus lumbar.

You got it.

Yeah. Lumbar cushions are a part of conventional wisdom. If you consider that the natural shape for the human spine is an S-shape, then of course you want to do something to protect that exaggerated arch that's supposed to be so natural in the upper lumbar area. But the point I'm making is that, that is not a natural place to have an arch. That place wants to actually be close to straight. It wants to be all stretched out. And the only place where you actually want a significant arch is way down below, where the bottom meets the back. That place wants to be arched. And there's actually really cool research. I don't know if you saw in the back of my book, my reference to the Jackson and McManus article, where they looked at 100 normal people with no back pain and versus 100 back pain patients.

And the finding was that back pain patients have more upper lumbar curve, less lower lumbar curve. In other words, S-spine. And the normals, the people who didn't have back pain, have more of a J-spine. So that's very, very cool evidence, radiographic evidence, that you want to have a J-spine, not an S-spine. And that was one of the few studies that makes a distinction between upper and lower lumbar curve. Whereas, a lot of the research just lumps it all together and draws the erroneous conclusion that lumbar curve and posture and curvature in the spine has no relevance for back pain, which is really crazy. It's like you did not look correctly and made this wrong conclusion. That's what's happening in these studies. So this study makes the right granular observations and then it's absolutely clear that you want the curves in the right place and not in the wrong place.

And that makes a huge difference for back pain. So anyways, so the lumbar supports are always about creating lumbar curve, supporting, if not creating. What we do in our cushion is first of all, it's not something there to create curves anywhere. It's actually there to take out curves. So it goes higher up, in your mid back. It's a firmer cushion. And the relevant part of it is that it has these friction elements. It took us a while to design. That was my first product. We only have a couple anyway. But you have these sticky rubberized nubs that are sewn in by someone, by hand on a machine. And it's sewn in to provide friction so that people can elongate their back, hook their backs to these little nubbies. And now, their back is in traction from the place of attachment down below. All of the erector spinae muscles are being stretched. The vertebrae are being eased apart. There's more room for the discs. There's more room for the spinal nerves. And this allows the first unraveling of bad posture and allows healing to happen.

It's the first baby step we like to teach people. And you can even do it with a towel, by the way. I don't want to suggest that everybody has to run out, although it is a very nicely designed cushion, works in cars, works in sofas. Makes bad chairs into good chairs, basically. And then eventually, I designed my own chair as well. So that really is very handy. But if people don't want to spend money, you can fold a towel and put it side to side behind your mid back. It does mean you have to be a bit of an engineer to make it not slip and slide and stuff. It can work on a fabric chair where it'll hold its place and afford you the same kind of traction or stretch or at least decent traction. So that's what I recommend people start with.

Excellent. I really like that idea.

I love it too, because right now, sitting gets such a bad rap. Sitting is supposed to be the new smoking, sitting is supposed to kill you, what have you, what have you. And I think no, sitting is totally natural. People have been sitting forever, since the beginning of our species. They've even put sensors on the Hadza, that's the hunter gatherer group, and discovered that they sit about the same number of hours that we sit. While the researchers credited their squatting, I credit their good form. Not necessarily related to squatting, but just having the right spinal shape. In any case, I think sitting can be marvelous for you. We know that it allows more focused thinking, that's why meditators sit. We know that if you force yourself to stand all day, there are other risks, like more risk of hospitalization due to varicose veins, higher risk of atherosclerosis and such.

So I think we just get a little... The media starts going crazy about some sound bites. But there's really not that much evidence for showing sitting to be bad, and I think it's great if you do it with good form. If you do it in moderation, punctuated by work breaks or study breaks, and there, I have a lot to say. In fact, we are in the process of creating a public television program about sitting, and it'll be released in June. It's a pledge program and it'll show stretch sitting in detail, stack sitting as well and little exercise breaks that are especially healthy to counter sitting. So samba and psoas stretch, like by lunging. So we show a few things that are really helpful.

Well, definitely let me know when that comes out and we can share that with our audience. I'm really enjoying this conversation.

Me too.

One more question, if you have a moment?

Take your time. It's so enjoyable to talk to you.

Great. In the near future, I will probably have Dr. Stuart McGill on the podcast.

Oh, yeah.

Yeah.

He's great.

He is great. And he is a big proponent of this concept of the big three. And for people who don't know Dr. McGill, he's kind of a legend in the field of back rehabilitation and he's done a lot of research on exercise influence on the spine. And he tries to debunk quite a bit of thought process that's out there. But his big three for exercise for the back are, he calls the curl up, the side plank and the bird dog. And in your book, you do mention some things about exercise. I just want to get your thoughts on when you hear the term core stability, what kind of comes to mind for you?

So again, the conventional approach is do exercise of some kind or other. And I challenge that because to me, the most important thing to do for your abdominal strength is to use the right muscles on the job. It takes no time. A little bit of training, and you got tons of opportunities with no equipment, no time, no expense, no nothing, and it's the natural way. So every time you have to lift something and your back could be compromised because it's getting compressed, or there's going to be impact because you're running, or you're on a bumpy bus and there's vibration, or you're planning to do the twist and there's going to be distortion of shape in the spine. Those are the times you wish you had abdominal strength and length and were resistant to the threats to the spine. So those are the times where you could do what we call the inner corset.

So that's chapter five in the book. And by the way, that's a free download on our website. It's a technique that can be done freestanding, that people can even without knowing all the other prereq, the lengthening and the shaping and so on. It's still really worth learning this. So I recommend people get that. And one of the ways you could invite the right muscle combination, because that's really what it's about. Most people focus a huge amount on rectus abdominis in doing some kind of curl. It used to be sit ups and those got out of vogue, thank goodness. But now it's still the problematic crunches. So the Canadian Army has thrown out crunches. Illegal, they don't do them at all. The US Army, if you have a back problem, you're not allowed to do crunches.

So they're on their way out. But in the lay public, it's still the most common exercise people do. And I think crunches are a terrible exercise. They're well named. They crunch your discs and they crunch your nerves, and that's not what anyone needs. So what we teach is this inner corset. It's done on the job, it doesn't take time like crunches and all these other problematic or any exercise, takes time. Instead, every time you are in need of some extra protection, because your back could be threatened by carrying, by impact, et cetera, then you imagine that you are walking in a cold ocean and the water level is rising and rising. And the top of you wants to shrink away from this cold water. And if you imagine that, you are likely going to recruit the right combination of deep abdominal muscles and deep back muscles rather than rectus abdominis, which is what people tend to focus on if they do anything for their abs.

So that's what I recommend. Just do that one thing, on and off all day, once again. Much more effective than just having a little regimen early in the morning and then forgetting about it all day. But also, it invites the right combination of muscles, as opposed to some substandard combo over inviting the rectus abdominis, not using the deeper muscle layer in the abs and backs. So this is like the natural thing to do, and it takes no time and it's going to prepare you for everyday life. Because it is done as it's based on your everyday life position of being a little bit slender and therefore, taller in your torso. So instead of being a shorter squatter cylinder, you get to be a slender taller cylinder, and that's what eases the vertebrae apart and gives all of those discs and nerves more room.

Beautiful. I love it. Anytime we can integrate health interventions into our typical day, it's just more efficient.

Totally.

That's a really excellent idea. And I know people think differently, there's different ways to go about it and that's what I'm about on the podcast is exploring new ideas and sharing it with people.

Congratulations that you're being so proactive about switching the field and finding different points of view. It's so refreshing to see the physicians not set in their ways, still exploring, still including people with different points of view. So really, hats off to you.

Well, I appreciate that. About wrapping up our time here. You've been so gracious with your time today. Esther, if people want to contact you, and I know you have people that you've trained in the method, where do people find more information?

Totally. So the best place is on our website, which has that awkward spelling, GokhaleMethod.com. Although, if people look up S-posture or Posture Guru, and the New York Times called me that. So that makes it easy to find and then you will be led to my website. So if you forget the spelling, that's how you find your way there. But, I am going to make a recommendation that if people are intrigued and they actually have aches and pains, or they would like to improve their posture, the best action step is to do initial online consultation or an initial consultation if you happen to have one of our teachers in your area. But the online consultations have proven fabulous for people who don't have a teacher in their area. Then you get to submit some images of yourself and we specify and you fill in a long intake form and your teacher, which I do these as well and thoroughly enjoy introducing people to this way of being in your body.

And so then we read. The teacher will read everything you've written, look at your pictures, already have some idea before they meet you. And then during that consultation, we upload the pictures, share screen and we point things out in the pictures that people are usually not at all aware of, where their curves are, what the underlying problem is. And then we chalk a way for them to improve their structure. How do you get from where you are to where you want to be, like the Ubong tribesman, right? And so which changes need to happen first? And then what? And then what? And we also give people some idea about what things will be easy and what things will be more challenging, which things will go fast, which things will take some more patience.

And that way they get a very good overview of what the project is that they are undertaking and how long it's going to be. To most people, it's very surprising that even after decades of being a certain way, they can, in very short order, make very profound changes. And more than half of our students use the word life-changing somewhere in the middle of their program. And that's not a small word. So it's like, this is a missing piece. And we're just so proud and feel so privileged and that we have something that's substantial to bring to people. And now with the upcoming Stanford randomized control trial, that's going to be more known about in mainstream, which is what we wanted. We want people to understand that this is logical. It's not just some froufrou thing that some weird people are doing on the side. It actually makes sense, everybody needs this in their body. It's an exciting juncture for us.

There you have it, folks. That's Esther Gokhale of the Gokhale Method, primal posture for a pain-free life. Thank you so much for your time. I'm really looking forward to keeping an eye on the work you're doing. And this is what it's all about, changing people's lives. I think that's why you and I both do what we do. We come at it from a different lens.

Yep.

But there's a lot of overlap and I'm really pleased we could do the interview today and get this out to people.

Thank you so much.

I want to thank you for your time. Yeah, thank you very much.

Thanks Dr. Lakhia. Bye.

You're welcome. Bye-bye.

Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to BackTalkDoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.