AAOS Now

Published 7/1/2008
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Robin L. Dennis, MD

Ending back pain through posture and movement

“8 Steps to a Pain-Free Back” is a step in the right direction

A personal experience with back pain and surgery was the genesis for Esther Gokhale’s 8 Steps to a Pain-Free Back. She describes the root cause of back pain as a posture drift (improperly tucked pelvis, slouched shoulders, and protruding neck) away from the naturally intended alignment.

Gokhale proposes two reasons for this adverse posture: the disruption of kinesthetic tradition passed from generation to generation and influences from the fashion and design industry. Her method details how to reestablish natural posture and movement patterns. Her key postural point is attaining and maintaining an anteverted pelvis, which places all other bones in appropriate posture, with the weightbearing bones aligned over the heels. Everyday activities (sit, sleep, stand, walk, bend) are opportunities to practice the corrected postures.

The eight lessons cover stretch sitting, stretch lying, stack sitting, stretch lying on your side, using your inner corset, tall standing, hip hinging, and glide walking. Lessons are separated into three sections: background information and importance, step-by-step instruction, and indication of improvement with troubleshooting. Pictures and diagrams demonstrating proper and improper posture assist the reader in understanding and achieving the correct posture. A glossary and anatomy diagrams round out this reference.

Overall, 8 Steps to a Pain-Free Back is a highly accurate analysis of natural postures and movement patterns (kinetic chain mechanics) involving functional activities. It shows how deviating from them can result in back pain, along with degenerative changes that needlessly age so many of us too quickly. Gokhale’s Method is a comprehensive approach that should alleviate pain if patients practice it regularly and maintain awareness of correct postures.

I think this is a great book for someone who is serious about achieving a pain-free back and willing to work to reach that goal. It could be recommended by an orthopaedic surgeon to patients looking for alternative treatments for back pain. Some of the step-by-step instructions are difficult to comprehend, although the accompanying pictures are helpful.

Many patients express their sincerity to be pain-free, but lack the discipline and patience to practice on their own until they realize lasting results. All “how-to” books suffer from this human shortcoming; if treatment takes time and does not guarantee instant benefits, it clashes with our fast-paced “fix-it-now” mentality.

This book is ideal for the back-pain sufferer who has already bought into the belief that poor posture (and not age, weight, work, genetics, or some other reason) is the main cause of chronic back pain and is willing to accept that relief can be achieved without a pill, masseuse, chiropractor, new mattress, or passive modalities in physical therapy.

Robin L. Dennis, MD, is a physiatrist at Resurgens Orthopaedics in Marietta, Ga.