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Customer Review

405 of 416 people found the following review helpful
5.0 out of 5 stars Best method for treating & preventing chronic pain, March 22, 2008
This review is from: 8 Steps to a Pain-Free Back: Natural Posture Solutions for Pain in the Back, Neck, Shoulder, Hip, Knee, and Foot (Paperback)
This is by far the single best source for healing back pain that I have seen. I hurt my lower back pretty badly doing heavy deadlifts after too long of a layoff (entirely my fault, I know), and pursued a wide variety of different treatment methods. I had previously been exposed to other postural/ alignment methodologies in an attempt to get rid of chronic injuries, which had been helpful, but nothing was as poignant, simple, or direct as Gokhale's work.

There are three outstanding aspects of this book:

1. Gokhale clearly identifies what ideal posture and alignment looks like, and backs this up with numerous photos.
2. Gokhale's method is very, very simple, and once learned, becomes integrated into your everyday life. I know of other methods where you have to spend 30-45 minutes per day doing exercises - this method requires very little extra bandwidth once you have learned it.
3. The book itself is beautifully laid out, with a balance between illustrative photos and explanations.

Considering the amount of time and money I've spent pursuing other treatment methods, this is a ridiculously good value. Don't discount it just because it is so inexpensive! I bought a copy for my parents, and two extra books as I constantly have them loaned out. If you are seeking to get rid of chronic pain, this is my #1 go-to recommendation.
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Showing 1-10 of 67 posts in this discussion
Initial post: May 26, 2010 9:16:16 AM PDT
Last edited by the author on May 28, 2010 7:33:00 PM PDT
Samantha says:
I really get tired of this whole posture issue and back pain. For those of us who have literally spent years treating back patients, as well as reading the literature, it gets old.

If you have back pain and are trying to figure things out, know that the whole theory of correcting your posture to relieve pain has some very serious flaws. The first issue is whether "bad" posture causes pain, and the second is whether we can change a person's posture at all. The research clearly says "NO" to both questions. For instance, on the issue of the association between posture and back pain, one study X-rayed 600 backs and measured subjects curves in the lower back (Hansson 1984). Some of the 600 subjects had acute (short term) back pain, some chronic (long term) back pain, and some no pain at all. The study reported NO association to be found between pain and spinal posture, which means that looking at the postural curve of one's back tells you nothing about how much pain someone has/will have.

Yet other studies have looked at things such as how far a person's head sticks out in front of them- known as the forward head posture- and all have reached similar conclusions that this has nothing to do with how much pain one has (Braun 1991). For gosh sakes, one study even took college freshman, measured their postural asymmetries (such as one hip or shoulder higher than the other), and then followed them for some 25 YEARS. The results? Postural asymmetries were NOT predictive of OR associated with future episodes of low-back pain, mid-back pain, or neck pain (Dieck 1985).

But can stretching and strengthening even change posture? Studies and review articles on the subject clearly say "NO" (Hrysomallis 2001). These are the kind of studies where objective measurements are taken of a subject's posture, and then participants go through a stretching or strengthening program for a period of time- and then are re-measured to see if any posture changes have taken place. For example, popular treatments, such as stretching out "tight" hamstrings, does not change the position of the pelvis- and in turn the curve of your low back (Li 1996). There's tons more good research I could cite, but you get the point- its all out there, been published for years. However despite the fact there's just no solid evidence to support this popular "posture therapy", it doesn't stop people from practicing it and perpetuating these myths. Either medical practitioners/writers aren't reading the literature, or they're choosing to ignore it. Whatever the case, it's just not a good thing for people with back pain.

But hey, don't get me wrong- that's not to say that a person won't read a book like this and get great results. Just keep in mind that when someone does a particular treatment and feels better, that does NOT prove that it was the treatment that did the trick. Without going into detail, there are a lot more factors to consider such as the natural history of a disease, regression to the mean, the placebo effect, or the outright belief that the therapy will work. That's why we have control groups to sort it out for us.

My advice? Stick to forms of therapy that have been supported in published, well-done clinical trials. Hope this helps.

In reply to an earlier post on Jun 20, 2010 4:18:20 PM PDT
Last edited by the author on Jun 20, 2010 4:19:29 PM PDT
badboy says:
Doctors used to recommend smoking Camels too. You say there is "tons more" research on the subject, but 3 of the 4 studies you list are 20-25 years old. The book does reference literature on the subject and many of those are beyond the year 2000.

Here's what I found under Hrysomallis' study: "Exercise has been promoted in an attempt to correct postural deviations, such as excessive lumbar lordosis, scoliosis, kyphosis, and abducted scapulae. One of the assumed causes of these conditions is a weak and lengthened agonist muscle group combined with a strong and tight antagonist muscle group. Strengthening and stretching exercises have been prescribed accordingly."

Ummm, stretching and strengthening exercises aren't used in this method - did you actually read this book and try it out at all? There are exercises listed near the end of the book, but these are used to accelerate progress and strengthen key muscles if needed but are not the focus of the method.

To say that posture doesn't affect back pain is simply ludicrous. Sitting with muscles constantly scrunched up, and reducing blood flow to the area surely has an effect. When you get a massage, and your tight muscles are loosened up, you feel good, and nice and light and loose. And that's what this method does -stretches out your muscles, gives your organs room to breathe and promotes better breathing and blood flow. And your saying that's not going to affect health?

Also, why stick to clinical trials and control groups, when you already have control groups of whole societies that support what the book is getting at?

In reply to an earlier post on Jul 3, 2010 9:55:41 AM PDT
Evaughn says:
1. The studies cited only prove that the usual ways of changing posture don't work. They don't test the Gokhale Method of addressing posture and back pain.

Conservative approach: Stretches and strengthening exercises that last only two (or 10 or 30) minutes a day

Gokhale Method: Not about doing exercises to stretch or strengthen muscles (except as temporary and optional supplements). It is about using everyday activities to stretch and strengthen muscles. Bending (hiphinging) is a hamstring stretch; walking (glidewalking) is a gluteus toning exercise; sitting (stretchsitting) lengthens the back. Compliance is high because of immediate positive feedback; duration is all day and night after learning the basics; effects are striking.

2. The studies cited (and most back pain / posture studies) only show that the usual parameters studied don't show correlations with back pain. The Gokhale Method looks at finer grained parameters and finds strong correlations between posture and pain. We used to look at fat this way - all cholesterol used to be lumped together and now we know there is good cholesterol and bad cholesterol (Hdl's, ldl's and the jury is still out...)

Conservative research: By studying total lumbar curvature (lumping upper and lower lumbar curvature together), the research misses two critical factors that have strong and opposite influences on pain.

Gokhale Method: Based on anthropological and historical research, and an attentive search of the medical literature, Esther Gokhale claims that a pronounced L5-S1 curvature (behind behind) and minimal upper lumbar curvature correlate with a healthy spine whereas tucked pelvis and swayed back correlate with back pain. This is exactly the finding of the study published in Spine that Gokhale cites in her book. (Jackson RP, McManus AC. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size: a prospective controlled clinical study. Spine 1994;19(14):1611-18.)

Read the book, try the techniques - they will change your life.

In reply to an earlier post on Jul 3, 2010 9:19:32 PM PDT
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In reply to an earlier post on Jul 4, 2010 6:01:26 AM PDT
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In reply to an earlier post on Jul 4, 2010 6:29:36 AM PDT
Last edited by the author on Jul 4, 2010 6:32:34 AM PDT
Samantha says:
Sorry for the multiple posts, some Amazon thing...

Okay, I'll say it again: There is no association between static or dynamic posture and low back pain.

TOTAL lumbar curvature: There aren't a lot of recent studies on this, simply because once there's been a lot of studies done on a subject in the past, and the same findings keep coming up, well, there's no reason to keep on doing them. But, since you seem to want to hear about more recent studies, look up the one where they took 50 patients with chronic low back pain, 50 controls, and X-rayed their backs (Tuzun 1999). NO differences were found in the curve of the low back (lumbar lordosis) between those with and without low back pain. Interestingly, no differences were also found in the sacral inclination (which directly influences the L5-S1 curvature).

REGIONAL Lumbar curvature: I can assure you that "the research" has NOT missed studying the upper and lower lumbar curvature. A good example of this is a RECENT study that looked at 170 subjects, low back pain, and regional lumbar posture (Mitchell 2008). In a nutshell, they specifically looked at upper and lower lumbar posture separately while analyzing subject's standing and sitting static posture, as well as the dynamic upper and lower lumbar spine posture as subjects performed a variety of tasks. The result? Back pain was not associated with differences in regional lumbar spine angles.

BTW, it was not the finding of the Jackson study that a pronounced L5-S1 correlates with a healthy spine. The study showed that two-thirds of the total lumbar lordosis occurred at L4-L5 and L5-S1, not just at L5-S1 alone. I see a problem here.

The number of randomized controlled trials showing that the Gokhale Method is effective: 0

But hey, if you think the book will help you, by all means, don't let me stop you- read it and use it. The placebo effect in medicine is around 30%, so you've got a reasonable shot at getting better for awhile. I also had a patient once who had hip pain. A friend told her to rub her morning urine over the area to get rid of the pain. She did it and it worked- swears by it to this day. Try that on your back- might just change your life...

In reply to an earlier post on Jul 4, 2010 6:37:50 AM PDT
badboy says:
Once again: have you actually read and tried the methods in the book?

I looked up the Mitchell study and the Background to the study mentioned that - despite the "tons of research" you mentioned - the relationship between LBP and posture is not fully understood. And this being in 2008. But hey, no reason to repeat any studies like you say.

The study mentions that measuring true usual posture is difficult in the laboratory setting, and that this is an acknowledged weakness of the study. But you didn't want to tell us that, right? Well whoda thunkit?

And the Mitchell method involved measuring subjects sitting and standing for 5 seconds as the postural norm, then having them perform 5-second movements bending forwards and backwards and repeating this 3 times, and repeating functional tasks all of 3 times.

I'd say you're ignoring the forest for the trees.

Placebo effect? Wonder why doctor-prescribed exercises or other books didn't work then....guess there's just some magic placebo effect that hits everybody who reads this one? As for the number of randomized control trials that show the method is effective being zero - well how many randomized control trials show it's ineffective?

In reply to an earlier post on Jul 4, 2010 7:44:56 AM PDT
Last edited by the author on Jul 4, 2010 7:57:24 AM PDT
Samantha says:
1) of course the relationship between pain and posture isn't fully understood- few things in medicine are, and on that we can finally agree. That's why its so funny when I come across a book like this that thinks it knows exactly why everyone's back hurts- and knows the cure!

2) of course measuring posture can be difficult, but if you look at the method used in the study, well, its pretty sophisticated! Beats snapping a few pictures of random babies and adults to try and make your point.

3) of course all studies have weaknesses- but that doesn't automatically discredit a study's findings. Besides, the Mitchell study is far from the only one that has analyzed upper and lower lumbar posture and drawn the same conclusions- but, I'm growing tired of citing research, you'll have to do the rest on your own- maybe it will make the revised edition! I'm outta here, my point has been made...

In reply to an earlier post on Jul 4, 2010 9:05:57 AM PDT
badboy says:
1) It claims improving bad posture will help or relieve back pain. Why that's such a radical concept is beyond me. The Mitchell study looks at bending this way and that and doing a few tasks. Doesn't seem to be the same thing.
2) Sometimes a simple and natural environment is best. I guess people walking the talk is irrelevant to you.
3) When the weakness is a measure of the very thing you're trying to determine, that leaves a pretty significant margin for error.

How many trials showed the ineffectiveness of the method did you say again? Oh and, didn't read the book eh?

In reply to an earlier post on Oct 9, 2010 7:25:17 AM PDT
Last edited by the author on Jun 26, 2011 2:50:34 PM PDT
Kurt, you wrote a wonderful review and I can't wait to try this out. Don't know why some people are so opposed to "standing up straight" and doing simple exercises that work. I'm going to get the book and definitely give it a try. And it's not the same as some of the other things "Samantha" suggests that might work. I did the Royal Canadian mounted police 5BX and XBX Programs 8 minute exercise routine for years and it really worked. I bet the same thing happens here. Thanks again!

PS: I used Epsom Salts baths every day which allowed me to walk again without a cane, and stop taking the addictive pain pills prescribed to me by my doctor. When I walked into his office without the cane and he asked "what changed" and I told him, he said "hot water has a placebo affect. Epsom Salts don't relieve pain." Some eyes don't see, I guess! Now I take magnesium pills every day and don't even need the baths anymore except after unusual stress and strain. Not one medical practioner ever suggested magnesium. They said I had to have surgery or "never walk again." The years I wasted going to them. Years and years of disability and PAIN. Almost all gone now, thanks to information, suggestions and reviews like these.

Can't wait to try out these new exercises. Thank God for Amazon and all the good people here.
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