The latest innovation in back-pain treatment is less interested in where it hurts than in which of your movement habits, built up over a lifetime, are responsible for the pain.
The theory is that when major muscles shorten in one direction, there is an immediate compensatory adjustment in both nearby and distant muscles of the body. Rather than massaging or stretching the hurting section itself, the treatment is focused on ‘muscular chain therapy’ (MCT), which aims to change posture to ensure that all those muscles are firing synergistically.1
Global postural re-education, as it’s also known, can ease the pain not only of specific syndromes like ankylosing spondylitis, an inflammatory condition of the spine that can lead to fused vertebrae—where calcification of the ligaments and discs cause the vertebrae to join together, becoming rigid and inflexible—but also of generalized chronic low back pain. One study of this approach in 61 patients with chronic low back pain found that, after 12 weeks of weekly sessions, there were improvements in pain, physical functioning and general vitality.2
In 100 patients treated with either MCT or ultrasound, just a single session of MCT provided relief.1 It’s also proved superior to segmental stretching, which aims to stretch one muscle at a time.3 Here’s a rundown of the most popular postural re-education therapies with the greatest evidence of success.
Egoscue was started in the late 1970s by physical therapist Pete Egoscue of San Diego, California, who, after a bout of intense physical debilitation, was determined to find natural self-healing.
Combining postural analysis with specific corrective exercises, Egoscue not only healed himself of chronic pain and dysfunction, but ended up founding an entire system of self-healing.
After recording a client’s symptoms, Egoscue practitioners identify problem areas by visually assessing both the person’s posture and gait while walking. Photos of the client’s posture are taken from the front, back and side, then fed into a computer, which compares these images with the correct postural stance. After analysis, the program provides a list of individualized corrective exercises that the practitioners then tweak, based on the patient’s input and their own visual assessment.
“We look at the body as one solid unit,” says Crystal Sallee, director of Egoscue University in San Diego. “If you have a symptom in your knee, for example, we acknowledge that symptom. But we’re looking for the underlying cause. And we look at the entire body to see where that symptom is originating from.”
After the initial visit, which takes around two hours, there are follow-up assessments where the exercises, which can take up to an hour a day, are changed to match the patient’s progress.
Currently, there are 25 Egoscue clinics across the US, as well as hundreds of practitioners and trainers worldwide. Sallee says that, recently, there has been an influx of Western surgeons and doctors of physical therapy. “They’re coming to us to supplement their practices,” she says. “Some are switching practices altogether.”
Matthew Carratu, a former osteopath in Berkshire, UK, is typical. Disappointed by the “rudimentary exercise prescriptions” available for patients in standard osteopathy or physical therapy, he wanted a way to bridge treatments with effective rehabilitation to help people recover from the effects of long-term sitting. Egoscue proved to be what he was looking for.
“Muscle and bone as living tissue are shaped by our activities and expression and, as a result, a considerable number [of patients] now present with lifestyle strains,” says Carratu. A sitting posture, he says, creates a “kyphotic tendency”—an extreme curvature of the upper back commonly referred to as a ‘hunchback.’
In 2008, he tested the effects of long-term sitting in 40 18-year-old schoolboys in Windsor, UK, with lung and diaphragm tests. Compared with the averages from 10 years ago, the boys were 18 percent down on tidal volume (the amount of air inhaled during relaxed breathing) and 12 percent down on power (peak flow, the maximum speed of exhalation).
“From my 26 years of professional work, I attribute that to laptop/iPad/phone use,” he says. “[High school graduates] are demonstrating thoracic patterns that a dentist with 30 years of bending over patients expresses.”
In a 2014 thesis by Zachary Vehrs at Brigham Young University,4 Egoscue corrective exercises proved to be effective for easing chronic knee and hip pain. Vehrs is now a certified Egoscue practitioner, trainer and clinic owner in Seattle, Washington. He says Egoscue can either stand alone or be used in conjunction with other healing methods, such as chiropractic, which also aims to achieve a similar outcome through better postural alignment.
“We’re just taking a different approach by addressing the muscles that are holding your alignment in place,” he says. “The bones do what the muscles tell them. So if the muscles are always pulling your bones out of alignment, then we have to address the muscles for the alignment to stay in good position and to achieve lasting relief.”
One of the main differences between Egoscue and other alternative therapies for back pain, such as chiropractic and massage, he says, is that the practitioner is not manipulating, changing or doing anything to a client’s body.
“We believe that everyone is their own personal expert. No one knows more about you than you. You’re the one in your body feeling what effect the exercises are having. And based on that feedback and how your intuition and your body feels doing the exercises, that’s what guides the therapy process.”
One of his patients, Martha Ritz (not her real name), a 67-year-old woman in Salem, Oregon, had scoliosis and a long history of back pain. Doctors had given her a back brace, and she was taking up to six painkillers a day just to be able to function. Most of her time was spent lying down with a heat pad to ease the pain.
“After one week of doing her Egoscue exercises, she no longer needed her back brace and was able to stand for longer periods of time,” says Vehrs. “After eight sessions, she was golfing, dancing with her granddaughter, bowling and was no longer reliant on pain medication.”
According to both Vehrs and Sallee, at least 90 percent of Egoscue clients improve if they do their exercises consistently and attend their follow-up appointments. Some patients feel better within a few weeks, although others can take a lot longer.
Dr Nancy Wright (not her real name), 58, a dentist in Coos Bay, Oregon, has mild multiple sclerosis.
Her right hand used to go to sleep at work on a regular basis and her back was always in pain. She also had peripheral neuropathy (numbness and pain in the feet and hands). After three weeks of the exercises, her hand was no longer falling asleep and gone was the back pain, but it took three months before her neuropathy diminished significantly.
Shannon Robinson, a photographer in Reading, UK, had been experiencing severe back pain for years and could find no relief from painkillers. Chiropractic adjustments, acupuncture and osteopathy had also all failed. “Egoscue was my last resort,” she says. “I just wanted to be pain-free.”
After five months of working with Egoscue practitioner Nicole Parsons, she was mostly pain-free at last. “I very rarely had slight pain after long hours at the desk. But nothing compared to how bad it was,” Robinson says. “Egoscue changed my life and introduced me to a pain-free way of living. I have taken up yoga and spinning, which complement my Egoscue exercises, and my fitness is improving.”
“All we’re doing is teaching the body how to move properly and retraining the muscles to hold the bones in a proper position,” says Parsons. “Age is definitely not a limitation.”
The Gokhale Method
This technique also uses healthy posture and movement to heal back pain and other problems. Like Egoscue, it was founded by a practitioner whose own health issues forced her to find new solutions.
Crippling back pain during her first pregnancy and unsuccessful back surgery set California-based acupuncturist Esther Gokhale on a crusade to find the root cause of back pain. She traveled to Brazil, Portugal and India to learn from native populations and discovered that, unlike Westerners chained to their desks, people involved in less restrictive daily activities not only had no back pain, but also an entirely different kind of posture, which she dubbed ‘primal posture.’
As she writes in her book 8 Steps to a Pain-Free Back, “It’s quite different than American spines. If you look at an American’s spine from the side, it’s shaped like the letter S . . . That S-shape is actually not natural. It’s a J-shaped spine [where the lower back is not another curve, but more vertical and upright] that you want.”
Unlike Egoscue, the Gokhale Method has no lengthy exercise regime. The focus is on retraining patients how to sit, sleep, stand, walk and bend in ways to prompt the spine back to its natural J-shaped primal posture. As the muscles and bones realign, pain and disability are eventually cleared, Gokhale maintains.
Says Bristol, UK, practitioner and yoga instructor John Carter, “The principle is if we can get extra length in our typically compressed spines while going about our lives, that changes sitting [or walking or bending] from something that hurts to something that heals.”
To attain ‘correct’ posture, patients are asked to take a deep breath and notice how the ribcage lifts, making them taller. They maintain that lift as they exhale. Repeating this several times adds extra length to the spine.
Another subtle spine-stretching exercise uses a lightweight object, such as a folded cloth, balanced on top of the head. Pushing the head up against the cloth while making sure not to lift the chin, the spine automatically lengthens and the ribcage lifts.
Another exercise imagines a ‘sky hook’ attached to the top of the head gently pulling you upward, which also adds length to the neck. These exercises can also be done while sitting, standing or walking.
One item of basic equipment is a Stretchsit cushion, recommended for office chairs and car seats, to get hours of gentle stretching in the back while driving or working—but a simple folded towel hung over the back of the seat would also do the trick.
Claire Robinson, 43, of Bristol, UK, lived with myofascial pain and trigger points (‘knots’) in her muscles for over 10 years.
She tried lots of traditional treatments, including strong painkillers, plus acupuncture, physiotherapy, osteopathy, chiropractic, yoga, Pilates, Putkisto, meditation, Trigger Point Therapy, X-Pain method, pain management, massage, reflexology and Alexander Technique—all to no avail.
“Since I started practicing the Gokhale Method, my symptoms are now virtually nonexistent,” she says. “The method has enabled me to know my limits and work within them.”
But it didn’t happen overnight. Robinson says it took a long time to create new habits of sitting and moving again.
But the payoff, she says, was worth it. “It’s amazing how knowing what it is to have good posture can make you look taller, slimmer, feel more confident and, above all else, not be in pain.”
Created by American chiropractor Eric Goodman, Foundation Training (FT) is another exercise/postural approach that started from an alternative therapist’s personal experience of crippling back pain.
At age 26, Goodman was a student at a chiropractic college when multiple herniated discs in his lower spine sent him to a conventional doctor. Told he needed spinal fusion surgery, he instead became obsessed with figuring out why his back had degenerated.
Eventually, he realized that incorrect movement, plus all the sitting he’d been doing while studying, had placed undue strain on his spine because the posterior chain muscles—the spinal erectors, gluteals, hamstrings and calf muscles—were not being used. He then started to strengthen these back muscles through exercises he developed and, within a year, he was pain-free with no surgery.
Goodman says that going to a doctor to get rid of back pain often only makes things worse, because surgery and painkillers do nothing to fix the cause of the problem. “We really have no idea how to treat these things, and it’s because they can’t be treated,” he says. “They have to be changed.”
Decompression of the spine, anchoring and hip hinging are the three main principles of FT. Decompression is through active breathing: the patient inhales to expand and lift the rib cage away from the pelvis, and then holds it up as he exhales by tightening the abdominal muscles.
Creating space between the ribs and pelvis allows the lower spine to decompress while opening up the chest and pulling the shoulders out of their commonly rounded position.
Anchoring is about stabilizing the pelvis downward using the adductor (inner thigh) muscles. “The majority of people have externally rotated hips due to the positions our modern lifestyles pull us into,” says Aberdeen FT practitioner and certified instructor Mora McGovern. “This means the external rotators are tight, which inhibits movement of the hips and lower back, thus causing compensatory movement patterns which, in turn, cause pain or injury.”
Hip hinging teaches the brain to make the hips the center of movement and to activate the posterior chain muscles for good posture. McGovern says that most people lift things up using the spine as the center of the movement. But what FT teaches patients to do is to pull the hips back while lifting the chest, thus activating the back muscles, stabilizing the spine and taking the strain off joints.
Like both the Egoscue and Gokhale Method, FT claims to work for around 90 percent of patients when practiced regularly and correctly. It requires no equipment, and McGovern says that people of any age and fitness level can do the 15–20 minutes of daily exercises. Positive results are rapid because, unlike other exercise forms, FT specifically targets the entire posterior chain as a single muscle system.
“It occurs very quickly because we are simply teaching the muscles to do what they are designed to do,” says McGovern. “Once the posterior chain is activated, the exercises continue to strengthen these muscles with continued benefits.”
Tom Webster of Aberdeen, UK, had a history of back problems and back pain. Chiropractic, massage and visits to the osteopath gave temporary relief, but the problems always came back. With FT, he says, “I felt improvement almost instantly. Even the breathing exercise seems to pull everything together, and you feel the stretch.”
Webster says he hasn’t felt so good in years. “I’ve started cycling, kettle bells and even taken up slacklining, which would have been near-impossible a few months ago.”
Three back-pain healing stories
Ron Jackson (not his real name), 32, was lifting maximum weights, unspotted, in a free-weight gym when he sustained an injury, yet continued to train. Six weeks later, he was in agony with signs of extreme pressure and swelling of the nerves in the lower spine, causing leg pain and making bladder control difficult.
Magnetic resonance imaging (MRI) showed herniated (‘slipped’ or ruptured) discs in his lumbar spine and sacrum. Surgeons wanted to operate, but Ron instead decided to try Egoscue with UK osteopath Matthew Carratu, who gave him a ‘crisis menu’ of exercises. Within three days, Ron could control his bladder and had reduced his pain scale from 7/10 to 4/10.
This motivated Ron so much that he did his exercises twice a day, and three weeks later, his pain was down to 2/10. By the third month, he’d taken up yoga and was pain-free.
The Gokhale Method
Haleh Agdassi, a physical medicine and rehabilitation doctor in Palo Alto, California, had “neck and shoulder tightness” that she attributed to her years of wearing white lab coats with heavily laden pockets, causing a chronic head-forward posture.
After attending a posture class with Esther Gokhale, she immediately felt better. “It was just after I left the class and sat in my car that I started noticing the change.”
Today, she says the Gokhale Method has changed her own medical approach. Most patients who come to her with back pain have tried numerous modalities for healing, but now she simply refers many of them to the system that worked so well for her.
Yanis Massard, now in his 40s, was a longtime surfer and stand-up paddle boarder who worked out every day until his back went. Stuck on a sofa for several months with a herniated disc in his lower spine, he couldn’t stand, sit or lie down without severe pain despite painkillers.
After stumbling across FT on YouTube, he invested in a series of FT videos. “Slowly but surely, the unbearable
hip pain that radiated all the way down to my toes began receding,” he writes. “Six months after my back went out and about two months after starting the FT program, I was back in the water. Life saver.”
The Founder Exercise
According to Eric Goodman, this is the primary exercise in FT—the key that unlocks the posterior muscle chain that runs down the spine and legs, and reinforces proper movement while strengthening the entire back. “If you find yourself sitting for long periods of time, take a break every hour or so and do the exercise. It only takes a minute, and your back will definitely thank you,” he says. Dr Goodman also walks you through the exercise on www.youtube.com/watch?v=BWV6keJUDeo
1) Start with your feet about 24 inches apart, knees slightly bent. Make sure your weight is on the heels of your feet.
2) Pull your hips back to make a straight line from the knees to your ankles. As your hips pull back, the chest lifts.
3) Reach your arms back, fanning the fingers and opening up the front of the body as much as possible. From this position, you should feel a lot of tension in the lower spinal muscles.
4) Take a deep breath in and, as you exhale, lift your arms up in front of you, keeping the hips back and not letting your knees come forward, weight still on your heels. Take a big breath while holding this position.
5) Exhale, knees bent, and stretch your arms down until your hands touch the floor, still keeping your weight on your heels behind you, and really stretch the hamstrings.
6) Take a big breath in this position and hold for 10–15 seconds.
7) Run your hands up your shins while pulling your shoulders together, then lift your head, arching your spine as you lift your upper body. Once the spine muscles feel braced, reach your arms behind you, fanning the fingers again. Make sure your weight is on your heels, the knees are back, the chest is high and the lower back muscles are really tight.
8) Slowly bring your arms all the way up in front of you again, and increase the tension as much as you can for around
9) Stand up straight, pressing through the heels and dropping your arms.