"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 http_FasenditGetAllCheckedAbstracts and the Feldenkrais Method httpfeldenkrais.com and the work of anthropologist Noelle PerezChristiaens. Back pain is a tricky beast. Most Americans will at some point have a problem with their backs. And for an unlucky third http treatments wont work and the problem will become chronic. 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 http_highwire_article_pdf.fulltext.pdf 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 shes sharing their secrets with back pain sufferers across the U.S. About two decades ago Esther Gokhale httpgokhalemethod.combiographyEsther_Gokhale_L_Ac_ started to struggle with her own back after she had her first child. I had excruciating pain. I couldnt 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 dont 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 wasnt convinced Western medicine could do that. So Gokhale started to think outside the box. She had an idea Go to populations where they dont have these huge problems and see what theyre doing. Added June  So Gokhale studied findings from anthropologists such as Noelle PerezChristiaens http who analyzed postures of indigenous populations. And she studied physiotherapy methods such as the Alexander Technique http_FasenditGetAllCheckedAbstracts and the Feldenkrais Method httpfeldenkrais.com. 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  was crying because they were frightened to see somebody with white skin  theyd 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. Theyre quite old. But the truth is they dont 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 its very compelling. And its quite different than American spines. If you look at an Americans spine from the side or profile its shaped like the letter S. It curves at the top and then back again at the bottom. But Gokhale didnt see those two big curves in people who dont have back pain. That S shape is actually not natural she says. Its a Jshaped spine that you want. In fact if you look at drawings from Leonardo da Vinci  or a Grays Anatomy http book from   the spine isnt shaped like a sharp curvy S. Its 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 Jshaped spine is what you see in Greek statues. Its what you see in young children. Its good design Gokhale says. So Gokhale worked to get her spine into the J shape. And gradually her back pain went away. Then Gokhale realized she could help others httpgokhalemethod.com. She developed a set of exercises wrote a book http and set up a studio in downtown Palo Alto. Now her list of clients is impressive. Shes helped YouTube CEO Susan Wojcicki http and Matt Drudge of the Drudge Report http She has given classes at Google Facebook and companies across the country. In Silicon Valley shes 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 http an internist at the Palo Alto Medical Foundation. She puts Gokhales method in the same category as Pilates and yoga for back pain. And it doesnt bother her that the method hasnt been tested in a clinical trial. If people are finding things that are helpful and its not causing any harm then why do we have to wait for a trial Jain asked. But theres still a big question looming here Is Gokhale right Have people in Western cultures somehow forgotten the right way to stand Scientists dont know yet says Dr. Praveen Mummaneni http a neurosurgeon at the University of California San Franciscos 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. Id like to go and take Xrays of indigenous populations and compare it to people in the Western world Mummaneni says. I think that would be helpful. But theres 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 Gokhales success. In other words its not that the Jshaped spine is the ideal one  or the healthiest. Its what goes into making the Jshaped 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 thats correct Mummaneni says. Youre not going to be able to go from the S to the Jshaped spine without having good core muscle strength. And I think thats key here. So indigenous people around the world dont have a magic bullet for stopping back pain. Theyve just got beefy abdominal muscles and their lifestyle helps to keep them that way even as they age."