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Why Back Pain Is Nearly Non-Existent In Some Populations


And today in Your Health, let's revisit a popular story aired in this segment. It's about back pain. Most Americans have a problem with it at some point. And for an unlucky third of the people in the United States, treatments don't work and the back pain becomes chronic. There are a few places, though, where back pain hardly exists, mostly indigenous cultures far removed from modern life. In this encore, NPR's Michaeleen Doucleff takes us to Palo Alto, Calif. to visit a woman who thinks she knows why these traditional societies have such healthy backs.


MICHAELEEN DOUCLEFF, BYLINE: After she had her first baby, Esther Gokhale couldn't even bend down to pick up her child.

ESTHER GOKHALE: I had excruciating pain. I could not sleep at night. And I was just crippled.

DOUCLEFF: Gokhale had a herniated disc. Eventually she had surgery to fix it. But a year later, it happened again.

GOKHALE: And they wanted to do another surgery. And, you know, you don't want to make a habit out of back surgery.

DOUCLEFF: Gokhale is a smart woman. She has a degree in biochemistry from Harvard, and she's a licensed acupuncturist. This time around, she wanted to think outside the box, and here's what she came up with.

GOKHALE: Go to populations where they don't have these huge problems and see what they're doing.

DOUCLEFF: Gokhale went online and searched through medical studies. She studied the work of some leading anthropologists, and she found something intriguing - several studies of traditional populations reporting very low rates of back pain. We're talking about people who live far away from modern life. Now, most of us would've stopped there - at doing research on the web - but not Gokhale. She went to the mountains in Ecuador, to tiny fishing towns in Portugal and to the remote deserts of West Africa.

GOKHALE: I went to villages where every kid under 4 was frightened to see someone with white skin.

DOUCLEFF: Gokhale took photos of people who walked with water buckets on their heads, collected firewood or sat on the ground weaving for hours.

GOKHALE: I have a picture in my book of these two women who spend seven to nine hours every day, bent over, gathering water chestnuts. And they're not spring chickens; they're quite old. But the truth is that they don't have back problems.

DOUCLEFF: She tried to figure out what all these different people had in common, and the first thing that popped out was the shape of their spines.

GOKHALE: They have this regal posture, and it's a very compelling.

DOUCLEFF: And quite different than American spines. Here's an experiment. Take a friend and have them stand up and turn to their left so you're looking at them in profile. If they have what we think of as good posture, then their spine is shaped like an S. It curves at the top and then back again at the bottom. This is what's drawn in medical books. But Gokhale didn't see those two big curves in people who don't have back pain.

GOKHALE: That S-shaped spine is actually not natural. It's a J-shaped spine that you want.

DOUCLEFF: In fact, if you look at drawings from da Vinci - or a "Gray's Anatomy" book from 1901 - the spine isn't shaped like a curvy S. It's much flatter almost all the way down the back. And then at the bottom, it curves to stick the butt out, so it looks more like a J. It seemed to her that this J shape was key to a pain-free back, so she developed a set of exercises to get her spine into the J shape. And gradually, her back pain went away. Then Gokhale realized she could help others. She wrote a book, set up a studio in downtown Palo Alto.


UNIDENTIFIED WOMAN: And so without further ado, welcome Esther from all of us here in Silicon Valley.


DOUCLEFF: The day I caught up with her, she was giving a workshop at one of the biggest law firms in the world - Jones Day in Palo Alto. About 50 workers dressed in khakis and pencil skirts came to learn how they could sit at their computers for hours without hurting their backs. Gokhale brings a volunteer to the front to demonstrate the most common problem - the way we hold our shoulders.


GOKHALE: Now, if we look at you from the front view, we can see that the portion of her hand that faces forward is mostly her knuckles and not so much the thumb.

DOUCLEFF: Americans tend to scrunch their shoulders forward so our arms are turned in. That's not how people in indigenous cultures carry their arms.


GOKHALE: And we're going to show you a very simple way of addressing this.

DOUCLEFF: Gokhale gently takes the woman's shoulders, pulls them up, pushes them back and lets them drop, like a shoulder roll. And then the woman's arms dangle by her side.


GOKHALE: This is a natural architecture for our species. So it behooves us all to explore this.

DOUCLEFF: Her list of clients is impressive. She's helped YouTube CEO Susan Wojcicki, Matt Drudge of the Drudge Report, and she's given classes at Google, Facebook. In Silicon Valley, she's known as the posture guru. But there's still a big question - is she right? Have people in Western society somehow forgotten the right way to stand? Praveen Mummaneni knows spines intimately. He operates on them three times a week and co-directs the Spine Center at the University of California in San Francisco. Mummaneni says scientists don't know yet why some traditional cultures have fewer problems with back pain. Nobody's done a systematic study or even documented the shape of their spines.

PRAVEEN MUMMANENI: I'd like to go and take X-rays of indigenous populations and compare it to the Western world. I think that would be very helpful.

DOUCLEFF: But Mummaneni says there's a whole bunch of reasons why postures of Americans and the shape of their spines may be different than indigenous populations. For starters, Americans tend to be much heavier.

MUMMANENI: If you have a lot of fat built up in your belly, it can tend to pull your low back forward.

DOUCLEFF: And that would curve the spine?

MUMMANENI: That could curve the spine. And people who are fairly thin probably have less curvature.

DOUCLEFF: And, thus, a spine shaped more like a J than an S. Mummaneni also points out that Americans are much less active than people in traditional cultures.

Do you think that that sedentary lifestyle could have an effect on the spine shape?

MUMMANENI: I think the sedentary lifestyle promotes a lack of muscle tone and a lack of postural stability because the muscles get weak.

DOUCLEFF: Everyone knows that weak abdominal muscles can cause back pain. And, in fact, Mummaneni says that might be the secret to Gokhale's success. It's not that the J shape is the ideal one or the healthiest. It's what goes into making the J shape that matters.

MUMMANENI: And you have to use muscle strength to get it to look like the J-shaped spine.

DOUCLEFF: So Gokhale has somehow figured out a way to teach people to build up their core muscles without them even knowing it.

MUMMANENI: You're not going to be able to go from the S to the J without having good core muscle strength, and I think that's a key here.

DOUCLEFF: In other words, indigenous people around the world don't have a magic bullet for stopping back pain. They've just got beefy abdominal muscles, and their lifestyle helps to keep them that way even as they age. Michaeleen Doucleff, NPR News. Transcript provided by NPR, Copyright NPR.

Michaeleen Doucleff, PhD, is a correspondent for NPR's Science Desk. For nearly a decade, she has been reporting for the radio and the web for NPR's global health outlet, Goats and Soda. Doucleff focuses on disease outbreaks, cross-cultural parenting, and women and children's health.

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