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In search of better back pain treatment: NPR guides us to the right destination (with a few detours along the way)


4 Star


Lost Posture: Why Indigenous Cultures Don't Have Back Pain

Our Review Summary

Will adopting the posture of indigenous peoples help reduce rates of back pain?

Will adopting the posture of indigenous peoples help reduce rates of lower back pain?

The story discusses a technique called the “Gokhale Method” for reducing back pain by focusing on exercises that can help to improve posture. It’s clear that a lot of reporting went into the piece. And the story does a good job of highlighting that building up “core” strength in the abdomen is important for limiting or preventing back pain, regardless of whether one uses the Gokhale Method. However, the story seems to dismiss causes of back pain that aren’t related to muscle strength, and it doesn’t address cost at all. Also, while the story does eventually warn us that there’s little if any hard evidence to support the Gokhale approach, we have to wade more than halfway through the 1,200-word story before the first caveat is introduced. Such an important qualifier should be delivered sooner.


Why This Matters

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) reported in 2010 that up to 80 percent of Americans experience lower back pain in their lifetime, with up to 20 percent experiencing “protracted” pain and as many as 8 percent experiencing chronic back pain. In other words, back pain is something that most Americans will have to deal with at some point. The 2010 NIAMS report cites annual back pain-related costs of $50 billion. Any treatment options for a health problem that affects this many people, and can have this kind of economic impact, is worth covering.


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story doesn’t mention cost at all. And cost could be a significant factor for anyone interested in pursuing the Gokhale Method. According to the Gokhale Method website, a 45-minute initial consultation (in person or via online video) costs $165. For maximum value, the story could have provided some discussion of the Gokhlae method cost vs. comparison of other strengthening programs — e.g. physical therapy, Pilates, yoga, working with athletic trainer.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story doesn’t quantify the benefits of the Gokhale Method in any way. Nor does it quantify the potential benefits of mimicking traditional cultures with low rates of back pain or of having the so-called “J-shaped spine” that the Gokhale Method promotes. Now, perhaps that’s understandable, since the story does eventually acknowledge that the Gokhale method has never been studied in a clinical trial, and that it’s not clear whether J-shaped spines are really more common in indigenous societies. But we thought it was unacceptable for the story to wait some 750 words — all focused on benefits — before introducing these notes of caution. Moreover, while the story does note that stronger abdominal muscles may help limit back pain, there’s no attempt to quantify the potential benefits of abdominal exercise either. And those approaches (Pilates, physical therapy, etc.) have been well-studied. Instead, the story rests largely on anecdote. For example, it notes that Esther Gokhale (who developed the method) “worked to get her spine into the J shape….[and] her back pain went away.”

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story notes that an active lifestyle, and strong abdominal muscles, can reduce the risk of back pain. And there’s a lot of evidence to support this. But not all exercises are created equal. Some exercises that people associate with abdominal strength may actually aggravate lower back pain. Full sit-ups can worsen back pain as can bilateral leg lengths. Also, poorly done Pilates or yoga can as well. All require some training. The same is true of a generally active life style — excessive squats, planks, core strengthening can worsen back pain. Some acknowledgement of that fact would have earned the story a Satisfactory rating here.

Does the story seem to grasp the quality of the evidence?


This was a close call that we’ll give the benefit of the doubt on, with some reservations. The story presents no evidence, other than a general assurance and an undocumented reference to a tribe in central India, that indigenous cultures have lower rates of back pain. It might very well be true, but the premise is not supported in the story. In addition, the story includes some lines that beg to be backed up with evidence, such as: “Everyone knows that weak abdominal muscles can cause back pain.” How does everyone know that?

However, even though it comes late, the story does make clear that the Gokhale Method has never been tested in a clinical trial — and that no one has done a study on traditional cultures to see why some have lower rates of back pain (if, in fact, they do have lower rates of back pain). Because it does eventually address the lack of evidence to support Gokhale’s claims — the main hook for the piece — we’ll give the story a satisfactory rating.

Does the story commit disease-mongering?


We looked closely at some of the story’s statistics on low back pain for this criterion. The story says that “most Americans will at some point have a problem with their backs,” which is true — the NIAMS data back it up. But the story also says that “for an unlucky third, treatments won’t work and the problem will become chronic.” The “unlucky third” claim links to a 2012 Gallup news release, which reported “an average of 31% of Americans reported having a [chronic] neck or back condition.” But the numbers in the same release shed a little extra light on the subject. Specifically, the numbers show that the “unlucky third” would appear to refer primarily to the 36-37 percent of Americans in their mid-50s and older who self-reported having chronic pain in their back or their neck during a Gallup poll. NIAMS estimates that the number of people with chronic lower back pain is more in the 2-8 percent range. However, the “unlucky third” claim is supported by some data, and the story linked to it. So it gets a Satisfactory rating.

Does the story use independent sources and identify conflicts of interest?


In addition to Esther Gokhale, the story cites two physicians. The story clearly notes that one of the physicians refers patients to Gokhale.

Does the story compare the new approach with existing alternatives?


The story does stress that having good core muscle strength is important to reducing or preventing back pain, regardless of whether one uses the Gokhale Method. And it discusses approaches other than Gokhale to achieve that strength. However, it would have been good to note that there are multiple factors that can contribute significantly to back pain, including arthritis, osteoporosis, and injury. With any sort of nerve impingement (e.g. herniated disc pinching nerve), exercise alone will not work. And if there are degenerative changes, often more treatment is required, and that is very common. Finally, not all back pain is benign, and one would need to rule out things like metastatic cancer if pain is ongoing. The story would have been stronger if it had noted that sometimes exercise isn’t enough — and sometimes other treatment options are required so that a patient can manage the pain well enough to begin an exercise regime.

Does the story establish the availability of the treatment/test/product/procedure?


The story makes clear that the Gokhale Method is available.

Does the story establish the true novelty of the approach?


The story makes it clear that Gokhale’s claims to novelty aren’t actually all that novel. It notes that the benefits achieved with Gokhale (and in the indigenous lifestyles upon which they are based) are probably due to an active life style and better muscle tone — rather than to any particular “secret” that the medical community was previously unaware of.

Does the story appear to rely solely or largely on a news release?


The story isn’t linked to any news release that we could find, and includes enough original reporting that we can be sure it wasn’t based entirely on a release.

Total Score: 7 of 10 Satisfactory

Comments (1)

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Joseph Cimino, DC

June 15, 2015 at 2:37 pm

This review is very generous at the least. Even in the satisfactory aspects, one points out it wasn’t quite\completely satisfactory. Before Gokhale, many others have looked at indigenous peoples to see why they didn’t have back pain, this was glossed over by NPR. The issue relates more to the entire lifestyle of said tribe, the daily physical demands, usually of substance living; something few in the comforts of “civilized” living will be willing to give up, let alone raise their infants in that environment, (excluding religious sects).

I am all for a new perspective on back pain and back related issues, but there is a “quick fix” mentality in America and in media reporting that irks me.