Home › Blog › Do People Have No Back Pain in Some Parts of the World?

Back pain is a hot topic and given that 85% of Americans experience back pain at some point and 1/3 of those will develop chronic back pain, it’s easy to understand why. But do those numbers hold true everywhere, or do some places in the world have no back pain?

One back surgery down, unwilling to have another and desperate for a permanent solution to her back pain, Esther Gokhale was committed to answering that question.  An acupuncturist with the work of an anthropologist who studied the posture of many diverse indigenous populations and several physiotherapy methods under her belt, she set out on a ten year journey to remote villages in places like Ecuador, Portugal and West Africa, keeping a photographic record of all she found.

Immersing herself in these cultures, her first clue came from simply observing people as they engaged in daily life. Whether they were standing, sitting, working, walking, or carrying heavy jugs and baskets on their heads, their posture was clearly remarkably different. For some reason their backs appeared much straighter, the way we used to stand up straight when we’d be admonished for slouching. Instead of the “S” shaped curve of our modern American backs, to her, these backs looked more like the letter  “J” (a very much shallower “S” is perhaps more accurate).  But it also looked vaguely familiar. Esther realized she had seen this posture in early art, like the statues of antiquity, and even in early anatomy books from the 19th century. So, what happened?  To figure that out, we need to understand how the spine works.

The purpose of the spine is to provide rigid support for the body and to protect the spinal cord and nerve roots which branch from it, as they carry critical information from the brain to the rest of the body. To understand how it works, it helps to think of it as a series of blocks stacked one on top of the other.  The blocks, called vertebra, have shock absorbers between them called discs. The vertebrae have a back part where the vertebrae meet called facet joints, and the column formed by the facet joints is what houses the spinal cord and the nerve roots which branch off it. But like any tower of blocks stacked too high, the spine naturally has a stability problem. To address this, the spine has two crucial support systems; ligaments and muscles. Ligaments act like duct tape to hold the spine together, and limit motion. But in addition to staying together, the spine also needs to stay aligned, otherwise vertebrae would slide past each other pinching nerves, causing both pain
and dysfunction.  How your spine achieves this all important alignment stability is through a group of segmental muscles, called MULTIFIDUS. Without these incredibly important muscles, each individual vertebra would become misaligned each time you moved. When these small stabilizing muscles atrophy due to inactivity or injury, a vicious cycle of instability causing injury causing instability begins. The curve of the spine also assists in maintaining stability, as it allows it to distribute load more effectively. You can learn more about Multifidus atrophy and spinal stability in Orthopedics 2.0. This video is a great explanation of how the spine works:

So what could be going on that could be responsible for straighter backs and no back pain?  Very simply, their stabilizing systems are healthier and stronger because they are significantly more active, and significantly thinner. Atrophied Multifidus muscles and more weight needing to be distributed result in more curve. When you need to fish or hunt for dinner and carry water and goods on your head for miles just like your ancestors did before you, there are both epigenetic and environmental factors at work. Thankfully, these things work in both directions, and Esther Gokhale went on to formulate a physiotherapy program to strengthen one’s core muscles to improve posture, which not only helped her back pain, but many others’. Egoscue is another program focused on correcting posture and your body’s alignment through strengthening key muscles.

The upshot?  The indigenous people studied had healthy backs because of their lifestyle, past and present. In our own culture in centuries past, young girls were taught good posture by walking with books on their heads.  Young boys didn’t need that training as their level of physical labor and activity accomplished the task.  But in this time of inactivity and overeating due to modern life, it takes a concerted effort to return your spine to health, and when you do, you’ll find yourself standing straighter with less or maybe even no back pain!

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile