The back button ... Esther Gokhale, right, teaches techniques for maintaining better posture. Photo: Jim Wilson

Matt Drudge recently noted an anniversary of his aggregator news site with a Twitter post: "18 years of DRUDGE REPORT in February! And STILL sitting ;)."

Drudge, 46, hasn't just been sitting for two decades. Like so many workers chained to their technology, he has been hunched over desktops, notebooks, smartphones and tablets, and it's all taken a toll on his body. He tries to limit the time he spends sitting to four or five hours a day, but sometimes he sits for up to 17 hours.

To ease his back, neck and shoulder pain, Drudge says, he has learnt how to adjust his posture. Whether he's typing in the car, from the wooden folding chair in his Miami home office or from a boardwalk bench at the beach on cloudy days, he makes sure to tilt the top of his pelvis forward, roll his shoulders back, elongate his spine and straighten his craned neck.

Sit up straight.

Sit up straight.

Drudge is one of thousands of people who have trained with Esther Gokhale, a posture expert in Silicon Valley. She believes that people suffer from pain and dysfunction because they have forgotten how to use their bodies. It's not the act of sitting for long periods that causes us pain, she says, it's the way we position ourselves.

Gokhale is not helping aching office workers with high-tech gadgets and medical therapies. Rather, she says she is reintroducing her clients to what she calls "primal posture" — a way of holding themselves that is shared by older babies and toddlers and that she says was common among our ancestors before slouching became a way of life. It is also a posture that Gokhale observed during research she conducted in a dozen other countries, as well as in India, where she was raised.

For a method based not on technology but primarily on observations of people, it has been embraced by an unlikely crowd: executives, board members and staff at some of Silicon Valley's biggest companies, including Google and Oracle; and heavy users of technology such as Drudge.

posture

An evolutionary issue.

"I need to do things that make sense and that I can see results from. Esther's work is like that," says Susan Wojcicki, 44, one of Google's senior vice-presidents, who has suffered from back and neck pain that she attributes to doing too much work at her desk.

Gokhale is not the first to suggest that changing posture is the key to a healthy spine. Practitioners of the Alexander Technique and the creators of the Aplomb Institute in Paris similarly help clients find more natural and comfortable ways to position themselves. Pilates and physical therapy can improve posture and bring awareness to it. A handful of companies, including Lumo BodyTech, now sell personal posture monitors, offering smartphone users constant feedback about the way they hold their bodies.

Gokhale's methods have not been tested scientifically, although a doctor at the Palo Alto Medical Foundation is planning to conduct clinical trials this year.

But Gokhale, who was trained as a biochemist at Princeton University and studied at Stanford's medical school, has some influence among medical professionals, particularly in Silicon Valley. More than 100 have referred patients to her, and a similar number have taken her course, she says.

For many office workers, sitting at a desk all day goes hand in hand with back, neck and shoulder discomfort. Stress and poor positioning can bring on aches or exacerbate injuries among workers faced with heavy computing, frequent travel and long meetings. Regardless of occupation or lifestyle, backaches affect most Americans — about 8 in 10 deal with the pain at some point in their lives, according to Richard Deyo, a professor of family medicine at Oregon Health and Science University.

The expenses are huge as well. By one estimate that appeared in The Journal of the American Medical Association, the national cost of treating people with back and neck pain was $US86 billion in 2005. And with back pain one of the main reasons for worker disability, missed work because of these aches might cost employers close to $US7 billion a year, according to one study.

For most people with back pain, the aches are short lived and relief comes with rest and time, according to Deyo. But methods to help those with chronic pain are diverse. Standing at a desk has become a popular way to ease discomfort. Exercise, yoga, acupuncture and chiropractic have also been shown to reduce pain. Medical treatments such as surgery and steroids continue to be important options, doctors say, even amid concerns that these have been overused.

Haleh Agdassi, a rehabilitation doctor with the Palo Alto Medical Foundation in California, sees back and neck pain so frequently among heavy users of computers that she calls it the "Silicon Valley syndrome." She encourages clients to try a mix of non-surgical strategies but finds it frustrating that treatments for such a common problem are only modestly effective.

"There's no magic bullet out there for back pain," she says. "That can be overwhelming for patients. It's an anxious, vulnerable crowd — they're looking for solutions." Gokhale, 52, can relate to the anxiety of searching for an answer. She previously dealt with pain in her lower back, first as a college student practicing yoga, then as a young mother with sciatica. She eventually had surgery for a herniated disc, but it failed, she says.

When doctors suggested she try a second time, Gokhale began a search for other answers. Many of her own clients come to her similarly exasperated, she said.

Drudge read Gokhale's book, 8 Steps to a Pain-Free Back, before training with her in person. "I needed her touch, her observations and her humanity," he says.

In Gokhale's courses, offered in her Palo Alto studio and in cities across the country, students relearn how to sit, stand, sleep and walk. While some clients take private classes, many enrol in group workshops with eight to 10 people who meet for six 90-minute sessions. While the students are often strangers, the classes are casual and intimate: most clients wear yoga clothes or sweatpants, and they giggle awkwardly as Gokhale adjusts their bodies.

Gokhale says that most Americans tend to be relaxed and slumped (think of a C-shaped spine), or arched up and tense (an S shape), the stand-up-straight style of posture that some parents demand of their children. She helps her students return their bodies to the stance that she says nature intended: upright and relaxed (a tall J spine).

With the care of a kindergarten teacher, Gokhale adjusts clients' bodies from bottom to top. She helps clients relax the front of the pelvis downward, so the belt line slants forward and the butt angles back, so "your behind is behind you, not under you" (a contrast to the neutral pelvis recommended in Pilates and some physical therapy).

Gokhale guides students' rib cages that sway too far back, so they are flush with the stomach. She takes their hunched shoulders, rolls them up and brings them gently back and down. And she helps students release tension in their necks by re-centering their heads over their spines and pulling upward slightly at the hairline on the neck. The result is an elongated and well-stacked spine that many students say they can maintain comfortably because their muscles are not strained.

She encourages people to take the class with colleagues and relatives, so that students can help remind each other to adjust their bodies. But even those who work alone find ways to remember their posture.

After doing a group workshop with Gokhale this year, Drudge says many things now remind him to make adjustments — seeing others with poor posture at Starbucks or the gym, passing by his reflection in a window, or sitting down in a chair to work.

"But I don't beat myself up about it. When I'm aware of my posture, I fix it," Drudge said. "And eventually, I think, it becomes who you are."

NEW YORK TIMES