Many of the situations that I manage with folks are conditions that came on without a notice, warning or dramatic event. Out of the blue some part or action has become difficult and painful. Common sense suggests that these things came on slowly but surely, eventually taxing some part of anatomy. Although sometimes just called a sprain or strain, these injuries are also given names such as “—itis”, “repetitive use injury” or “degenerative —-“. Although not inaccurate, I dislike the effects these terms can have. Often, I will observe them conveying a false sense of hopelessness and a sentiment of fatalism about ones situation. The march of time cannot be halted, but these conditions occur for known reasons, and changing those reasons for the kinder, can lead to a positive change in the situation.
So what exactly needs to change?
Our present tenses are the result of everything that previously brought us here. We are arguably the ever evolving result of our past experiences, tendencies, habits, efforts and underlying potentials. Taking it back to high school physics, Newtons first and third laws give a good underlying explanation for this:
First Law: An object at rest/in motion stays at rest/in motion unless otherwise acted upon by another unbalanced force.
Third Law: For every action, there is an equal and opposite reaction.
Summarized: Things will happen/not happen and continue to do so unless something else acts on it. These actions/inactions have predictable effects on other things.
Translated: Everything happens, has happened and will happen for a reason.
This model has a rather mechanistic view of things, which although easy to conceptualize, is only partially true. Our world is much more complicated than that. Cause and effect is all around us though, and Eastern thought has a different term for the same concept; Karma.
There is a wonderful passage in Jon Kabat-Zinn’s “Wherever you go, there you are” (1) that does a great job conveying the concept of karma:
“Karma means that this happens because that happened. B is connected in some way to A, every effect has an antecedent cause, and every cause an effect that is its measure and its consequence, at least at the non-quantum level. Overall, when we speak of a person’s karma, it means the sum total of the person’s direction in life and the tenor of the things that occur around that person, caused by antecedent conditions, actions, thoughts, feelings, sense impressions, desires. Karma is often wrongly confused with the notions of a fixed destiny. It is more like an accumulation of tendencies that can lock us into particular behavior patterns, which themselves result in further accumulations of tendencies of a similar nature. So it is easy to become imprisoned by our karma and to think that the cause always lies elsewhere – with other people and conditions beyond our control, never within ourselves.”
We are capable of incredible possibilities, intellectually, physically and creatively. Often our bodies and personalities tell a story not only of our inheritance, but also of our preferences, practices, habits and past traumas/troubles. The way we hold ourselves, our gait, our ability to relax or focus, our ease of movement, reaction speeds, resting muscle tone; all convey the rippling past that holds the present up.
What can drive this is our human capability for significant adaptation to our environmental demands. Challenge a tissue/body system, it will respond to meet that challenge. Do it often, it will try to be ready for it and adapt itself. Adaptation cannot occur overnight in most cases, and the rate of loading the challenge needs to match the bodies rate of ability to adapt. Load the skin with friction slowly and often: you will form a callus. Load it too quickly for the tissue to adapt: a blister forms instead.
OUR MUSCLES ADAPT
The most obvious examples that relates to our physical bodies is that of neuro-muscular adaptation to stresses or a lack of stress. It’s commonly observed that if you gradually take on an activity (cycling, running, resistance training, etc), what was hard at first will eventually be easier. If you do an endurance activity habitually, you get more endurance. If you perform strengthening exercises, you become stronger.
In our culture that is always looking for a short cut to attain their goals, the truth can often be challenging and maturing. If you want to be good at running: run a lot. If you want to be fast, then run fast. A lot. If you want to be good at distance running, run for long periods/distances. It is that simple.
This is known in the conditioning and rehabilitation worlds as the SAID principle. This stands for specific adaptation to imposed demands. Roughly translated: If you do something demanding regularly, below the threshold of injury/tissue breakdown, it will become easier.
Unfortunately the converse is true as well; with disuse we lose strength, capacity and often atrophy can occur. General deconditioning can begin to occur body wide after simply 24 hours of bed rest (2). In fact, muscles begin to atrophy within the first 24 hours of immobilization after injury (3). This is where the old adege of use it or lose it holds fairly true.
Now the idea that performing physical challenges will eventually lead to them being easier assumes that we perform whatever chosen activity in the most efficient and durable way possible. Often we do not. Often we take the easiest, least demanding method to perform the task (4). This can lead to uneven distribution of labor, and certain tissues become overloaded, eventually breaking down. This is the case of muscle strains when some excessive load happens suddenly, and tendon degeneration/failure as overload is chronic. If it was just repetitive use done well, the body would merely be exhausted. Often, such is not the case.
This is where learning how to move well, not just a lot is crucial. Sensing and being capable of good, durable movement patterns requires time and regular practice. I have written about this HERE, and HERE.
OUR BONES ADAPT
This phenomenon of continual adaptation also applies to our bony skeleton. Known as Wolfs Law, it is observed that in a normally functioning body, bone will lay down bone as and where demanded. If the demands/loads on bone are increased, the body will adapt to make the bones stronger, thicker, denser. If there is a lack of demands, as in the case of inactivity, the body will reabsorb the tissue and the density will decrease.
The result of chronic focal loading of bone, too much too soon, is a stress fracture. This typically only occurs with habitual high impact or end range activities like running, jumping, dancing or gymnastics (5). Think of stress fractures as the blisters of bone.
Now, conversely, the the result of chronic disuse is osteoporosis.
This is why the most effect treatment for osteoporosis is progressive resistance training (6). It just reverses the process. Ideally, if our body lifts weight/strains under controlled resistance daily, osteoporosis should only happen due to uncommon metabolic reasons. Although wonderful forms of regular aerobic exercise, regular walking, cycling or swimming will not accomplish this (7,8).
So with disuse bone wastes away, but with excessive loading hypertrophy can occur, and the bony mass enlarge. This is seen in the imaging of long term weight training/power athletes (7,8).
Hypertrophy in response to habitual high loads on focal parts of are body are also the cause of bone spurs. Think about that. Bone spurs will only occur because of excessive loads.
That bone spur on your heel is because you habitually yanked on your plantar fascia day in, day out, and your body responded by anchoring it down more effectively.
Bone spurs in your spine? Sounds like you hung out in end range spinal extension enough to motivate your body to send reinforcements.
Bone spurs can be seen as the excessive callous of our skeletons.
A third example of bony adaptation to habitual demands is seen in deformities. When we are born, our skeletons are not solid, and are much more cartilage than hard bone. The result is that our bony structure will form based on the loads and movement patterns placed on it. This is the case in being bow legged, knocked kneed or flat footed. That is just how you learned how to walk, and the bones adapted. The tragic skeletal structures of individuals with spastic cerebral palsy display this eloquently.
Now even with mere longstanding postural habits, spinal deformities can often occur throughout our lifespans. It is common knowledge that hunching over hours on end, under load, day in day out can lead to a hyper kyphosis. It is not so common knowledge that habitually leaning to one side/leg and breathing asymmetrically can contribute to a scoliosis (9).
Again, all of these examples are the effects and outcomes little things building up to bigger things. At times, the snow ball becomes the avalanche.
OUR MINDS, THEY TOO ADAPT
Our neuro-muscular and skeletal systems are just two visually obvious and striking examples of adaptation. More subtly, but nonetheless very much present, our mental/psychological states are in constant adaptation. Arguably it is our nervous system itself that drives the adaptation of our bodies! It is good to remember that there is always a brain willing (or not willing) those muscles and bones. Within that brain is a person, holding motivations, fears, desires, goals and values.
Our brains are vastly complex, but two simple ways in which psychological and mental processes effect our bodies is found in trauma and hyper vigilance (or, prolonged sympathetic states).
Previous injuries or painful events will often have a memory effect on our bodies. These events are traumatic, debilitating and at times very frightening. For periods of time we learn to avoid injured limbs, parts or movements, and this does not seem to always improve without conscious effort, even as the anatomy has healed (10). Beyond avoidance, our nervous system has two general reflexive responses to injury beyond the production of pain; splinting and neuromuscular inhibition (11, 12).
If an action is perceived to be dangerous or threatening, your brain with say no and cut the power. These are the cases of backs and knees buckling. Often we have to retrain parts of our body to be responsive again after injury.
If a movement or range is perceived to be dangerous or threatening, your brain with prevent it. This this the splinting, the cramping, the tightening of muscles with injury. Often we have to retrain parts of our body to relax again after injury.
At times this splinting/inhibition can bleed over to our general habits and confidence with use of the limb/part injured. This is known as fear-avoidance, and it can be at times a large contributor to the chronicity of some situations (10).
Besides the effects of trauma, at times for a variety of reasons we can get stuck in a sympathetic response to a great portion of our life demands. I have written about this HERE. This can result in general hyper vigilence. For many of us this hyper vigilance will result in excessive muscle tone, often a spinal extension strategy, and often favoring centering ones weight over and back on our right side. It keeps us ever ready for what ever may come to us. It goes without saying, this will not allow you to rest/relax and will overload certain parts of anatomy if it is our preferred and typical strategy.
Mindfulness, breathing exercises, and at times cognitive behavioral therapy, are often some of the necessary solutions to these issues (13, 14). Sadly, it is often under addressed in our health care system.
SOME CHANGES ARE PERMANENT, OTHERS ARE NOT
Postural adaptations occur often, and when habitual, changes can become solidified. Kyphotic and scoliotic curves, the arch height of our feet, hip structure and the angulation of our legs all are seemingly permanent once our skeletons growth plates have fused.
As excessive loading of certain tissues marches on over time, degeneration often occurs to tendons and joint. In the case of osteoarthritis, the changes to cartilage seems permanent, and currently our best treatment is to prolong the time before an inevitable joint replacement via physical rehabilitation of movement strategies. Although modern medicine is looking into techniques to replace damaged cartilage in otherwise healthy joints, the best strategy to prolong joint health is to train your self to move well/durably.
In the case of tendon degeneration, there are a variety of surgical repairs when the damage is to far gone. When the tissue is not completely ruptured, non-surgical treatments is preferred, but again, it all comes back to learning how to treat and load the tissue without overloading it.
Squatting hurts your knees? Learn how to squat and not twist your knees.
Push ups or lifting things overhead hurts your shoulders? Learn how to not shrug your shoulders when straining.
Back pain when you do difficult or prolonged things? Learn to strengthen your core and apply it to life. Such as what is explained HERE.
TENDING OUR GARDENS
Neuro-muscular, skeletal and mental adaptations are just three broad examples of our incredible potentials for the good and unfortunate. In our busy, cerebral, fast paced and strikingly sedentary lives it is important to recognize our habits, tendencies/practices, and make conscious choices about them. This comes back to taking responsibility for our situations. Hence, karma.
Learn to move well not just often, learn to recognize your current boundaries and how to effectively maintain, challenge and even broaden them. Learn to recognize habits that may be sabotaging or preventing you from attaining the this. Learn to inhabit your body.
We are arguably the ever evolving result of our past experiences, tendencies, habits, efforts and underlying potentials. Cherish this for the garden that it is, and tend it everyday.
- Kabat-Zinn, John “Where ever you go, there you are: Mindfulness and meditation in everyday life” Hyperion 2005 p.220
- Convertino VA, et al “An overview of the issues: physiological effects of bed rest and restricted physical activity” Med Sci Sports Exerc 1997 Feb; 29(2): 187-90
- Booth FW “Effect of limb immobilization on skeletal muscle” Journal of Applied Physiology 1982 May; 52(5):1113-18
- Selinger JC, et al “Humans can continuously optimize energetic cost during walking” Current Biology 2015 Sept; 25(18): 2452-56
- Romani WA, et al “Mechanism and management of stress fractures in physically active persons” Journal of Athletic Training 2002; 37(3): 306-14
- Layne JE, Nelson ME “The effects of progressive resistance training on bone density: a review” Medicine and Science in Sports and Exercise 1999; 31(1): 25-30
- Sabo D, et al “Bone quality in the lumbar spine in high-performance athletes” Eur Spine J 1996; 5(4): 258-63
- Sabo D, et al “Modification of bone quality by extreme physical stress. Bone density measurements in high-performance athletes using dual energy x-ray absorptiometry” Z Orthop lure Grenzgeb 1998; 134(1): 1-6
- Vlaeyen JW, et al “Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art” Pain 2000 Apr; 85(3): 317-32
- Rice DA, et al “Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives” Semin Arthritis Rheum 2010 Dec; 40(3): 250-66
- Mense, Siegfried “Muscle Pain: Mechanisms and Clinical Significance” Dtsch Arztebl Int 2008; 105(12): 214-9
- Hofmann SG, et al “Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials” J Clin Psychiatry 2008 Apr; 69(4): 621-32
- McCracken LM, Turk DC “Behavioral and Cognitive-Behavioral treatment for Chronic Pain: Outcome, predictors of outcome, and treatment process” Spine 2002 Nov; 27(22): 2564-73