Over the past century we’ve seen our world transform into a more industrialized civilization with major technological advancements. Yet, during this time period, especially in the past 30-40 years, there has been a dramatic downturn in the physical capabilities of humans through the lifespan. Chronic back pain continues to rise year over year. Those out of work due to disability has never been higher. The other day as I walked through the airport I realized a large percentage of those around me either required a motorized ride, assistive device, or were flat out laboring to carry a small piece of luggage while walking to their gate.
More details on this picture in PART II
The obvious factors to blame are ultraprocessed nutrition (looking at you Food Pyramid) and sedentary lifestyle, but in reality many factors have played a role in this rapid decline. I feel the most overlooked player in the functional capacity disaster we’ve created is messaging. The narrative surrounding health, wellness, medicine, and healing needs a major rebrand.
The following are client narratives I hear on a daily basis:
“I stopped doing anything on the ground because of my knee arthritis”
“I can’t lift weights because of my back issue”
“Oh no, no… I can’t play my favorite rec sports anymore because of an old injury”
“I used to run, but my hips nag me, so I stopped doing any training”
Or my personal favorites:
“My doctor told me I can’t pick up my grandkids because my back is too fragile”
"My doctor told me I can't play pick-up basketball because my x-ray looks
like I have a knee of a 90 year old"
Side note:
Why would a clinician who
is trying to "help" someone
ever say that to a patient?
How can that possibly help!?
(I'll save that rant for another time!)
Now you might think I am just picking on people for making excuses. That’s absolutely not the case… and I am arguing quite the opposite. It’s very easy to be sucked in to the “hurt = harm” mindset. Pain and dysfunction can be very threatening, both physically, psychologically, and emotionally. Rather, I am picking on the culture created in traditional biomedical models that any ache or pain means something is “wrong with your body and someone (not you!) or some pill/injection/surgery must fix it”.
This sends a horrific, unproductive message:
You are fragile
You are not capable or you must limit the activities you perform
And guess what… your body listens and buys in to this false message.
Let’s quickly rewind and define PAIN:
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” – IASP definition of pain
Our brain is a prediction machine. It works off of past experiences and makes predictions on how to respond to certain stimuli based on those experiences. Therefore, our thoughts and perceptions have a direct impact on influencing the narrative of a painful or threatening experience.
The best example of this “pain narrative” experience is a young infant running around the house, tripping, and falling on the floor. What is their immediate reaction? More often than not, they’ll pop their head up, turn straight toward mom or dad and check their reaction. The kiddo is unsure. Their little nervous systems do not have much history to predict from. Therefore, they are looking for more sensory input from mom and dad on how to respond to the experience. If the fall led to a small painful stimulus, but it’s paired with a big smile and clapping from mom and dad, then most likely the kiddo will hop back up and continue playing. Pair that same small painful stimulus with a look of fear, concern, and panic from mom and dad… well, then you may have a sobbing child on your hands.
Obviously, if an infant puts their head through the drywall when rounding a corner like my nephew once did, then their nervous system won’t be looking for input from mom and dad… they’ll be bawling their eyes out!
So what’s my point?
Most may think the “smart adult” is just tricking the kid into thinking they are fine. Not so fast… it’s actually the “smart kid” using the adult’s reaction to confirm what their internal perception is already telling them… they are safe and resilient. The key factor is the current internal state of the infant at time of perceived or real threat. A few days prior the same kiddo may have taken a similar spill except at the time the child was running on fumes having missed their nap and a few hours ago wolfed down some tasty sugary treats leaving their current internal state hangry, tired, and completely dysregulated. So when the fall occurred, there was no amount of clapping or happy smiles from mom or dad that could have positively affected the internal state of the child. In fact, the child may not even take the time to look up and see the reaction of mom or dad.
Therefore, the current bodily environment, combined with the thoughts and perceptions of an experience, play an integral role in mapping both past and future pain and dysfunction in our brain. And guess what, the adult brain is the same brain as that little kiddo. We all have periods of feeling tired, hangry, frustrated, concerned, stressed, and overwhelmed… and just like that little kid it directly influences our internal state and how we respond to daily stress, pain, or dysfunction.
It’s much easier for us to wrap our head around the example of the child’s internal state and how to promote resiliency. Yet, for some reason, as we age at some point the narrative flips on the resiliency of the human body. When an adult gets hurt or tweaks a muscle they walk into a doctor’s office and unlike the kiddo seeing an encouraging parent clapping and smiling, the adult brain sees scary posters on the wall…
"Does your back hurt? You may have SCIATICA…" (with a picture showing a hunched over person with a scary red heatwave near their low back running down the leg)
Posters with an x-ray of the human body… every joint lit up brighter than a Christmas tree with red hot spots – next to it an ad for the latest joint pain medication
I do want to be clear. I am NOT saying that all pain and dysfunction is in your head. I am NOT saying that if you just have a positive attitude your pain and dysfunction will magically go away. I am NOT discounting the severe impact acute injuries can have on the body. And I am NOT saying traditional biomedical models are useless… these models save lives every day. I am just shedding light on the fact that our internal pain and dysfunction map is molded by three main criteria:
Implicit memories of past experiences
Current thoughts and perceptions of the experience
Current functional status of our neuromusculoskeletal system
Due to the properties of this criteria, the body’s “pain and dysfunction map” is not static, it’s moldable… dynamic and plastic. This is what’s so special about the human body… it has the capacity to be resilient! And, it is also why I cringe every time I hear the narratives I quoted at the beginning on this blog! Each one of those statements can be challenged and potentially proved false if you holistically address all three of the criteria listed above.
Stay tuned for PART II of this article series...
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