When you’re out of shape, it takes discipline to get back in shape. Even if you know very well it is good for you and that you have experienced the benefits of more physical activity in the past, it takes willpower to start. And when you start moving, even though it feels liberating to move again, it still takes willpower to get moving again two days later. Only when you’re moving for a longer time, for a lot of people the pattern reverses: you feel bad if for some reason you get a week without real movement.
Why is it that something that is so good for us, takes discipline and willpower to do? Why didn’t Mother Nature make us better? Why didn’t evolution through natural selection equip us with some mental module that keeps us moving?
Part of the answer to that last question is simple: energy preservation. Wasting energy is not a good thing to do in the competitive world called nature. Preserving energy is deeply rooted in our organisms. Rest when and wherever you can. It probably is a hyperbole, but I guess all animals need to preserve energy as much as they can.
Still, most animals, including ‘wild’ humans, move a lot and therefore are in a good shape. What makes them move? Their environment does. Hunger, need for shelter, sexual appetite gets them moving.
You can imagine an organism being pulled by two ropes. One rope is being pulled by the organisms ‘personal motives’: preserve energy. The other rope is being pulled by the environment: eat, survive, and reproduce.
If you then suddenly (in biological terms) change the environmental pull, the balance between the two pulling forces will be disturbed.
In the case of 21st century humans, our environment has a feeble and faint pull to get us moving. So we move in the direction of our ‘personal motive’ of preserving energy and as a result are out of shape.
So you can keep using willpower and discipline and push yourself, or you can change your environment and let it do the pulling. It is easier being pulled than to push.
How can we change our environment for more movement? That is food for another blog. But let us look at this principle and it’s consequences for people who have had an injury.
In my practice, I see a lot of people who need my guidance after an injury, even after injuries that probably were quite common in our ancestral past, like an ankle sprain. Why do they need a physical therapist and why do they not somehow know or feel what they have to do to get better?
I think it has to do with the same two pulling agents: ‘personal motives’ like pain, fatigue, fear and avoidance are not countered (or not enough) by the environmental pull. This leads to prolonged rest and avoidance of loading the tissues (like limping), and can even cause the infamous vicious circle of fear and avoidance.
Imagine a Hadza hunter-gatherer who, in the wilderness near Lake Eyasi in Tanzania, sprained his ankle during the hunt for a dikdik antelope. Being focused on the hunting, he probably didn’t feel a lot of pain at first, but a few hours later he feels an annoying pain around his lateral ankle and automatically starts limping. Once in camp he may even rest a bit more than usual and if the injury is significant, he may not go out on a hunt the next day or two. This is not a real problem, he can count on their tradition of food sharing, and maybe take the downtime to make some new arrows or other tools.
Also, medically speaking, this behaviour is what we’d call adaptive, meaning that it promotes healing. But what is adaptive behaviour at first can become maladaptive! But because the Hadza are one of the few people still living much like they did so for thousands of years, this injured man still has his environment pulling him in the right direction. He cannot afford to rest longer than necessary. As soon as possible (but not sooner) he will gradually take up all his tasks and physical activity. The balance between the pulling of the environment and his ‘personal motives’ lead him to a quick recovery.
Note that this scenario is almost certainly too simple. Sometimes the environment can exert too much pull (e.g. running away and climbing a tree to escape a dangerous animal can irritate the injured tissues). And I’m sure, although I don’t know of any data, that the Hadza also have ankle sprains that do not heal perfectly.
So physical therapists in the western world often need to mimic the pulling of the environment. Broadly speaking, the people you meet, including your PT, are part of your environment. We need to pull the patients out of their protective behaviour. This pulling must be gentle and gradual, and adequately timed.
Sometimes we need to pull the patient in the other direction, towards more rest, because the patient has an environment that pulls too much! An independent construction worker with an acute back pain that keeps on working, through the pain, even though he is taking a lot of painkillers. No fear and avoidance here, but maladaptive none the less.
So next time you have an injury, think of that Hadza man, and come and see me! 😉
Cheers,
Pieter
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