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by Craig Liebenson
What Happens When We Feel Activity Isn’t Safe?
The feeling of risking your physical wellbeing whilst working out can be quite concerning, especially for people experiencing musculoskeletal pain. It is natural to associate hurt with harm and assume activity is dangerous. Often we are told to rest when in pain and, “let pain be your guide”, so, the question is, how do we SAFELY return to the activities we love or value?
The first thing is to trust yourself. Your lived experience of pain is always valid. No-one can tell you what the “3 Best Exercises” are for your specific lower back pain, knee pain, etc. No-one can tell you that your pain is in your head or tell you it’s psychological because your scan is clean. Your pain is always real. That is the first thing.
Secondly, try self-care. Explore different types of movement that you enjoy. “Move to Improve” is a good guide since rest can lead to rust. But, don’t force anything, simply explore easy steps to see if you tolerate it. Keep a positive attitude and remember, not every hurt equals harm. If activity is uncomfortable but tolerable, that’s alright, since the motion is the lotion.
Third, avoid sitting too much or for too long. Every hour, try to go for a 15 minute brisk walk. If that is too frequent then try to walk for 30 minutes every 2 hours. Walking is a very low stress way to get activity. In terms of speed, brisk or power walking is ideal. In addition to walking, simple ‘Movement Snacks’, like light yoga, stationary bike, hip mobility drills, etc. can be performed for about 5-8 minutes every 4-6 hours. This keeps the window open for recovery by slow-cooking exposures that will gradually build your activity tolerance back up.
Fourth, if you feel severe (intolerable) or unusual pain, have had an injury, or are lacking confidence in your self-care, then seek out a Health Care Professional (Physio, Chiropractor, Osteopath, or M.D.) to guide you in this process. You can tell if you went to the right person if they:
- Listen to your story
- Validate your lived experience
- Seek to provide you with reassurance and reactivation advice
- Avoid jumping right into ordering scans
5 Questions to ask your Doctor or Health Care Provider from Choosing Wisely Australia
The World Has Stopped Moving
Did you know that 86% of people don't meet the World Health Organization’s (WHO's) recommendations for Physical Activity? Steven Hawking, before he died, said, “the cause of most diseases is we eat too much & move too little. Why it is more people don’t realize this is beyond my comprehension”. People are sitting more, obesity and diabetes are on the rise. Choosing to use motorized transportation instead of walking or biking contributes to a syndemic of climate change and obesity.
By increasing physical activity to meet the WHO’s guidelines, the risk of all causes of mortality can be reduced by 30%. These guidelines are as follows:
- Reduce sitting time
- Perform moderate activity for 30 minutes per day, 5 days per week
- Perform progressive resistance training (strength training) 2 days per week
To understand how big a problem this is, just look at Type 2 diabetes. 100 years ago, only 1% of the population had diabetes. Today it is 10%, and 40% are pre-diabetic. The irony is that life span has increased by 20-30 years from a hundred years ago. But, tragically, health span has shrunk, meaning inactivity, hypertension and diabetes are all significantly higher in 30 year olds today than in the past.
Lisa Berkman, Thomas D. Cabot Professor of Public Policy and of Epidemiology at the Harvard T.H. Chan School of Public Health and director of the Harvard Center for Population and Development Studies, say this promising trend may have stalled in recent years. "There is evidence from national studies that people who are now in their 30s and 40s may actually be in worse shape than people that age were a generation ago - an increase in diabetes, obesitym and other chronic conditions," she says.
Lifestyle and Non-Physical Factors
When we’re experiencing persistent, disabling musculoskeletal pain, restoring our activity tolerance necessitates, we look at our emotions and how much our relationships suffer, including our sense of identity. The outcome, as James Clear shows, is tied to our processes and our identity. If our goal or the outcome we want is to participate in valued life activities again, then what's required is a systematic process, such as slow-cooking graded exposures to the activity we want to return to. This means don't do "too much too soon". In other words, focus on small, but frequent "movement snacks" rather than longer duration or higher intensity activities.
What's most important is to regain our sense of identity as it relates to our field of affordances (the action possibilities we perceive as available to us). With pain, our field of affordances shrinks as it loses its elasticity. The process of regaining this elasticity is called the ‘ecological approach’ in that it is always about your personalized context. Each person has different goals that matter to them. The plan should always be focused on what matters to you. It should include clear landmarks or criteria by which to identify progress. Finally, no plan will succeed without social support. In the ecological approach, not only is it about your goals or activities, but also the team or community you have in place to help you stay accountable and motivate you through "nudges" and teamwork.
This loss of functional independence and ability to participate in valued life activities is always biological, psychological, and social. It’s never just about your body OR your emotions, but ALWAYS involves both. Some of the keystones we evaluate include
- Sleep
- Stress
- Emotions
- Social withdrawal/isolation
- Diet
- Sunlight
- PhysicalActivity
- & more
To think that medicine, physiotherapy, massage, chiropractic or acupuncture are the answer, is an over-simplification that assumes biological factors are primary. This starts with Health Care Professionals avoiding unnecessary tests, treatments, and narratives that further reinforce an oversimplification based on a primarily biological view of a complex human experience.
Peter Attia, MD, refers to the traditional medical model where diagnostic tests are performed to find the single cause of disease and subsequent curative treatment as ‘Medicine 2.0’. This started in the Renaissance and was a giant leap forward from Medicine 1.0, which existed from pre-history and didn’t involve the scientific method of generating a testable hypothesis and then accepting new conclusions even if they overturned previous beliefs. While amazingly successful for reducing infant mortality, infection with surgery, and infectious diseases such as smallpox and polio as people live longer today, we see lifestyle related conditions catching up with us.
Dr Attia refers to Medicine 3.0 as ‘lifestyle medicine’, which is designed to increase our health span so it lasts our lifespan. No-one wants to live with various disabilities from ages 60-90. So many people are living longer than society did a few generations ago, however, ironically, most are LESS healthy at a younger age; meaning we have a ticking time bomb of preventable Metabolic Syndromes (neuro- degenerative diseases) in our world. Yet the status quo of Medicine 2.0 is perpetuated by a profit driven system which benefits Health Care Professionals, the Pharmaceutical industry, and the entire medical-industrial complex by doubling down on often unnecessary tests and treatments, rather than preventive, lifestyle measures. We are great at treating disease, but only in our infancy in learning how to promote health. Medicine 3.0 aims to address the reality that we are metabolically challenged due to modern dietary habits (eg. over-consumption of ultra-processed foods) and physical inactivity.
Summary
Let’s stem the tide of the worldwide inactivity crisis which equally affects people in both high & low income countries. Risking obesity & diabetes rates in wealthy regions are proof positive of this epidemic. Popular treatments for pain like pills, shots, surgery, massage, chiropractic, and acupuncture haven’t lived up to their hype. Culture reinforces this and the vested interests of health care providers doubles down on keeping people passive victims while they are offered various ‘quick fix’ modalities and procedures.
The alternative is to support people in self-care & empower them so that they aren't fragile and become resilient again. A key missing ingredient is to provide social support for community-based physical activity promotion. “Move to Improve'' is the way forward - slow-cooked to build tolerance at each person’s pace with support from both peers and professionals for the journey back to participation in activities meaningful to each person.