The pain paradox- Our easy lives make life hard for us

What does your aching back or shoulder have in common with hardening of the arteries or heart disease? They are all “lifestyle diseases”, i.e. problems that arise not because of a flaw in our construction or genes, but due to a mismatch between what our bodies have evolved to require for good health, and our current lifestyle. We are experiencing what could only be called an epidemic of chronic pain, and a third (30.7%) of Americans now suffers from chronic pain. For a health professional dedicated to minimizing and eliminating pain from people’s lives, this is a shocking statistic. Prescription drug use and abuse is subsequently at an all-time high, and the federal government has been forced to start taking steps to deal with the situation.

Lifestyle disease: A disease associated with the way a person or group of people lives. and can be prevented by changes in diet, environment and lifestyle, such as heart disease, cancer, stroke, obesity etc.


But is masking pain arising from living incorrectly in our bodies a good idea? The ever rising percentage of people in chronic pain shows that it may not be. We need to understand what we are doing wrong in order to fix the problem, and since we are all doing (or not doing, as the case may be) the same thing, understanding our mistake can be hard to do. But the paradoxical nature of the pain epidemic is this; our lives are too easy. By attempting to make our lives easier, we have actually made them harder. Let's look at why that may be the case.

It may come as a surprise to you, but a certain degree of hardship is good for you! Not convinced? Imagine how much easier it would be to float around in a weightless environment than it is to  carry your body weight around against the downward pull of gravity on Earth. But do you know what happens to the human  body in a weightless environment? Any astronaut can tell you: osteoporosis, loss of muscles mass, loss of balance, lowered testosterone, depression and more. The fact that we evolved with the gravity of our planet also means that we require gravity in order to thrive, just like a fish that has evolved for a life in water requires its habitual environment in order to survive.

Modern life requires a minimal amount of physical activity, and the activity we have lacks variety. You may at first protest, thinking “but I’m very active, I go for walks several times a week, I’m up and down the stairs in my house all day and I love to garden”. I’m sorry to have to break it to you, but even though it may be more than what some of your peers get that is not a great deal of activity, and more importantly, not very strenuous activity. Your DNA doesn’t compare you to other relatively inactive westerners, it expects the type and degree of activity we humans have experienced during our long history on planet Earth. If you think back just a few generations, you'll realize that your great grandma and grandpa probably worked much harder simply because they had to to put food on the table than you do in your yoga class. Actually, there's really no comparison. 

Modern-day westerners have gotten used to comparing activity to inactivity (sitting) which is perceived as the baseline, but that’s misleading on many levels. Sitting is not our natural state, historically speaking, low-grade activity (walking, household chores etc) interspersed by heavier activity (hunting, farming, fighting) is. Prolonged and frequent (as in sedentary work) sitting actually carries its own risks, in addition to the fact that it also means that you aren’t being active. It is now known to be an independent risk factor even if you engage in exercise activities outside of work.

Our bodies are designed for a certain degree of hardship, and this strain is actually helpful on many levels. The oft' touted anti-oxidant effects of fruits and vegetables? They are largely produced by the human body itself in an effort to defend itself against the toxic effects of plants (yes, really)! Exposure to cold, heat, sunlight and fasting have all been shown to result in beneficial changes in our bodies, even resulting in better aging, aka longer health spans. The word used to describe this is hormesis.


A short working definition of hormesis is: ‘a process in which exposure to a low dose of a chemical agent or environmental factor that is damaging at higher doses induces an adaptive beneficial effect on the cell or organism.'


Physical strain; lifting heavy objects, running fast, walking long distances, twisting, turning, pulling, pushing and carrying all have their distinct and beneficial  effects on the composition and functioning of the body, and this is what is commonly missing in today’s world. A leisurely stroll with a cup of Starbucks in your hand or a weekly yoga class simply doesn’t meet the requirements for physical activity that have been shaped by our long evolution. And so, without the physical stimuli required by your DNA to produce strong, healthy tissues, your body gradually starts to malfunction and cause pain.

Adding insult to (real or metaphorical) injury, the loss of exposure to the mild to moderate discomfort regularly involved in a more active lifestyle leads to a hypersensitivity in our nervous system, resulting in even small stimuli being perceived as painful. Simply put, being inactive makes you overly sensitive, and not in a good way. It simply leads to you suffering more from anything you feel, and that fact alone should be a powerful incentive to move more.

Physical inactivity makes you much more sensitive to pain.

A more recently understood phenomenon, called Fear Avoidance Beliefs in scientific circles, has put the nail in the coffin. When our ancestors hurt, they couldn’t afford not to move, to hunt and farm, there was no sick leave or disability pay, there was no-one to sue or blame. When our modern bodies, weakened by our inactivity and thus poorly prepared to withstand challenges sooner or later (and one might perhaps  add,  unavoidably) get injured we now have the dubious luxury of avoiding certain movements and positions out of a fear of causing more pain and injury. Anyone who’s seen a person with acute low back pain move (or perhaps been one!) knows what I’m referring to here. The problem with the logical assumption that it’s best to “take it easy” and act in a protective way when the body hurts is that it is completely wrong. Fear avoidance beliefs and the resulting behaviors have actually been shown to be the very gateway to chronic pain, and are to be avoided at all costs. When you move around stiffly and carefully in order to avoid pain, the stabilizing muscles that are part of the deep spinal structures atrophy and abnormal and, unfortunately, lasting movement patterns quickly form and contribute to pain that lasts way past the time it takes for the body to heal.

Avoiding movement in order to avoid pain has been shown to lead to chronic pain.

So assuming I have convinced you that the greatly reduced amount of strain on every system of the body that a per default modern-day existence in an industrialized information-age society leads to is a trap, what are you to do?


Here are some suggestions for steps to take to build a healthier, more resilient body and mind. But before you get going, bear in mind that a body that has adapted to a sedentary lifestyle needs some help adapting to increased levels and new types of activity. Have an evaluation and some treatment by a physical therapist to straighten that spine, loosen those hips and activate muscles to help prepare your body for physical activity. Skip this step at your own risk, and be prepared to sustain injuries and experience feelings discouragement if you do. Running has the highest injury rate of all recreational sports in part due to the lack of preparation of the (western) body for running. So get into prehab - prepare your body for activity before you start.


Once you’re ready, however, and take steps to become more active you will discover that Nature has created a strong incentive for us to move: the uplifting and extremely pleasant experience of the immediate and long-term effects of physical activity on your body chemistry. Way bigger a concept than merely a "runner’s high” , physical activity makes you feel happy, feel pleasure, energy, optimism, confidence and a stronger connection to the world around you.

Physical activity makes you feel good both immediately and in the long term

• Schedule an appointment with a physical therapist. Physical therapists are the movement specialists, and can make sure you know what to do to prepare your body for activity. It is a mistake to assume that the activity itself is sufficient to help your body adapt appropriately. If you grew up sitting in schools and cubicles instead of hunting and gathering, you need some prep work first. A physical therapist can also give you ideas for what type of exercise you’d benefit from, create an exercise program for you and tweak it as you go along. It is, for example, very common that runners are too weak  for running, 

 

• Increase your level of activity gradually - muscles get stronger faster than e.g. tendons and ligaments. Allow your body some time to adapt.

 

• Choose whatever form(s) of activity that you find enjoyable and fun (or in the beginning, perhaps least objectionable?) but make sure that you exert yourself. If it feels easy, it’s not helping you much.

 

• Allow about 60 days for a new habit to form. After that, being active will happen more organically - you’ll feel like something is missing if you don't move.

 

• Perform at least part of your movement outdoors. Light is the most powerful force affecting your circadian rhythm. If your inner clock is out of whack you will not get enough deep sleep to fully benefit from the movement. See here for more ideas for how to sleep better.

 

• Make sure you are both performing resistance exercise (e.g. weight training) or some equivalent thereof as well as some "aerobic" exercise, i.e. something that makes you breathe (much) harder. 

 

• If you are in pain and this prevents you from performing exercise, get help (and no, drugs aren’t “help”, while sometimes appropriate they are a short-term band-aid). With the help of a physical therapist, physician, psychologist and anyone else you need, change your body and mind back to their “factory settings”, and while you’re hurting, do your very best to move as much and as normally as you can (see fear avoidance beliefs above).

In chronic pain, pain is not a good indicator of whether you should move or not. 

• If you have any pain or limitations, use a physical therapist to help guide you. Personal trainers, athletic trainers, yoga instructors and the like are only trained, to varying degrees, to assist healthy people. An injury requires a totally different approach and a in-depth knowledge of the relevant pathoanatomy and rehabilitation.

 

• If you suffer from anxiety or depression, absolutely get moving. Exercise is more effective against mild to moderate depression than drugs, a fact that actually means that lack of exercise makes you depressed.

Lack of exercise causes depression.

• Realize that some pain and discomfort here and there is normal, natural and a part of life. Exercise makes you sore, life’s adventures can injure you and make you sore, but our bodies are amazingly resilient. Learn to (appropriately) disregard little aches and pains, but seek help when needed.

 

• Don’t fall for the common misperception that we are weak and vulnerable. The pharmaceutical industry as well as a large part of the healthcare industry rely on you seeing the body as an accident waiting to happen. They are misleading you, and you can choose to not believe them and build a healthier body instead. Screening for illness is not the same as increasing your health capital, it’s merely checking to see if the shoe has already dropped.

 

• Contemplate and be grateful for your gradual and incremental success, instead of focusing on where you are still limited. Health is not a binary issue - every little bit counts and helps move the needle in the right direction.

 

• ENJOY! A life, of which movement forms an integral part, is an enjoyable life. Enjoy and be proud of your fearlessness, resilience and strength. They are part of the human experience, and qualities that create a “virtuous cycle” exponentially increasing your heath and happiness.

References:
http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)60690-4.pdf


https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/what-federal-government-doing-to-combat-opioid-abuse-epidemic


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2248601/


http://www.sciencedirect.com/science/article/pii/S1526590010006012


http://www.space.com/23017-weightlessness.html


http://journals.lww.com/co-cardiology/Abstract/2011/09000/Prolonged_sitting___is_it_a_distinct_coronary.8.aspx


http://europepmc.org/abstract/med/19668291


http://nautil.us/issue/15/turbulence/fruits-and-vegetables-are-trying-to-kill-you


http://www.ncbi.nlm.nih.gov/pubmed/17318365


http://www.ncbi.nlm.nih.gov/pubmed/25864076


http://gettingstronger.org/hormesis/


http://www.ncbi.nlm.nih.gov/pubmed/17964227

http://pms.sagepub.com/content/74/1/79.short 

http://go.galegroup.com/ps/anonymous?id=GALE%7CA269530998&sid=googleScholar&v=2.1&it=r&linkaccess=fulltext&issn=10895159&p=AONE&sw=w&authCount=1&isAnonymousEntry=true


http://www.sciencedirect.com/science/article/pii/S0304395999002420

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