The Weaknesses of Conventional Medicine and the Science of Human Performance and Injury
As you might have gathered if you have read any of my previous posts, I have some scepticism about the current state of accepted science when it comes to how to optimally exercise to improve performance and reduce injury.
My journey through my own injury problems, my experiences of the biomechanical anomalies in myself and in my clients, the flip-flopping the scientific community have done on diet and exercise, and a lifetime interest in the general health problems of society have also led me to question the wisdom and efficacy about how we treat many of the common afflictions people suffer from.
Another major influence on my way of thinking on this topic comes from the time I spent in East Asia. I lived for nearly 5 years in Korea, and my wife is Korean. You might ask why this is relevant, and perhaps if you haven't lived in East Asia or understand the cultural differences, it might be hard to understand. There are many fundamental differences between broadly Eastern and Western culture, but the crucial one for the purpose of this article is the Western focus on the individual vs the Eastern focus on the group or on the "whole".
The Western focus on the individual enabled our culture to break things down into categories and to be able to focus on the core components of how things work, hence the creation of the scientific method. This has been a tremendously successful way of going about things, but obviously has its weaknesses. The problem with attention to individual details and putting things into categories is that it is easy to miss the bigger picture. The weakness of Eastern culture is that it can miss important details, but it's focus on the group or the whole seems to bring about more harmony.
I think this is very relevant to the strengths and weaknesses of conventional medicine and it's treatment of illness and injury. On the one hand, the Western method, which is conventional medicine, gives us clear results; if we do this or give this drug it has a clear effect on improving condition x. The effect is quantifiable, repeatable, and provable. On the other hand, Western medicine can be obsessed with effects on a certain molecule, cell cycles, specific sites of injury, and specific diseases. What is often lost is the effect on the whole body as a system, and a strong focus on cures rather than prevention.
Having lived in Korea for so many years, it is clear to me that people generally have a healthier diet, but more importantly the people will often give you a story for why they are eating something. None of it was particularly sophisticated, "this vegetable will improve your strength", "this one will make you more virile", "this one gives you more energy". But the truth of the claim and the over-simplification is not important, what is important is that they have a reason for what they are eating that goes beyond the pleasure of their taste buds. Like westerners, they know about which foods have what vitamins and minerals, but as well as this there is a narrative of certain foods being generally good for health and well-being that exists outside of the mere nutritional value of the food.
When it comes to exercise, the traditions in the East are those of martial arts, which incorporate a much greater focus on the use of the entire body and the physical part of the art is incorporated much more explicitly with mental well-being, and even social harmony. Obviously, not all East Asians are doing martial arts (perhaps much less than you might think), but the tradition leaves a mark on the culture and the practices are definitely a "bigger picture" way of exercising, rather than just to lose weight, get a six-pack, or bulk-up.
These are generalisations, of course, but maybe you get my point. Some western scientists in recent years, especially as they have been exposed more and more to other scientists and thinkers from all over the world, have cottoned-on to the fact that conventional medicine has been overly caught-up with specific processes in the human body. Back in the year 2000, the idea of systems biology started to gain traction and this was an acknowledgement that complex biological organisms, like humans, cannot be understood solely by figuring-out how each of their small component parts operate, but how they all operate together in a overall system.
My first experience of this way of thinking came from updating my personal training qualifications upon coming to Australia. It wasn't part of the course, but the course instructors just happened to be movement coaches and not regular trainers. One in particular was a fan of an company called, "Functional Patterns". I recommend anyone reading this to check these guys out, however be warned that the founder has a bit of a weird cult-like following and he himself, although an expert in biomechanics, goes way beyond his expertise for my liking, often slipping into politics and a much broader, almost ideological stance on his training.
Functional Pattern's methodology is based largely on the work of Thomas Myers, an anatomist and physician who discovered the interconnected nature of muscle and fascia. His book, "Anatomy Trains", is a complex look at how muscle and fascia connect to create an interconnected network that not only supports movement, but is a key component in how your body maintains it's structure. Our muscles don't work in isolation, so addressing human performance and injury by treating or exercising isolated areas of the body is always going to be an incomplete way of trying to improve performance, and treat and prevent injury.
Much of my work has been influenced by this book and Functional Patterns, and if you look at the kind of exercises we all advocate for, you'll notice a way of moving that can be, and often is, compared to movements used in martial arts. This is no coincidence, as martial arts have combat origins, and producing optimum power and leverage for combat requires full body, integrated movements that obey human evolved biomechanics. Simply building muscle, losing weight, and looking good in a mirror do not require people to be this functional. When your life is on the line in battle, you'd better be as functional as you possibly can be, which is why exercise based on fighting is likely to come closer to the optimal way of training your body.
Treating your body as a whole system has major therapeutic benefits also. I have been training people for over 15 years now and I am constantly frustrated by how people are being taught to exercise. Got a sore knee? Strengthen your quads. Got a sore shoulder? Do some external rotations. Got a sore back? Do some rolling on it. And in general, do more stretching.
These solutions are too simplistic and too local. Thomas Myers actually shows the chains of muscle and fascia dissected out of human cadavers; the muscles in your body are connected, they don't work in isolation, which means you cannot fix a problem in one area by doing isolation exercises, and the bad news is that you are likely to cause imbalances that may either make the problem worse or shift it elsewhere. The horrible part is that this could take months, even years to surface and you'll never be able to link it to the exercises you were doing to fix your original problem.
Of course, you might come back at me and say, "how do you know this is happening?", and you'd have a point. However, ask yourself how you know that what the physio is prescribing to you is doing any good? Most people get better with rest, but then pain resurfaces when you go about activity again because nothing has really changed for the better. The evidence base for physiotherapy interventions is good when it comes to specific injuries and conditions in the short -term, but it is scant for long-term success and prevention of further injuries to the area and injury in other areas of the body. Also, few have asked whether there is a better way of rehabilitating injuries than the isolation exercises prescribed by most physios, coaches, and trainers.
The sad fact is that the state of modern day science is not what it was either. Academics tow the line and conform to gain status, power and position in universities, as well as being hamstrung by university policies and political movements. Truly innovative new ideas just aren't being tested for. It has been up to individual practitioners to try to show results, which people are justifiably suspicious of. No universities have taken up the opportunity to test a full-body integrated training regime like Functional Patterns or I would promote. It seems that they just aren't interested.
The Cynical View vs the Complex Reality
The cynical view of why preventative techniques, such as I promote on this website, are not being studied has been understood for quite some time. Those in favour of alternative medicine talk about the perverse incentives involved in the creation of medical drugs and procedures. It basically states that preventing illness and injury is not especially profitable for drug companies, medical equipment manufacturers, and surgeons. If people aren't getting sick, you can't make a profit from them. I think there is some truth to this claim, but those that posit this as the sole explanation are missing the complex reality of understanding human health. A good summary of some of the problems in the current scientific/medical systems in place are made in the video below. It uses the specific example of the over-prescription of anti-depression and anxiety medication, especially in the US.
Another reason conventional medicine gets hung-up on looking at specific processes - like in the cell or focussing on specific muscle groups in rehabilitation - that may not be necessarily well integrated with the entire human body, is the incredible complexity of controlling the variables and gaining any reliable data on testing the human body as a whole system. If a drug has a specific effect on a cell mechanism, for example, you can see it under a microscope, you can understand the mechanism of the change, and you can often test to see the effect on animals. Animals obviously share many of the same cells, DNA, and tissues, and can get similar diseases and injuries. Only once a drug or medical procedure has been through a lot of animal testing is it then given the go-ahead for human trials, for example. When you test on animals, you can really narrow-down the list of variables to see the true effects of the drug; you can control their diet, the amount of exercise they have, their social interactions, even their genetics.
The problem is, of course, humans are not like other animals in many ways, and I would argue the most obvious physical difference is in the way we move. Testing a drug is one thing, but how do you test biomechanics in humans with anything other than humans? If you want to know the reason there seem to be so many different trainers out there advocating different kinds of exercise, this is it. The fact is that there is no scientific consensus on the fundamentals of exercise, why our posture deteriorates with age, how to prevent injuries as you age, how best to improve athletic performance, and most importantly even a basic outline about how we are supposed to move. We can send rockets into space, we can build self-driving cars, but scientists have a very poor understanding of how to exercise the human body optimally, and until they do, their prescriptions about how to prevent injury and improve performance will be deeply flawed.
You might then ask, "Why should I listen to you?". Trouble is you have to listen to someone, so how do you make the choice about what exercise or diet theory to place your bets on? A common response is to go with the scientists, but like I said, they are woefully inept here and the proof is the vast array of different exercise theories that they have very little to say on.
My advice would be to follow an exercise regimen based on sound foundations. The reasons I am such a big fan of Functional Patterns is that its methods are based on human evolutionary theory, systems biology, a very thorough look at human anatomy, and the results of countless hours of experience training and rehabilitating people. What are other forms of exercise based on?
Yoga - tradition, historic practices, Hinduism, Buddhism.
Cross-fit - weightlifting, competition, endorphin rushes.
Traditional weight training - bodybuilding, aesthetics.
Static stretching - ??? It seems like the right thing to do?
This where I often lose people. Surely many people get a lot of benefit from the above forms of exercise? They are all better than sitting on the sofa all day, but they aren't optimal. They won't halt or reverse the deterioration of people's bodies as they age, they'll contribute to it; they won't help prevent injury, they'll contribute to it. They have a range of health benefits, but they are not biomechanically efficient ways for a human to move and they may even hinder your ability to remedy your problems.
Something to Think About
It annoys me that I am sceptical about conventional medicine and science more generally these days, but something to think about that is very topical is the way we are currently dealing with the COVID-19 pandemic. All the scientists I see on the news are talking about drugs to combat the disease, vaccines, masks, lockdowns, and social distancing. What I haven't seen much of is how to live a healthier lifestyle so that your body is prepared to combat the disease if you are exposed to it. This seems particularly relevant given the kinds of people that most likely to die from COVID-19 usually have one or more health conditions. Diabetes and obesity are strongly correlated with death from the disease, for example, and these are conditions that most people can do something about.
What concerns me is that many of the precautions we are taking to avoid catching the virus are actually really bad for your immune system. Social contact - which includes actually touching people - is not only crucial for mental well-being, but physical and immune health also. Mask wearing is clearly not natural or healthy, and the hasty development of drugs and vaccines is also something worth being concerned about, as the long-term effects of such treatments will surely be a bit of an unknown.
I have always been a sceptic of alternative medicine, and in many cases - like homeopathy for example - the mechanism behind their supposed efficacy is clearly spurious and any results from the treatment are obviously because of the placebo effect. However, modern science still has surprisingly basic things to say about preventing illness and injury, and this is where the alternative therapies come in to try and fill the gaps in our knowledge. It is no coincidence that they often have a link to Eastern culture and a theme of oneness or wholeness and harmony, both in the body and mind and with nature.
To say that many of these alternative therapies are mumbo jumbo is to state the obvious, but where they can be right by accident is their focus on the natural; the focus on relaxation and taking time to find calm in natural environments. It seems to me being as physically close to states that resemble our evolutionary history is the way forward. This ranges from simply just spending more time in nature rather than concrete environments, but also consuming natural foods, and moving in natural ways. That last category is what I am focussing on in what I do.
Just on a personal note, I moved to a leafy northern beaches suburb of Cairns in Queensland, Australia, precisely to find a better connection to the natural environment. I've also cleaned-up my diet in recent years along with training in human biomechanics that is in sync with how humans evolved to move. Having just hit the age of 40, I am undoubtedly moving better and am generally healthier and more energetic than I have ever been, even in my early twenties. In a world currently enduring a pandemic, being closer to nature, away from the big cities and being in great physical and mental shape surely gives me as good a chance as anyone of avoiding sickness and injury.
Health, seemingly, has hardly ever been of greater importance in our lifetime; to me it feels like relying on the news and scientists to guide us to better health is probably not as wise as many of us used to think it was (me included). Time to think for yourself, and that has always been the best idea anyway.