UNDERSTIMULATION AND CHRONIC PAIN

The Weakness Behind Our Chronic Pain

The chronic under-stimulation of our bodies tissues perpetrated by sedentary  trends in modern living is a significant part of the reason so many of us struggle with chronic pain. Our bodies have lost their natural capacity to withstand the pressure of injuries and repetitive strain. Our connective tissues have lost their elasticity, and our muscles have lost their ability to stabilise our joints during weight-bearing. But just how weak have we become compared to our ancestral blueprint?

For a short while (20 million years), we, as hominids, were vigorous, agile hunter-gatherers. Then momentarily (10 thousand years), we were sweaty agriculturists. We worked in heavy industry for a back-breaking nano-moment (150ish years). Now, even more suddenly, after this wildest of rides, we find ourselves  slowed down, sat down, buttoned down in cool climate-controlled offices, staring at screens. Which means there’s a lot to be grateful for. And also, there is a lot to be concerned about.  

In a very real sense, you are still an undifferentiated indigenous hunter-gatherer. Your interests may have moved on from that life, but your cells and tissues have certainly not.

We used to hunt our own food .

For millions of years, we boisterously hunted and gathered to survive. Now, suddenly, to meet our survival needs, most of us must just sit  quietly. And sitting for a living is only one example of how we’ve slowed down physically.  

Once we finish sitting all day at work, we still need to procure food, which comes pre-subdued, pre-slaughtered, pre-cleaned, pre-butchered, pre-preserved, pre-packed, and increasingly even pre-chopped.

Then, after a successful hunt, we float our food by trolley, which is a short distance from the store to the vehicle. The car then carries our food home to save us the effort—those few who carry our own shopping home notwithstanding. 

We used to find and carry our own water. 

Instead of finding, collecting, and carrying the awkwardly heavy water we need to survive, we have just to turn a dainty little tap with two fingers. 

We used to carry our  carry children everywhere.

Instead of carrying our offspring from A to B, any time there’s a distance to travel, we have buggies and SUVS .

We used to build our own shelters.

We have an army of specialised tradespeople who build our shelters. They are among the shrinking number who still do hard physical work work, while most of us do not. On the occasions we still engage in strenuous physical work, we buy or hire power tools.

We used to evade predators and defend our territory.

We are no longer required to exert ourselves to evade predators. Or engage in physical conflicts with our own species, like most of our nearest primate relatives still do as a matter of routine. 

We even used to wash our own clothes.

Even the relatively minor amount of ‘heavy lifting’ generated by washing clothes has been generously taken off our hands by machines. Only two generations ago, washing and drying clothes alone was relatively intense labour—by our current standards at least.

Meanwhile, evolution is slow, so in 100 years, the ancient cellular mechanisms that drove all this activity remain entirely unchanged. Thus, at a very deep genetic

So, we have not adapted to sitting in place of hunting,  killing, butchering, carrying, searching, digging, building, scrubbing, climbing, walking, running, chasing, chopping, lifting, and fighting. 

Consider the potential work  involved in finding, tracking, subduing, killing, butchering and carrying home one of nature’s athletic phenoms like a large antelope. Then consider driving to the supermarket to buy steak. The effort required to punch through a single layer of plastic wrap is hardly comparable.

It’s entirely possible that the average urban-dwelling human in 2025 will engage in something like 

 5% of the intense physical activity that our distant grandparents did. Even our society’s most elite physical performers cannot compare with the physicality of hunger gatherers. 

A 2010 BBC documentary series called Tribe followed Bruce Parry’s efforts to keep up with hunter-gatherer communities. The series’ concept was to see if Bruce, an ultra-durable ex-SAS soldier, could endure the routine life activities of small Indigenous groups. 

The series was a thoughtful and respectful window into the Indigenous life, the life we ‘used to lead’. But it was apparent from the very start that compared with hunter-gatherers’ boisterous, rippling athleticism, even SAS soldiers are incredibly soft and gelatinous life forms.

Bruce was repeatedly humbled, especially on occasions when he attempted to engage in the more physical tasks that tended to be performed by the men in these communities. 

One particularly telling moment came when young girls from an African tribe felt Bruce’s bicep muscle. They had initially been very impressed with Bruce’s size. But once they felt his muscle tone, they found him to be so marshmallow-like that it triggered an uncontrollable and prolonged bout of giggling among the group. After this, they appeared to still very much like Bruce, but perhaps they did not take him very seriously as a man. There was no coming back from the bicep check. Bearing in mind once again, Bruce was one of a tiny group of the planet’s most elite and durable soldiers.  

Tribe offered other rare comparative glimpses of how our bodies now compare with their natural state. The Byaka people are a tribe that lives deep in the Congo Basin and still lives entirely off the jungle. The Bayaka love honey, which they consider a rare delicacy. Within the family group, it is the father’s job to gather honey, and if he doesn’t literally ‘man up’ and gather it often enough, his wife will start to berate him. The reason for his reluctance will become apparent

When the spousal peer pressure gets beyond a certain level, it becomes easier just to get the damn honey. This is a testament to the power of these women’s personalities  because, for the father, getting the honey is a legitimately death-defying task.

Honey bees in Congo make their hives impenetrably high in the canopy of the tallest trees to hide their precious honey from predators. Their other deterrent to predation is a highly aggressive nature—one that African bees are renowned for. But neither of these terrifying variables is insurmountable for Byaka men.

By our suburban standards, Byaka  are impossibly brave and possess herculean strength. The supermarket’s honey aisle would need the addition of starving lionesses before it could compete with the Congo Basin’s perilous honey procurement standards. Bearing in mind that in Africa, bee swarms kill twice the number of people lions annually.

Hive-bearing trees in the Congo can be five times the height of an Olympic high dive. Their flat expanse of trunk offers no footholds, so climbing means hacking your foot and hand holds as you go. The only equipment was an axe and a vine loop around the waist. 

After more than an hour of hacking footholds as he goes, the man reaches the canopy, where there are finally some branches to sit and rest while he sizes up the hive. During this time, his wife makes a fire and sends him a bundle of smoking leaves to take the edge off the bee’s pending fury. 

Then, 50 metres up a tree with no safety gear and almost naked, the man simply hacks open the hive to harvest its honey. Getting stung more times than you could count in the process, without so much as flinching let alone falling. During the entire process, Byaka men make considerably less fuss than most of us would over a single bee sting whilst lying on a lawn chair. Let alone receiving hundreds of stings while hanging off the edge of a cliff with no safety gear. In fact, they dont make any fuss at all. The entire death-defying painfest is a poker-faced affair.

Imagine the panic most of us would feel being attacked by an entire hive of African bees 50m high on a tree branch, with no safety gear. Yet these men are exactly the same species as us, with the exact same genetics. They are not genetic freaks; they are just normal family men, rainforest style. 

Byaka men are simply approximate an embodiment of the human potential for physical strength and resilience. 

The point is that the average level of physical conditioning  we have now, compared with how we were for millions of years, is different. It’s very different. It’s like comparing the average pampered and slightly overweight golden retriever with the average Yellowstone timber wolf, which, for the record, is the difference between marshmallow and stainless steel. The primary reason for this is a lack of movement.

Strong tissues are resilient tissues. More specifically, strong muscles and mobile fascia  that have a strong, vital connection to the central nervous system are the key to pain resilience. Muscles and fascia are not just responsible for movement; they also protect us from injuries and wear and tear. 

So, in part, the story of our pain is the story of our cultural domestication and profound loss of physicality. Although achieving a persistently pain-free state  need not involve developing super Indigenous human levels of strength,

And on a level, we all know this. Exercises  are often the first solution we think of when looking for a solution to our pain. Common wisdom and scientific knowledge agree that weakness in the likes of the core and the shoulders rotator cuff are heavily implicated in chronic pain. Yet few pain sufferers really grasp just how weak we’ve become. Many chronic pain cases involve not only muscle weakness but full-blown muscle wasting. 

We all know that exercise is an important ingredient in pain rehabilitation . Many of us know that it applies very specifically to our own aches and pains, having felt its benefits. Yet even among the most motivated and aware patients, there is a strong tendency to underestimate how weak we are. This is reflected in the difficulty all diligent clinicians have in persuading people to stick to their exercise plans in the longer term.

If you have had chronic hip pain, for example, once you have successfully treated the pain, you’ll need to keep working on strengthening  your hip and stabilising muscles for the rest of your life if you want a reasonable chance of staying pain-free. This is because urban living is not going to keep your hips strong. Even walking and running won’t cut it because of the hard, flat surfaces we live on. The hip will need specific attention. 

The wild underestimation of our need for strengthening extends to the professional realm. I routinely meet people who have had hip and knee replacements and have been given a month’s worth of exercises and cut loose by their physiotherapists, similarly for injury sufferers. Yet all these issues indicate a need for long-haul strengthening programs, all in the name of offsetting the unrelenting jellification of our muscle tissue at the hands of this digital age of sitting.

Don was a bright-eyed, bushy-tailed, youthful Englishman on the verge of a retirement that he was very much looking forward to. After nearly 50 years of office-bound work and associated executive stresses, he’d climbed the corporate ladder and was more than ready to climb back off. He and his wife had purchased a beautiful new home away from the rate race, with extensive gardens that he was itching to get stuck into, which was where the big problem arose.

Don was bursting to get stuck into a major transformation of his expansive new gardens. But his right shoulder would not allow it. Historically, the shoulder has generated a low-level ache from time to time over a 10-15-year period. Then, 2 years before we met, it suddenly became a debilitating pain that prevented him from using his right arm for much more than typing and cooking. Technically, he could still do things like gardening and housework. But the pain he would experience for days afterwards had to stop all strenuous activity.

This pain becoming truly chronic meant Don was looking at a far different retirement from the one he’d envisioned for himself and his wife. Once pain becomes chronic in our society, the long-term prognosis  is bleak. And Don knew it. Instead of an active, thriving time of rebirth, retirement had become daunting. Would it just be a case of living with pain and disability in a property he couldn’t care for over the next 20-30 years?

Fortunately, Don’s pain was very treatable. It took about six months of steadily breaking up deep, painful adhesions in his rotator cuff  and pectoral muscles (caused by decades of desk work). Slowly and painfully, his pain came under control and then vanished. Yet, despite appearances, this left what could be seen as an even bigger problem: muscle wasting. 

Like virtually everyone in Don’s situation, he had muscle wasting in his rotator cuff and the muscles of his upper back. This loss of support was why his shoulder had gotten so bad. Naturally, this had been caused by years of desk-bound work tasks. Not only did Don have weakness in these muscles, but he was missing several kg of lean muscle in his upper back. This showed up as deeply hollowed-out areas behind his shoulder joints and blades.

If you looked at the upper back of a Byaka man his age, you would still see rippling dense muscle  in the upper back and behind the shoulder. Perfect for climbing trees and hauling heavy objects across rugged terrain. Don’s back, by contrast, was flat, hollowed out, and lacking any definition. 

Once pain-free body, most patients discharge themselves (understandably) or agree to perform exercises but largely fail to follow through. But Don was deadly serious about ensuring his pain didn’t come back. He was determined to undo the harm his career had done to his body and thrive in his retirement. It was an impressive level of resolve.

Don was given a band to perform exercises targeting the muscles’ strength and tone behind the shoulder joint and upper back. The request was to do them for 10 minutes every day, a similar commitment to the one we make to our teeth. There wasn’t a specific number of reps required, only a time limit and the intention of repeatedly failing the muscles over the 10 minutes.

Even the most committed patients seldom stick with this protocol seven days a week. But not Don. Don did them seven days a week without fail, come rain or shine. When he had to travel for work, he faithfully packed his band and did his exercises  in his hotel room. The same went for holidays when most of us are prone to ditching the wagon.

Because he was pain-free and swamped, several months lapsed between check-ins. The first time I saw Don after prescribing the exercises, he had more  tone in the area behind his shoulder joint. Instead of being totally hollowed out, there was a better contour, and the muscle had firmed up a little. I was delighted with his progress.

It was another 10 months before I saw Don again. The house he had bought was in another town, and he had limited himself to 2 days of remote working. But he came in for a check-up when he was back in town. I was expecting the usual mix of good and bad news that tends to include a steady reduction in compliance with the exercises   and some level of pain relapse. But I was in for a delightful surprise.

At 66 years of age, after less than a year of using his band at home, Don looked totally different, even with his shirt still on. On sight, he appeared taller and broader than his former self. From the back, you can see that he was actually filling out his business shirt with muscle. On closer inspection, the transformation was even more impressive. The muscle behind his shoulder and across his upper back was extremely dense and hard. The frail gelatinous bands of muscle that he could scarcely contract were long gone.

As you might expect, Don’s shoulder pain had not returned despite a dramatic increase in heavy work tasks that would previously have been impossible to sustain. In fact, he commented that his upper body felt more tolerant of heavier work than it had done in over 20 years. No doubt this change, being pain-free, and his new lifestyle had all assisted with increased muscle mass.

Don is a shining example of what we can do to help our muscles escape the gravitational force of this sedentary leaning world. Even after decades of neglect, his muscles rejuvenated and returned to their all-important role in supporting and stabilising his spine and shoulder joints. He felt better and even looked better. But it was a meaningfully different outcome to so many cosmetic gym transformations. He had escaped a cycle of chronic pain that was severely threatening his healthspan and potentially even lifespan. Ageing people who cannot stay active often don’t live as long. 

There is a vital bit of context to Don’s story that helps highlight the value of rehabilitation in chronic pain—a cautionary tale within a cautionary tale. When we started his rehab , Don had been running and going to the gym religiously for 20 years, despite which his shoulder muscle still wasted nothing. 

Naturally, we all hope that the effort we put into fitness protects us from pain, and it certainly does. Don would have been far worse if he had not stayed fit all those years.  But there is much scope for vital omissions in the modern fitness realm.

In Don’s case, his shoulders had gone neglected for two primary reasons. The first was that running doesn’t do much for the shoulder girdle. The second reason was more nuanced.

He had greatly emphasised pushing movements (like bench press) in his gym routines and overlooked the need for pulling movements that target the upper back. This was compounded by the fact that when he did a pulling movement (like seated row), he just used his arms, thus failing to recruit his upper back muscles.

Thus, Don’s entire fitness regimen unwittingly neglected his postural muscles and his all-important upper spine and shoulder stabilisers. Both of which fell into further disarray once his pain became so bad that he couldn’t go to the gym at all. 

In any case, for Don, everything was well and ended well. After seeing and feeling the change in him, I felt confident that if we’d gone all the way and turned him out into the wilds of the Congo, he would have been shimmying up giant trees in no time. But, of course, that wasn’t necessary to get the desired gardening outcome.