“Remember – nothing in biology makes sense, except in the light of evolution.” – Daniel Lieberman
I like to view the human body through the lens of evolutionary biology. Many of the anatomical and physiological elements of our bodies make more sense when you see them as long-term adaptations to the demands and functions required of our bodies living on this planet. This may seem like a strange tangent or thought-experiment, but bear with me – I assure you that the millions of years our bodies have spent evolving to their current and brilliant form is relevant to our lives today.
There are a host of diseases and dysfunctions that presently plague people across the globe which we refer to as “evolutionary mismatch” diseases. The evolutionary mismatch concept is a fascinating theory that helps to explain the growing epidemic of health problems like type 2 diabetes, osteoporosis, tooth decay & impacted wisdom teeth, as well as low back pain. To reduce the theory to its simplest components, it posits that the current environments in which we live are far removed from that of our ancestors. The demands on our bodies are now so different from those of our hunter-gatherer ancestors that our bodies are poorly adapted for what most of us do with our day-to-day activities and occupations. The result is a growing number of health issues that we struggle to deal with today as a society.
For example, we know from the few remaining groups of hunter-gatherers that a typical male walks about 9 miles a day, and a female approximately 5-6 miles a day. These people move around throughout the day, carrying various loads (including children), and doing various – but probably not repetitive – tasks like digging & foraging, climbing trees, and hunting for food. They will of course sit occasionally, but they definitely would not sit in chairs for 8-10 hours a day staring at a computer screen or driving. They would most certainly not be eating food rich in sugar & sucrose but lacking in fiber, they probably wouldn’t have rampant allergies, need to wear eyeglasses for nearsightedness, or die from heart disease – at least at the rate that we do in modern society.
There are entire books on this subject, but I will get to the point as it relates to back pain: the less your typical daily activities resemble those of a hunter-gatherer or “caveman”, the more you may want to think about how to modify your activities to remedy this mismatch dilemma. Am I asking you to throw away your shoes, go spear a bison, climb a tree to raid a beehive for honey, and never take another tylenol for a headache, or sit in a comfortable chair? Absolutely not. Modern human society is filled with incredible technological advancements that have solved significant problems for many of us – surgery, antibiotics, electricity, the internet, dentistry, air / car / space travel… obviously I could go on and on. But – a number of these have made our lives so comfortable and easy that our bodies are no longer required to do the basic things they needed to do for millions of years, and we have ended up with unintended and unforeseen problems.
One of these appears to be low back pain (LBP). This is a complex and multifactorial problem that is difficult to attribute to any single cause, and we don’t know the prevalence of it in our ancestors. It is probably at least due in part to our unique (amongst apes and most mammals, at least) upright bipedal stance, but it does appear to have worsened as people transitioned away from hunter-gatherer lifestyles and towards agriculture, and then contemporary society. Today, LBP is a leading cause of disability, and can affect approximately 80% of us during our lifetime. That is just about… everyone!
I will provide two extreme examples of a person whose daily life has probably veered too far from a lifestyle that evolution has prepared their body for.
Imagine a farmer or construction worker, their body spending 8+ hours a day bending, lifting, and contorted into prolonged awkward positions with heavy loads. This person is repetitively putting stressful loads on their spine, and it is likely that, eventually, their back is going to protest and let them know about it!
Now imagine a desk-jockey type, someone spending 8+ hours a day at work on an excel spreadsheet or graphic design project, who then comes home and spends a few more hours eating, watching tv, and maybe playing some video games. This person has a very different problem from our first example, but they are actually even more likely to develop low back pain as a result of not enough loading and disuse.
A comparison of LBP incidence between Tibetan farmers and Indian tailors revealed an interesting observation: the percentage of these populations affected by LBP was less in the group that performed repetitive loading of the spine (about 40% in the farmers) vs. the group that spends most of their day sitting (about 60-80% in the Indian tailors).
Now, I am not casting judgment on these people, or on you if your average day resembles theirs. Parts of my life do as well. But I bet you can guess which person needs to do a little more work on their flexibility and strength, and which person probably needs to be taught how and when to take breaks and maybe some pointers on movement technique to spare their spine from too much loading in poor positions. The hunter-gatherer type lifestyle appears to have a “goldilocks” amount of movement – not too much loading, not too repetitive in nature, and certainly without long stretches of hours spent sitting in comfortable chairs.
So, that was a long walk to say that it would behoove us to take these concepts into account when thinking about our overall health, as well as with back pain that we experience. Especially the type of back pain which appears to have “come out of nowhere” and persists over months and years. One of my jobs as a spine specialist is to teach people how to achieve this. I work with my patients to set up a plan for them to move often, move well, and to modify the types of activities they’re doing so that they can build up some resilience and gain control over their back pain.
Dr. Roland Alley, PT, DPT
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At Gunks PT, we can provide you with a comprehensive plan of care to address your specific type of back pain issues. Call us today at 845-579-5007 to schedule an appointment with us. You can also set up a free discovery visit via phone or zoom so we can discuss your options and goals:
