Rooting out the problem behind the pain

Posted in Life Bites |

Begoña Ruiz Núñez

"I switched my approach as a physiotherapist from ‘the problem is where the pain manifests', to ‘the pain manifests because there's a problem’. The more I helped patients to solve their troubles, the more I realised how all aspects of who we are as human beings (emotional, cognitive, social, sexual, physiological) are interconnected, and how the interplay between each of these key areas influences our health and wellbeing". 

My blog isn't about any recent or striking new piece of research or topic relating to natural health, nor is it about any mind blowing discovery. It's also not intended to be a biochemistry lesson on how certain micronutrients have an effect on body cells, organs and/or systems. I also decided against focusing on how important it is to exercise before we eat, which is linked to a fundamental way of living for our ancient hunter-gatherer tribal ancestors.  Instead, my blog is more of a 'thinking out loud' kind of piece about a subject I've been mulling over in my mind for a long time. It's rooted in years of interaction with colleagues, experts, students, friends and patients, and is a reflection of my own experience and interpretation of reality today – which might be completely different tomorrow.

My experience of working holistically – both with patients and in my approach to life – began with osteopathy almost 15 years ago. I switched my approach as a physiotherapist from ‘the problem is where the pain manifests', to ‘the pain manifests because there's a problem’. The more I helped patients to solve their troubles, the more I realised how all aspects of who we are as human beings (emotional, cognitive, social, sexual, physiological) are interconnected, and how the interplay between each of these key areas influences our health and wellbeing. There are many variables at work simultaneously, each of them playing a different role and impacting our physical and emotional health in different ways at any given time. An individual's nutrition, daily exercise or movement, social life, sex life, ability to feel or accept love and their childhood can all be grouped into three areas, namely physiology, psychology and environment, as part of a clinical psychoneuroimmunology (PNI) approach. The term PNI was coined at the end of last century and the approach is seen as increasingly relevant given that lifestyle-mediated disease is now the principle cause of both morbidity and mortality. The goal of a PNI practitioner is to restore or maintain health through the understanding of the intricate connections between the different parts of our being.

One hundred-plus years on, there are still some questions that remain the same: How should we eat? How should we move? What is the ideal way of living to restore health or stay healthy? What are the keys to healthy aging? Personally, I feel that approaching healthcare from an evolutionary perspective is a perfectly reasonable starting point. Surely, when considering what diets are most suitable to humans to think about what foods best suit the genes that we presently have, that have remained largely unaltered over the course of the last 20,000 or more years? This perspective is, of course, the primary driver of the ‘Paleo’ movement. Just a shame it's been ridiculed and trivialised by some segments of society with images of primitive cavemen and fad diets.

I must also admit that the more I investigate and read, the more I realise how ignorant I actually am, because so many aspects remain unclear. This includes ideas that have become gospel in the nutrition, natural movement and sport sciences fields, and wider society. Beliefs cemented in the last third of the previous century have either been marginalised in the peer-reviewed scientific literature by seemingly contradictory evidence, or conversely, they have been 'validated' and given elevated importance. If health or disease is all down to lifestyle, then the question remains simply:  Is it possible to prescribe a lifestyle regimen that allows everyone to remain healthy over the majority of their lifetime or to overcome the main chronic diseases of modern society?

Epidemiology, the branch of medicine that studies how often diseases occur in different groups of people and why, has historically dominated healthcare decision-making. More recently, randomised controlled studies (RCTs) have taken centre stage. Both approaches have their problems. Regarding epidemiological studies, the fact that they might show trends, associations and correlations, rather than being able prove cause-and-effect relationships, now often seen as the gold standard, is just one issue. Another problem is that you end up seeing trends that revolve around average, often very large populations, so losing all the interesting effects around the so-called ‘outliers’ or  ‘non-responders’, in other words, the many who inhabit the fringes either side of the centre of the bell-shaped curve.  RCTs are often no substitute. It’s difficult to test multiple interventions or look at dietary effects because everyone’s needs and requirements are so different. They are also incredibly expensive and there are often economic interests using them to push their latest drug or food product.

So, how do you validate a lifestyle from a scientific point of view? Considering we eat such a variety of things in such different forms (think: bread, bananas, olive oil, sirloin steak, shrimps, ice cream, tea, wine), we exercise very differently in gyms or outdoors, we live alone or with others, harmoniously or otherwise, we work in an office or outdoors, and so on; how could all these variables be taken into account when considering a (scientifically validated) effective program?  It’s not difficult to see, especially when you consider our genetic individuality as well, why a one-size-fits-all approach could never live up to that.

Things must change. Treatments can't be standardised because all the variables are constantly changing, and no two patients are ever the same. Different individuals haven't all lived in the same environment when they were children, nor did they have the same nutrition. They didn't all experience the same level of love, or enjoy a normal and healthy sex life. They don't have the same job, family, or daily life routine, and they don't exercise in the same ways. They don't get excited or motivated by the same things, and, what's even more important, they don’t feel or experience the same under the apparently exact same circumstances, even if their clinical diagnosis is identical. These are just a few of the reasons why the way to restore health in different individuals has to be different for different people. But there can nevertheless be some underlying principles that apply to more or less everyone, these helping each person find their way back to health.

Frankly, it's this lack of standardisation of approach that I think makes my job so amazing, challenging, motivating and beautiful. Because in the end I've realised it's all about balance. And the key to shifting the equation towards health is always to find the balance within each of those variables I've discussed above. So, analyse, doubt, share, discuss, interact, play, enjoy and experience. That's living. 

Date: 02 July 2014