Heuristics, Rules of Thumb, and Crude Looks at the Whole
Related to exercise and pain
A heuristic is a problem-solving technique that uses mental shortcuts to find practical solutions to complex problems. It may involve trial and error, rough estimates, or “rules of thumb.” Heuristics can't guarantee optimal solutions, but will frequently provide "good enough" solutions that are useful. In the presence of complexity, the use of heuristics if often preferable to exhaustive microanalysis of all the relevant data, which might create delay, confusion, or information overload.
For example, consider the problem of deciding how to eat a healthy diet. The micro-analytical approach would involve reading all the relevant research on nutrition. But this literature is vast and contradictory. You could spend years on a single issue without getting a clear answer, such as whether its healthy to consume red meat, or drink alcohol in moderation. A more practical approach is to zoom out for a big picture look at basic patterns in the field. These patterns might be vague and imprecise, but can be useful. Here are some common and popular heuristics about nutrition that derive from this kind of big picture thinking:
eat whole foods, not too much, mostly plants (Michael Pollen).
eat a rainbow
eat lots of fruits and veggies
eat like a hunter-gatherer
avoid processed foods
eat foods that your great grandmother would recognize as foods
when shopping at the grocery store, make purchases from the outside of the store, not the inside
These formulas won’t always guarantee optimal food choices, but they will generally point you in the right direction with a minimum of analysis.
The use of heuristics to solve complex problems has been studied by some very smart people. The political scientist and Nobel prize winner Herbert Simon coined the term "satisficing" to describe the use of heuristics to find solutions that were good enough, but not necessarily optimal. The psychologist Daniel Kahneman, also a Nobel prize winner, explained how heuristics aid decision-making by reducing cognitive overload, but also create predictable biases. The physicist Murray Gell-Man (another Nobel prize winner!) and co-founder of the Santa Institute for the study of complexity, coined the phrase "crude look at the whole" to describe the benefits of zooming out and way from small details to discern big picture patterns.
With these ideas in mind, following are some heuristics related to moving better and feeling better which I have collected over the years. Some are well-known and well-established, while others are my own ideas and more speculative. These are based on twenty years of experience seeing clients and reading research. This list governs a variety of issues, but is more illustrative than complete.
As you look through these, remember that these are just rules of thumb and will not be right in every case. You can think of them as default assumptions (or Bayesian priors) that might be overcome or modified by evidence. Many represent obvious and “101” level knowledge but are also frequently ignored because people outsmart themselves by getting obsessed with details and missing the big picture.
Musculoskeletal Pain
Pain is hard to explain. Especially when there is no clear connection to acute injury or repetitive stress. This is because:
pain can be felt in a different location from the tissue damage;
pain is affected by many variables other than tissue damage;
pain may be driven primarily by increased sensitivity to pain
Most new pains will resolve on their own without intervention. Pain is a signal that a healing process is taking place, and that process usually resolves the pain. For example, the natural history of acute back pain is recovery in six weeks without intervention.
Good therapy can speed natural history but not by a lot. And it mostly works by removing barriers to healing like moving too much or not enough.
Pain resolution is hard to explain. Therapies usually get the credit, but more plausible explanations might be natural history, regression to the mean, placebo effects, or unmeasured variables.
Pains that have persisted for a long time will probably continue to persist. Especially if they have persisted through a variety of circumstances and good attempts at treatment.
Persistent pain is easier to manage than eliminate. Therapy can reduce disability and suffering more than you think, and reduce pain less than you will probably hope.
Effective exercise therapies have a lot in common. Even though they appear different. Almost all involve strengthening, mobilizing or coordinating the muscles and joints near the site of pain as much as possible, without making the pain worse. It is reasonable to try each.
Effective manual therapies have a lot in common. Even though they look different. Almost all work through either: (1) a light touch that creates a novel sensory stimulus and sensory gating; or (2) a hard touch that creates a “good pain” and descending inhibition.
The benefits of manual therapy are temporary. And can usually be duplicated by at least some form of active exercise therapy that can be done anytime, anywhere, by the client, on their own, for free.
A good therapeutic relationship is key. A necessary and occasionally sufficient condition for good outcomes.
The client has most of the power and knowledge. The client usually has far greater knowledge and control over the problem than the therapist. The therapist can’t “fix” the client, and instead facilitates, supports and informs.
General interventions work just as well as specific interventions. Working to improve general fitness, sleep, stress, nutrition or drug use will usually be just as effective as specific interventions directed at the painful area. Unless the pain is clearly related to acute or repetitive stress injury.
Co-morbidity is highly revealing. Pains are more likely about systemic general health than specific local tissue pathology if they are accompanied by multi-site pain and/or other complex chronic health conditions like depression, anxiety, fatigue, insomnia, IBS, autoimmune disease, or obesity.
Exercise
Stress and adaptation. Exercise is about giving yourself a controlled dose of physical stress. Getting fitter is adapting to the stress.
Goldilocks principle. The degree of stress necessary for adaptation is not too much and not too little. The body should be “embarrassed” but not “traumatized."
Adaptation requires recovery. Adaptation happens only during rest and recovery, and if you don’t adequately rest and recover, you won’t adapt to get fitter.
Progressive Overload. To continue getting fitter, you need to increase the stress gradually over time.
Diminishing returns. As you get fitter and fitter, it becomes harder to get even fitter, because the goldilocks window shrinks down to nothing.
The SAID Principle. Adaptations are specific to the kind of stress imposed. Therefore, the fastest and efficient most efficient way to get better at X is to practice X, not Y.
Exercise is a miracle drug. Engaging in the right kind, volume, and intensity of physical activity improves every organ system in the body, and every dimension of health - physical, emotional and mental.
A well-balanced exercise plan. Move around a lot every day at an easy pace; make it a habit to frequently pick up heavy stuff or move with moderate intensity; every once in while move like your life depends on it.
Conclusion
As I was writing these, I noticed there were many different ways to formulate these rules, and there are some questions about which ones are more fundamental and which are derivative. I actually found this to be a good exercise that clarified my thinking, and I would recommend that others do it as well. If you do, provide suggestions in the comments.