The Evolution and Importance of PreHab
The main objective of this article is to demonstrate why PreHab is an importance practice for most individuals on this planet. We will discuss where and when the need for PreHab arose, according to science and cite many resources along the way. However, it would only be fitting (pun intended) to speak about “what” and “why” PreHab exists before discussing why people should practice it.
Let’s Start with Why
Author Simon Sinek has popularized asking WHY. His books, Start with Why and Find Your Why are bestsellers and for a good reason. Sinek demonstrates how the importance of understanding why we do the things we do will ultimately influence how we do these very same things. He proclaims that when we understand the “why” behind our motivation, we can help ourselves stay committed to the process or chosen path long after motivation has waned. Without a doubt, motivation will wane or pass at some point. Motivation is never a constant. Remembering the true “why” to what we started will certainly provide a chance for resurgence when we need it, but it can also help us develop sustainability in our commitment from the beginning.
When we understand why we pursue a specific objective, we can recognize more opportunities to create sustainability in the given process, which will increase the probability of success.
Understanding “why” is similar to the parable of: “give a man a fish, he feasts for a day, but teach a man to fish, he will eat for a lifetime”. If you understand why you practice PreHab, you will inherently make your practice much more effective and ultimately become more masterful, as well as creative in your practice.
What is PreHab? It is a Practice.
PreHab is a practice. A practice is an activity that one engages in with the intention of either becoming a better person or to become better at a specific skill… or both.
Meditation is practice that people engage in to develop the skills of improved focus, deeper compassion, more accessible empathy and a way to manage one’s own emotions. Meditation is also a practice that is used to help refine ourselves as people and or spirits.
Basketball teams have practice in the same vein. These teams are looking to sharpen their skills of dribbling, passing, guarding, shooting, communication and discipline. These teams also practice to become better.
Hopefully the concept of practice is clear. It’s time spent developing a skill and becoming better. Now, let’s look at PreHab in this construct: developing skill and getting better.
The Attributes of PreHab
Yes, PreHab is a practice: an activity to develop certain skills and get better… but develop what skills and get better at what? These are great questions, and we can break PreHab down into more definable chunks.
PreHab is an intentional practice using exercises and techniques to increase overall mobility, facilitate neuromuscular activation and develop neuromuscular coordination to foster stability.
PreHab exercises and techniques:
• MOBILIZE
• ACTIVATE
• STABILIZE
Goal of PreHab
The overall goal of a PreHab practice is to improve movement quality, which will enhance performance, as well as health and also increase longevity in physical activities.
PreHab improves movement quality, enhances performance and increases longevity.
Terms for Practice
Chances are that if you have not been working as a dedicated fitness professional, strength/performance coach or been competing as an athlete, there is a high probability that you may have never heard these terms: Mobilize, Activate and Stabilize when it comes to exercise and training. So, let’s take a little time and touch on each concept briefly.
MOBILIZE is the process of expanding the range of motion of a joint or several joints collectively. There are numerous ways to mobilize: soft tissue therapy, breathing, joint distractions, stretching, articulations and more. For those that are unfamiliar with any of the aforementioned techniques, we can default to the common conception of “improving one’s flexibility.”
ACTIVATE is the process of stimulating and causing specific myofascial tissues (muscles, tendons and fascia) to create a controlled contraction or “fire.” Like mobilization, there are many different exercises and techniques used to activate a given “muscle,” (which is a bit misleading as it is a bit more complicated on a physiological level.) But to make things a bit more digestible, let’s just say that activation exercises are trying to “turn on” specific neuromuscular connections that will help certain “under-activated” muscle group’s “fire.”
STABILIZE is the process of generating an adequate amount of neuromuscular coordination throughout the body that will allow an individual to withstand or resist any outside force, including gravity and momentum, and accurately construct a movement pattern. Essentially, “stability” in human movement is a product of motor control and physiological capacity. Can the neuromuscular system coordinate the movement despite external influence? And do the tissues, muscles, tendons, fascia and more, have the resiliency and capacity to meet the physical demands of the movement? If all of that sounds like too much, simply look at Stability as the ability to control movement.
Now, we will discuss the attributes of Mobility, Activation and Stability in much more detail in other articles. But, hopefully we touched on them enough to have an idea in your head as we begin talking about why PreHab is necessary.
Why PreHab is Necessary
Why do we use PreHab? Prehab helps prepare the body for the physical demands of training, competition and life. Why is PreHab necessary? The answer to this question is much longer. To start to answer this question, we need to take a step back and look at our world from a bigger point of view.
Today’s World
Today’s world is truly amazing for many different reasons. We have row upon row of tall, towering steel buildings that stand virtually shoulder for shoulder for miles decorating the skylines of Hong Kong, Dubai, New York and hundreds of other cities in the world. And within all of these cities, we have moving walkways, escalators, elevators, trains, cars, scooters, bikes, skateboards and more. All of them literally whisk people off of their feet and transplant them into a new location with little or no physical effort on their part.
Today’s world is also full of advanced technology that has put an abundant amount of information available to each of us with only a push of a button on our phones. On top of that, our technology makes it easy for us to communicate with anyone almost anywhere in the world. If a person in New York wants to speak with a person in Hong Kong, they could do it instantly on an array of devices and apps and they could also do it for free. Barriers of communication have been chiseled down to mere bumps on our smart phones.
The same is true for our food supply as well. Food is easily available and as long as you have the money to pay for it, you can get food any time and virtually anywhere. On top of that, you can also have the food brought to you as you sit at home on your couch talking to your friend in Hong Kong before you stream the latest movie from your phone on to your wide screen television in your home.
Not All Around the World
The amazement of our advanced technology and automation have not yet encapsulated the entire world. There are still some places on this planet, as documented in Michael Pollan’s documentary, In Defense of Food, where people still need to climb trees barefoot and without any harnesses to gather some honey to eat or hunt wild animals with spears. In the undeveloped or developing nations of the world, life has some different physical as well as social demands. However, these are not the places in the world where PreHab has become a necessity.
Developed Nations & the Modern Lifestyle
According to the BBC documentary, Planet Earth II, approximately 50% of the world’s population now lives in cities. It is truly here, within the modern lifestyle of these developed nations that PreHab is now a necessity.
Perhaps the definition of a modern lifestyle, as well as developed nations remains a bit too vague; we can look at it from another perspective. Let’s use a simple checklist to help us understand if we qualify PreHab as a necessity.
PreHab Checklist:
Here is checklist of some simple questions that will help determine if you personally qualify with a need for PreHab:
• Do you live in a home with furniture? You qualify for PreHab.
• Do you wear shoes for a majority of the day? You qualify for PreHab.
• Do you go to the gym and use any form of wearable technology, such as the Apple Watch, to “increase your physical activity?” You qualify for PreHab.
What are your answers? Did you qualify for PreHab? If not, here is one last question: do you care about health, your body or the way that you move? If so, you’ve qualified yourself for PreHab.
Now, you might be looking at these checklist questions and wondering what is the reasoning behind asking about furniture or shoes or wearable technology. Well, we will explain and let’s start with talking about the environment and its effect on human movement.
“The pattern of disease or injury that affects any group of people is never a matter of chance. It is invariably the expression of stresses and strains to which they were exposed to, a response to everything in their environment and behavior.” (Calvin Wells: Bones, Bodies and Disease)
Environment
In essence, there is one primary reason why you need PreHab: the modern lifestyle is an environment that is unfavorable to the biomechanics and health of the human body.
Negative Consequences
Although technology and automation have advanced tremendously, the modern lifestyle in developed nations embodies an environment that creates a long list of negative consequences that many people have never dared to imagine would be true.
This phenomenon is not exactly new. The National Academy of Sports Medicine (NASM) created an entire certification course based on the negative affects that the modern lifestyle is having on human movement. In their Corrective Exercise Specialist course, NASM reports that the advances in technology and automation in daily living has contributed to the formation of numerous malalignments and “compensations patterns” in human movement, including Upper and Lower Cross Syndrome, Pronation Distortion Syndrome and more. (NASM)
More Than Movement
In her book, Movement Matters, bio-mechanist Katy Bowman reports that many of her clients have the “inability to fit foot and hip [corrective] exercises into their day [as representative of] the larger immobility of their [lives].” Bowman saw the effects of modern lifestyle going beyond just human movement and health. More specifically, Bowman reports: “school or work or relationships or work distribution in the home, was preventing their body parts from moving. They were immobilized by the expectations of society and their culture.”
In Movement Matters, Bowman goes into great depth on how the absence of movement and the absence of particular movements or positions are literally robbing individuals of their ability to perform and more importantly, maintain their own health.
There are many other attributes that are needed for optimal health in the modern world, for which we will save for some one else to discuss. Instead, we shall focus on the role of PreHab, which is to improve movement quality and in doing so will assist in improving overall health.
Made to Move – A Lot
On a quick side note, one of the reasons PreHab and movement quality is so important is because the human body was actually designed to move – a lot! Scientific American published an article by Herman Ponlzer titled: Evolved to Exercise, which documents how the evolution to bipedalism (walking/running on two feet) was the mechanical transformation that allowed humans to travel (and move) while using fewer calories. This transformation lead to great migrations out of Africa that helped humans to settle all over the entire globe. These evolutionary transformations also lead to Persistence Hunting.
Persistence Hunting is the practice of hunting wherein humans track animals in packs until the animal overheats from running and needs to stop running. Four-legged animals use more energy to travel the same distance as bipedal humans because of the shape of their bodies. The bipedal attribute allowed for longer strides and the ability to vertically stack one’s mass as opposed to horizontally bridging the mass. To understand the difference, see how much effort it takes for you to crawl than walk or stand.
Once an animal had overheated, humans would pounce on their prey and score food for the entire clan. Yet, humans got more than just food out of Persistence Hunting and the evolutionary transformation to bipedalism. Humans also got larger brains.
Runner’s High = Brain Growth
Ponzler explains that the prolonged periods of physical activity in Persistence Hunting produced endocannabinoids in the brain that rewarded humans with a “runner’s high.” The neurotropic molecules of their “runner’s high” would stimulate neurogenesis that would create larger brains with better memory and cognitive abilities.
Ironically, these larger brains would soon go on to create the modern world, which would literally rob the human of as much physical activity as possible.
Evolution Promotes Movement
Evolution has equipped humans with a body that can perform more activity with less energy and also installed a hormonal reward system, the “runner’s high”, to prompt humans into prolonged states of activity. Essentially, the human body is designed to move and move constantly.
A Lingering Question
The premise that the human body evolved to move a lot may be a bit hard to digest, especially when we fast forward to our modern world and see so many people leading sedentary lifestyles with little physical activity.
In order to understand how modern humans can lead such physically inactive lives while having a body that was designed for a lot of movement, we will need to look at the relationship between human movement and the environment.
A Special Relationship
Human movement is greatly influenced by the environment. Not only does the environment present a plethora of physical barriers for movement, our modern lifestyle, as Bowman referred to in her book, also offers a host of social and behavioral barriers to movement.
The Environment helps to shape Human Movement.
Rush Hour Subway Ride
First, let’s look at the physical barriers. Imagine that you are riding a subway in New York City in the middle of the week’s evening rush hour. It’s been a long day for you and there is a seat available. You know that it will take you thirty minutes to get to you final destination and you have your gym bag with you. Now, there is a great probability that you will take the seat (albeit the behavioral norms of being a gentleman or considerate woman and offering the seat to another). So, the opportunity to sit is presented in this environment and there’s a high probability that many of us would take advantage of sitting as opposed to standing for thirty minutes while holding a heavy gym bag.
Now, let’s layer on some behavioral barriers to this example. As mentioned before, there is a high probability that you would not sit if you wanted to behave as a gentleman or a considerate woman. You may opt to be the conscientious citizen instead… until you realize that when you stand, you end up getting in the way of people exiting and boarding the subway car. So, you might reconsider your position and you may not. That’s almost a 50/50% probability to calculate.
One probability that many of us might employ would be to practice some yoga or do some stretches in that crowded subway car. Not only is there a chance that we would think that we are being obnoxious for splaying out in a Warrior Pose, but there is a high probability that some one in that subway car would call us rude. Additionally, the chances that you would get down on the floor of the subway car to stretch in say a figure-four pose or a straddle position would most likely seem ludicrous to most of us.
Author’s note: I admit that I am one of the few that would actually stretch in a subway car. In fact, I would use the railings and handle bars to help configure most of my stretches despite what my friends or family had to say. Consequentially, I notice many people watching me stretch on these subway cars with a bit of a smile. I imagine that their smiles were representative of their efforts to vicariously stretch with me. Or simply, they felt good watching me move.
This example of riding the subway during rush hour simply points out the existence of both physical and behavior barriers to human movement in the modern world. However, it does not sum up the totality of the special relationship between human movement and the environment.
Task Orientation
There is an important attribute that needs to be understood about human movement: Human movement is task-orientated.
What does really mean that human movement is task-oriented? Well, to be eloquent in response, it means that all the movements that any human ever makes is made to complete a specific task. There are no arbitrary movements. Every single movement has a purpose.
Let’s look at this in more detail because it might be hard to believe. How did you get into the place that you are at now? You probably walked, but maybe you ran, crawled or rolled into the place where you’re at now. However you got there, all the movement was for the purpose of transporting yourself to the place you are in right now. Same goes for the way that you open a door or scratch your nose or open your mail. The examples are endless.
Let’s explore another example that will help illuminate the task’s influence over human movement. Let’s say that you are trying to pick up a pencil off the floor. Chances are that you would just bend at the waist or hinge at the hips with minimal knee bend. But, if you were to pick up something heavier, like a 50lb. sandbag, chances are that not only would you bend your knees and squat your hips down to the floor, but you’d also lift up the sandbag from one edge and tilt it up vertical in order to wrap your arms around the bag. Then you would brace the bag against your trunk and stand up with it.
There is a noticeable difference in how each task is performed because the task itself influences how people will move.
The specifics of the task will shape human movement.
Refocusing Perception of the Task
It’s important to understand that the specifics of the task will shape human movement but it’s just as important to acknowledge how “perception” of the task also influences human movement.
What do we mean by “perception”? It is how we look at the task and how much awareness or attention we place on the task and how the body executes the task.
Let’s look at the task of picking up a pencil. The perceptual process is pretty straightforward: we see the pencil on the floor, we acknowledge that we either need the pencil or just don’t want it on the floor. Our attention remains on the pencil as we pick it up just like a basketball player keeps their attention on the hoop when they shoot. Our attention is never initially on how we complete the task.
The main reason that our attention will shift to how we are performing the task is when we realize that we have not or cannot perform the task.
Back to the example of picking up a pencil off the floor. Now, imagine that the person has a bad back and bending over to pick up the pencil causes pain in his back. It’s here that this person will shift attention to how they perform the task, but usually just enough to coordinate a movement that does not cause pain and completes the task.
Let’s look back at the basketball player; imagine that they miss the shot. They might start to examine their shooting form and make adjustments. They might shift their perception and change their movement.
As human beings, we only focus on how to perform a task if you are primed or cognitively directly to examine how we perform the task.
Differentiating Perception
Quick recap: Human beings are task-oriented creatures. We move specifically to accomplish a targeted task, either consciously or unconsciously. This phenomenon is literally one of the main reasons that personal trainers and coaches have careers.
Rob Kram, General Manager of The St James Health Club, Trigger Point Master Instructor and long time Personal Trainer, teaches his training staff how to “differentiate” an exercise as a way to demonstrate the trainer’s value to clients.
Kram teaches his trainers to allow the client to start any given exercise on their own. This allows the client to initiate their already developed “task-oriented” movement habits around the given exercise. After the client has started the exercise, Kram instructs his trainers to observe the clients form and analyze their biomechanics. Then, Kram instructs his trainers to stop the client in the middle of the set and give two to four different adjustments to improve results. Here’s the differentiation in action: the cues that the trainer provides to the client will change the client’s perception of how to perform the exercise and thus change the actual movement.
Let’s just imagine that the client is doing a push-up and the elbows are splayed out at 90-degree angles to the spine and the hips sag low as the client presses up. The trainer can ask the client to reposition the elbows on a 45-degree angle to the spine to provide more shoulder girdle stability and then interject the following cues: zip up your abdominals, kick into the floor as you push and try to separate the floor with your hands.
If the client integrates these adjustments and cues into the exercise, the form will surely change simply because there was a new way of perceiving or understanding what was necessary to complete the task of a push-up.
This “differentiation technique” is a helpful tool trainers and coaches use to demonstrate the value that they bring to the table, and more importantly, an opportunity to teach their client or athlete that how they perceive the task and how they perform the task will make a difference in their movement.
The perception of the task will shape Human Movement.
The Organism
So far, we have discussed how the environment and the task, as well as the perception of the task, help to shape human movement. Now, we need to turn our attention to the organism and the Law of Mechanotransduction.
Wolff’s Law
German anatomist Julius Wolff spent much time examining and comparing the femur bone amongst many individuals and observed noticeable differences in shape and density. Wolff would go on to propose that “bones grow and remodel throughout life to adapt to their mechanical environment.” This claim would become Wolff’s Law and become the premise of mechanotransduction.
The Driving Force: Mechanotransduction
If you were like me, you probably were excited when you bought a brand new glove to play Little League. I got my glove, rubbed it down with some oil and then I stuck a ball into the glove, wrapped the glove up really tight with a belt and stuck it underneath my mattress for a couple of nights to help “break in” the glove.
Well, maybe you didn’t play in Little League, but you’ve bough a new pair of running shoes or a new pair of dress shoes. And it took you a number of days or even weeks until those shoes felt very comfortable because they finally molded to your feet. All of these are examples of mechanotransduction, the driving force of change in our world.
“Mechanotransduction is the process wherein the mechanical forces (tension and compression) will deform (reshape) objects including the human body.” (Bowman)
Bio-mechanist Katy Bowman dedicates an entire book to mechanotransduction and it’s affect on the human body. In her book, Move Your DNA, Bowman cites plenty of examples of how the movements that we make and the positions that we spend time in are actually deforming, (the mechanical term for reshaping,) our bodies.
Why Should We Care?
I have no interest in just throwing out jargon terms like mechanotransduction. But there is good reason to and the thing is, I am not too sure how to explain the importance of mechanotransduction without sounding like a fear mogul. However, mechanotransduction is an important and powerful phenomenon that is greatly influencing how we move as well as our overall health.
If we all realize that the positions that we spend a lot of time in and movement that we habitually employ are actually reshaping our bodies, then we can take action that can minimize or perhaps even counter the effects of these positions.
“Our bodies are being shaped and reshaped by the positions we spend time in and the movements that we repeatedly perform.” (Bowman)
Living Proof
Would you like an example of the concept of mechanotransduction? Here’s a very simple exercise to try that will demonstrate the validity of mechanotransduction.
Move Your Toes
Take your shoes and socks off and look at your toes. Now, try to move only your pinkie toe. Can you move it without moving the other four toes? Chances are that if you wear shoes for the majority of the day that you will not be able to move your pinkie toe without moving the other four toes. Your shoes have re-cast your foot and have inhibited the ability to move your toe.
If you can move your pinkie without moving the other four toes, the chances are that you either practice a lot of yoga and/or some other type of movement while being barefoot or you might be young enough that the prolonged use of shoes has not deformed your foot and robbed you of the ability to move only your pinkie toe.
S.A.I.D. Principal
The fitness industry has known about mechanotransduction for decades, but has been referring to it as the SAID Principal, more formally known as the Principal of Specific Adaptions to Imposed Demands.
The SAID Principal dictates all of fitness programming as it outlines the cause-and-effect relationship of training and exercise. For example, if you want to get strong, you need to lift heavy things. Lifting heavy things, such as performing a Deadlift, will be the Imposed Demands, from which getting stronger will be the Specific Adaptation. Conversely, if you want to develop the endurance and stamina for a marathon, then you will need to run long distances, numerous times!
Essentially, mechanotransduction is the premise of the SAID Principal.
The Devil is in the Details
If you want to get real strong, the SAID Principal implies that if we can just lift heavy things, with adequate rest and recovery, we will meet our goal. However, many people have already tried this and at some point either found themselves not achieving their goal of “getting real strong” or worse yet, end-up injured.
The reason that the SAID Principal may not work for many people is because there are many details that they are missing in their mechanotransduction experiment.
In order to truly understand mechanotransduction and apply the SAID Principal in training or exercise, we must truly understand the evolutionary nature of Human Body and Human Movement.
A Short Lesson in Evolution
The evolution of our species, homo-sapiens, to what we are today has taken roughly ten millions years with many milestones along the way. We learned to stand up and walk roughly four million years ago. We created tools approximately three million years ago. We migrated out of East Africa two million years ago. We started cooking one million years ago. Then we made clothes, created languages and civilizations.
According to Daniel Lieberman, an archeologist professor from Harvard University, humans spent a large amount of time, virtually two million years, living and working in Hunter-Gatherer societies. In these societies, humans literally hunted and gathered (forged) to survive. But don’t be mistaken. Just because the term Hunter-Gatherer may paint a simplistic view of their lives, these humans did not live simplistic lives at all.
In his book, The Story of the Human Body, Lieberman chronicles the lives of Hunter-Gatherers and notes the level of physical activity and variability in their lives. Hunter-Gatherers practiced Persistence Hunting as mentioned before and also spent much time foraging or gathering berries, twigs and other pieces of vegetation to eat. They had no weather reports and no satellite images to scout with. They had to rely on their instincts and their physical capacities to find both food and shelter.
Now, a couple of descriptive paragraphs cannot surely capture the realities that our ancestors endured for hundreds of thousands of years and this article is not a history report on Hunter-Gatherers. What is essential to understand is the vast difference between the life of a Hunter-Gatherer and a Modern Human. More important, it is important to understand that while both the environment and experiences of a Hunter-Gather and Modern Human are vastly different, but the Human Body remains virtually the same.
Evolutionary Timeline
Humans evolved over millions of years to become very physically active Hunter-Gatherers. Only 10,000 years ago did humans first start to farm, and it wasn’t until the 8th Century that the Agricultural Revolution took hold and farmer societies started to populate the world.
During the 18th Century, the next revolution occurred, the Industrial Revolution, which lasted until the end of the 20th Century when the Digital Revolution was finally upon us.
The world dramatically changed very quickly in regards to the evolutionary timeline of the world. Humans went from throwing spears and climbing trees to building cars and flying planes much faster than it took humans to learn to walk on two feet or use language. It took only a few thousands of years these modern changes to occur compared to the millions of years for these evolutionarily changes to develop.
When we look closely at the comparison: we can see that humans learned to dramatically change their environment in a few thousand years, while it took nature (evolution) to change humans over millions of year.
Changes by the Numbers
• 350,000 Generations as Hunters and Gatherers
Evolutionary Adaptions
• 84 Generations of the Agricultural Revolution
• 7 Generations of the Industrial Revolution
• 2 Generations of Digital Revolution and Environmental Changes
(Spina 2018)
The human body evolved over millions of years while the environment that humans live in has dramatically changed in only a few thousand years.
Timeline of Changing Environments
Approximately 10,000 years ago, humans learned how to farm and this invention started the slow transition from a hunter-gatherer lifestyle to an agricultural lifestyle. The agricultural revolution, (technically three revolutions,) would help humans to build cities, create empires, reproduce more readily and consolidate power. (Lieberman)
Even though the agricultural revolution was beneficial to fortifying the existence of the human species, this cultural shift was treacherous to the human body. People started to habitually experience back pain and many other ailments or injures once they transitioned to an agricultural lifestyle. In fact, it was all of the pain and collection of ailments that literally drove the human race into the Industrial Revolution. (Lieberman).
During the industrial Revolution, humans sought to use machines to save their bodies from the pain and suffering of an agricultural culture. From the cotton gin to the steam engine, humans continue to produce different types of machines to free them from the burden of physical labor. Low and behold, humans did not realize the hole that they were figuratively creating for their bodies and their health. (Lieberman)
Invention of Exercise
Towards the end of the Industrial Revolution and at the advent of the Digital Revolution, humans noticed that their health was deteriorating because of the lack of physical activity in their lives. The solution was simple: exercise.
Exercise would soon become a staple of the Modern Environment.
Modern Environment Defined
What is the modern environment? That’s a great question and the answer has some different branches to it that we need to explore. First, we really need to qualify the parameters of a “Modern Environment” to that of developed and developing nations, because there are still some places on this planet that have been exhibiting the same environment for millions of years, such as the Artic, remote islands and even many forests and deserts.
Let’s set the parameters of our modern environment to encompass all developed countries and areas in the world where technology, machinery and automation have a sizable influence on daily life activities.
Living in the Modern Environment
Chances are that if you are reading this, you live in the modern environment. In fact, you might be sitting at a desk and reading this on a computer as I am literally sitting at a desk and typing this out on my computer. So, we can easily just look around and see what our modern environment really is in detail.
Surfaces
The modern environment is full flat surfaces. Sometimes steel, sometimes concrete or pavement and sometimes wood. Occasionally, the surface is grass, dirt, sand or rock. If that’s not the environment you are in, consider yourself lucky. As for me, I have not placed my feet on a natural surface literally in months. I live in a metropolitan area and I wear shoes for the majority of my day as I walk around the insides of buildings, parking lots or garages. Even as an avid runner, I spend more time on treadmills, paved roads or paths as opposed to natural trails – even though I love trails.
Transportation
Why do we even speak about running when our modern environment is full of cars, planes, trains, scooters, bicycles, skateboards and more? All of these options have severely reduced the need to run or even walk. Instead, most of us in the modern environment are transported from location to location while sitting in or on some type of vehicle.
Do you remember that our Hunter-Gatherer ancestors would practice Persistence Hunting where they would run for 3-5+ hours at a time?
Automation
In our modern environment, we have the ability to produce things, including tools, clothes and even food, at a very fast rate. In fact, we produce so many things so fast that millions of retails stores all across the world literally have millions of ‘things’ just sitting on shelves not being used at all.
There is no need to run 3-5+ hours a day on a hunt if you can literally walk into a grocery store and buy dinner for the night.
Technology
The scope of technology in the world today is astonishing. We have smartphones with voice and face recognition, as well as GPS, heart rate sensors and much more. So, technology can tell who we are, where we are and whether or not we are at the right heart rate for training.
Technology also makes an unbelievable amount of information accessible to us almost instantaneously as long as we are connected to the Internet. Additionally, we can communicate with anyone in the world via video, phone or emoji –as long as we have his or her contact information.
Why walk to the grocery store, when we can order food online to be delivered from the best-rated restaurant in the neighborhood, which we may have never been inside of or even seen?
Modern Lifestyle
Our modern environment is having a powerful affect on our lives. It has made it easy to have access to many things that are necessary for life, such as food, shelter, relationships and even status, significance and meaning. However, our modern environment is also placing constraints and limits on us.
Early on, we used the term Modern Lifestyle because “lifestyle” includes behavior, norms and culture, all of which have an additional affect on our movement, bodies and health.
The Modern Environment sets the stage for our Modern Lifestyle.
Lifestyle’s Affect Movement and Our Bodies
Our modern lifestyle, the way that we habitually behave within the confines of our modern environment, is shaping human movement and human bodies… and not necessarily for the best either.
Sedentary Lifestyle
All of the advances in technology, mechanics and automation in our Modern Environment helped create a sedentary lifestyle for a large majority of humans.
What is a Sedentary Lifestyle?
Simply put, a sedentary lifestyle is analogous to an inactive lifestyle.
The word “sedentary” refers to a seated position, which requires very little energy or effort to maintain. Thus, any person that spends much time seated would exert minimal effort or energy throughout the day and would be considered “inactive.” Please note that a person does not need to sit all day to lead a sedentary lifestyle.
A recent National Institute on Health (NIH) study was able to quantify a sedentary lifestyle by counting the amount of steps taken in a day. If you take less than 5,000 steps in a given day on average, you would be categorized as having a sedentary lifestyle. (Tudor-Locke)
Remember during Persistence Hunting, our Hunter-Gatherer ancestors could easily run 3-5+ hours just to get a meal.
Comparison: Hunter-Gatherers and Modern Humans
When we compare the Hunter-Gatherers to Modern Humans, we can see some noticeable differences in the composition of both the lifestyle and the human body.
All the Way Down to the Cell
In fact, research has shown that our modern lifestyle is creating adverse effects all the way down to the cellular level. First, anthropologists have determined that Hunter-Gatherers would move for eight hours per day and were ten times more active than modern humans. Additionally, anthropologists compared the shape of our bones to the bones of Hunter and Gatherers and found noticeable differences. There is an estimated amount of loss resiliency due to the loading behavior of modern humans. (Abbott/Bowman)
In particular, the static positioning and mechanical loads in a sedentary lifestyle can literally force some cells to be overstretched and deformed (reshaped) into a longer, thinner shape that is weaker, while other cells can actually be squished together and then literally bind together just like scar tissue. This binding will limit the tissues ability to slide, which then inhibits how well and how far the joints can actually move. Now, this get even worse when these overstretched and compressed cells regenerate without a diverse mechanical load to guide a systematical and healthy reproduction of the cell. (Bowman)
From the effects of mechanotransduction, the act of prolonged sitting or prolonged standing for that matter, the body is slowly taking the form of these two positions and are literally adapting to make this positions easier to maintain over time. (Bowman)
In short, our modern lifestyle is slowly reshaping our bodies to be more efficient at creating and maintaining all of the positions that we embody most frequently, which for most modern humans tends to be sedentary positions. (Bowman)
Circulation
Another negative effect that our modern sedentary lifestyle has on our bodies is impedance on our cardiovascular system and our body’s ability to circulate blood to all of the cells.
Our bodies use movement to help circulate the blood and disperse nutrients and oxygen. When we move, our muscles will literally pull oxygen into the cells. Without movement, our heart is left to push the blood through the body and worse yet, due to the compressive forces on our tissue due to the positions that we embody, blood may not actually reach numerous cells, thus starving the cells of oxygen and nutrients. (Bowman)
Health Risks of a Sedentary Lifestyle
In some shape or form, (pun intended,) you probably have heard of the health risks associated with a sedentary lifestyle. Here’s a short list of the risks:
• Increased Risk for Cancer
• Increased Risk for Diabetes
• Increased Risk for Cognitive Decline and Dementia
• Increased Risk for Heart Attack and Strokes
• Increased Loss of Lean Muscle Mass
• Increased Risk of Depression, Weight Gain and Illness (Flu)
(Rimmer)
Elevated Stress Levels
In addition to all of these health risks, our modern lifestyle is helping to keep our levels of stress elevated with all of our advances of technology and automation. Our addictions to smartphones, emails, binge watching TV shows, traveling between time zones, worrying about deadlines and much more. Our modern lifestyle offers an unlimited amount of stimulus at any given point in time, which leads to chronically elevated stress levels. (Bowman)
Remember, stress can disrupt our sleep, weaken out immune system, make us gain weight and adversely affect our health.
Solutions?
Our collective awareness of the health risks associated with a sedentary lifestyle leads us to look for solutions. One of the solutions was a catching new slogan: Sitting is the New Smoking, a battle cry for many people to start moving and exercising more. In fact, many technology companies jump at the opportunity to create wearable devices, such as the Fitbit and Apple Watch that prompt us to move more and exercise.
The Center for Disease Control (CDC) recommends that individuals get one hundred and fifty minutes of moderate exercise or seventy-five minutes of vigorous exercise, as well as walk 10,000 steps a day to reduce health risks associated with inactivity.
Even though we thought moving more and exercising was the antidote for a sedentary lifestyle, there was more to the problem that we were not considering.
Sustainable Solutions
While Medical and Public Health authorities advocated lifestyle reform, Dr. Benjamin Baddeley stated in his own study that “[we] need to find sustainable ways of integrating physical activity throughout the working day rather than viewing exercise purely as an extracurricular activity.”
CNN published an article that echoed Baddeley’s sentiment. In “Sit less, move more,” author Keith Diaz, an associate research scientist in the Columbia University Department of Medicine, states that simplistic guidelines to exercise more is not truly effective. Diaz advocated that people needed to be told “how” to exercise and move more. (Scutti)
How To…
We have now come back to the question of “how to” exercise and move, the underlining notion in the practice of PreHab. We understand that a sedentary lifestyle with it’s chronically elevated levels of stress is not the optimal lifestyle for human health, but we will soon see that simply combining exercise with a sedentary lifestyle is not be the sole answer.
Modern Need for PreHab
A brief recap
We’ve discussed how the human body evolved over millions of years to be very active each and every day. Then we discussed how advances in technology and automation have limited the need to move for the modern human, who has become much different on a cellular level when compared to our Hunter-Gatherers ancestors.
We can assign responsibility for these cellular differences to the process of mechanotransduction, which refers to the way that shapes, positions and movement patterns are constantly reshaping our bodies. Remember that the SAID Principal is based on mechanotransduction.
We also discussed the fact that human movement is task-orientated, which means we pay attention to what we are doing, but not necessarily how we are doing it, unless we can’t initially complete the task. Maybe you can see the logical progression here that leads to the invention of PreHab. PreHab was invented and we will look into how it was born and how it has evolved to today.
History Lesson: The Invention of PreHab
Human beings used to run through forests, climb over rocks, climb under bushes, throw spears and sit on the floor. Then in a relatively short time, humans found themselves a brand new environment, the modern environment.
“The modern environment is completely different from the environment that dictated the evolutionary changes to the human body.” (Lieberman)
New Environment, New Lifestyle, Same Body
In the 1970’s, people finally started to embrace exercise as a necessity as they noticed that they were losing their health and gaining inches around their waist line. For the next couple of decades, people used exercise for health, recreation and even employment. (Taubles)
As the physical demands of the Modern Lifestyle lessened, the need to exercise began to increase.
From calisthenics to step aerobics and jazzercise to bodybuilding to Strength & Conditioning programs to powerlifting competitions to cross training to CrossFit to Functional Training and Tactical Training plus more, the world of exercise and fitness grew immensely in a relatively short period of time.
From the 1970’s to present day, exercise, fitness and sports programming has exploded.
Disparity Leads to Injury
Consequentially, the growth of fitness, exercise and sports created a large disparity: the level of fitness programming and exercise usually exceeded the physical capacities of the average modern human. Few humans could perform a specific sport or fitness related task, while most others could not. However, many of the other modern humans still tried and ended up getting hurt.
The disparity between the physical potential of the fitness industry and physical capacity of an average modern human leads to injury.
During this time of disparity, specific sports or fitness programs, such as CrossFit, would be blamed as being unprofessional and irresponsible in the realm of fitness programing and coaching. However, most people did just not realize what was truly happening to their bodies.
The modern human slowly lost their physical capacity due to living in an environment that cultivated a sedentary lifestyle and behavior.
Not Fit Enough to Exercise
Essentially, the modern human was not fit enough to exercise anymore and this de-evolution of human capacity lead to the invention of PreHab. PreHab is designed to be a supplemental portion of a training program that helps a person to become fit enough for the actual training program.
To help spread the movement of PreHab, a slogan grew popular:
“PreHab to Avoid Rehab.”
Coin and Popularized
In 2007, Tim Ferriss was the first to popularize PreHab. In his renowned book, The Four Hour Body, Ferriss utilized a conversation with physical therapist Gray Cook to uncover two exercises that would prevent his back pain from recurring while he exercised. Ferriss termed this strategy of “preventative training” as PreHab.
Due to Ferriss’ role of thought provoker, it wasn’t too long before “PreHab”’ was common speak with many Strength & Conditioning Coaches and Personal Trainers.
Variability in Movement
Variability in human movement is important to the health and functionality of the body. Variability, or the process of engaging in various different movement patterns and utilizing numerous different positions, helps to disperse the mechanical load throughout the body. More specifically, variability in movement will help to spread the mechanical load and accompanying forces, during which more of the tissues will literally share the load/forces and reduce the likelihood of overloading or injuring a specific section or area of tissue through repetitive movements.
Additionally, variability will utilize a large range of motion of more joints, which will strengthen the motor control of these joints and give more access to more positions and movement patterns.
Accessible Positions and Movement Patterns
The chances are that you have heard the phrase: “use it or lose it.” Well, this phrase represents the fundamental truth about “accessibility” of movement patterns and positions.
Human movement is coordinated by the Motor Cortex, which resides in the top middle of the brain, with assistance from the rest of the Nervous System. This is where “use it or lose it” is critical.
Mechanoreceptors all throughout the Peripheral Nervous System sends Afferent Signals into the Central Nervous System and specifically the Motor Cortex that “remind” the brain of positions that the body is in. For example, when you sit in the bottom of a squat, mechanoreceptors spend impulses to the Motor Cortex that says that this is a position that is available to us. Once the Motor Cortex is reminded of a position, it can then send out Efferent Signals to help reconstruct that position another time, and the more that we enter a position, the more that we remind our brain that we can construct the position, and our bodies grow more efficient in doing so. Thus, a cycle of informing and reconstructing occurs. (Spina)
Conversely, if we do not spend time in a position, it is much harder for the body to reconstruct that position because the Motor Cortex does not “remember” the position. Essentially, a position can become inaccessible to us if we do not spend time in it. (Spina)
When positions become unavailable to the body, the diversity of mechanical loads and forces at the joints and through the tissues become more repetitive and dangerous. (Bowman)
Movement Variability helps to make more Movement Patterns and Positions accessible to the body, for which the body can disperse and share mechanical loads and forces more evenly throughout the joints and tissues.
Is PreHab Necessary?
Historically, the fitness industry has been known to create training concepts that are not always valid, necessary, or both. A perfect example is the elevation-training mask that is supposed to assimilate the body to higher altitudes. The mask doesn’t work!
Another example is the concept of “muscle confusion,” a premise that we need to do a variety of different movements in random order to help confuse and even the shock the muscles into growth. This is not a valid concept either. Muscles do not need to be confused, tricked or shocked into growth. Muscles just need to be used in order to grow.
PreHab is here to stay because there is plenty of evidence that supports the need for PreHab in our modern lifestyles.
Benefits of PreHab:
• PreHab educates people on “how” to move.
• PreHab develops biomechanical integrity and efficiency.
• PreHab Programs guide individuals through a process of mechanotransduction and create welcomed adaptions that the individual is seeking: movement quality, enhanced performance as well as increased health and longevity.
Resources
Move Your DNA: restore your health through natural movement, Katy Bowman – Propriometrics Press – 2017
Movement MATTERS, Katy Bowman – Lotus Publishing – 2016
The Story of the Human Body: evolution, health, and disease, Daniel Lieberman – Vintage Books – 2014
Humans Evolved to Exercises, Herman Pontzer, Scientific American – January 2019
NASM Essentials of Corrective Exercise Training, Micheal Clark-Scott Lucett-Brian Sutton – Jones & Bartlett Learning – 2014
CARs Advanced Interpretation and Application – Lecture– Dr. Andreo Spina & Dr. Michael Chivers – Functional Range Systems – 2018
Functional Range Assessment Certification Course – Dr. Andreo Spina & Dr. Michael Chivers – Functional Range Systems – 2018
Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists, Thomas Myers – Churchill Livingstone/Elsevier – 2014
De Blaiser, C., Roosen, P., Willems, T., Danneels, L., Bossche, L., De Ridder, R. (2018). Is core stability a risk factor for lower extremity injuries in an athletic population? A systematic review. Physical Therapy Sport, 30, 48-56
Araujo, S., Cohen, D., Hayes, L. (2015). Six weeks of core stability training improves landing kinetics among female capoeira athletes: a pilot study. Journal of Human Kinetics, 45, 27-37
British Journal of General Practice – Sitting is the new smoking: where do we stand? – Benjamin Baddeley – May 2016 66(646): 258
Yes, sitting too long can kill you even if you exercise – CNN – Susan Scutti – September 12, 2017
Pearson, O., Lieberman, D., The Aging of Wolff’s ‘Law;: Ontogeny and Responses to Mechanical Loading in Cortical Bone – Yearbook of Physical Anthropology. 2004
Tudor-Locke C, Craig CL, Thyfault JP, Spence JC, A Step-defined sedentary lifestyle index: <5000 steps/day – Applied Physiology, Nutrition and Metabolism Feb 2013; 38 (2): 100-14. Rimmer J., Sedentary Lifestyle is Dangerous to Your Health, NCHPAD.org