updated 1/18/07

The ‘Use It Or Lose It’ Principle

The importance of stimulation and movement in healing

by Paul Ingraham, Vancouver, Canada MORE

Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.

Articles in the Biological Literacy series are fun explorations of how the human body works. See below for a complete listing of articles in the series.

Everyone knows you’ve got to “use it or lose it,” but what does that mean exactly? What do we lose, and why? And how does using it help?

Activity is good for “them”

With every passing decade, physiologists have understood even better that a person is a colony of cells, both our own and really surprising numbers of “alien” cells, everything from friendly bacteria in our gut to ancient organisms that have developed such a close working relationship with our own cells that they have become us.

All of that life inside of us, the life that makes us who we are, needs constant maintenance, a constant supply of nutrients. We have to stay active not so much because it’s good for us: we have to stay active because it’s good for them. They need nutrients, oxygen, waste removal — and they never sleep, never stop needing those services, not for one minute of our lives.

Bourne concentrated on rest and mobility. From somewhere in his forgotten past he understood that recovery depended upon both and he applied rigid discipline to both.
The Bourne Identity, by Robert Ludlum, p137

Adaptation

You are your stresses.

There is a reason that babies all look pretty similar: none of them have been shaped by stress yet. Oh, sure, they have some distinguishing features, but nothing like adults. They are kind of larval looking, all of them.

Much of who you are as an adult is a modified — stress-adapted — version of an original template. What would you be like if you had never had anything but extremely mild physical stresses in your life? What if you grew up in a padded, zero-G room? You would literally be fragile. Your bones would be like Styrofoam. You would look different: your skin would be a different colour and texture, your joints a different shape. You wouldn’t be able to do much of anything in normal gravity.

What if you grew up in a padded, zero-G room?

Most of who you are and what you are physically capable of is the result of adaptation to stress.

All of biology is organized around adaptive reactions to stimuli: immediate reflex (neurological) responses, nearly immediate hormonal and behavioural responses, tissue change responses. Every response is about improving conditions for the organism. Starting to fall down? The organism reacts to stop it. Regular pounding impact on your legs? Make the bones stronger. Etc.

Take away the stresses, and the body steadily stops investing energy in unnecessary adaptations. Adapting is “expensive.” You don’t do it if you don’t have to.

What is it, exactly, that we have to use?

Everything — but, above all, your heart and lungs, and your brains if you want to keep sharp into old age.

The evidence is overwhelming that moderate aerobic activity is probably the single most important kind of exercise … because there isn’t a single cell in your body that doesn’t depend on a constantly blood-borne supply of oxygen and nutrients. The delivery system must be constantly challenged.

There isn’t a cell in your body that doesn’t need a constant blood-borne supply of oxygen and nutrients.

But you really have to use anything that you don’t want to lose.

There is a concept in athletics called “training specificity.” It’s one of the Laws of Exercise: you get good at what you do, and only what you do. If you jump up and down on one foot, you’ll get good at jumping up and down on one foot … but not the other foot. If you lift weights slowly, you’ll get good at lifting weights slowly … but not good at lifting them quickly.

You kind of need a specific exercise for anything you want to keep in shape. Which is why so many exercise experts recommendation a wide variety of exercises.

But what happens to stagnating tissue? Other than just not getting tougher? Well, it gets dysfunctional and incompetent …

Clear and present danger

Even though people are well aware that you need to stay active, few people understand just what exactly goes wrong when you don’t exercise — other than going to fat. There are at least two major concerns that are not widely understood.

First, reflex degeneration.1 We are full of reflexes, some of which are going to get exercised almost no matter what we do — like the swallowing reflex, say. But a lot of neurological responses can easily get neglected, like postural reflexes in a chair-bound office worker. If you spend many hours a day in a chair, you simply don’t have to work very hard to stay upright. It’s easy to stay upright! Not only do the core stability muscles go to pot, but so do the reflexes that activate them.

If you spend many hours a day in a chair, you simply don’t have to work very hard to stay upright.

Second, muscle tissue dysfunction and painful trigger points.2 Trigger points, better known as muscle knots, are more clinically significant than most doctors understand,3 causing and complicated countless painful injuries and problems, especially back pain,4 to say nothing of an incredible amount of moderate stiffness and low-grade discomfort that limits exercise and suppresses quality of life in countless small ways. Trigger points will form in muscle tissue when that tissue is either overstimulated … or stagnant … and the combination is especially deadly.

The weekend warrior whose muscles stagnate in a chair throughout the week but are challenged on the ski hill on Saturday is pretty much doomed to an accumulation of increasingly problematic trigger points, often misinterpreted as “getting too old for this.”

The Goldilocks Principle

So, we know from research that regular moderate activity is generally a good thing,5 6 7 tissue stagnancy is bad news, and that overexertion is dangerous to healing tissues.8 9

That pretty clearly implies a need for some kind of in between exercise intensity, something not too easy nor too hard: but a Goldilocks “juuuust right.”

I’ll finish with a diagram:

The Biological Literacy Series

Dance of the Sarcomeres — A mental picture of muscle knot physiology explains four familiar features of muscle pain
The ‘Use It Or Lose It’ Principle — The importance of stimulation and movement in healing
Natural Imperfection — Evolution doesn’t care if you have back pain … just as long as you can breed
Oh, a flow-induced system of mechanotransduction! Of course! — A century-old mystery of bone biology was solved just a little while ago
Eccentric Contraction — A peculiar phenomenon in muscle physiology
Stiffness, tightness and limited range of motion are not always the same thing — An interesting little thing to understand about your body
We Are Full of Critters — The human body is a colony of ten trillion co-operating cells
How Many Muscles? — A (slightly tongue-in-cheek) tally of the body’s many muscles
The Sixth Sense — Proprioception, the vital but mysterious sensation of position and movement
Ugly Bags of Mostly Water — The chemical composition of human biology
An Introduction to Biological Literacy — Why you need to know more about your body
What Hurts You — The strange science of pain perception

Notes

Nakazawa et al. Journal of Gravitational Physiology. 1997. Return to text.
Save Yourself from Trigger Points & Myofascial Pain Syndrome! Return to text.
Most doctors are well aware that there are serious shortcomings in the medical management of most musculoskeletal problems, especially chronic pain cases. Dr. Jonathon Tomlinson, an instructor at St. Leonards Hospital in Hoxton, explains that “undergraduate training is focused on hospital orthopedics (broken bones and anything else that’s amenable to surgery) or rheumatology (nasty inflammatory diseases) which comprise a minority of the aches/pains/strains and injuries that people actually suffer from.”

Medical researchers have done many studies showing that most doctors do not understand aches and pains or heed expert recommendations. A good recent example is a paper in the Archives of Internal Medicine showing that family doctors frequently ignore guidelines for the care of low back pain — see Williams et al.

More generally, the Journal of Bone and Joint Surgery, and the Journal of the American Osteopathic Association, have both published papers recently showing that physicians simply do not have an adequate understanding of musculoskeletal medicine. In 2002, Freedman et al felt that “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.” Then again in 2005 in JBJS, Matzkin et al concluded that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.” Most recently, in 2006, Stockard et al wrote “82% of allopathic graduates ... failed to demonstrate basic competency in musculoskeletal medicine.”
Return to text.
Save Yourself from Low Back Pain! Return to text.
For instance: Puetz et al. Psychol Bull. 2006. From the abstract: “Chronic exercise increased feelings of energy and lessened feelings of fatigue …” And of course there are countless other kinds of research showing an incredible variety of exercise benefits. Return to text.
Or consider the enormous body of cultural and medical wisdom that constitutes the foundation of taiqi and qigong in China. See Appendix A for more. Return to text.
Staying active is well known to be a significant factor in longevity and sustained quality of life. See Buettner, for instance, or Larson or Corcoran or Nakazawa.
Return to text.
“Exorcizing Myths about Exercise” an audio recording from Quirks & Quarks (CBC Radio One). This excellent radio segment discusses recent scientific evidence that debunks several exercise myths, showing that stretching isn’t as useful as you might have thought, that working out exclusively on the weekend may actually be dangerous, and response to aerobic and strength training may depend on your genes. Return to text.
Lamb et al. Lancet. 2009. It’s been in vogue in physical therapy for a long time now to “mobilize” injuries as quickly as possible — probably too much in vogue. In the zeal to get people on their feet again ASAP, serious sprains — which are worse than fractures in some ways — are almost never put in a cast. Turns out that’s a mistake. A 2009 experiment published in the Lancet presents clear evidence that a full cast for a severe ankle sprain is superior to the almost universal practice of using braces and tubular compression bandages. The editors write, “This elegant study highlights the need for trials to address common problems.” Return to text.