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  • Alex Phillipos

The Iceberg

Previous blog posts have touched on the idea that health problems aren't usually one-offs, but the result of cumulative stress and strain on the human body. An example given is sustained posture: a desk worker needs to sit at their table and in front of a screen for eight hours a day, nearly continuously. Even if a standing desk is an option, a static standing and static sitting posture are still two static postures, unless you can somehow do your desk-work while doing squats. Assuming our desk-worker commutes to their job, they may need to drive in. Melbourne's average commute time is 60 minutes, so let's add another two hours of static posture. That's ten hours a day. Fifty hours a week assuming a work week of five days. Two-thousand six hundred hours a year assuming our worker works every day of the week with no time off, which subjects the human body to mechanical strain. This strain expresses itself as deteriorating posture, poor movement patterns, and discomfort. That's an example of static posture. Dynamic postures subject the human body to different kinds of



strain. A delivery driver needs to get in and out of their vehicle, lift and carry boxes, bend, twist, reach, crouch, and stand. Even if they get a lunch break where they stretch and relieve their tension, they are still subjected to dynamic and varied stress in a mechanically different but conceptually comparable way to the desk worker. Over time, the delivery driver will experience different discomforts: ongoing muscular soreness, deteriorating posture, stiffness, and pain dependent on the nature of their work. Both of these examples are an illustration of how the stresses of life impose mechanical demands on our bodies. Our bodies are able to meet these demands in a broad sense, but because of the nature of the world and the way it works, it's never truly possible to be free of these demands or reverse their course entirely through rest. Our lives shape our bodies, and for someone who lives a quarter, a third, or a half of their life at work or in work-related tasks, that can cause physical problems. This means that as a result of the way our world is designed, we as participants in that world are exposed to a constant, unremitting baseline of physical demand that can overload our bodies. That's the problem, how do we solve it.

In broad strokes, people can get by with exercise and sensible living. I believe that 90% of Allied Health would be rendered redundant overnight if people drank enough water, got enough sleep, ate sensibly, and engaged in thirty to forty-five minutes of brisk exercise on a daily basis, preferrably somewhere sunny. Does this sound like self-help quackery? Yes absolutely. Is it effective advice? Yes to that too. Most of the strain of life can be effectively addressed with exercises. Most, but not all. When people present to clinic with discomfort that doesn't seem to have a cause, that discomfort is most likely the result of compounded stress on the human body that has exceeded the body's ability to adapt, and which has also exceeded the capacity for exercise and activity modification to remedy. Our desk worker typically presents with headaches, neck, and upper limb pain in addition to the back pain. Our desk worker may participate in pilates, yoga, and walk the dog thrice-weekly, but their pain has built up to this point anyway. Our delivery driver has back pain but of a different quality, as well as knee, hip, and shoulder pain from repeated movements. Our delivery driver may lift weights, swim, and play football in their spare time, but their pain has built up to this point anyway. These presentations are the tip of the iceberg: the appreciable and reportable results of the accumulation of stress, functional maladaptation, and ongoing mechanical demand on the body. The rest of the iceberg is everything that has built up and contributed to the point that the top one-tenth of the problem has broken water and gotten bad enough to bring someone into the clinic.

The problem you come in with is just the tip of the iceberg. If you treat the presenting problem, you're just treating the top one-tenth of the iceberg while ignoring the other 90% of very real contributing factors pushing the top tenth as high as it is.

Proper, effective treatment hits the whole iceberg and chips away at it at whatever speed the patient can manage. The problem with this approach is that because the demands of life are ongoing, the iceberg regenerates, waxes and wanes. Nobody's body is ever really free of the requirements of life, and there is always the potential for things to escalate to the point where symptoms and pain are severe enough to break through to the surface. Does this mean that people need to come in three times a week for the rest of their lives? No. Does this mean that people can benefit from ongoing monitoring? Yes. Not everyone needs to be monitored to the same degree of scrutiny, but everyone's got an iceberg. What can Allied Health do to help? Realistically, anything short of a post-scarcity reorganisation of society isn't going to do much. Allied Health can help chip away at the iceberg but it'll never be completely gone because there are always stressors, always demands, and always an accumulation of wear and tear. Allied Health professionals can chip away at this iceberg; keeping an eye on things like movement abnormalities, postural disturbance, pain, and how your life is affecting you. Is this unfair? Yes. Is there anything you can do about it? Yes. Find a practitioner that educates you about the demands of your life, as well as empowers you to take positive steps towards managing those demands. See you in clinic. #AtlasPhysio #PhysioClinic #Fairfield

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