The human body is remarkable. It is resilient, adaptive, and efficient. We may never fully understand all the complexities of the body but there is one thing we know for certain: it is not like a car.
Analogies are wonderful tools for expressing ideas and explaining otherwise complex information. They are common in healthcare as clinicians often used them to explain a diagnosis or treatment. While analogies can simplify information and build understanding, they can also create misunderstanding. One of the poor analogies floating around the internet and clinics of healthcare providers is “patients are like cars.”
People are Not Cars
For those unfamiliar, here is a quick summary of the “patients are like cars” analogy. Cars require regular maintenance to prevent breakdown. As a car operates, it wears down over time. Regular maintenance includes tire rotation, alignment, oil change, and changing the air filters. Some maintenance work can be put off, but eventually, the check engine light will notify you of a serious problem. Let’s look at how this applies to people.
The analogy is used to explain that people require regular check-ins and maintenance work from healthcare providers. This may include regular massage, chiropractic “alignment,” or correctional exercises and manual therapy to “fix” imbalances. Not the quotations around the word fix. This is where the analogy falls apart. Let me clear up a common misconception about maintenance for your body. Yes, it does need to be cared for with regular exercise, a healthy diet, and good sleep hygiene. We know that exercise makes us healthier and more resilient. Exercise improves our fitness level, reduces our risk for many illnesses and diseases, and provides many psychological benefits. We experience improved mood, retention of information, and energy and alertness with regular exercise. Taking care of your body with exercise, good nutrition, and adequate sleep is not the same thing as relying on someone else to change your body.
Personal trainers, nutritionists, and sleep clinic doctors all provide guidance, but ultimately, you are responsible for making the lifestyle changes. You put the work in. You are in control and can conduct all your maintenance independently. You do not need to have a mechanic (healthcare provider) perform regular maintenance on you.
Adaptation versus Breakdown
Our bodies can fall victim to injury, infection, disease, or other serious ailments. In many cases, our bodies can fight the issues itself. As the saying goes, if you treat a common cold aggressively it will resolve in seven days but if you let your body take care of the cold itself it will take a week. Similarly, over 90% of low back pain will resolve on its own without any intervention. (source)
Biomechanics does a poor job of explaining pain. Current research does not support posture as a driver of pain. Simply sitting up straight will not eliminate or prevent pain. Even lifting with a rounded low back likely does not contribute to the development or maintenance of low back pain. The same is true for the neck. You don’t need to worry about “texting neck”. ( Source) Mechanics matter for performance – tweaks to your lifting mechanics may help you lift more weight – but mechanics are poorly correlated with pain. Similarly, research does not support the idea that our bodies fall out of alignment. (source) Furthermore, we do not need to be balanced. Our bodies are resilient and adaptive. Our bodies change relative to the demands we put on them. It is perfectly normal and healthy to have more strength or more mobility on one side compared to the other. (source) The alignment of our body does not matter; fitness, metabolic (nutrition), and mental health are what matters.
A key difference between a body and a car is the ability to adapt. Cars only breakdown. If you take a car on a road trip, you do not build its endurance. You cannot increase a car’s horsepower but taking it on hills or drag racing. Conversely, weightlifting and sprint training will build up a body. (source) Meditation and high-quality sleep can sharpen our minds. (source) High-quality gas can help a car run optimally and slow the breakdown of an engine and related parts while high-quality nutrition can enhance the human body beyond its current capacity. Again, I am not stating our bodies do not need maintenance, I am saying we do not require passive maintenance from other people. Manual therapy – massage, joint manipulation, acupuncture – may feel good, but they are never necessary. There is no ailment that cannot be resolved without the aid of someone else manipulating your body. If a nerve is fully entrapped – resulting in it a conduction block – a simple cracking of the joints will not change that.
Does this mean you should avoid all manual treatments? Not necessarily. Instead, you may need to readjust your expectations. Pain may reduce after treatment (often due to a placebo effect), but the treatment was not necessary. Do not allow a healthcare provider to scare you into needing regular “adjustments” or other passive maintenance work. Research simply does not support that they are needed. Ever.
Check-ins Versus Treatment
To remain resilient and to enhance our physical and mental capacities, we need to put in the work. This can be done independently. This does not mean regular consultation with healthcare providers is inappropriate. In fact, regular check-ins are encouraged.
Healthcare providers, like physical therapists and family physicians, receive advanced training and can provide individualized education regarding your body. They can help you design optimal exercise and nutritional interventions, or refer you to the appropriate provider (like a registered dietician). They can also screen you for underlying signs and symptoms that may be cause for concern. This includes regular assessment of vitals (blood pressure and heart rate), physical fitness (cardiovascular capacity and strength), and neurologic system (reflexes and sensation). Medical providers can also perform routine blood work and other assessments that require advanced training, equipment, or both. I encourage you to establish regular communication with various healthcare professionals. A yearly examination can ensure you are on the right track with your health and fitness goals. If you a veering off course, your provider can give you a nudge in the right direction. Should you require a full bout of treatment, they are then available for you.