Monday, September 12, 2011

Evils, Enablers, and Exercise
Joint pain, spine pain, stomach pain, sciatica, tennis elbow, plantar fasciitis, cancer pain—the list grows longer as folks age. I often wonder what makes my patients “give up” because of the pain. I wonder what it means to “give up,” what it is they are “giving up,” and what evils lie beneath that prevent them from experiencing a good day of get up and go. To answer these questions we need to first understand some key definitions.

Even though hand and wrist pain may slow you down, you can still remain active.

The give-up

This occurs when patients throw up their hands over things out of their control. They become frustrated to the point they stop all pursuits. The causes of their frustration may include minor disabilities, chronic aches and pains, systemic diseases, and a long list of conditions that create impairments.

What is  “giving up”?

Because of the “evils” that prevent many individuals from taking care of themselves, there is an exchange of items, or “give ups.” These include independence, function, a free mind, comforts of life, communications with others, meaningful relationships.

Forces of evil

Evils are habits, thoughts, and actions that make up who a patient is. There are two types of evils: good evils and bad evils. Each has its place in a patent’s battle for fitness.

Bad evils are habits, thoughts, and actions an individual chooses that limit a healthy lifestyle. Bad evil habits include eating after 8 p.m., sleeping 5 hours a night, and exercising once a month. Thoughts, too, may be evil. Examples of bad evil thoughts are: “I don’t need to drink water” or “I don’t need to work out today.” Actions may be evil as well. Playing basketball without proper warmup is an example of a bad evil action.

Bad evils can also take the form of peer pressure. Neighbors, friends, family members, and schoolmates may all potentially offer reasons to not get up and exercise, enabling the patient’s own disabilities. Peers may offer subtle suggestions such as “It’s OK to stay home and rest today,” or “Take another medication.” These suggestions tempt a patient toward a path of inactivity, ineptitude and apathy. Physicians and physical therapists, too, can be complicit in this evil by suggesting “Don’t do it if it hurts,” instead of “Let’s find a way to get you functional!”

Help patients slay these evils by equipping them with a common sense understanding of their conditions. Help them develop tools that will help them reach their goals. Encourage them to make connections with enablers who will support their fitness progress with strategies designed to keep them happy, healthy, and independent.

In contrast to bad evils are “good evils”—activities which may not feel the best, but are essential health and well-being. Also known as “necessary evils.” An example of a good evil habit to encourage a patient to adopt is to stop eating at 6 p.m. Good evil thoughts include: “I’ll give up a diet soda today for water,” or “I’ll exercise Saturdays instead of playing X box,” or “I will get this done now.” Patients should also be encouraged to perform good evil actions, such as warming up, stretching, and playing a sport.

The consequences of evil

Patients should understand if they balance the evils of life—both good and bad—they will experience more success in their lives on all levels. Exercise is key. Therapists must help patients find the means to exercise, even if it requires convincing the patient to rise at 5 a.m. Strength training is also a necessary evil, stretching too. Patients who are affected by chronic pain particularly should practice good evils, since loss of function places them at risk of “giving in.”

What are the evils of exercise?

Good evils include stretching after a warm up phase. Why is stretching an evil? Many patients are gym members, but few use the facilties for strecthing. Men go to the gym to train, get stronger, and bulid their biceps. Women go to keep down their weight, look tone, and—more often than men—participate in group activities. Patients must realize that without stretching they will grow stiff and lose elasticity. Stretching is a necessary evil.

What evils apply to patients battling joint pain? Determine this by looking at the compression of the lower extremities. What are the most compressive exercises for cardio training? The answer, in order of most compressive to least compressive: treadmill, EFX, Nu-step, and bike. All are great warmups prior to stretching. If a patient’s arthritic knee joint hurts, the patient should consider the treadmill a bad evil because of the compressive forces that occur. In place of the treadmill suggest the bike to provide degenerative joints with movement for synovial flushing. The bike is a good evil.

 Patients who have joint pain may struggle to maintain independence. For these individuals strengthening large muscle mass while protecting joints is critical. Strategic strengthening of larger muscle groups around joint pain, performed with purposeful functional strategies, offers the greatest return. For example, strengthening the larger back muscles requires some pulling activities of the arms, such as lat pulldowns or a seated row. For individuals who have degenerative arthritis of the wrist, this may be difficult and painful to perform. A bad evil for patients who have degenerative arthritis of the wrist is push ups, a good evil is therapy band presses performed supine, with the bands wrapped around the wrist.


Physical therapists are enablers. They are creative by nature and training, and the health care providers best suited to help those with joint pain exercise safely and maintain independence. Helping patients understand good evils and bad evils can help them sustain an effective exercise strategy, and avoid “giving up” the treasures of independence and functional ability.

Robert Babb, PT, MBA, is owner and a practicing physical therapist at the Physical Therapy & Wellness Institute ( Robert can be contacted at