References:
- https://drdenef.com/covid-long
- https://link.springer.com/article/10.1007/s12035-021-02696-0
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10166245
- https://www.sciencedirect.com/science/article/pii/S1201971221007517

In the 21st century, healthcare professionals are witnessing a growing trend of musculoskeletal disorders (MSDs) that no longer respond effectively to traditional treatment methods. This phenomenon, which I term "treatment mismatch," arises from the rapid and profound changes in our environment and lifestyle. Understanding this concept is crucial for developing more effective therapeutic strategies that address the modern aetiology of these disorders.

The Evolutionary Mismatch

To comprehend the treatment mismatch, we must first explore the concept of evolutionary mismatch. For 99% of our evolutionary history, humans lived as hunter-gatherers in small, nomadic groups. This lifestyle, deeply intertwined with nature, shaped our physiology and behaviour. Our bodies evolved to respond to acute, short-term stressors with the fight-or-flight response, a mechanism designed to handle immediate physical threats.
However, the last 10,000 years have seen a dramatic shift. We transitioned from a nomadic lifestyle to agrarian societies, then to industrialised cities, and now to an information age characterised by rapid technological advancement. These changes have occurred so quickly that our physiological adaptations have not had time to keep pace. As a result, our stress response, once advantageous for survival, has become maladaptive in the face of chronic, psychosocial stressors such as work overload, social pressures, and the constant connectivity of modern life.

The Rise of Psychosocial Stressors

In today's world, many MSDs are not caused by physical trauma but by psychosocial stress. Chronic stress, job insecurity, fear of change, and even frustrations like an internet outage trigger the same physical stress response our ancestors used to deal with immediate threats. This includes neurohormonal changes that tense muscles, alter vascularisation, and redistribute nutrients—all of which are inappropriate for addressing the subtler, chronic challenges of the modern environment.

Traditional Treatments and Their Limitations

Traditional treatment methods for MSDs, developed in the 19th and 20th centuries, were primarily designed to address biomechanical issues resulting from physical trauma. These methods include manual therapies, physical exercises, and ergonomic adjustments that focus on correcting mechanical dysfunctions and alleviating pain through physical means.

While these treatments can be effective for conditions with a clear biomechanical origin, they often fall short in addressing MSDs driven by chronic stress and psychosocial factors. This is the crux of the treatment mismatch: therapies that worked well for the health problems of the past are less effective for the stress-related disorders prevalent today.

Addressing the Treatment Mismatch

To bridge this gap, manual therapists and healthcare professionals must adopt a more integral approach that integrates the understanding of psychosocial stressors and their impact on physical health. Here are several strategies to consider:

1. Integral Assessment: Evaluate patients not only for biomechanical issues but also for psychosocial stressors. Understanding the broader context of a patient's life can provide insights into the underlying causes of their MSDs.
2. Stress Management Techniques: Incorporate autonomic nervous system balancing methods, like The Reaset Approach, into treatment plans. Techniques that modulate the stress response and reduce its impact on the musculoskeletal system should be applied first, before treating overcompensations and the biomechanical dysfunction(s) themselves.
3. Patient Education: Educate patients about the role of stress in their condition and teach them self-management strategies. Empowering patients with knowledge and tools to manage stress can enhance the effectiveness of their treatment.
4. Adaptive Therapeutic Practices: Stay informed about the latest research and developments in the field of psychosocial health. Incorporate evidence-based practices that address the evolving nature of MSDs into your therapeutic repertoire.

Conclusion

The concept of treatment mismatch highlights the need for a paradigm shift in how we approach musculoskeletal disorders. By recognising the role of psychosocial stressors and adopting holistic, interdisciplinary strategies, we can develop more effective treatments that are attuned to the realities of modern life. Addressing this mismatch is essential for improving patient outcomes and promoting long-term health and wellbeing in the 21st century.

Recently I've been reflecting on Dr. Robert Sapolsky’s views on free will. A subject he as described in his book "Determined: A Science of Life without Free Will" where he argues that free will is an illusion, positing that our choices and behaviours are entirely determined by biological and environmental factors beyond our control. I can follow his reasoning but then I got to wonder about how where the placebo effect would fit in his theory. This can seem paradoxical at first glance, but seems they can be reconciled.

It was my believe that the placebo effect typically involved some level of expectation or belief influencing physiological outcomes, which might initially seem to require an act of free will. But if free will is an illusion, as Dr Sapolsky argues, then understanding how a placebo effect can still occur under determinism becomes an interesting puzzle... well I thought so anyway 😅

Understanding the Paradox
Mind as a Product of the Body:

• Sapolsky’s Perspective: Sapolsky argues that what we perceive as “mind” and “free will” are deeply rooted in the biological processes of the brain. Our decisions and behaviours are influenced by a complex interplay of genetics, neurobiology, and environmental factors.
  
• Implication: This means that our thoughts, beliefs, and expectations—key components of the placebo effect—are shaped by underlying biological mechanisms.
  

Placebo Effect:

• Mechanisms: The placebo effect occurs when an individual experiences a real improvement in their condition after receiving a treatment with no therapeutic value. This improvement is due to the individual’s belief in the efficacy of the treatment.
  
• Biological Basis: Research shows that the placebo effect can activate specific neural pathways in the brain that release neurotransmitters like endorphins and dopamine, which can alleviate symptoms and improve health.
  

Reconciling the Two Concepts
Belief and Expectation as Biological Phenomena:

• No Contradiction: If our beliefs and expectations are products of our brain’s biology, then the placebo effect fits within Sapolsky’s framework. The mind’s ability to influence the body through beliefs and expectations does not contradict the idea that these mental states are biologically determined.
  
• Neural Processes: The belief in the effectiveness of a placebo triggers biological processes in the brain that can result in physical changes, such as pain relief or reduced anxiety.
  

Automatic and Unconscious Processes:

• Non-Conscious Influence: Much of what drives the placebo effect happens automatically and unconsciously. The brain’s response to a placebo is not a matter of conscious choice but rather an automatic response to perceived cues.
  
• Learned Associations: The effectiveness of placebos can be partly explained by learned associations. For instance, if taking a pill has historically been associated with feeling better, the brain may automatically initiate healing processes when a placebo pill is taken, based on prior experience.
  

This is a work in progress based on my own thoughts and those of Professor R. Sapolsky’s books, including his latest, “Determined”, as well as A. Damasio’s “The Strange Order of Things” and elements of evolutionary and developmental mismatch theories.

The purpose of this simplified diagram is to gain a better understanding of whether and how we can evolve on purpose to better adapt and manage change. It illustrates the continuous body-mind loop where our body’s neuronal and molecular mechanisms, influenced by genetics, environmental factors, and individual experiences, govern our behaviour. Behavioural changes affect cognition, which in turn shapes the mind. The mind’s decisions, choices, and actions then alter the environment, creating new experiences that continue to influence our body’s mechanisms. Throughout this process, feelings are generated and play a crucial role at each stage.

At the moment, our rising “ biological footprint ” — a term I coined to capture the impact of our lifestyle, environment, and actions on our biological systems — is making us sick.
By understanding the interconnected elements of my illustration, I hope you/we can better comprehend what is happening and why, but also gain insights into how you/we can purposefully change or stimulate a process of evolving on purpose (evolopsis).

How do you feel about this? For example, by reading this, your body has created neuronal and molecular changes that alter your behaviour, perspective, emotions, choices, decisions, and actions, which in turn cause changes in your environment, creating experiences that further influence your body, changing the way you respond, and so on.

What I’m striving for with this illustration is to shed light on my understanding of how you/we can foster better ways of adapting and managing change. In other words, how we can create stability through change and evolve with the changing times, thereby improving our physical and mental health and wellbeing and foster a more compassionate and humane society.
Again it is a work in process… and I’m awaiting Prof. Sapolsky’s view on this.

PS: The key message of Robert Sapolsky’s book Determined: A Science of Life Without Free Will is that human behaviour and decision-making are entirely shaped by a complex interplay of genetics, environmental influences, and individual experiences. Sapolsky argues that the concept of free will is an illusion, and our actions result from deterministic processes involving the body’s neuronal and molecular mechanisms, which influence behaviour and cognition.

In our fast-changing world, stress has become a ubiquitous aspect of daily life. But why has stress, a general adaptive response meant to protect us, turned into a stressor that seems to harm us more than it helps? Does the answer lie in a conflict between biology and culture, or in other words, the concepts described in evolutionary medicine as evolutionary and developmental mismatches? Let’s take a look at these mismatch theories and see if they can shed light on the bigger picture.

Evolutionary Mismatch: A Legacy of Our Past

Evolutionary mismatch refers to the idea that the environment in which humans evolved differs vastly from the one we live in today. Our ancestors adapted to a world where immediate physical threats, food scarcity, and survival in the wild were the norm. The general adaptation response, involving the autonomic nervous system (ANS) and the hypothalamus-pituitary-adrenal (HPA) axis—more commonly known as the stress response and characterised by the "fight or flight" mechanism—evolved to handle these acute, short-term threats effectively.
In the modern world, however, we face predominantly psychosocial stressors such as work pressure, financial concerns, and rapidly changing technological advancements that affect every aspect of our lives. These stressors are not typically life-threatening but are persistent, leading to prolonged activation of the general adaptation response. Our bodies, still wired for ancient dangers, respond to these modern stressors with the same neurohormonal and physical responses as they would to a predator attack, as there hasn’t been enough time for an evolutionary more apt adaptation to occur. This conflict between biology and culture, known as an evolutionary mismatch, may be one of the reasons for the rise in physical health problems today, including obesity, diabetes, and cardiovascular disease, as well as mental health problems such as chronic stress, anxiety, and depression.

Developmental Mismatch: The Impact of Modern Lifestyles
Developmental mismatch, on the other hand, refers to the discrepancies that occur during an individual’s growth and development due to the environment they are exposed to at various stages. A mismatch because experiences for which we create protective or defence mechanisms during critical periods of development are different than the conditions/ experiences encountered later in life. These developmental mismatches can disrupt normal physiological and psychological development, leading to long-term health issues, including obesity, metabolic disorders, cognitive impairment and behavioural disorders

The Interplay of Evolutionary and Developmental Mismatches

Does the interplay between evolutionary and developmental mismatches compound the problem of stress in modern society? Our evolutionary heritage predisposes us to respond to stress in ways that are no longer appropriate for most contemporary challenges. At the same time, developmental mismatches exacerbate our vulnerability to stress by disrupting healthy growth and development. This interplay may indeed explain the rise in stress-related physical and mental health problems and why traditional treatment solutions often fall short, as they fail to address the underlying evolutionary and developmental causes.

To be continued...


References:

• Dellink, A. (2019). Essay: An Evolutionary Explanation of Burnout.
• Gluckman, P., Hanson, M. and Low, F. (2019). Evolutionary and developmental mismatches are consequences of adaptive developmental plasticity in humans and have implications for later disease risk. Phil. Trans. R. Soc.  374(1770): 20180109.
• Hoogland, M., Ploeger, A. (2022°. Two Different Mismatches: Integrating the Developmental and the Evolutionary-Mismatch Hypothesis. Perspect Psychol Sci. 17(6):1737-1745.
• Meyers, T. (2017). Stress: A conflict between biology and culture. Executive Support Magazine.

Tom Meyers is an osteopath (D.O. OSD, MSc. Ost), body-centred stress coach, and founder and instructor of The Reaset Approach, a therapeutic methodology and treatment modality designed to help individuals adapt, flourish, and thrive in the 21st century. Through workshops and writings, Tom aims to inform and revolutionise the field of manual therapy and empower therapists with the tools and knowledge to better serve their patients.

In an era marked by rapid changes and unprecedented challenges, where technology is ever more present, our approach to health and wellbeing to flourish and thrive, necessitates rethinking. This includes the rethinking of our foundational models. Do these models still serve us, or do they need revision?

For example, the traditional concept of the General Adaptation Syndrome (GAS), introduced by Hans Selye, has long served as a foundational model in understanding stress and its effects on the human body. GAS outlines a three-stage reaction to stress: alarm, resistance, and exhaustion. While these stages haven’t changed, I believe as we navigate the complexities of modern life, wouldn’t a more positive, dynamic and proactive term or designation be more constructive? This article reflects on the benefits of transitioning from GAS to the General Adaptation Process (GAP) as a more fitting model when talking about stress.

Understanding the Limitations of GAS
With GAS stress is presented as a linear, somewhat predictable process with a clear endpoint. While this model has significantly advanced our understanding of stress-related illnesses and the body's response mechanisms, I feel it falls short in encapsulating the fluidity and variability of human experiences with stress in the 21st century. The designation of "syndrome" provokes in me that it is a pathological condition, potentially overshadowing the adaptive and positive aspects of dealing with stressors. Stress is after all essential to adapt and manage change and is not per se the problem. That the stress response hasn’t evolved at the same speed as the challenges we created, and the physical reaction it engendered due to our increasing biological footprint (see my previous article) and that it is triggered for things it doesn’t need to, that is the true issue we need to focus on.

Introducing the General Adaptation Process (GAP)
Instead of GAS, I propose another way of saying the same thing but with a more positive and constructive connotation, f the General Adaptation Process (GAP). Using the process instead of syndrome means the stress response is seen not as a finite sequence of stages but as an ongoing, cyclical process of learning, growth, and resilience-building. This shift in terminology from "syndrome" to "process" can also reflect a more nuanced understanding of how individuals interact with, adapt to, and recover from stressors over time. GAP embraces the complexity of these interactions, recognising them as integral to personal development and wellbeing.

Embracing Complexity and Individuality
As each individual’s encounter with stress is unique, influenced by a myriad of genetic, environmental, and personal factors, it is maybe also a good idea to move away from the more static model GAS represents. I feel that GAP allows for a more personalised understanding of stress, emphasising the importance of individual pathways to resilience and adaptation.

Highlighting the Dynamic Nature of Adaptation
By viewing adaptation as a process, GAP accentuates the dynamic and ever-changing nature of how we respond to life’s challenges. It encourages proactive engagement with stressors, highlighting the capacity for learning and growth inherent in each stress encounter. This perspective fosters a more optimistic outlook on stress, seeing it as an opportunity for personal development rather than solely a risk factor for disease.

Encouraging an Integral Approach
For me, GAP promotes a more integral approach to stress management, integrating physical, psychological, and social strategies. This encompasses a broad range of practices, from physical activity and nutrition, social support to creating a DNA for your future to futurize yourself, underscoring the multifaceted nature of effective adaptation.
I also believe that GAP offers a more positive approach for individuals to conquer setbacks and will help them in the process of emerging from challenging situations with increased strength, skills, and wellbeing. By focusing on the process of adaptation, GAP emphasises the potential for positive transformation through the experience of stress.

Conclusion
As we face new and complex challenges in health and wellbeing, adopting the General Adaptation Process as term or designation offers a more empowering and comprehensive framework for understanding and managing stress. Shifting from seeing stress as a syndrome to a process not only reflects a deeper understanding of the nuances of human adaptation but also aligns with a proactive and optimistic approach to life’s challenges. This shift encourages individuals to embrace the journey of adaptation as an opportunity for growth, resilience-building, and ultimately, a more fulfilling life. In doing so, we acknowledge that the path to wellness is not merely about surviving stress but thriving through it, harnessing our experiences to foster a richer, more adaptive existence.

Background
The concept of peripersonal space, an area of space immediately surrounding us, is not just a physical boundary but a dynamic interface through which we interact with our environment. This space is neurologically represented and actively mapped by the brain, allowing us to navigate our surroundings, perform tasks, and communicate with others effectively. The understanding of peripersonal space has profound implications for manual therapy, particularly in innovative approaches like The Reaset Approach, developed by Tom Meyers.

Introduction
In manual therapy, the traditional focus has been on addressing physical ailments through direct manipulation of the body's structures. However, The Reaset Approach introduces a paradigm shift, emphasising not just the physical but also the neurological and psychological aspects of healing. The concept of peripersonal space becomes relevant here as it extends the domain of therapy beyond the tangible, into the realm of the patient's sensory and spatial perception.

Content
The Neuroscience of Peripersonal Space: Research in neuroscience reveals that peripersonal space is monitored by a network of brain areas that process information about objects close to the body. This network is involved in integrating sensory inputs with motor actions, highlighting its significance in manual therapy, where touch and movement are central elements.

Peripersonal Space in The Reaset Approach: The Reaset Approach, with its holistic perspective on healing, recognises the importance of peripersonal space in therapy. By recognizing and respecting this space The Reaset Approach practitioner creates a feeling of safety and trust  which is crucial when the objective is lifting the autonomic lesion and creating autonomic balance. By acknowledging this space and effectively tuning into it a practitioner facilitates the necessary  conditions for a deeper level of healing that transcends physical manipulation.

Implications for Manual Therapy: Understanding and respecting the patient's peripersonal space can lead to improved therapeutic outcomes. It allows therapists to be more attuned to the subtle cues that patients emit, enabling a more nuanced and effective treatment strategy. Moreover, this awareness can enhance the patient's sense of safety and comfort, crucial elements in the healing process.

Conclusion
The Reaset Approach is comprehensive therapeutic methodology, developed in response to the evolving nature of patients' health challenges, and a hands-on treatment modality with a focus on reasetting autonomic balance before addressing their symptoms. By its integration of  the neurological and psychological aspects of peripersonal space into treatment The Reaset Approach stands truly takes manual therapy into the 21st century.

In the realm of manual therapy, the usual treatment approach puts emphasis on altered structural or functional patterns triggered by external forces. Manual therapists’ treatment of these altered physical patterns is mainly based on a form of manipulation to restore balance.
The Reaset Approach brings about a paradigm shift in response to the constantly evolving nature of today’s health challenges. Instead of solely attributing issues to external forces, the author has introduced the term “autonomic lesion” to emphasise the role of the autonomic nervous system (ANS) in the changing health landscape. The autonomic lesion, evolving into an autonomic dysfunction, has emerged as the primary contributor to contemporary, often multimodal health problems. These issues extend beyond mere physical health and wellbeing, impacting behaviour, cognition, emotions, time perception, and social interaction.

The deliberate focus on the autonomic balance in The Reaset Approach, and thus on resolving the autonomic lesion and consequent autonomic dysfunction, is gaining significance in today’s fast-changing and challenging world.

The author points out that the stress response has itself become a stressor because of a conflict between our slow-evolving biological evolution and the exponential speed at which our culture (environment) is changing. The rapid pace of modern life has surpassed our biological capacity to adapt. The conflict that arises translates itself into the “autonomic lesion” and develops into a specific kind of autonomic dysfunction: stress-related dysautonomia (S-RD).

It is this stress-related dysautonomia that has become the main direct and indirect cause of a wide range of physical and mental health problems (psychosomatic dysfunctions) in the 21st century, in contrast to the external physical forces leading to somatic dysfunction of the 20th century. The success of a treatment is interdependent on the treatment of the S-RD, i.e. the “reaset” (return to ease) of the autonomic dysfunction and lifting of the autonomic lesion.

With a primary objective of “reasetting the ANS first and maintaining it during treatment”, The Reaset Approach addresses the paradigm shift that 21st-century healing methods need and initiates the revolution in the evolution of manual therapy for improved patient outcomes.

In today’s fast-changing world, where adaptive and psychosocial stress has become central to dis-ease patterns, reasetting the ANS has become essential and key to helping patients cope with the challenges of modern life and thus preventing dis-ease from settling in. Where dis-ease has already set in, reasetting the ANS should be included in the treatment modality as a pre-treatment before addressing the patient’s symptoms.

Rooted in the principles of pioneers like Dr A.T. Still and Dr R. Virchow, The Reaset Approach has emerged through a journey of continuous exploration over 16 years, after the author’s patients reported that his way of working was different from that of his colleagues and other more conventional manual therapy methods. This echo still resounds today in new patients who find their way to him and his students.

The author, founder and practitioner of The Reaset Approach, Tom Meyers, is now presenting workshops internationally to share this therapeutic methodology and treatment modality, taking it beyond his own treatment room and out into the world. He also has committed himself to helping reshape educational curricula worldwide to include the importance of initiating autonomic balance in today’s changing aetiology of disease patterns.

“Taking yourself and your skills into the 21st century” and “initiating a revolution in the evolution of manual therapy” are not merely slogans for the author but an ongoing message and narrative, inviting all to join in an exploration of the changes needed to meet today’s health and wellbeing challenges and those emerging in the future.

Author: Tom Meyers
Discover more about Tom and/or The Reaset Approach at www.thereasetapproach.com

References:

Hallman, D. M., & Lyskov, E. (2012). Autonomic regulation, physical activity and perceived stress in subjects with musculoskeletal pain: 24-hour ambulatory monitoring. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 86(3), 276–282. https://doi.org/10.1016/j.ijpsycho.2012.09.017
Liem, T. (2016). A.T. Still's Osteopathic Lesion Theory and Evidence-Based Models Supporting the Emerged Concept of Somatic Dysfunction. The Journal of the American Osteopathic Association, 116(10), 654–661. https://doi.org/10.7556/jaoa.2016.129
Liem, T., van den Heede, P., et al. (2017). Foundations of Morphodynamics in osteopathy. An integrative approach to cranium nervous system, and emotions. Handspring Publishing.
Meyers, T. (2019). The effect of the “Reaset Approach” on the autonomic nervous system, neck-shoulder pain, state-trait anxiety and perceived stress in office workers: A randomised controlled trial. MSc. Thesis. Dresden International University (DIU) and Osteopathy Schüle Deutschland (OSD). https://bit.ly/47r8juO
Waitzkin, H. (2006). One and a Half Centuries of Forgetting and Rediscovering: Virchow’s Lasting Contributions to Social Medicine. Classics in Social Medicine. https://www.medicinasocial.info/index.php/socialmedicine/article/view/6/7