Last week, I had the great pleasure of sitting down for a chat with my good mate Mikki Williden on her podcast Mikkipedia to talk about human evolutionary biology and its relevance to modern-day rehab.
Here’s the link to the episode https://podcast.mikkiwilliden.com/436
My Conversation with Mikki Williden on Tendinopathy
Ancestral Rehab for Modern Pain
I recently sat down with Mikki Williden on her podcast to discuss tendinopathy treatment, and what started as a conversation about her hamstring injury evolved into a deep dive on how understanding our evolutionary past can transform how we approach modern pain and rehabilitation.
Not All Tendons Are Created Equal
I explained to Mikki a distinction that’s crucial for effective treatment: positional tendons (like those around the hip) maintain stability with minimal elongation, while energy-storing tendons (like hamstrings) absorb and recoil force like springs. When energy-storing tendons get injured, they enter a problematic cycle—the tendon gets “shielded” from the forces it needs to recover, while the brain creates cortical inhibition saying “that hurts, don’t do that.”
The Treatment Protocol I Use: Vibration Plus Isometrics
I shared a protocol that I’ve been using lately that addresses both tissue damage and neurological inhibition:
- The Vibration Component
- The Isometric Component
Why Movement Variety Matters
I explained that not all muscle fibers connect directly to tendons—many go out to the fascia. Low-level contractions typically recruit only type I fibers, pulling on just 20% of the tendon, which might not generate enough shear force to stimulate the tendon cells that produce healing collagen.
I reframed “overuse injuries” for Mikki: Maybe it’s not overuse—it’s same-use. Road running hits the same fibers repeatedly. Spreading that metabolic activity over diverse movements could prevent these chronic issues altogether.
My Evolutionary Foundation
My perspective was shaped by two key influences during my osteopathic training: Phil Beach’s archetypal postures (which he’d been developing since the 1980s) and my supervisor Rob Moran’s evolutionary medicine approach.
Phil Beach’s insight is profound yet simple: furniture is recent. Throughout human development, we were in constant reference to the ground. Hunter-gatherers don’t stretch—they maintain musculoskeletal health through floor-based living. Different environments created different rest postures: long sitting in hot, dry climates; squatting in wet environments; kneeling on tatami mats in Japan.
The floor test matters enormously: if you can’t get up off the floor, it represents a breakdown in physical capability.I’ve worked with older people whose chief complaint was simply not being able to reach the bottom cupboard. Coaching them on getting up and down from the floor—without even using the treatment table—proved incredibly empowering for independence and fall prevention.
The Mismatch Hypothesis
Over 6-8 million years of evolution, biology optimized us for one thing: turning scarce calories into offspring. We’re incredibly efficient, or we wouldn’t be here. But here’s the crucial distinction I emphasized: we’re evolved for fertility, not longevity. Our anatomy is perfectly suited for an environment that no longer exists.
Cultural evolution moves exponentially faster than biological evolution. Just consider the last 15 years: smartphones, social media, doom scrolling. We evolved to live in caves and pick berries (😀) not process infinite digital information.
Understanding Your Guardrails
I described to Mikki how multiple layers shape who we are: deep evolutionary time sets broad possibilities; near ancestors through epigenetics create tighter constraints; maternal environment during fetal development; birth environment; and finally, personal factors we control—diet, activity, lifestyle.
Understanding these “guardrails” allows us to give ourselves grace. Some of these things aren’t our fault. This is how we are. The question becomes: how do we use our modified ape brains intelligently to navigate the modern environment?
Beyond the Injury: The Big Rocks of Health
When chronic issues won’t resolve, it’s not just the one thing you think it is. I try to steer people toward the big rocks of evolutionary health: nutrition, movement, sleep, and stress management. These pillars all affect tissue health, recovery, and injury resolution.
In my clinical practice, I often see acute flare-ups of chronic conditions. People say “it came from nothing,” but that “nothing” might be the mismatch we don’t think about—we’re not loading our bodies in varied ways, we’re not sleeping well, we’re chronically stressed.
Key Takeaways
- Chronic tendon injuries involve both tissue damage and brain-based inhibition
- 50 Hz mechanical vibration can reset muscle tension and bypass neurological blocks
- Movement variety (not just volume) is essential for tendon healing
- Floor-based postures maintained our ancestors’ mobility without dedicated stretching
- Getting up off the floor is a fundamental measure of physical capability
- We’re optimized for reproduction, not longevity—modern health goals require intentional strategies
- Chronic issues require looking beyond the injury to sleep, stress, diet, and lifestyle
Here are some links to resources we discussed.
Links
- Phillip Beach Archetypal postures https://phillipbeach.com
- Mark Sisson – Archetypal Rest Postures video https://www.youtube.com/watch?v=4bYxDcyoTpA
- Darryl Edwards, https://www.primalplay.com
- And one I forgot to mention in the podcast episode, Katy Bowman over at Nutritious Movement