Important Concepts

What Would a Caveman Do?

In my opinion, we’ve got to consider the human body from a different perspective than we normally do. It’s all about protecting our bodies for a very long life. It’s not about overworking them. It’s not about wearing them out. It’s not about high impact exercise and forcing our bodies to do things they weren’t meant to do.

I can’t say that I’ve stuck to this concept during my lifetime, but I’m just asking you to follow my line of thought. I’m asking my kids in particular to listen, because at this time in my life I care more about their future happiness than I do my own. When I had my children, I was given that Faberge egg; that finest of things I could hold in my hands, with all its amazing little delicate parts. Something that will increase in value to me as time goes by. I will vow to protect it and help it to increase in value…to reach its full potential. I will shield it from harm and pass it on only to another who would cherish it as I do.

But unlike the Faberge egg, these lovely possessions of mine have a mind of their own. They get to make choices about what they want to do with their minds and their bodies. And unlike the Faberge egg, I can’t just put them in bubble wrap or stick them in a china cabinet. But I can try my best to give them the tools they need to maintain their shine and value. And I want to share some of that with you, my reader.

And now, with less than a decade before retirement, I realize I can only pass my message on to a limited number of patients. The message needs to go to more. Ergo, the blog. The Internet.

And because I’m not a shrink, a gynecologist or urologist, this will be mostly about protecting the bones and joints. But let me tell you, protection of that beautiful packaging you were born with, will be one of the most important things you can do to ensure happiness into and through your “golden years” (if ever there was a description more inappropriately used, it was that one).

There are a couple of important concepts and the sooner you understand these concepts, the more quickly you will come to understand what I’m talking about, and the sooner you will start to be able to make your own decisions regarding the way you deal with your body; not only your musculoskeletal system, but your whole body and mind.

When I state these concepts, I’m sure there will be much disagreement and many who will argue against them. These folks will come out of the woodwork to disagree with me and so let me just say right off the bat, “Bye, bye. It’s my blog and I get to say what I want to say.”

My credentials: I’ve been alive for over a half century. I’ve been married for over 30 years. Both of my parents are alive and tango dancing. I’ve had two children. I’m a doctor and have been practicing orthopedic surgery for over a quarter of a century! Interesting way of putting things, isn’t it? Okay, no double blind, prospective studies, but you really can’t argue with those credentials.


So here goes;

1: The human in the form of homo sapiens, has really not evolved in about a hundred thousand years, give or take a hundred thousand.

2: Our bodies weren’t put together to last much past the age of about 25.

I don’t know how I decided that these two concepts were of key importance in telling you how to protect your bodies from the ravages of age. Maybe it was through reading. Maybe it started in college when I was taking comparative anatomy. Maybe it has to do with my own physical experiences and those of my patients. But as I work through my blog and try to impart my knowledge to you, I will remind you of those concepts and ask you to think about what a caveman would do. What would a caveman do? Maybe that will be our mantra.

Homo sapiens (that’s us), pretty much stopped evolving once we became intelligent. So, I can’t sit here and say that we stopped evolving 100,000 years ago, or 125,000 years ago. But whenever we became smart enough to start communicating and modifying our environment, we gradually stopped evolving. I won’t haggle over 25,000 years.

Evolution is a process by which the species improves its ability to survive and reproduce. The function and the appearance of the organism changes so that they are better equipped to thrive in a given environment. In the natural world, this is an ongoing process. But once humans began to be able to modify the environment to compensate for our weaknesses, evolution essentially came to a standstill. We are no longer improving and in fact, as a species, we might even be devolving.


Let me give a couple of simple examples. There’s no question, we all think we can do without our appendix. Before the time of surgery, people died if they had an attack of appendicitis. Over many centuries, those humans with a beefy appendix, which was predisposed to getting infected, died off. They didn’t get an opportunity to pass on the beefy appendix genes to their offspring. Those who were born with an appendix that wasn’t as likely to retain fecal material and get infected got to pass on their improved appendices. Less of them died as a result of appendicitis. If we weren’t so smart, eventually the process of evolution would have completely eliminated the appendix, by sadly, eliminating all the folks who could pass on that gene. But because we were so smart, we learned how to do surgery and take out the infected appendix. And no one is going to reject a potential mate just because he or she has had appendicitis. Therefore, we keep the appendix gene in our gene pool, and we keep having children who will eventually have appendicitis and will eventually have to have their appendix removed.

Is there any doubt that this is true and that if we figured out a way to manipulate our genes, one of the first things we would experiment with would be the elimination of the appendix from our gene pool? That would be a no-brainer. There would be no downside to it! The appendix is totally worthless and even though it can be removed through a simple operation, there are still a fair number of folks every year who die from the disease or even complications of the surgery itself.

So let’s go a step further, to something up my alley (surgically speaking), but something nonetheless very important. Let’s talk about the anterior cruciate ligament. That’s something that’s dear to my heart, not just because I do bunches of operations on folks who have torn their ACLs, but because I have torn mine and I’ve had three other close blood relatives who have torn theirs. That means my family is likely, genetically, pre-disposed to tearing their ACLs, and I have likely passed on the crummy ACL gene to my children. And if each of my kids has two kids and their kids have two kids…you do the math, mainly because I can’t. Never was any good at math and I think I passed that gene on too.

But no potential spouse is going to count my kids out as a result of some theoretical potential to tear their ACLs or have kids with weak ACLs. However, if we were cavemen and living closer to a time when reproducing adults selected potential mates based on the appearance of vitality, the ability to get food and the ability to care for their offspring in the natural world, then a limping cave girl/boy would likely be rejected, just like a limping mare will be rejected by the stallion or vice versa. That lameness, no matter what the cause, would be naturally rejected as a potential weakness and over time, the knee ligaments of the human species would have improved rather than worsened, because we humans, as a species, have got to have some of the crummiest pieces of crap for knee ligaments and cartilages in the world of animals.

We learned how to modify our environment to keep from hurting our knees. We learned how to compensate for weak knees by being charming and having more things to entice potential mates other than the strength of our knees and bodies.  Chicks even learned to love scars! And finally we learned how to do surgery on knees. As a species, our knee ligaments will NEVER get any better and in fact our predisposition to knee cartilage and ligament injuries will only get worse with the decades as people with bad knees get together and have babies with doubly bad knees!

Here’s another great example of how the evolutionary process got cut short in humans. Let’s take birthing babies. As you know, many babies have to be delivered by forceps or by C-section. Why is that? Well, one reason could be that the pelvic outlet isn’t big enough to allow the safe passage of a baby. Really, that’s the main reason and I’m not going to go into all the other reasons, because they are secondary. Secondary to things like our life styles. But let’s just focus on a pelvis that is too small to allow the passage of a baby. Again go back to our cavewoman. If she was delivering a baby that wouldn’t pass, she and her baby would have died. The only women who would have survived childbirth along with their babies were those who had large pelvic outlets. They would have passed on their genes and their daughters and granddaughters would have survived as well. And if that process had continued for another century or two or ten, eventually child birthing would have been something more like horse or cow birthing; something that would happen without incident and without assistance 99.9% of the time. But somewhere along the way we got smart. We figured out how to stick things up in there to pull the babies out. Then we learned how to take them out with a knife. And frankly, I’m glad we did. But now the world has a population of women with small pelvises who can’t deliver babies without a knife and anesthesia. It’s okay, because we have that technology. But you see how the process works in a very simple, direct-effect scenario.

Whew! I had to get that out. I really want you to understand this concept because it is essential to understanding the way we are and why we have pain and disease. Hope you followed me and hope you see the correlation to human knee ligaments…and for a lot of things for that matter; like hypertension, diabetes, and a funny shape to the bones of our shoulders which predisposes us to having  problems with our rotator cuff.


Several years ago, I was chatting with a neurologist in the hospital cafeteria, and somehow, we got on the subject of obsessive-compulsive behavior. He felt that many human behaviors we consider to be obsessive compulsive are really just natural human behaviors that probably benefitted us as primitive creatures.

Take nail biting for example. Nail biting was probably a necessity for the caveman. Humans had evolved into creatures who used their hands for very delicate, upright activities. The natural scratching of the earth which grinds down a horse’s hoof was not sufficient to keep our fingernails cut low enough to perform those intricate deeds. We had no clippers. Sure we could sit around and rub our nails on a stone. But why do that when we had perfectly good teeth? Sorry to offend, but they probably munched on their toe nails too.

So why would we consider nail biting to be a bad or nervous habit, or an obsessive-compulsive behavior? Now I’m not saying it’s a desirable behavior. After all, we have clippers. But after that conversation I started thinking about nail biting and cavemen. I thought of my own family. I’m a nail biter and so are my kids. My husband is not. He gets to cut his nails! I can’t remember the last time I cut my nails. I don’t feel nervous when I bite my nails. I can try not to bite my nails. But I am a nail biter. Is nail biting as inherent to me as my hair color or my hair straightness? I started thinking about genetics, and how the genes for nail biting might be passed down from generation to generation, just like curly hair (which my husband and both children have).

And then…is the propensity for having pain and painful conditions passed down from generation to generation, just like the genes for curly hair and nail biting? Of course it is.

And then…did the predisposition to have painful conditions come from my parents? Of course not. It came from the cavemen, because remember…we have not evolved since then. We haven’t improved our body’s ability to be pain-free whatsoever. We have only improved our collective ability to prevent and treat that pain. And that’s why pill-makers have jobs. Seat belt makers. Roof builders.  It’s why I have a job!


I started considering human evolution (or lack thereof) when looking at many of my patient’s illnesses. I also considered human evolution as I made recommendations for treatment and more importantly, for setting expectations. And last but not least, I consider evolution when making recommendations for prevention of illness. What would a caveman do?

I’m an orthopedic surgeon, so I’ll try for the most part to stick to what I know best. That’s always safest. But I think the principles can be applied to all disciplines, and frankly, to much of what ails us in life in general.

And here’s why. Because we’re really put together to last about 25 good years. It’s probably a shock to read that when we’ve all been shooting for a hundred. Or reading about how 60 is the new 50. The truth is that if we were living in a completely natural world, humans would last about 25 years on average. Right…but we’re not living in a natural world. So what? So…tell that to your body. It doesn’t know that you’re born in 2010 or 10,000BC. It doesn’t know whether you’re born in Minneapolis or Mozambique.

Up until 1900 the average age of death of women was about 40. Women often died in childbirth. But remember, I said that because of our intelligence we figured out how to birth babies with forceps and C-sections. Then someone invented birth control pills. That resulted in a huge improvement in the life expectancy of women and children.

Women were pretty clever, and way before 1940 they had already figured out how to keep from having a string of babies. They relied on old-school routines, like the rhythm method and abstinence! I remember my grandparents slept in twin beds. My Irish and Mexican Catholic grandparents had only two kids each, proving that twin beds work! Do you recall Scarlett O’Hara’s plan for birth control once she realized her waist size had increased following the birth of the unfortunate little Bonnie Blue? She moved into another room and locked the door on poor Rhett Butler! And she didn’t have any more kids!

These early methods of birth control, among other earlier advances in medical care and safety resulted in a gradual increase in life expectancy. I’m going to go through a litany of reasons we live a long time in this unnatural world so you can understand why our bodies wear out just when we least expect it. That way I can help you get prepared for it. Stay tuned!



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