You may have heard the analogy regarding an overflowing cup as a representation of stress or injury.
Essentially, your ‘cup’ is your capability to handle stress (physical, psychological, and social; since they all interact with each other and are inseparable). The ‘liquid’ in the cup is the combination of all the stresses in your life.
And when the liquid overflows the cup, it represents a negative outcome; in the psych realm- this may be depression, anxiety, etc. In the physical world, this would be a pain or injury.
Let’s play around with this analogy- mostly focusing on the physical realm, though like I said, it is impossible to separate these different stressors in our lives and they often interact.
Let’s start with the overflow= injury or pain.
Generally, the analogy only focuses on water spilling out the top of the cup.. But I think we can expand it to include any water that escapes the cup, this could then also include spilling during the pouring of liquid into the cup, and leaking out of cracks and holes in the cup.
Cup= physical and mental capabilities, activity and stress tolerance, and overall work capacity.
Remember that this can be any form of stress. Including physical training load (aerobic work, strength training, physical chores and duties at home or work), lifeload (work, caring for kids or parents, community responsibilities, social responsibilities, etc), as well as psychological stresses tied to the above mentioned or occurring on a more hormonal or chemical level.
Side note: stress is often described ubiquitously as a negative thing, but it’s not. Some level of stressful overload is required in training, it IS training; a temporary overload in physical stress to allow an adaptation and therefore increased capacity; this is known as ‘eustress’. Without any stress (or liquid in the cup), the cup will atrophy and collapse on itself. ‘Distress’ is when the stress becomes too much, overloads the system and leads to breakdown.
OK, so to recap- water getting outside the cup is bad.
So now, how do we reduce spilling and overflow? The first two options are the most commonly given advice in the analogy..
-Decrease the amount of liquid
The liquid is a combination of many stresses that can come in many forms (we call this viewpoint the biopsychosocial model, aka look at all aspects of a person’s life). Maybe there are some stressful activities in life that you can let go of-such as poor time or money management habits that lead to stress. Identifying and correcting these can reduce the liquid.
However, for most people, their social and psychological life stressors are non-negotiable and non-flexible (can’t just eliminate kid and family responsibilities, not pay mortgage/rent, not work). So for many, the most flexible stressor is in the physical training realm. Maybe you have to temporarily cut down on physical training until other stressors alleviate then you can build it back up later.
Unfortunately, the most common advice given from the healthcare system to someone with an injury is to stop the activity that they think caused the injury. “Stop running and let it rest then build back up”. But this is akin to pouring out the entire cup and slowly starting to refill it again. This is lazy and inaccurate advice given by medical professionals that are too rushed or ill-equipped to help properly.
If the injury is caused by a slight overfilling, why not just pour out enough to get liquid level back within the cup, then……..
-Increase your cup size
This can be done by performing your training in a smart progressive way so you don’t warp your cup with unequal growth but you do increase your physical tolerance to training (improved stride efficiency and running economy, increased VO2 max, increased mitochondrial quantity, and increased capillary density, and many more).
Cup size is also increased by increasing overall strength via weight training and plyometric drills each of which increase our tolerance to physical stress. I would put mobility work and stretching in this as well.
This is probably where most of the things people think of as physical therapy are included.
In the non-physical, cup-increasing category: I would put things such as mindfulness practices, meditation, stress reduction techniques, doing challenging but enjoyable activities, having positive occupational, social and family interactions. These do not not add stress/liquid, but increase our tolerance for the slight stresses that can accumulate.
Two more strategies to reduce liquid outside the cup would be:
-Find and Patch Holes and Cracks Maybe it’s not the amount of liquid (stress and training) or the cup size (load or capacity) that is allowing liquid out, but maybe there is a specific hole near the bottom of the cup that is leaking water straight through. Find the hold and patch it, and water no longer gets out. This could be something like lacking adequate ankle range of motion for a normal walking or running stride. With an issue as glaring as this, it doesn't matter how strong you are, how good of stress management you have, you try to run on it and it’s going to cause pain.
Likewise, having grossly inadequate hip strength that causes a limp is quickly going to cause pain and this should be addressed quickly.
This is the second realm where people often think of physical therapy. To help identify and patch holes they cannot find (or a friend/running partner finds for them and points out).
A crack would be something like….a crack in a bone (stress fracture), we still want to build up our cup, but until that crack is healed, adding training load too soon will cause leaking.
Are you pouring into the cup from one inch away or throwing from across the room? This could be looked at as training progressions or changes. Slow and measured increases in running mileage or weight training load is an attempt to pour slowly and steadily- and is usually the best way to go (the oft cited 10% weekly mileage increase is also an attempt at this, though there’s no real evidence to support it and it doesn’t make sense for people starting or restarting from few miles).
Going from 0 → 50 miles per week or going from no weight training to 10x10 squats (or a brutal crossfit workout) is akin to throwing the liquid across the room. Sure, some drops may hit the cup but most are likely to spill.
We all know someone who defied this advice successfully, an athletic friend that went from weight training to ultras, or who can drop into a crossfit class and dominate without injury. But these people likely have a bigger (and wider) cup to begin with, so they can pour sloppily and still catch it.
Pour with a steadier hand. As I mentioned before, there is a fuzzy separation- if any- between the biological, psychological, and social spheres in humans. They all interact and influence each other. If someone’s life is very chaotic and out of balance, they may be pouring from a reasonable height, but with a shaky hand- therefore spilling more. It doesn’t mean that it’s not worth the pour. it doesn’t mean that they can’t also enjoy the pleasures of training, but it is something that has to be taken into account when looking at what has led to pain and injury. This is why at Zenith, we treat humans, not ‘conditions’ or injuries.
This is the difficult but wonderful thing about human bodies, and humans. We are an amalgamation of a million things all happening at once. There are a lot of different factors that can contribute to an injury, but that also means there are a lot of ways we can start treating and improving them.
Where this analogy fails:
Cups are solid, static, inanimate objects. Human capacity isn’t static, the human cup is ever changing and influenced by thousands of factors on a daily basis. We do our best to identify as many of the meaningful factors and change what we can.
Unlike inanimate cups, humans and other living creatures are built for growth and improvement. Have you ever considered how miraculous it is that we respond to eustress with growth, rather than having a predetermined number of steps, heartbeats, muscle contractions, etc. Our cups can grow and improve and aren’t just left to wear and erosion.
Well, that’s as far as I’ve taken the analogy in my head. I would love any comments to further develop the analogy or discussion/disagreements on where you feel it falls short. Thinking through this helps to simplify the often confusing world of pain and injury, or at least gives some thought structure for people to build on.