​Aesthetics and the damage done

This blog will be as much about aesthetics as it will be about the use of social media within our profession, as I’m sure we are all aware these are intrinsically linked nowadays. The fantastic Jack O’Brien has contributed to this instalment; I recently had the pleasure of sitting down for a coffee with Jack, I was electrified with the contents of our discussion and genuinely surprised that with so much time between catch ups that we seem to be on the same wavelength with a lot of things. He has truly understood and embraced the philosophy of this blog. For the purpose of this blog we define aesthetics as ‘having a sense of the beautiful; characterised by a love of beauty’.

I tell everyone who contributes to this blog that this is not about regurgitating the latest evidence you have read. Any monkey who has attended tertiary education can do that; what I am trying to stimulate through all of this is novel thought. This blog is about leading the (very) small cohort of readers into new concepts and thought processes of their own. So, thank you for reading. Read on to hear what Jack has to say, and my take on a few things, into aesthetics and its impact on the health realm. The title is a play on the Neil Young song of a similar title, if you haven’t heard it, go and listen; it is about heroin addiction, which is generally a pretty rough road as you can imagine. I think we can all agree that chasing aesthetics can be addictive; but this might not be as rough a road as the H train.

Aesthetics and the good.


Physical training is a fascinating concept.

All throughout history, humans have harnessed the power of simple training philosophy in order to survive, thrive and excel at life in all its facets.

Primitively, the primary purpose of training was purely function – how could you become a successful and efficient hunter; a stronger gatherer; a resilient, fearsome, tough warrior; a desirable mate.

Fast forward to the 21st century, and physical training has taken on a whole new meaning. Although these outcomes may still be the desired outcome for some people, training can now take on many different meanings.

Training could be all manner of things: -A social, community outlet -For aesthetic or vain endeavours -For specific competitive sports -To counter-balance our terrible diets and activity patterns of the 21st century. -To maintain an appearance for the social pecking order and to attract a relationship.

As a consequence, the pursuit of these things has caused a myriad of challenges.

We now have training methodologies that have such a narrow outcome in mind, it is at the expense of other things.

We have large populations subscribing to mind-sets and concepts that promise the world, yet are false, hollow and misleading – much less based on evidence.

No one is saying that training with specific endeavours in mind is a problem – heck, having goals is a key element to get results.

What could be said, though, is that the pursuit of a goal at the expense (and ridicule) of all else is a sure-fire way to:

a) attract attention and victimise yourself, and b) leave yourself vulnerable to the downsides or side-effects that are unavoidable in a polarised environment.


Put simply, if defining aesthetics as relating to the sense of beauty, this can be a hell of a powerful driver for improvement. In an evolutionary sense, aesthetic drives are used by many species to continue their existence. Frail and lame animals are subject to a high risk of failure to mate and replicate; they are not appealing in an aesthetic sense – this is the basis behind species remaining robust and healthy.

But are human beings much different? I think we have become different. The aesthetic drive has taken on an entirely different property for us, and as with many things referring to aesthetics in evolutionary terms has become quite moot especially when thinking about current and future human societies. Through the internet and social media modern human species now experience a multiplying effect on a few fronts; one of which is aesthetics and its impact. Aesthetics is different now.

It is still a driver for the human race; it will ultimately drive many humans towards goals, some of which have been listed by Jack. Yes, one of them is the drive to train, the drive to counteract the numerous ways in which our societies now become unhealthy. We are now so far removed from the natural world, however, that the aesthetic drive behind human being’s own evolution is now morphing into one which might not be as closely linked to natural selection as it once was – it might not be closely linked to health all that much anymore either. So, onto the dark side of aesthetics.

The dark side


The consequences of a pursuit of vanity.

Let’s be clear – the problem here isn’t vanity, or training for aesthetics.


Training for aesthetics is completely understandable and rational – as social humans, we want to look good, feel good and compete against others.

We want to look good naked, feel comfortable in our skin and have a healthy self-esteem, self-image and self-confidence. We want to be strong and dominant. There are plenty of healthy drivers behind the aesthetic pursuit.

When it becomes unhealthy is, in the absence of regulated and sensible competition, the pursuit engages in unrealistic, unsustainable and unhealthy habits.

However, the same can be said for any training, not just bodybuilding.

It doesn’t take a rocket scientist to observe that CrossFit has a certain reputation (valid or not, I’m not passing judgement on that) that can easily tip over from healthy to unhealthy.

The same can be said for powerlifters, long distance walkers and tennis players. The list is endless.

Here’s the main take away:

Health is imperative.

Goals are important.

And an holistic, moderate, considered approach that accounts (and controls for) for any potential negative consequences will always win in the end.


Jack has made probably the most salient point; aesthetics become unhealthy in the pursuit of unsustainable practices. If driven purely by aesthetics; that’s OK and plenty of people do still remain healthy. My argument essentially follows this rabbit hole down a little further; health has become a commodity, and very linked with aesthetics. The use of aesthetics, however, has become more extremist and more isolating. I do think that some people are able to practice moderation, but not a lot, probably not the entire human race. Social media has allowed these extreme images to become way more accessible than previously was possible.

It’s a numbers game really; now at least 80% of the world’s population own a television set (ref) and Facebook has 1.94 billion users. The aesthetic drive is now influenced by so much more media; extreme images are now mainlined into our families 24/7. The loudest voice is the one that gets heard the most and no one really wants to listen to a moderate message of much, especially not when it comes to aesthetics. I don’t think this has been the case throughout much of human history, as we see strange aesthetics crop up at every turn in the human society’s development. But now it seems just far more prolific; many more people have access to these images and ascribe to a certain extreme practice as the one for them. What is the worst thing here is that our children now do not have a choice in this; they are consistently exposed to extreme images, aesthetics and lifestyle practices.

This is not the forum for bagging out social media; but those of you who know me know that I do not to use it a great deal for personal things. For me personally, it comes down to a choice between what you want to portray and engage in; you always have a choice and as a private person I choose most things to remain between my closer connections. Far be it for me to cast an opinion on that choice; this is not the moral high ground. This is, however, a comment on what social media could be doing to human being’s aesthetic drive and its impact on population health.

Clinically, I see a few isolated issues with uneducated people following popular aesthetics on mainstream media. People may develop: ​

Rounded, anteriorly overloaded shoulders following a ‘beach muscle’ aestheticAnteriorly overloaded core trunk musculature from chasing ‘chiselled abs’ Anteriorly overloaded thigh musculature in chasing the ‘quadzilla’ look.

These syndromes would be great to write up just as Janda did with posture and maybe more applicable to the way we understand loading in the human system now, but I don’t think that even this stuff has not a hell of a lot to do with pain prevalence in people. People develop these issues due to a lack of adequate information and education to the contrary.

On a more global scale I think we can all agree on a huge mental health burden of constant visual stress and warped aesthetic drives of young females and males will be significant in future years. Physical health may follow this also; the ever-increasing pursuit of aesthetics over anything else because of the over-exposure to extreme images in all forms of media.

What role do health professionals have to play?


As alluded to in previous articles on this blog, the nature and landscape of health care, and specifically physiotherapy, is changing drastically.

There is a raft of new evidence, and model of practice, sweeping our profession – and for the better!

Our role is now less about being the ‘guru with the magic hands’, and more about being a patient’s ‘trusted advisor’ – someone who is across the current evidence and best practice (in a way that is meaningful to real life) and can apply that in a specific way to a given circumstance or presentation.

Our role, as physiotherapists, is to advise, guide and steer those who come to us for advice towards THEIR desired goals in a way that controls for potential negative outcomes, and optimises that patient’s biomechanics, attitudes, beliefs and desires.

THEREFORE, our approach MUST be different for each patient – there is no room for cookie-cutter approaches.

It also means that our approach must be TRULY patient-centred on their goals and desired outcomes, and applying our holistic knowledge to that scenario (which will OFTEN mean not just RCT-proven methods!)

Patient centred care is not just applying gold standard to everything. TRUE patient centred care is applying our collective knowledge to achieve an outcome as close to desirable as possible.


In summary, the damage done by polarised training modalities is not simply the fault of the uneducated athlete or weekend warrior. We as professionals are as much to blame.

We have the privilege of having one of the most scientific and respected professions, and it is our role to be a trusted advisor in a truly patient-centred approach to help people achieve their desired outcomes is a healthy, sustainable and enjoyable manner.

And how much fun is that!?


I couldn’t put it better myself; our roles as physiotherapists is about educating and leading patients into healthier choices whilst empowering them to achieve their own goals. If this is aesthetically driven, have at it, but retain the most important commodity for the patient – their own health. Maybe try to steer clear of the points mentioned briefly above.. More to come on a lot of this. Stay tuned!

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