The North Star Principle
Imagine you are dropped into a dense wilderness. You have no idea where you are. Tall trees tower over you. You can't see the sun or the horizon. You are lost and have no bearing on where to go next. You stumble around in circles, but as hard as you try, you can’t find your way out of the wilderness.
This is the chronic pain experience. You are hurting. It seems no one can tell you why. You know you are too stiff, not strong enough, have MRI findings, are inflamed, and you aren’t sleeping well. You know it’s getting worse, but nothing seems to work for long, if at all. Everyone around you has well meaning suggestions, and your medical providers seem to have conflicting opinions. You are not stuck in chronic pain. You are lost in chronic pain. You need a way to figure out where you are and where you need to go. You need a GPS and directions with the best course to a healthy, pain-free life. You need The North Star Principle.
The North Star Principle offers a key point on the map to navigate toward. It gives you clarity about what you are trying to achieve and how to take steps in the right direction. It allows you to look at possible treatments and assess whether it will be a waste of time and money. It cuts through the confusion and gives you the best next step. This is Align's third, and most important, Joint Pain Principle.
The North Star Principle:
In order to have healthy, pain-free muscles and joints, you must be adequately mobile, stable, and strong, with a healthy and regulated immune and nervous system.
Let’s unpack each element of the North Star Principle.
Adequate Mobility
In order to have healthy, pain-free muscles and joints, you must be adequately mobile.
When we say adequately mobile, we aren’t just saying, “you should stretch more.” We are referring to highly specific metrics. For example, your big toe should be able to bend backwards (or extend) 60-90 degrees; otherwise, you might experience problems elsewhere in the foot, ankle, knee, and hip. Your ankle should be able to flex 45-60 degrees, or it might cause problems in the joints above and below. Your hip should also be able to stretch backward 15 degrees, or it may cause problems in your knees or low back.
Why is it so important to have highly specific metrics? When we understand how each joint is supposed to function, we can assess them individually, measure their range of motion, and identify any that aren’t working properly. This gives us a list of mobility problems that could be causing or contributing to your pain. Remember, the hardest part of treating chronic joint pain is identifying and correcting the root cause of pain. When we evaluate based on metrics and data, we can easily identify root causes.
Adequate Stability
In order to have healthy, pain-free muscles and joints, you must be adequately stable.
Adequately stable joints do not have atrophied stabilizing muscles, joint misalignments, or dysfunctional movement patterns. Unstable and misaligned joints cause highly focused areas of load and stress. Again, there are highly specific metrics that can be measured for each joint. For example, your toes should be splayed outward from the midline of your foot, and the arch in your feet should support a level ankle. Your knees shouldn’t be knock-kneed, bow-legged, or rotated. Your pelvis should be level and square, and your shoulder blades should be upright between zero and ten degrees tilted forward. These are all metrics we look at in an evaluation.
Examining each of these areas, checking them against the specific metrics, and looking for more root causes gives you a highly specific “plan of attack” for treatment. If at the end of an evaluation, you’ve found 12 problems, you’re actually in a great position. You’ve discovered 12 easily treatable root causes that are exacerbating or causing your pain. Now you can prioritize and fix them one by one.
Adequate Strength
In order to have healthy, pain-free muscles and joints, you must be adequately strong.
If you don’t have adequate strength to support your lifestyle, your body will break down under the load. How do you know if you have adequate strength? Do the math. When engineers design a bridge, they calculate its shape, weight, and the stress on each section. Then, they select materials with the necessary load-bearing capacity—always with a margin of safety. We must apply the same principle to the body. We start by calculating how much load, or stress, is going on in each square inch of your body. This is based on your bodyweight, joint alignment, and lifestyle. Once we know how much load is being placed on the different parts of your body, we “choose” a material that has an adequate load bearing capacity to withstand those stresses with a margin of safety.
How do we “choose” a material for your body? Essentially, we increase the load bearing capacity of the bones, connective tissue, cartilage, and muscles in your body through the systematic application of increasingly heavier loads weekly via weight training. When we methodically identify the load bearing capacity of a joint system and increase the applied load on that joint system by 5-10% per week for 12-24 weeks, we can restore adequate load bearing capacity back to the muscles, connective tissues, cartilage, and bones.
If your current lifestyle activities drive your pain up, it’s highly likely you don’t have adequate strength and load bearing capacity to execute them.
Healthy & Regulated Immune System
In order to have healthy, pain-free muscles and joints, you must have a healthy and regulated immune system.
You cannot have healthy, pain-free muscles and joints if you live in a chronic inflammatory state. A healthy and regulated immune system acts to protect your body from foreign invaders and heal injured tissues through the body's inflammatory response. An unhealthy and dysregulated immune system creates and leaves excessive inflammatory cells in and around your joints, leaving them stiff and painful.
Key drivers of inflammation and immune system dysfunction are:
Ultra-processed foods you can’t make in your own kitchen
Dairy for 60% of the population
Gluten for 12% of the population
Excessive salt.
Additionally, you may need to rule out or treat any autoimmune disorders to achieve a regulated immune system and inflammatory state.
Healthy & Regulated Nervous System
In order to have healthy, pain-free muscles and joints, you must have a healthy and regulated nervous system.
You cannot have healthy, pain-free muscles and joints if your nervous system is dysregulated. Your nervous system is composed of your nerves, spinal cord, and brain. Your nervous system is what senses the world around you, interprets that information, and creates your sensations and experiences. You do not experience the world as it is. You experience the world as your brain interprets it.
Sometimes the pain signaling systems of the nervous system get stuck in the “ON” position. Pain patterns can be memorized, signaling pain even after the initial injury heals. Your original tissue damage can be healed, but if the pain systems of the body have gotten stuck in the “ON” position, your pain remains despite there being “nothing wrong” now.
What are the signs and risk factors for this type of dysregulation of the nervous system?
If you have been in pain longer than 3-6 months
If you have diffuse, broad based pain
If you have heightened sensitivity to sound, light, or touch
If you have heightened levels of anxiety, depression, or sleep disturbances
And Not Or
You’ll notice The North Star Principle says you must be mobile AND stable AND strong AND have a healthy and regulated immune AND nervous system. It doesn’t say you can be mobile OR strong. To have healthy, pain-free joints you must achieve all of these traits. If you are very strong but have weak stabilizing muscles, you can be in pain. If you are very mobile but you lack stability and strength, you can be in pain. You can have perfectly functional joints but still experience pain due to a memorized pain pattern and inflammation.
In order to have healthy, pain-free muscles and joints, you must be adequately mobile, stable, and strong, with a healthy and regulated immune and nervous system.
Move Toward The North Star One Step At A Time
The North Star Principle might feel overwhelming as a starting point, but when used correctly, it shows you the way out of pain. It gives you a direction to move toward. If a treatment isn’t going to move you closer to The North Star, then it’s a waste of time, money, and energy.
Evaluate how far away from The North Star you are now. Then, identify specific root causes using a data driven approach like we use at Align. Prioritize the problems that are most important to fix first, second, and third. With a methodical approach to addressing each and every problem until there are none left, you can find your way out of the wilderness of pain.
Author Matthew Lister
CEO & Founder of Align