The Four Pillars of Health

There are four pillars of health: activity, nutrition, sleep and stress management.  Without any one of these the temple of health will crumble.

I’ve been thinking about this for a couple of years now, wondering why we only get involved in one of these pillars – activity. I am told (by people within our profession) that it’s because the others are outside our scope of practice, but why? I know that our expertise in in the “activity” pillar, but what’s the point in working on this without addressing the other 3 pillars? Who builds a temple with only one pillar?


Physical activity, movement or exercise, whatever you’d like to call it (this is just semantics!) is the core of what we do and it is the main thing that we can get involved in to contribute towards health.  There is no disputing that we, physiotherapists, have expertise in building this pillar.  We provide rehabilitation exercises (post surgery or injury), we deliver rehabilitation classes (think cardiac, COPD, TKR), heck we may even do some prehabilitation exercise prescription (think athletes, prep for surgery etc).


But nutrition we ignore, and I can’t help thinking… what’s the point in prescribing exercise if we aren’t optimising the body to make the most of the exercises we prescribe.  In the post injury and surgical situation our bodies are affected by inflammation, why aren’t we suggesting nutritional methods to reduce inflammation? In obese patients and clients why aren’t we discussing how nutrition may reduce their musculoskeletal symptoms?  Yes we could leave it to the dieticians, but I am very sad to say that I have not had the best experiences with this approach.


After activity and nutrition, sleep is going to be the next big topic of conversation.  Sleep is when all the restorative magic occurs.  If we’re not sleeping we’re not healing.  Worse than that, if we’re not sleeping we’re creating opportunities for breakdown!  Increasing use of technology is the major factor continuing to the detrimental affects of lack of sleep.  Computers and mobile devices etc all emit blue light which affects sleep quality.  In addition to this stimulation in the form of, for example, activity, tv and video games, late night eating, alcohol, caffeine (has a 10 hour half life on average!) all contribute to reduced quality sleep and therefore less time for restoration.  Why aren’t we talking to our patients about this to optimise their healing and performance?

Stress management

The final pillar in our four pillars of health gets many names depending on which sector the presenter/author/advocator resides in. Mediation, spirituality, breathing; but essentially they all relate to mindfulness and the resultant reduction in stress. Different things work for different people here, it may be that you need peace and quiet, sunshine and nature, or gratitude and thanks.  What ever it is that works for you, you need to find it! As physiotherapists we can’t find it for people but we can facilitate them finding it for themselves.

People, our patients and clients, should be encouraged to build health skills within all four pillars.  They need to act outside their comfort zones and take responsibility for their own health, but they need to be encouraged to do this. It may not currently be within our current scope of practice, but it should be!

If Tim Ferriss ever asked me what I would put on a billboard given the opportunity (regular Tim Ferriss listeners will know what I am talking about), I would say “Own It!”.  To take responsibility and ‘own it’ relates to many personal and professional aspects of life but one in particular is health.  Own your own health, take responsibility for your health and simply start with these four pillars. Start with yourself and then our job is to share this with our patients and clients.