Compensation (Everybody's Doing It)

Many people can feel that their bodies have been compensating for a past injury or condition. Sometimes these compensations are themselves the cause of pain or weakness: for instance, you have a car accident, your body has no pain at all, but you seem to have a harder time lifting heavy objects.  Or, you have an ankle injury, it heals beautifully, but a few years later the opposite knee starts to twinge.  Over time rehab experts have developed guidelines about which body parts tend to compensate for ("pick up work for") other body parts.  With Neurokinetic Therapy™ we get even more specific, identifying exactly which parts of your unique body are involved in a compensation. The results can be surprising! Resetting these compensations can often be the key to healing a musculoskeletal injury. 

But while we tend to talk in negative terms about compensation (the word alone suggests something's missing), please remember that compensation is what the body does.  It's been doing it from when you were born, often prior to any injury or trauma, in response to the position of your joints, the shape of your body and the way you used it (possibly also the way you were carried, the kinds of shoes you wore, etc., etc.). This happens all over the world, in every culture, no matter its lifestyle. You could easily replace the word "compensate" with the word "adjust," or "calibrate."  

In order to accomplish a task with the tools at its disposal, the body adjusts and calibrates in very useful ways. Athletes are some of the best compensators, adjusting for and calibrating around pain and weakness as efficiently as they shimmy down a mountain or dodge a linebacker. We have the idea, based on research and clinical evidence, that there is an ideal way all muscles should work. That is a very useful construct---I use it in my practice every day---but there is no one, or no one I've heard of, whose entire body works that way. Each of us is a unique variation on the ideal.  

Below is a great description of how compensation works, from Douglas Nelson's book "The Mystery of Pain". But as you read it, please remember that every body's doing it: 

When you want to move, your brain considers the intended outcome and then figures out a way to accomplish the action. Knowing what the final goal of the movement is, the brain recruits every muscle and neural pathway available to accomplish the intended action in the most efficient manner. Every simple action, such as bending over to tie your shoes, requires a symphony of muscular action to take place. No single muscle is involved; multiple muscles must turn on and off at precise times to accomplish even the most basic actions. With such complexity, any disruption of the system can have vast consequences. When one muscle does not participate appropriately due to pain, or the memory of pain, other muscles must compensate by doing more. Over time, these overworked muscles may lose their sense of humor regarding their new job description. 

Changing the recruitment pattern of muscles is analogous to driving down a road and then finding that a fallen tree has blocked the route.  You still need to get where you are going, so an alternative route is employed. Unfortunately...these alternative routes aren't often very efficient. When the detour is removed (original pain), the brain still employs the inefficient detour. There is a redistribution of activity both within the muscle itself and also in the complex relationships between muscle groups.  This limitation of movement alters normal muscle function which then can potentially lead to more pain in the future. 

Dr. Paul Hodges has done some wonderful work with this subject (Hodges and Tucker 2011). His work has shown how pervasive these alterations are throughout the entirety of the muscular and nervous systems. By changing these muscle functions, we become less flexible in the broadest sense of the word. Our movement possibilities are limited, we become less efficient, and less adaptable in our nervous systems.

All true. But for all that (Gabi again), we're all compensators, and naturally artful at it. On top of which, many of us are or become, either through nature, nurture, or both, "excellent compensators". The body of an "excellent compensator" is especially good at figuring out what it needs to do to get the job done, even if that job is getting down a mountain at a record pace on a torn Achilles. Are this person's movement possibilities limited? Only compared to what he could do on an intact Achilles. Thus, someone may be born with or acquire scoliosis and be a great rock climber. Someone may start running marathons after losing a limb. Etc.

How to maximize your body's movement potential? Move your body in all the ways it can move, as far as you can move it.* Load and challenge your body with care. Study and apply good form. Aim for ease. Vary your movement practice and keep learning new moves, but return to the basics (walking, squatting, lifting). Your body will be adding and subtracting compensations along the way, adjusting and calibrating to history, use and position, just for you.  

*As far as you can actively move it. I haven't found value in stretching beyond your active range of motion. Or in mimicking Cirque de Soleil performers. A subject for another post....