COMPENSATORY MOVEMENT
Movement used habitually to achieve functional motor skills when a normal movement pattern has not been established or is unavailable
Part of my job in dealing with pain patterns of clients is to identify where pain is originating. When someone overuses a joint and creates issues with free range of motion (ROM), often we are compensate somewhere else along the line of the action to create the same power, force or generation of movement. Our body is very clever at ‘figuring stuff out’ if we ask it to perform a motion. Adding into that repetitive motions or actions and the body is very adept at hiding or creating actions by recruiting other factors or agents (read muscles, tendons or soft tissue) to perfect or continue a movement.
When I talk about soft tissues, I talk about not only muscle but tendons, ligaments, fascia and connective tissue. The last term is incredibly broad but it delves into the concept that it is not just muscle that moves joints. There is the whole network of sinewy structures that contribute to stabilising bones, or creating a platform or stable structure against which bones and muscles can push and generate power for movement. This network is discussed at length throughout this blog in terms of fascia and it’s role in movement.
I find great satisfaction when i can play detective and work my way through an issue or injury that is presenting in a client but find the cause of this issue somewhere else in the body. The body is an incredibly flexibile and adept creature that does a million different things in the space of a milisecond, harnessing power or movement from different sources when it is necessary. It is in the perfection of movement that my real interest has always been. As a dancer, as a recreational sports person and as a therapist, movement and the perfection of movement has always driven me to find new, better or different ways of creating movement.
One of the reasons that we train an action, is to create the ease of movement. We do things repetitively so that our body not only understands exactly what it needs to do but we also ask the body to perfect that movement, via recruitment of the most proficient contraction of soft tissues. We do these movements over and over again in our training to perfect the action and make it almost second nature. I do find it interesting that when I am asked by my coach to perform a new movement, I really have to concentrate and take in all the direction and then think about the purpose of the exercise and what we are trying to achieve and then try to put that concept into moving.
This action of repetition tells my left medial gastrocnemius to contract whilst i push off the floor and trains it to do that action consistently rather than having to think about it each time. It’s like the first time you do a pull up and you get told to pull your shoulders back as you lift towards the bar. After doing it several times you don’t have to think about that action as often as you have trained your body to perform that action in the most correct way because we recruit the larger muscles of the back to do the lift rather than the comparatively smaller muscles of the chest, bicep or anterior shoulder.
Am I getting off track?
The reason I cite these examples is that when we injure those trained muscles through repetition or overuse, our body is quick to adapt to any changes. As a result of a weakness or injury we may create a small internal rotation in a major joint such as the shoulder, which then creates a small adaption further down the chain of the arm - say medially rotating the elbow. This change then creates a load or strain on other muscles (in this example the pronators of the forearm) which become more active in performing the motion. As with any worker, ask it to perform extra duties and the worker will comply. For a period. Then - they get tired. They also get cranky and they start to not perform as well. This is where injury steps in and we can begin to feel issues in areas that seemingly come out of nowhere. These we label COMPENSATORY PATTERNS.
J Gordon Zink is the oft quoted man of the Common Compensatory Patterns (CCP). His development of theories of fascia movement in the late 1970’s became the text of choice for osteopathic medicine and the treatment of postural deviations caused from fascial stressors. In essence we create certain patterns of movement to deal with tension or stress (load) on our bodies.
Compensation comes from weakness or inability of a muscle to perform its role in movement. Hence we create other stressors to compensate for load further down the chain. The figure of Aphrodite is a good example of creating curves and bends in the trunk to compensate for an original deviation at the hips. You can see the associated compensation in the bend and flex of the shoulder line to deal with the upward motion of the L hip caused from an uneven placement of weight in the lower limbs. This simplistic example is the basis for what we find in our body when we overload a major element of movement.
Chasing these patterns in the body is primary to our focus as Remedial Massage Therapists as we are trying to ascertain a causal link between a perceived injury. Where pain may be in the left shoulder, we may look to the R hip to ascertain a contributor further down the chain. If I am looking at a baseball player (pitcher) who is suffering elbow issues, I may choose to look at the shoulder first to ascertain any weakness or instability here before looking at the primary sore bit of the elbow. We can take this further and begin to look at the hips or even the ankle to ensure there is adequate stability moving up the body from the initial actions of a pitchers swing. This is where movement becomes so interesting as movement usually implies a symphony of co-ordinated effort of various factors to achieve the complexities of a throw, or a jump or a twist.
This is where elements such as Functional Movement Screen can come into play where we may look at certain basic movement patterns and try to assess where there might be inability to perform core movements that may lead us to identifying where a weakness pattern may exist that is contributing to movement issues.
The danger in post injury recovery is that we try to go back to larger movements (like jumping) before we are ready to perform the task. Sure we can create the leap but are we able to create the stability and adequate strength to perform this task repetitively and with full unabridged generation of power. In a sports context this is the most vital assessment as when we are lunging for a ball or tackling a player, we don’t want to be thinking about our back and how it is moving and being cautious, turning on our core etc… we simply want to perform the task and achieve the result. In this way we may develop compensatory patterns that will achieve the result but won’t be sustainable in the long term.
Identifying these aspects in recovery from injury is vital to the coach/trainier/therapist. We need to ensure that the body is primed and trained for action with the most sustainable function and recruitment of elements possible. If not, smaller injuries and chain effect issues will be the result and that will only create a dis-satisfied client who finds themselves constantly finding new niggles and pain patterns.
