The Compensation Equation

The idea of ‘compensatory dysfunction’ is not a new one; the fallen arch causing shin splints, the weak rotator cuff causing pain in the front of the shoulder as examples. Especially when one is working with athletes and performers, however, it is important to take this idea a few steps further. Theirs are bodies that require regular maximum output in specific patterns, regardless of what else is going on in other places. The micro-tear here, the mild pelvic displacement there, the increased anxiety that saps some of the neural energy necessary for firing and about a thousand other things all make it requisite that some other part of their construct takes up the slack.

The compensation that is required for maximal performance around a small, existing problem or problems becomes normal for the body over time. It’s not normal, of course, but it manifests like a bad habit. Part of the detective work in treating these performers is ‘asking’ the body what dysfunction is feeding off another. The answers received here are critical.

The body will create a shift in force here to protect a micro-tear there in order to prevent the small problem from becoming a larger one. Even when the initial problem has resolved itself, though, the new pattern remains, putting unwarranted stress on a different part entirely. This has the possibility of creating a new joint dysfunction, micro-tear or whatever somewhere else. Who knows what the first report of ‘pain’ will be from the athlete? It will probably be the thing that adversely affects his ability to perform. To be sure, though, the cause and effect of it all begin to blend in time.

So what does this mean? Are we doomed to an endless cycle of compensation? Further…isn’t this just hype? I mean, sometimes, we just get hurt because we get hurt, right? I get asked questions like this a lot. Answers are as follows: Good question. No. No. And Yes.

Suppose an 85 kg player misses the soccer ball and hits his opponent’s leg instead. Or, more simply, an anvil drops from the sky and lands on the leg. The leg breaks. Where’s the compensation there, Einstein? Answer; with the initial mechanism of injury…nowhere. But, it is in the construct of everything that happens afterwards, from the first minute of injury that we begin to see it. The limp, the gross inflammatory response and myofascial guarding and armoring, the walking on crutches, the sensory radicular loop back to the CNS, the stress associated with being in pain and having no physical outlet, the varying levels of depression that come from not playing and a million other things all have an effect on the whole body (and, yes, the ‘psychological’ factors do have real, physical by-products which can also be treated).

With chronic or repetitive stress injuries, the detective work gets more fun. We need to think about the compensation that has gone on from the first micro-tear all the way through to the initial report of pain and reduced function. This is said keeping in mind that most people, especially high level performers and athletes, actually think that pain is normal.

A typical day at the circus:

“My wrist hurts me when I land on it. I don’t know if I can work.”
“When did you first notice it?”
“About six weeks ago.” Six WEEKS? The usual battery of questions ensues from therapist to patient. Then,
“Is anything else causing you pain or discomfort?”
“No.”
“Really?”
“Well, my neck bugs me a bit.”
“How long has that been going on?”
“About 8 months since I fell from the trampoline, remember?” Hmmmmmm.

There’s an analogy that has been related to me many times by my Russian friends and clients (most of whom are acrobats), “If you wake up and you feel no pain, you’re probably dead.”

The factors involved in compensatory dysfunction will, without doubt, affect recovery. Managing as many of these variables as possible is critical in the recovery of the elite performer…and indeed, with anyone. This management is as important as conditioning maintenance and the more traditional methodologies of therapeutic exercise and local manual therapy for example. The patient will get better in time, but if there is some other way we can intervene to put their body in the best possible position to heal itself…why not at least try it.

When one is dealing with professional sport and performance, it is not just the health of the athlete and getting them back quicker that is in question. One is also dealing with winning and losing, show quality, team cohesion, sponsor and producer happiness, the effect that this athlete being out has on the others who have to shoulder their workload, and, of course, the inevitable financial cost of it all.

With this in mind, it is important to look at the whole body when treating the injuries of the performer. Ensure the continued condition of the artist or athlete; train whatever you can on them that is specific to their performance (or not as possible) to keep them in as good a shape as they can be. Treat the injured part; deal with the direct pain in the ankle, strengthen the joint, provide proprioceptive exercises as required, assist in the restoration of appropriate joint mobility, etc., etc. Treat the areas where it’s clear there has been compensation; help correct the ilial upslip resultant to the limp, release the armoring tissue protecting the joint on the outside of the leg, help to reactivate the VMO to make sure the patella regains it’s track, correct the sacral torsion that you find and strengthen the pelvic floor. Also, treat places where you think there may have been compensation and give as many systemic interventions as possible; lengthen the dura, rebalance rhythms as possible, use acupuncture, craniosacral therapy, systemic massage, use your integrated sport medicine team, whatever you have!.

Use the clubs in your bag. Every little bit that we can do to help their bodies get back to better than normal counts!

There’s a great scene in Aaron Sorokin’s West Wing where the campaign manager is speaking to the President. In addition to telling the boss that he doesn’t like working with people who don’t race sailboats (using an analogy of pulling kelp off of the hull to gain an extra little bit of boat speed), he further indicates that if anyone thinks that he won’t do anything at all that will help and cost nothing to win, they are absolutely out of their minds.

Treating the injured performer is like racing sailboats, I guess.

With excerpts from Rick’s book currently in production, The Things I Don’t Know (long list).

More on ‘The Whole Body’ in further chapters,

CV / Resume

Biography

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The Compensation Equation