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LAYERS OF COMPENSATION

Originally Published: Monday, 17 February 2014

Remember when you suffered that frustrating acute injury? That old injury most likely still affects your movement and function today. Our bodies are hardwired with an incredible ability to protect injured tissue. When the body sustains an injury a cascade of protective events begins. Pain receptors are activated sending signals to the cortex communicating that injury occurred. The cortex receives and processes these signals responding by down regulating neurological reflexes and altering muscular tone of the system. This leads to cortical asymmetry resulting in an imbalance in function between the right and left sides of the body. This leaves the individual in a compensated and under functioning neural state that may predispose them to further injury.                                       

For most of us, especially high-level athletes, we have not sustained just one injury but many. With each injury the cascade occurs, which moves the body further from optimal muscle function and support. I like to call this phenomenon “layers of compensation”. When I begin to rehabilitate an injury the patient often will note some pain from an old injury. This is due to the fact that as we begin to allow the body to support itself properly the compensation patterns developed to protect old injuries are removed. While this is positive progress towards optimal neuromuscular function it leaves old injuries vulnerable until they are also repaired. 

As we continue to resolve various layers of compensation we can help the individual return to proper recruitment patterns free of compensation.  An example from a recent case would help explain this. A patient recently came in with an acute low back disc injury. While the patient surely had damage in their low back they had a history of severe ankle sprains, and a right knee injury. The cascade in this case began with an ankle injury which led to compensation. These poor movement patterns led to another ankle injury which was followed by a knee injury. After many years of altered muscle tone and neural reflex the patient sustained a disc injury. 

To fully rehab the disc injury it was necessary to address each area of injury.  I like to compare the process of full injury recovery to the activity of putting a puzzle together. Piece by piece we take care of old injuries, and neural compensation patterns. This allows the individual to not only feel relief but to move beyond injury and reach their goals.