The following is the first in our new series…
COMPENSATION
Often when one part of our lives goes on the blink we learn to fill in the blank with new behavior. Is this a good thing?
In today’s post, our guest, Greg Taylor, a well known and respected New York City physical therapist, talks about how this happens with injuries to our bodies and what we can do to help ourselves heal.
Greg, a former dancer with the Joffrey Ballet, is Director of Physical Therapy at the Foot Center of New York, affiliated with New York College of Podiatric Medicine.
O.L.D. asked Greg to share some ideas with us about recovering from injury.
OLD: Greg, can you explain how compensation occurs after an injury?
GREG: There is a physical adaptation that takes over when our body is unable to operate in the same way it did prior to the injury.
The mind tells the body to continue on with the activity and will incorporate new techniques and methods to accomplish this goal. Some good, some not so good.
Different muscle groups, joints, breathing patterns, and energy resources will be called on to finish the task at hand, and because the body is made up of different systems and subsystems that each have their determined role, when one part is called upon to substitute for another (the injured body part) an imbalance starts to occur.
It can be as obvious as limping after an ankle sprain, where the uninvolved limb now spends more time on the ground and thus requires increases in muscle work, joint stress, oxygen demands, and energy.
It can also quite often be less obvious, as with a mild hip injury that limits your range of motion. You are still able to walk but have now adapted new ways to do old things. Incorporating hip-hiking muscles in the back for walking and adapting new standing and sitting positions are some subconscious ways the body will protect itself from re-injury.
While there have been physical changes due to the injury we often don’t make logistical changes to our way of life.
OLD: What are some of the ways this compensation can become problematic?
Greg: Problems can arise with compensation from injury when the adaptation is sustained over a prolonged period of time. Unfortunately there is no predetermined problem list for any particular injury, but there are some commonalities that clinicians can identity.
Remember, everyone is different and we all bring different characteristics to the healing table.
Co-morbidities, extent of the injury, body type, and quality of life all play a part in the scope of problems that may occur.
Over-use injuries of compensating muscles, tissues and joints are the most common problems to watch out for.
The last thing you need when healing from an injury is to create another injury! It is also important to remember the emotional and psychological effect that can come about when dealing with a chronic or even acute injury.
If you know that it is painful to be on your feet for prolonged periods this may lead to cancelling activities that you enjoy, thus adding feelings of dependence and even depression.
(In the 1960’s, Saad Nagi created a model to explain how pathology can first be an impairment, then lead to functional limitations, and finally become a disability. This model helps clinicians determine the most effective point of intervention.)
OLD: What are some clues for us that the injury compensation might be causing problems?
Greg: The most immediate clues that injury compensation is causing problems are new pains!
This may sound obvious but quite often I have patients that don’t connect a new pain as being associated with an old injury, especially if the new pain is located far from the original one.
I know of a patient who was healing from injury to his left great toe and had gotten to the point where he could run again, even though the toe was not completely healed.
Soon he started to report a pain in the front of his left shoulder that became worse the more he ran. An analysis of his running style discovered a compensation of a slight forward shoulder thrust - he was subconsciously avoiding fully pushing off his great toe - an antalgic terminal stance - causing tissue irritation and inflammation at his anterior shoulder.
His mind had memorized the point of pain and subsequently sought to avoid it, as far up the kinetic chain as his shoulder!
Let me also share the example of my father and his knee pain. He told me it had completely resolved and he was much better.
During my next cross-country visit, I noticed that he was still limping in the same way as the last time I saw him.
I asked him why he was still limping when he had told me he was much better.
“Oh, that’s right, I am,” he said and straightened up and walked away perfectly limp-free!
It’s also important to be aware of changes in energy demands. Is that flight of stairs you normally handle easily now finding you breathing harder once at the top? Do you find yourself searching for a seat on the train when you once did not mind standing?
OLD: What can we do?
To be continued… Tune in tomorrow to get some great answers!
Gregory P. Taylor, PT, DPT
Director of Physical Therapy – Foot Center of New York/New York College of Podiatric Medicine
55E. 124th Street, New York, NY 11201 212 410.8090
GTaylor@NYCPM.edu
http://footcenterofny.org/physicaltherapy.html
http://footcenterofny.org/
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