biomechanical compensation and chronic pain

BIOMECHANICAL COMPENSATION AND
CHRONIC PAIN

Biomechanics Compensation

“Baseball injuries are common and can impact a player’s ability to participate. An injury to any region can influence the player’s ability to swing the bat. As a part of the athlete’s rehabilitation, a sports-specific program should be implemented re-introducing the hitting cycle that addresses proper biomechanics……    Use of appropriate hitting mechanics must be ensured during rehabilitation to avoid compensation.”  From the December 2015 issue of the International Journal of Sports Physical Therapy (Return to Hitting: An Interval Hitting Progression and Overview of Hitting Mechanics Following Injury)
I’ve heard it a thousand times — Doc, my problem is spreading.  What was originally hurting at point X is now hurting at points X, Y, and Z.    What’s really going on here?   Does this person have some sort of “disease,” or is it something else?  Truth be known, there is a good chance that the problem is compensation.   The best way to grasp compensation is to have a basic understanding of Biomechanics.

  • BIO = Living
  • MECHANICS = The way that forces act on objects, either moving or resisting movement.
  • BIOMECHANICS = Applying mechanical principles and physics to the human body

In order to create torque, muscles apply forces to bones that act as levers.  The joints themselves acting as fulcrums.  As long as the object you are attempting to move is not too heavy, or there is too much friction present, movement will occur.  When we move, we are always trying to gain mechanical advantage.  For example, when a baseball player is trying to hit a home run, he does not “choke up” on the bat (move his hands further towards the barrel).  He grasps the bat at the very end of the handle because greater bat speed can be generated from that position.  When using a simple lever; pushing on the very end of said lever is where the most force can be generated.   Almost everything we do on a day to day basis involves an attempt to gain mechanical advantage. 

Due to injuries, athletes lose mechanical advantage.  What does this mean?  Allow me to give you an example using an elite swimmer I saw yesterday.  This individual (we’ll call him Joe), currently a scholarship swimmer at a major college program, has been swimming competitively since kindergarten.  Competitive swimming entails hours upon hours of repetition, always refining your form to be as biomechanically efficient as possible.  A couple of years ago, Joe felt something “give” on the right side of the bottom of his chest.

Being a hardcore competitor with a self-proclaimed “high tolerance for pain,” the plan was simply to suck it up and work his way through it.  Before long, the injury to the chest started working its way to the shoulder, and around his ribs.  As might be expected with what turned out to be FASCIAL AHDESIONS; the trainers and team clinicians COULDN’T FIND ANYTHING WRONG WITH JOE.  Needless to say, his coach pushed him to continue to work through the problem.  It wasn’t long before the pain had moved into his neck, upper back, and entire left side — from his triceps to his TENSOR FASCIA LATA.  

Joe’s times continued to increase until the day came when he simply couldn’t compete.  What started out as a small injury to the front of his RIB CAGE, had, due to Biomechanical Compensation, engulfed a quarter of his body.   When examining Joe, it was obvious that there were any number of areas of his body that were tethered, and unable to move properly.  After spending an hour and a half with Joe, the difference was immediate and significant.  Hopefully, those results hold, and I will be able to provide you an update to Joe’s situation in the near future.

It is important to remember that all tissues compensate all the time.  Bone grows in response to mechanical pressures put on it, whether normal or abnormal (Wolff’s Law).  Cartilage degenerates and thins in response to aberrant mechanical stresses.  Muscles will either atrophy or hypertrophy, depending on the tensile forces (or lack thereof) they must deal with.   Not only are FASCIAL ADHESIONS usually a compensatory reaction (PLANTAR FASCIITIS is a great example), so is TENDINOSIS.  And although it’s not a musculoskeletal issue, LIVING THE HIGH CARB LIFESTYLE will eventually burn out your pancreas (can anyone say Diabetes?), forcing some of that load to the ADRENAL GLANDS (can anyone say Fibromyalgia?).  What can be done to prevent harmful compensatory reactions in the body — particularly in athletes?  Although we could probably come up with dozens, let me give you just a few.

  • MAINTAIN A NORMAL WEIGHT:  Thirty years ago, this bullet would never have had to been included — especially for athletes.  But with 70% of the population overweight or obese (and another 7 to 10% considered “FUNCTIONALLY OBESE“), it bears mentioning.  Here is a simple example.  When you gain weight (most particularly BELLY FAT), you move the fulcrum point of your vertebrae (it’s called the IAR or Internal Axis of Rotation) not only outside of the vertebrae where it belongs, but depending on the size of the belly, potentially completely out of the body.  As you might guess, this puts a massive abnormal stress on spinal discs.  If you are overweight or obese, you are forcing your body compensate in hundreds upon hundreds of ways — none of them advantageous to your sport or your health. 

  • DON’T OVERTRAIN:  I have had the privilege of treating professional athletes in my practice.   Although some might look it on the outside, few of them claim that what they are doing as far as their training is healthy.  If you spend six to eight hours a day performing repetitive motions, not only are you likely to end up having a wide array of injuries, but INTENSE CARDIOVASCULAR OVERTRAINING tends to push people towards LEAKY GUT SYNDROME

  • USE PROPER TECHNIQUE AND EQUIPMENT:  Although this might sound like a no-brainer, you would be surprised how often it’s not followed (many times inadvertently).  For instance, due to my insanely high arches, I couldn’t function on any level, let alone as an athlete, without my orthotics from Shawn over at Xtreme Footwerks.  Whether it’s proper footwear, braces, taping techniques, correct form, cross-training instead of doing the same thing all day long, or any number of others; following this simple advice will prevent injuries.  Likewise, if you are injured; deal with it today.  Do not wait until its compensatory effects have swallowed you whole.

  • UNDERSTAND AND ADDRESS INFLAMMATION:  Although it’s beginning to change, too many athletes don’t think about INFLAMMATION until they are injured.  If you could get ahead of the eight ball by stopping Inflammation before it starts, you might be able to head off real problems.  A doubly big deal considering INFLAMMATION ALWAYS LEADS TO SCAR TISSUE.  I just wrote an article about an athlete doing this very thing — YOU HAVE UNDOUBTEDLY HEARD OF HIM.

For those of you who have just undergone Tissue Remodeling, don’t confuse “BULLSEYING” with compensation.  And if you feel you are losing ground as far as your health is concerned, make sure to take a quick at THIS POST.

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