Compensation. That’s the ‘C-Word’ we’re going to talk about today. Well, I’m going to add capacity to this conversation as well.
The two major things that we need to consider when talking compensation are task and capacity. Capacity being the range of motion that we can display, our strength (or control) in that range of motion, and our endurance in that range. Different tasks require different capacities and ultimately it is our tasks that will determine if, and what type of, changes need to be made.
For the practice of addressing compensation patterns we need to understand the demands of the task; task being specific sport, a movement, or even a static posture. To paint a picture of the demands of a movement and how that will direct our assessment lets look at a task that darn near everyone completes every day, walking.
When considering the demands of walking we can start at the foot, or more specifically, the big toe. When pushing off of your back foot, in order to load your foot optimally, you need to be able to extend your big toe 55 degrees. Meaning, standing up straight with your foot flat on the ground you should be able to peel your big toe off the ground quite a bit.
If, for whatever reason, you do not have that range you are going to have to create a movement strategy that doesn’t require it. That could look like turning your foot out and rolling through the big toe knuckle, putting more weight on the outside of your foot rather than the big toe, or even shortening your step length.
We could spend all afternoon listing the potential strategies a person could develop to walk around a stiff big toe, but I think you get the point. Long story short, we get in trouble when we end up loading a muscle and/or a joint, faster, with greater load, for a longer duration, or in a direction that we don’t have the capacity for.
Compensation patterns are tough to manage as an athlete/patient because typically you don’t feel the consequences until after you have completed your task or workout. For example, you are on vacation walking all day and the next day your knee is the size of a grapefruit. Felt fine when you were walking, so good that you have a hard time attributing that to the problem, but now you have a hard time even walking to the hotel lobby.
In my experience it’s these compensation patterns that are to blame for most of our non-traumatic injuries/pain. Non-traumatic meaning not a car accident, a nasty tackle on the field, or a fall on the court. These are the times the doctor needs to put on his Sherlock Holme’s hat and start the hunt for everything that could be contributing to that muscle or joint being overloaded. That means when your doctor is assessing the problem at hand they will (or should) assess areas that may seem unrelated to your pain.
How do you know if you fit in the camp of ‘sub-optimal compensation patterns’? Well, like the examples above, intermittent pain or discomfort that occurs in the same location could be an indicator. Knowing your back is going to hurt after a long run, your neck will hurt after you press over head, your knee gets angry when you walk long distances, your wrist hurts after a day of front squats… the list goes on.
It should be said though that this in no way means you’re broken or need fixing. Sometimes the answer is dialing back volume and building up endurance, or taking the time to build strength. And sometimes we just need to develop a new compensation pattern that may not cost quite as much. The answer is not always difficult or fancy.
Keep an eye out on my instagram (@DrGingerBeard) the next few days and I’ll be sharing some range of motion, strength, and endurance tests to determine if there are some areas in your body that could benefit from a bit more attention.