Compensation! Compensation!


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Compensatory pain! What the heck is that? Often times people start off having pain in one foot or one knee and then over time they develop pain somewhere on the other side of their body or their back. Now people have a tendency to either think ‘My body is falling apart!’ or ‘I must be getting old, everything hurts!’ but really it is very possible these injuries could be related.


When one part of your body is injured, it’s only natural to want to ‘baby’ the injury and take pressure off that side. This may mean that you start to put more pressure on the opposite side or start using the other arm more. This can contribute to overuse injuries in other areas of your body.


Also, your body is quite remarkable in that without even realizing it, your body will compensate for injuries in your body. If you have hypermobility in one area of your spine, your body may automatically stabilize surrounding areas causing those to become hypomobile or vice versa. If you lack range of motion in your ankle, your body will compensate by placing more torque on your knee. Or if you are a runner, and you lack some range of motion in your big toe extension, you may inadvertently compensate when you run by driving your opposite shoulder forward more and develop anterior shoulder pain! (True story!) What?! Your body does this stuff without you even realizing. This may go on for some time before you start developing pain elsewhere.  


In order to avoid injury, you want to make sure your range of motion and strength is symmetrical on both sides. Often times when there is a deficit in range of motion on one side, or one side is weaker than the other, this can lead to injury……because of, you guessed it, compensation!


So to prevent these injuries from occurring, you need to try and balance yourself out. If you have a weaker knee or ankle, do some strengthening exercises for that side. If you have a more flexible side, try to stretch more on the other to even them out. The best time to address these issues is before you have pain! In this way, you may be able to prevent injuries down the road.


So basically, your body is one extremely complex, unbelievably remarkable machine, where everything works together. You may not be able to make the connection, but hopefully if you are working with a talented physical therapist, they will look at your overall movement quality and be able to determine what the heck is going on! That is also why it’s important to be aware of when you are feeling the pain, or with what movements or activity.


If you tend to isolate your rehab to just one part of the body, you may not fully address the problem, and your pain could come back. You need to look more globally at how you are moving to potentially determine the underlying cause of your pain. If you fix the underlying cause of your injury, your pain should go away and stay away! (providing you keep up with your exercises)

Mindful Walking

Mindful Walking

Maybe you’ve heard of mindful meditation or mindful eating, but have you heard of mindful walking? When I say mindful walking, what I mean is the state of being present when you are walking. In other words, to focus on the activity you are doing while you are doing it. So instead of walking and thinking about everything else in the world, practice this exercise of walking and thinking about how you are walking.


Walking is a very repetitive movement that is performed everyday and can lead to overuse injuries if done incorrectly. It’s funny to think that walking can be done incorrectly when you’ve been doing it since you were 1 yr. old. But there are certain things you should think about and be mindful of if you have pain when you are walking or you want to prevent pain.


  1. ) Are you heel striking with every step? Or do you tend to shuffle around? One way to be aware of if you are heel striking is to listen. Do you hear a scuffle or just one solid tap with each step you take. You may think why is that important? If you fail to heel strike, meaning bringing your toes back with every step and letting your heel touch the ground first, you could literally trip over your toes. This could lead to a fall, especially in older adults. Some people are unable to pull their toes back due to weakness in their tibialis anterior. (See my post on strengthening your ankles especially the one where you pull your toes up)


2.) Are you pushing off more with one foot than the other? Some people have a dominant side, but be aware that you are walking as evenly as possible in order to strengthen both sides equally.


3.) Are you leaning forward and looking down at the ground? Do your shoulders fall forward? Or are your shoulders back and head up? Your mom was right–mind your posture! When you are walking, too much leaning forward and you could develop a stooped over posture. Your psoas (hip flexors), pects., and cervical extensors will shorten. Your glutes might become inactive and that muscle imbalance can lead to all sorts of hip and knee injuries.


4.)  Are your feet rolling in when you walk? Check out the bottom of your shoes to see where the wear pattern is? Do you pronate? Most people tend to pronate or roll their foot in when they walk. Often people that have collapsed arches tend to pronate. If this is the case, you can try to strengthen your foot intrinsic muscles and potentially wear arch support in your shoes.


5. ) Think about how you walk up/down stairs. When you go up, are you pushing through your heel? Is your foot halfway off the step? When you are coming down the stairs, are your toes leading or your heel?


When you are walking up the stairs, think about getting the whole foot on the step and pushing up through your heel so you are activating your large muscle groups including your glutes and hamstrings. Give your poor gastroc muscles a break and let the bigger muscle groups take over. When walking down the stairs think of leading with your toes like you are stepping into cold water and rolling through your foot.


6.) Did you have a recent injury and now you are limping around? Stop that limp! If you don’t, your body could memorize this new gait pattern, and that could lead to all sorts of secondary compensatory injuries. If you are still healing from an injury, you should still try and walk as normally as possible. If that means you need to use a brace, CAM boot, or cane to get around for a bit, then use it until your pain improves and you can walk more normally.

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