Compensation and a different take on nagging pain...
About 7-8 weeks ago I took a weekend seminar called NeuroKinetic Therapy. It blew my mind. This rarely happens.
People move differently in pain. When we are in pain we adapt our movements to protect what hurts and reduce our overall pain. This is just the surface.
Digging deeper the adaptation to pain involves:
- a redistribution of activity within and between muscles
- changes to our mechanical behaviour (i.e. modified movements and stiffness)
- changes at multiple levels of our motor nervous system
Adaptation to pain has short-term benefit but potential long-term consequences. Take home point.
Our body is resilient. Unless a major trauma is the direct cause of the of a pain, we are able to adapt/persevere through dysfunction via compensatory patterns. Heck, even after a major direct trauma we begin to compensate. Let's look at hamstring injury. After an initial hamstring injury gait kinematics are quite normally out of whack once an athlete is fully recovered. This leads to high re-injury rate of the same hamstring and/or a high injury rate of the opposing hamstring. Crazy right? Not really. Read on.
Think back to the first time you rolled an ankle. It hurt. You hobbled around for two weeks. Then poof, everything is back to normal. But is this really the case? Why is it that your ankle stiffens up every now and again, or why does your knee hurt on the same leg when you go for a run 10-12-24 months down the road? This is just the surface.
Now, let’s look a bit further.
Although there can be other factors, the most limiting factor to any movement is pain. When you’ve hurt your ankle and you go to walk normally, your brain isn’t having any of it because the pattern of normal movement hurts! The neural pathway of least resistance isn’t cutting it. However, luckily for us, we have many muscles that are capable of different actions. This allows us to create a movement pattern to walk in, a roundabout, pain free way. So for two weeks, we walk in this compensatory fashion. All the while, ingraining this motor neural pathway into our brain; for two weeks! 14 days! Think of how much walking you do over 14 days?! ALOT. So fast-forward to a point where the structures in our ankle are no longer painful. Halleluiah! All is back to normal right? Not necessarily. Pain stimulates adaptation. However, a resolution of pain does not necessarily provide a stimulus to return to the initial more efficient motor-neural pattern. We’ve been using this altered neuromuscular pattern to walk for 14 days. It’s not broken. Why would we fix it? The brain might modify it to make it more efficient, but a full return to the “original way it should be patterned” is not really going to happen. This has been proven in research. With this sustained altered pattern comes altered biomechanics, muscle imbalances and eventually dysfunction and pain. BOOM. We’ve come full circle.
Let’s come back to this course I took.
It’s pretty phenomenal stuff. There are some visual screening tools out there such as FMS and SFMA that are very useful in the assessment in movement and function. However, I always thought that there could be more to finding and fixing the root cause of pain; NeuroKinetic Therapy does this. It addresses the causes of dysfunctional movement/coordination problems at their root in the motor control centre in the cerebellum. The motor control centre stores these dysfunctional movement/coordination patterns and directs their completion through the spinal cord and the muscles.
Instead of using visual observation, manual muscle testing is used to assess whether or not a muscle is strong (facilitated) or weak (inhibited). When a muscle tests weak, the motor control centre perceives this as a failure. The main objective is to then reprogram the motor control centre to correct these dysfunctional movement patterns.
Those who know me personally would agree that I’m not into rainbows and unicorns. If I see something work and see results, I’ll generally be up for giving it a shot. If it seems like fluff, I’ll leave it behind. Having used this new technique on some patients with nagging long-term pains, I can honestly say that the results are amazing.
If you’ve been having some long term issues, I hope this blog post gives you a new perspective on what might be the root cause of this. As always, if you have any questions, concerns or comments, please post them below or stop by Satori or the Richmond Olympic Oval and we can grab a tea and chat about it all.
Dr. Kristian Frantzen