Compensatory Process - How Clubby Joe Got So Twisted

The Secrets of Compensation, or, Why We Might Be Crooked

   

Meet Clubby Joe. Joe is a slightly off-kilter sort of fellow. When he was young, and flexible, his body was pretty well-balanced. His shoulders appeared level, his hips appeared level, his knees and ankles were at the same level, his head was straight and his back was, as well. But Joe was born with club feet, bi-lateral in his case, and while his doctors had told him his feet had been “corrected,” they hadn’t accounted for all of the aspects of club feet, nor how Joe might have his body compensate, or adjust to, the small differences that were not so apparent in his youth. But as the years went by, Joe began to notice some problems with certain parts of his body. And he went to see doctor after doctor, each who told him something different than the last, and none of whom seemed to be able to look at Joe’s body as a unified whole, but only as separated parts. And so Joe began to have some real problems, and nobody seemed to have any solutions that actually made a difference.

In a perfect world, our bodies are relatively bi-lateral – that is, our left sides and our right sides are equivalent. Things like arm swing, leg swing, hip and shoulder height at all phases of gait, head erect, heel strike, etc., all happens fairly similarly right to left to right, over and over every step we take. But if one thing is off-kilter – one joint segment has a reduced range of motion, maybe we stubbed our right big toe, maybe we sprained an ankle – the whole system has to adjust for this interruption of bi-lateralism. And the process whereby our body attempts to adjust for any such discrepancy of our bi-lateral balance is called compensation.

Now, our bodies are really pretty amazing when it comes to the whole process of compensation. We can compensate at literally every joint in our body, and many actually do just that. But there is a method to the madness, as it were. First, it’s important to know that our body’s have two primary goals always at the top of the compensation hierarchy. The first is that our eyes must maintain what is called a level horizon line, and the second is that our inner ears must always be able to tell where the head is in relationship to the surface the body walks upon – that is, our inner ears need to balance. If we cannot maintain our balance through these two mechanisms, our entire organism cannot function – vertigo can completely disrupt our ability to function at all. So our bodies will do some really amazing compensations to keep these two functions working optimally. This is important to remember as we continue our story of the compensatory process, because our bodies can sacrifice many things, including some very painful things, to make sure these two functions are not disrupted.

So, in the next chapter, we will start slowly looking at what happens when we change just one element of the bilateral functioning of Joe’s body. And Joe may have reason to change his smile. Stay tuned!

 

Well, here is Joe, once again, only this time, Joe has a shortage in his left femur – the long bone of his leg. This is about a two inch difference from his right side, which is a pretty substantial difference, but helps us see easier what happens to Joe. You will notice Joe has a bit of a tilt, but as I suspect that you suspect, Joe can’t really walk around like this, because his eye level and inner ears are all unbalanced, and Joe isn’t likely to get very far trying to walk like this. Instead, Joe is likely to make some rather immediate changes to other parts of his body to get those eyes and ears back to normal. But exactly how will he accomplish this, er, feat?

First, he might walk with his toes more extended, and spend less time on the heel of his left foot – this is an attempt to lengthen the left leg functionally. But to account for the full two inches in this manner, while it can be done, is a real struggle for the body. You see, the next most important thing about compensatory processes are that they not place too great a burden on the body’s energy expenditures. This means that the compensation employed must be as simple, or low-energy, as possible. So if the body can make changes at multiple levels, it will spread the energy expenditure around – share the load, you might say. So Joe’s right hip might rise allowing his left hip to drop, and his left shoulder will then have to rise and the right shoulder drop so that his head remains level. But the heel rise and the hip drop together just might fulfill the requirements for adequate compensation of his two-inch difference. Or maybe not – it might require more segments to adjust, as well.

When we refer to segments, we simply mean divide the body into groups of joints with proximity to others, so, the first segment, from a compensatory process perspective, is from the ground to the knee joints. The second is from the knee joints to the sacrum and pelvic joints; the third is from the pelvis to the shoulders, and the fourth is from the shoulders to the top of the head. These are also spoken of as primary, secondary, tertiary, and quaternary levels of the body, biomechanically-speaking, that is. This matters because we refer to these levels when looking at how much compensation has taken place in any one person’s body. To compensate at all four levels often means that the compensation is of long duration, and is an indicator of how one must approach any changes to the biomechanic balance of the body in question. To make changes too suddenly is essentially the definition of trauma, so slow is almost always better.

So let’s see what happens if we make a few adjustments to Joe’s right/left balance to account for his 2-inch difference. First, let’s shift his pelvic level and his shoulder level:

Note that Joe’s head is now parallel to the ground plane, so his eyes and inner ears can maintain balance. But his spine is now curved, a result of shifting his pelvic and shoulder levels to compensate for the leg difference. His left foot is also in what is called an equinus position – the heel is off the ground, and he is bearing more weight on his forefoot.. Now, over time, Joe is likely to experience any number of musculo-skeletal problems, with the most obvious being back problems. But he also may be an early candidate for a broken hip, or at least hip replacement. His knee, especially his left knee, and his left ankle, are also at higher risk for arthritic changes and possible joint replacements. This depends on many factors, of course, but with no other intervention, Joe’s compensatory mechanics are merely shifting the potential for trauma to other parts of his body.

So, in our next installment, we will see what happens to Joe after many years of compensatory changes. Stay tuned!