One common term we like to throw around with Accelerate ACL athletes is “compensation pattern.” The term is used to describe an improper movement pattern that places more stress on parts of the body than normal (for example: for a number of reasons, running or jumping can put more stress into the knee than it should).
Before we dive into the technical side of compensation patterns in the body, let’s first look at a few types of “compensations” that we are more used to seeing in day to day life (unrelated to the human body, the knee, or the ACL).
- If you’re working on a team at work, each team member has certain responsibilities. If there’s a slacker on the team, someone else must take on his/her responsibilities. In many cases, the person who takes on extra responsibility also takes on added stress, which can lead to burnout.
- If a pitcher is on the mound and the infield behind him makes multiple errors in an inning, the natural reaction for the pitcher is to overcompensate. He puts the responsibility of getting people out on himself, and starts pressing to get strikeouts. This leads to increased stress levels, and sometimes erratic control.
- Imagine you’re in a game of tug of war. There are 4 members on each side of the rope, and it’s looking like a stalemate, but a member on your team decides to quit. In order to continue holding the rope steady, all 3 remaining team members must exert more force on the rope, meaning more stress on their bodies.
In each of the above examples, there was a team responsible for completing a task. When one team member stopped doing its job or did not perform adequately, it placed more stress on the remaining team members, leading to potential consequences.
The human body works in a similar way. The nervous system and muscles in the body are the team responsible for creating movement. For instance, the act of putting a glass on the top shelf requires the nervous system to direct the muscles in the hand, arm, and shoulder to work together to complete the task.
If the nervous system is not performing optimally, a muscle is not activating properly, or a muscle is too weak to perform the task, the other muscles involved take on more stress than normally required. If the other muscles aren’t up to the task, more stress is placed on other soft tissues, like joints, ligaments, and tendons.
After an ACL injury, the body immediately starts to develop compensation patterns. You may notice the most obvious compensation patterns like limping and putting more weight on the unaffected leg. The nervous system has determined how to coordinate movement in a way that puts less stress on the affected knee.
At first, this is a great strategy, because it protects the knee from further injury. However, it also means the muscles responsible for normal movement patterns start to atrophy. Long term, these compensation patterns and the associated atrophy will need to be overcome in order to return to 100%.
As you recover, these compensation patterns become less evident. Hopefully, you’re able to return to what feels like a normal gait and able to start loading the affected leg again.
However, in most cases, less noticeable compensation patterns tend to stick around. This is what makes it so difficult to “regrow” the quadriceps to it’s normal size. At 100% activation, the quad can generate significant forces around the knee, and the body is still slightly apprehensive about allowing these forces to occur. Therefore, it compensates by making other muscles do the work.
These compensations can occur throughout the kinetic chain (everyone’s response is a bit different), and should be addressed fully through the ACL recovery process. Failing to do so will increase the risk of further injury to the new ACL OR the areas of the body that are working harder due to compensation (like the opposite leg).
In order to address compensation patterns that occur as a result of an ACL injury, we recommend the following strategies.
- When a physical therapist or physician recommends an exercise, ask them how your body might compensate (or perform the exercise incorrectly). If possible, do a few reps with them and ask if they notice any compensation patterns.
- Understand the intent of an exercise. Know what muscles you are supposed to feel working when performing the exercise. If you don’t feel the right areas working, you are likely compensating.
- Every time you perform that exercise, perform it with intent. FOCUS (can’t emphasize the word focus enough) on how you are executing the exercise and see if you can feel yourself compensating in any way. If you identify compensation patterns, try to make the necessary adjustments. If you still can’t get it right, decrease the intensity of the exercise by modifying range of motion or trying it with less weight.
- If you’re struggling with any of these strategies or feel like you aren’t performing an exercise correctly, shoot us an email at firstname.lastname@example.org. We are more than happy to take a look to see if your body is compensating in any way.
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