Written by Dawn Lewis
I was working on a client this week and was reminded of how insidious compensation patterns can be. This client, we will call her Zelda, severely broke her left tibia about a year and a half ago. Surgery to put plates, screws, and pins in her left tibia was successful, but has left her with a new normal. Her left leg and her right leg no longer operate similarly.
This has, of course, led to a systemic compensation pattern. I say to students all the time that where you have pain depends on where the conversational conflict rests in the body. When the body is in the process of compensation there is a distinct communication in the tissues.
Using Zelda as an example: When the damage to her left tibia occurred, the conversation immediately began between the tibia and the talus, as well as the tibia and the femur. The left tibia asked the left talus, “Hey, listen, I’m having an issue, can you move lateral with me?”
“Sure, no problem, I’m not doing anything else at the moment.” The left talus responded. When you look at Zelda, you can see that she rides along the lateral edge of her left foot, and her left arch is slightly raised off the floor. This tells us how the communication continued. The left talus, having shifted laterally to accommodate the left tibia, said to the tarsal bones, “Hey, can you guys twist with me? I’m helping a friend.” “Sure.” They said.
Now that the body has taken care of the potential for pain at the ankle and in the foot, the conversation moves proximal to the articulation between the tibia and femur. The tibia might ask the femur, “Are you able to move lateral with me? I’m stuck over here.” To which, the femur might respond, “Sure, no problem, but I need to go anterior too, that okay with you?” “Of course,” the tibia replies.
Now we have a situation where the tibia and the femur are lateral and anterior, the talus has moved lateral and the tarsal bones are twisted into supination. But, as much potential for pain as possible has been averted.
stop pain potential as much as possible. For Zelda, the next level of communication was between the femur head and the hip bone. The hip bone agreed to the arrangement and moved anterior and slightly lateral. Continuing on the left side, the hip bone then had to ask the spine and the lower ribcage to move anterior and to the left.
While the spine and lower ribcage were able to accommodate the shift to the left, they could not move anterior. They were already involved in a compensation pattern with the shoulder girdle and were unable to do as the hip bone asked.
This is where Zelda’s pain was, in the lower back between the left lower ribcage and the left hip bone. The pain is where the conversational conflict lies. As long as each area accommodates the requests made, pain is averted, but as soon as an area cannot adapt to what is happening, there is conflict, and therefore there is pain.
What would have happened if Zelda had an old foot injury, maybe a mild fracture in the fifth metatarsal? The bones and tissues in the foot would have long been compensating for that injury and might have been unable to acclimate to the new normal created by the tibial injury. In this case, Zelda’s pain most likely would have been in her ankle or foot.
Or, if the left hip bone was busy compensating for the right hip bone by moving posterior and toward lateral rotation? In this case, Zelda’s pain most likely would have manifested in the iliofemoral joint itself or at the knee, depending on what the femur decided to do. Maybe the pain would have bounced back and forth as the femur tried to oblige both parties.
Obviously, in deciding to stay with Zelda’s left side, I have left out several things. There is no examination here of the influence of the muscle tissue or the state of the connective tissue. Both can make a difference to compensation patterns. I also did not talk about the left fibula, which automatically moved with the tibia, and caused a fair amount of muscular compensation. Finally, we did not address the right side. The body is capable of more than one conversation at a time and the right side was asked to shift in a variety of ways.
So, Zelda walks into my office and says her left leg feels fine, but her lower and mid back on the left are sore and stiff. Although bodywork will not be able to restore Zelda to her previous version of normal, bodywork is crucial to the maintenance of her compensation patterns.
My decision was to work most of Zelda’s posterior body. When I was working on Zelda’s left calf, releasing the muscles that were holding the tibia as far lateral and anterior as possible, the tibia shifted back toward a more neutral position. It was at that moment that Zelda told me her mid back was cramping.
I had entered the conversation. I asked the tibia to shift to a more neutral position, to loosen up, it agreed, which changed its communication with the femur, the femur’s conversation with the hip bone, and the hip bones conflict with the lumbar spine and lower ribcage.
Instantly, the other players in Zelda’s compensation pattern did not know what to do and began to complain. I left the calf, worked for a few minutes on releasing and mobilizing the lower ribcage, and then returned to the calf.
Quickly, however, I knew that I needed to release obturator exturnus and let the hip bone shift, this let the femur loosen up, released the hamstrings, and gave me further relaxation of the calf muscles.
When Zelda made her way down the stairs after our session, she commented on how much better her back felt, but now the front of her left knee was kind of burning. A connective tissue reaction to the softening of the compensation pattern that left me thinking, “if only people would book for 2 hours more often.”