Believe it or not, your body does not like to be in pain. In fact, your body will do almost anything it can to avoid pain. Like some sort of escape artist, your body compensates around several layers of injury in an effort to avoid pain. But when we can no longer compensate around all the previous wear and tear we have experienced in our lives, the body will experience pain. It is critical to understand that the absence of pain does not equate to a fully healthy body. Anything that affects the range of motion or strength of an area of the body will cause us to compensate – even if we do not experience pain in that area.
Think back to ALL the different injuries you have had in your lifetime. For some of us there are only a few minor falls, while others have several fractures, a couple surgeries, and a few major falls or car accidents. And these are just the mechanical injuries – don’t forget that emotions, stress, and poor eating habits can all adversely affect the body leading to changes in the mobility of the connective tissues.
For example, imagine you broke your right leg when you were 8 years old. It was casted properly but in order to heal your leg you had to be immobilized up to the knee for 6 weeks. When your leg came out of the cast your movement was limited and you had trouble straightening your knee. But you’re 8 years old and within 4 weeks of moving around you’re pretty much good as new. The problem is that there likely is still an imprint of that injury in the body – perhaps there is some scar tissue that formed around the fracture site, or the knee has 95% of the range of motion of the uninjured side, but you have difficulty achieving full extension. These are not a big deal when you are a child but they can affect the way the entire leg moves.
Then when you were 10 you had an emergency appendectomy. You had great doctors who were able to remove the appendix with minimal impact to your body. You follow your doctor’s orders and ease back into activity when ready. Once again you now have another layer of injury that may be affecting your mobility. A surgical scar cuts through several layers of connective tissue. Each of those layers should be able to glide and slide relative to each other but the scar tissue that initially forms during healing may limit this mobility. Once again, it’s not a big deal because you’re 10 and you can run without pain…but now you’ve lost a few degrees of extension in your hip because of the limitations of the scar.
Now we fast-forward another 10 years. There have been some injuries – a fall playing hockey where you landed on your tailbone, a sprained left ankle that recovered within 2 weeks, and a stubborn pneumonia that required a couple rounds of antibiotics. Without going into detail, each of these injuries present another small restriction in mobility that your body will compensate around. You don’t experience any lingering pain from these injuries, only your mobility is affected.
As you move through your 20s you don’t have any major physical injuries. Instead you gradually decrease your physical activity as life becomes busy with other commitments – school, relationships, work, etc. Because your body is a simple use-it-or-lose-it system you begin to lose more mobility as well as some muscle mass. You sit most of your day so your hamstrings and hip flexors begin to tighten up. The commitments that stop you from exercising also typically come with some stress. Worrying about your grades, relationship, or money from work have added another long-term layer for the body to compensate around; this time affecting the mobility of the connective tissue around the intestines.
Finally at the age of 35 you decide it’s time to regain your health. You’ve put on a bit of weight but overall you consider yourself to be pretty fit. You enjoy running and begin to run a few kilometres a few times each week. After 3 weeks you begin to get an annoying pain at the start of your run in the bottom of your right foot. After a few more weeks your pain has progressed to the point where you feel it anytime you have to stand and you have had to quit running. You’re given the diagnosis of plantar fasciitis and are told that you likely increased your mileage too quickly. While this may be true, there are some other deeper issues that need to be addressed that lead to the development of your injury. Your current injury is really due to the cumulative effect of ALL the injuries you’ve had in your life.
The body was already compensating around a decrease in hip extension and knee extension from your surgery and fracture. You did not notice those limitations because you weren’t previously running. The movement for running requires a larger range of motion than simply walking and challenged the right leg in a way it could not handle. Missing the end range of motion for hip and knee extension has placed extra stress on the plantar fascia on the bottom of your foot and caused it to breakdown.
But don’t forget that in order to fully rehabilitate an area of the body you need to look at the nerve and blood supply (view article about the body as a self healing mechanism). The appendix scar, the antibiotics for the pneumonia, the decreased activity through your 20s, and the general stress of life can each create another layer affecting the mobility of the connective tissue of the abdomen. The problem is that all of the blood supply to your leg has to pass through the area that has decreased mobility, potentially placing the blood flow under tension – like placing a kink in the garden hose. The nerve supply to the plantar fascia may be restricted due to pressure on the sciatic nerve following the fall on your tailbone in your teenage years. None of these issues on their own are enough to cause your plantar fasciitis, but the cumulative effect of each of them has created a situation where you can no longer compensate around your limitations and you experience pain.
As you can see from this simple example your rehabilitation will be complete if you address all the compensations the body has been making that have contributed to the most recent injury. Remember: an absence of pain does not equate to health. When we are able to compensate around our limitations we will not experience pain. When we are unable to compensate anymore, we will experience pain due to the breakdown of tissue.
Unfortunately, when we do experience pain from the culmination of wear and tear, removing the last layer that put us over the edge does not always return our body to balance. As mentioned previously, what you are experiencing in this moment is the sum of everything that has happened to you in the past. Removing the previous layers of compensations will allow the body to return to balance, heal itself, and function better into the future.