Great Compensators

Happy New Year!

I hope you all got a chance to enjoy the holidays with family and loved ones. After my article on compensation patterns I began thinking more about how the body completes movement goals. Many experts will say that athletes’ are great compensators. At first I debated that statement, I thought the exact opposite. I thought athletes’ were individuals who didn’t need to compensate. But then in my personal experience of treating athletes I started to pay attention to how many soft tissue dysfunctions were a result from or somehow related to compensation patterns. Just today I treated an athlete who reported low back pain every time he ran over the past two weeks. He was evaluated by a different therapist to have low back instability, however I thought his issue was more related to a compensation pattern. So his treatment with me consisted of training him to revert out of his hip extension compensation and force him to fire his glutes more. He walked out of the athletic training room reporting no more pain and even completed the team conditioning today pain-free.

I guess athletes’ are, in fact, great compensators. They are able to produce a lot more force with inefficient motor pathways than the average person, which means that even when not in the most optimal positions an athlete can still move better than most. After coming to this conclusion, I had this additional thought, how does compensation affect weight training? Because healthy athletes need to constantly improve their physical fitness to stay competitive.

I once found a video online with Cal Dietz talking about this question and I think he hit the nail on the head so I am going to try my best to paraphrase what I learned from his video. For a practical discussion we will use a standard step-up exercise as an example. On average, when prescribing the step-up as part of a rehab protocol (or weight training) the target muscle group is the glutes. What if I told you the athlete is compensating (asymptomatically) and not properly firing his/her glute? The exercise would then be performed by the quad and/or the lower back and hamstrings. In that case, the athlete will be training their body to use their thigh muscles to pull their center of gravity (CoG) forward and slightly up. Rather, we would want the athlete to improve their ability to generate a vertical force with his/her glutes during a step-up but in the event they are compensating this doesn’t happen.

Sometimes the method to address this problem is to assess for compensations and reset them but Dietz offers another fix. If the goal of the step-up is creating a vertical force, and the compensation changes the outcome of the exercise to be moving one’s CoG forward and up then how can we better match the outcome to the goal? Cal Dietz describes performing a “lateral” step-up where the edge of the step is parallel to midline and placed directly adjacent to the uninvolved leg. This position takes the element of moving one’s CoG forward or laterally out of the exercise. Thus guiding the athlete to produce a vertical force and subsequently requiring more glute activation. Considering all of this I must now ask, if an athlete is not using the most efficient neuromuscular pathway then are we just training them to be better compensators? The body needs to move and to breathe so when we demand an athlete to perform a squat they will accomplish that squat no matter what. Obviously we would encourage activation of the glutes for optimal movement but athletes will continue to move more and more weight with or without the glutes.

Just as how Cal offered an alternative approach to the step-up, could/should we reevaluate some of our frequent rehab exercises to better align the outcome with the goal? I’d love to hear your thoughts on these questions and athlete compensation as a whole.

On a side note, do any of you have New Year resolutions that relate to your clinic? I want to be more proactive in my injury documentation and not save things for the end of the day/week.

Mark D.

@MarkDomATC