Today I am going to continue to address the topic of Movement. If you recall from our earlier posts, Movement is our main focus here at Elite Spine & Sport. My goal for this entry is to try and summarize roughly an entire year of chiropractic school into a few paragraphs. Here it goes…
Movement is often confused with motion, but thanks to earlier posts, we know better than that now. Quality movement requires not just proper joint motion, but also coordination, stability, balance and proprioception (knowing where your body is in space). Each of these parts of movement could be multiple blog posts on their own. All these factors mean that your brain has a lot of things to control and be aware of at all times. There are many mechanisms in place to ensure that this intricate dance flows smoothly. For the sake of simplicity, we are going to ignore some factors, but in order to understand the big picture, I will need to address a couple. We will certainly dive into all these topics at a later time.
Before we begin, it is important to understand a few words.
Nociceptor: A sensory receptor that detects actual or potential tissue damage.
Nociception: The perception of the potentially harmful input provided by nociceptors.
PAIN: The suffering caused by injury or illness.
Important note: Nociceptive input does not necessarily mean you will experience pain, nor is it required for you to experience pain.
To begin, nociception alters movement; it changes the way you move. This is known as compensation. If you don’t believe me, think about the last time you twisted your ankle. What was the first thing you did once you stopped cursing? My guess is that you started walking with a limp. This is a way your body protects itself. The alarm signals sent out from many nociceptors, inform your body that there is ankle damage and decreased ankle stability. Therefore, the plan is to compensate in order to decrease movement at that ankle. Now the question is, why does this happen?
There is a pretty cool reflex in your body often referred to as arthrogenic muscle inhibition, which means muscle inhibition from a joint (see Fig. A at the bottom of the page). Using our ankle injury as an example, we can assume we have damaged a couple ligaments (known as a sprain). That activates nociceptors (damage receptors) which send a signal to your spinal cord. When that message is received, it is immediately relayed to the motor output area of your spinal cord. The message your motor output area receives says, “Do NOT send movement commands to the muscles around the ankle”. Think of it like hitting the big red emergency stop button on an assembly line. This decreases the activity of the muscles, in order to protect the unstable and damaged ankle.
Well now you are stuck with inhibited muscles around your ankle, but you still need to be able to walk. This is where compensation comes into play. Your brain will now recruit a different muscle/movement pattern in order to allow for locomotion to occur. You can walk, but you now walk with the altered version we know as a limp. This is a pretty amazing hard-wired protective mechanism that occurs automatically.
Ok, so why does your chiropractor care about compensation? Recall that there are ideal movement patterns which allow our joints to function optimally in the position of greatest congruence (the position of least friction). We call this joint a CENTRATED joint. Once you begin compensating and using different motor patterns, you have now slightly altered the dynamics of the joint, which does not allow joint centration to occur. Non-centrated joints lack the ability to evenly transfer force, placing them under greater stress. Increasing stress on joints makes them more prone to degeneration and future wear. The more your brain uses alternative movement patterns, the more they become habit and difficult to avoid. This is likely to send you on your way to increased wear and tear over time, and in turn, greater compensation. My goal as a chiropractor is to first stop the damage/nociception. Then we need to begin to retrain, through rehab, the original movement patterns. This allows you to get back to functioning at the level you were intended.
An important point I would like to stress is to NOT wait it out and let the issue resolve on its own. The healing process for damaged tissues (in our case, your ankle) can take weeks or even months to fully repair. While you are waiting for that damage to be repaired, you continue to train your brain to use compensatory movements. Recall from the beginning of this post that nociceptive input does not necessarily mean you will experience pain. Therefore, even though the initial pain may have gone away in a couple days, there may still be nociceptive input leading to continued compensatory movements and even stronger habits. A likely result of these new patterns is more problems down the road. The solution is to seek treatment as early as possible.
Pain is a very complex subject, and in future posts, we will further discuss its role in movement. My hope is that now you have a better understanding of why we have made your quality of movement our number one focus at Elite Spine & Sport, LLC