The human body is super smart and will keep us moving through just about anything. But, within that sentence lies the problem. We are programmed to “work through the pain” or “wait it out” because the pain will eventually just go away. Unfortunately, that’s not how it works. When we experience pain, our body will create a new movement pattern in order to decrease the pain. This sounds great in theory, but the new movement pattern is dysfunctional and begins to create an undesireable chain of events in the body. Normal biomechanics, muscle activation and coordination of movement are all affected. In the world of physical therapy, we call this compensation.
Compensation is one of the main factors that determines how long a patient needs to be seen for PT (post-surgical patients are exempt from this). Why? Because as a society, we wait. We wait for the pain to become debilitating. We wait 6 months, 2 years or 10 years. We wait and think we can work through the pain. But, here’s the deal. We don’t work through pain, we compensate.
I love seeing patients as soon as possible after the onset of pain. When someone tells me at their evaluation that they’ve had pain for less than 4 weeks, I am ecstatic. For both of us! A few weeks is not enough time for the body to have gone into crazy compensation land and it’s easier to treat the cause of pain from the start. However, when a patient explains a pain history of 6 months or more, there are layers of pain to address. I always tell my patients: “It’s like peeling an onion. Because you’ve had the pain so long, your body will present one way today. As we work through the layers of compensation, we will get to the original cause of pain.”
A few weeks ago, I evaluated an ironman triathlete who has been dealing with significant pain…everywhere. She has neck, shoulder, foot and hamstring pain. She still runs 6+ miles, but has developed the mantra: “I just run through the pain.” We have slowly evaluated each area, but when I went to ask her to do one simple movement, I was floored. In addition to the list above, she has had left hip pain for 3+ years. She has seen specialists to rule out hip pathology. All they have ever found is insertional hamstring tendon inflammation.
PRONE GLUTE LIFT TEST
This is the test I asked my patient to do…and the reason for this post.
The Test: Gluteus Maximus (GMax) activation in a prone position. The knee is bent to 90 and the patient lifts the leg up in a small range of motion. It is not a strength test. I use it to see how the GMax is firing. (Remember, the GMax is the main extender of the leg).
Video 1: Glute Lift without Compensation. As the leg lifts up, the lumbar muscles (paraspinals) do activate, but the GMax is the initiator and main controller of the movement (after you’ve contracted your core, of course).
Video 2: Glute Lift with Compensation. Honestly, I’ve never seen this before. She rotates and side bends her spine to try and lift her leg. Think about that. She tries to use her spine to move her leg. Can you imagine what is happening during her gait and run? This is what ignoring your pain looks like. (Yes, she gave me permission to post).
Take Home Point
- Don’t wait. There is no working through the pain…it’s called compensation.
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Lori Duncan, DPT, MTC, CPT is a respected Physical Therapist, Manual Therapist and Pilates instructor in Lafayette, CO. Lori is passionate about preventive physical therapy and education and is a nationally recognized presenter. She can be reached at [email protected] You can also follow Duncan Sports Therapy + Wellness on Facebook  & Instagram  for more free tips and information.