Where injuries come from
In my practice probably the most common question I get asked is... ‘how did this happen?’, ‘where did my injury come from?’, ‘why has this happened?’ when really I think the most important thing is that we need to stop it from happening again!
I would say that on the whole, every injury I see (bar the contact sports injuries where you know what happened.... someone has been run into/ jumped on/ twisted/ punched/ pulled to name a few mechanisms!) is a result of the ‘straw that broke the camel’s back’.
My favourite quote: ‘Look at the stone cutter hammering away at his rock, perhaps a hundred times without so much as a crack showing in it...and yet at the hundred and first blow it will split in two ... and I know it was not that blow that did it but all that had gone before’ Jacob Riis
An accumulation of repetitive, often unbalanced movements that literally eventually caused the tissue to give way, often doing something as innocuous as putting a sock on. The soft tissue of the body is made up of collagen and elastin. Ironically as time has gone on they’ve found that collagen is actually a bit stretchier than elastin but that’s not important, the bit that is important is if you pull an elastic band repeatedly to stretch capacity thousands of times, eventually it will give way, particularly if you’re pulling it at a bit of an angle.. the one side will start to fray before the other side.
Stand up and let’s for argument’s sake say that you have a tight left hip. Turn your left leg inwards a little bit to demonstrate this. Now you still have to be able to face the front like a normal human being who does everything in front of them, so your body has to compensate by turning a little bit to the left, probably at your lower back or the junction between your thoracic and lumbar spine. Now because your back is twisted, your neck has to twist a little to the right so that you can still look forward (if you don’t believe me then keeping your left hip turned in, and keeping your neck in the same position, unwind your spine. You will find you are ever so slightly turning your head to the right if you have properly compensated for all the ‘adaptations’ in your body). We can look at the effect the hip will have on the left knee because of the hip position: the knee cap will have to change its position, the ankle/ foot will have to change it’s position in order to stabilise the lower leg. Everything is affected from your big too, right up to the muscles in your eyeballs, and who knows what caused the hip to become stiff in the first place... it could have been that the neck was really stiff from sleeping funny and the changes all occurred down the line, or it could be a stiff ankle joint which has caused the changes up the chain. Or maybe this hypothetical person just always sits with their left hip crossed over the right, or he did a lot of boxing as a child and being right handed the left hip was the one that stiffened up through all the rotation that happened in the joint over and over. Perhaps he/ she had a broken leg as a teenager and has an ever so slightly shorter leg, and also when on crutches for 6 weeks the left hip stiffened up as a result of having to carry the leg around while non-weight bearing. We call this the kinetic chain, the chain of all the bits of your body that work together to make you function. The body will always ‘make a plan’ so that you can function as best you can, and often these strategies are not beneficial in the long term, but if you were part of a caveman clan on the move and you sprained your ankle, and your body managed to offload your ankle enough so that you could walk (probably at the expense of your hip/pelvis/lower back) you’d be pretty glad that your clan wouldn’t be able to leave you behind at the mercy of the elements!!
As you can see, unless your physio can trace through every single inch of what has happened to you, every habit you have and every injury you’ve had, it’s pretty difficult to determine the exact cause of why we are how we are. From my point of view it’s most important to get you balanced again, to stretch out what is tight through soft tissue treatment (hands on physiotherapy), the use of a foam roller and stretching. Also to tighten up what is long is very important, if you have too much range in one muscle around a joint this joint cannot be in balance and therefore something is being overloaded. A long muscle is generally a weak muscle, and is often just as likely to be injured as a short, tight muscle, it’s all about if the muscle is able to do its job.
My advice to you is that if you have an injury somewhere, start to think of all the injuries that you’ve had in the past. Dig in the depths of your memory for your favourite sitting position as a teenager (probably the slouch, but was it to the left or the right!), think about any accidents/ falls you’ve had, the dodgy chair you sat on at work for years... it may not have been a massive problem when you were younger but it caused changes in your body and now something could be happening as a result of that as your tissues have got a little older and stiffer. Your physio doesn’t need to know every inch of your history, but it is helpful to know that ‘you’ve always had a stiffer right ankle from your cricket days’, or ‘ever since you went head first down the mountain while skiing you’ve had headaches’, even if your problem is a sore right thumb. Let the physio decide what is relevant or not. And if the physio looks at just the joint affected, I would be inclined to seek a second opinion!!
My absolute favourite youtube video that just describes so well what happens in our bodies is below. Now I will warn you there is a little bit of goriness to it, in the fact that the beginning it shows a bit of a human dissection, but if you can get through that, it will just make so much sense to you as to how your body stiffens up, adjusts to whatever stresses you put on it... fascinating stuff.
The Fuzz Speech: http://youtu.be/_FtSP-tkSug
Feel free to fire any questions at me, and I hope that helped you understand a little more about your bodies.