As the launch of my AiM Method draws ever nearer I thought I’d write a bit about the value of taking an injury history and what it might mean for you or your clients / patients.
Injury history, aka previous medical history (PMH), plays a huge part in your movement potential today. Some might say that injury history and PMH are different but for me they represent significant influences on the body as a whole. Taking a term that was used by A.T. Still, the founder of Ostepathy, I like to use the term “insult” to the body as a way of thinking about these influences.
Definition of insult:
An insult is generally something upsetting or distressing to the system and creates a ripple in the system that changes the frequency and flow of how the body rests and moves. Generally organizing itself around the problem.
Now, many people (myself included) will come at you with an injury list as long as their arm, and many times over, people will forget injuries ever happened or can’t remember which side it happened on. Why? Because we simply do not place any importance or relevance to things that happened in the past.
The general vibe is that once that thing healed, we are good to go and becomes a thing of the past. I have news that is not the best news you might have heard today however… if you have had injuries in the past, there is a high likelihood that their insults still echo around in your bones, joints and muscles today.
My thoughts are that when an injury occurs, we make adjustments in our system to accommodate the injury. If I sprain my ankle, I will change the way I walk in seconds. This, in turn, changes my mechanics and has a knock on effect throughout the whole body.
If you aren’t aware, my Flow Motion Model (FMM )describes the movement of every bone and joint in the walking cycle over the duration of each stride. If an injury causes you to put less weight through one leg, we can measure the impact on your whole body using the AiM Method and simple assessments. It’s these adjustments that take place in your mechanics that remain present in the system long past the time it took for the injury to heal. I’ll offer up some examples later.
In a perfect body (i.e. utopic body) everything would have freedom of movement, no limitations and all joints would communicate freely with each other, with no joints doing any more or any less than they need to at any one time – this creates a state of zero tension in the body. The FMM that I mentioned earlier is specifically a utopic model. It’s how we would all get maximum benefit and output from our bodies if we were able to access this state of movement nirvana. But we are also realists and know that this will never (probably ever) be the case. So what we are left with is observation of bodies that are not able to access this state, and what we find are joints that move left but not right, favourite legs to stand on, spinal shapes that are far from optimal and two feet that are different to one another.
As soon as the body makes an adjustment, we are simply observing how the body has moved away from it’s optimal ‘Centre’. Only in ‘Centre’ – which is what I call the “Holy Grail” of movement – can we experience that state of zero tension.
Movement away from Centre creates one very simple outcome… and that is a change in the joint system as a whole. If you move your pelvis left of centre, you now have less opportunity to move left and too far to travel right and thus it’s likely that you will have to find other ways of getting weight into your right foot when walking, and so you start leaning excessively with your upper body and begin to create whole body shapes that look different when on your right foot, to when you are on your left foot. This creates a state of imbalance where joints move easily in one direction and not the other across three planes of motion throughout the whole body. It can be seen in the way you walk, and translates directly to how you ‘feel’ as well. It affects the way you feel because as you move away from ‘zero tension’ you move towards increasing tension in your system. Tension is experienced in the tissues as joints open and create an eccentric load or a stretch in the muscles on that side of the joint. Just as tension is experienced on one side of a joint that is opening, so compression is experienced on the side of the joint that is closing. When a joint closes, two bones begin to move toward each other creating that compression. Tension on one side, compression on the other. When we analyse areas of discomfort in people and cross-reference to their resting posture, you always find that areas of discomfort match with a joint space that is open (under tension) or closed (Under compression) and simply guides us to create appropriate movements to satisfy the required outcome. If it’s open, lets close it. If it’s closed…. Let’s open it. Not rocket science! Lol
Let’s take a Psoas or hip flexor muscle for example. 90% of the time when you complain of a right psoas or hip flexor, you might describe it as tight and your practitioner will recommend that you stretch it. This would imply opening the joint on the front of the hip in an extension and yet if you are over-extending your right hip because you find it easier to bear weight on your left foot, you might be excessively opening this joint already and thus a stretch is exactly the opposite of what you need to be doing. A resting posture assessment would highlight this and the AiM practitioner’s decision would be to figure out how to close that joint as an outcome to the work.
If there is tension and compression at play in your body, then your body must have organized itself around something that happened and that something more often than not comes down to injury history or Pre-Medical History – for ease I’m just going to lump these two terms in “Injury History” but that could mean anything from an ankle sprain to an appendectomy. We have all done stuff, so why shy away from it, or ignore it, when in fact to deal with it, might be the very thing that sets our body free.
The first thing to do might be to make a list! Yep, sit down, nice cup of coffee and roll back the years!
Over the years I have consolidated injury history into four categories, you can use them to categorise your list, and may even help you to remember some forgotten stuff.
The catergories are:
- The oldest injury
- The most impactful
- The untreated injury
- The unconsidered injury
The oldest injury
I always get injuries set up in a timeline as this gives me the opportunity to begin to make sense of how a person’s body may have begun adjusting to cause the problems they are experiencing today. Your very first injury no matter how large or small will no doubt have had a huge impact on you, whether young or old, you were cruising through life, ignorant of pain and discomfort and suddenly BOOM…. Your body had good reason to adjust. If the movement patterns that you chose to access post injury were not addressed in the treatment element then it’s likely that the compensatory movement patterns you adopted to work around the injury are still present today. Clue: the conventional model does not target movement repatterning as part of a treatment. For the main part it’s still treat the pain rather than the system. I know this is changing now but it’s a slow change and as this piece is about history, you’ll find we haven’t been very good at it over the past 50 years at least!
Your oldest injury might be the first time you created a new movement pattern that enables you to carry on without irritating the problem, thus the brain attaches good value to the movement and continues for years ahead to make use of it.
Most impactful injury
While your first injury would have created change in the system, what if we next consider the outcome of a much bigger incident or something that you would describe as the most impactful injury. This could be a surgery or a road accident, for me it was breaking my jaw I think. This had huge impact on my movement patterning in the years since. I was 19 years old.
Fractures, concussions, landing on coccyx bones, ankle sprains, ACL ruptures, shoulder dislocations and many more more, are all just examples of huge impacts that make a significant difference to how we choose to rest in our system. Anything that changes the joint structure or the joint structures potential for movement will impact the restring posture and dynamic potential for our overall movement and move us further away from our ‘Centre’.
The most impactful injury could also be the earliest injury too, in which case I would definitely pay attention.
The untreated injury
We’ve all been there: rolled an ankle, it’s disrupting your sport ‘which you need in your life right now’ and simply carried on regardless. As I say, we’ve all done it. You didn’t treat it (but I also include here that you probably equally didn’t treat it well.
For an ankle sprain (I use ankle sprains a lot as they cause a lot of damage locally to the ankle and the treatment thereof is generally so poor): if you settled for RICE, a bandage and some wobble border and writing your name in the sky with your toes… I’m sorry to say but your ankle sprain remains untreated. You can take it from me, I suffered 13 ankle sprains in 13 years from the age of 13 to 26, I didn’t begin treating it until I was well into my thirties.
The unconsidered injury
I think this is my favourite…. “Oh that? Well, that happened years ago and I didn’t think anything of it”. This is where the person is aware of what happened but ignored it and cracked on without treatment.
An alternative scenario in this category is the fall onto the outstretched wrist that lead to a wrist injury that was so bad it caused you not to think about the impact to your shoulder. The wrist was treated… the shoulder wasn’t and now potentially both are playing out in how you swing your arm which has a direct impact on your ribcage which impacts on pelvis and therefore your legs and feet too.
What are we looking for when we find out these things?
Quite simply I would be very keen to assess the resting and dynamic state of the areas of injury and see how they impact the system as a whole when you rest and move.
So what was your oldest & most impactful injuries? And which ones remained untreated and potentially unconsidered. Is it possible they could all be playing out in your system to create the tension and compression relationships you experience in your body today?
I enjoy the detectivery that goes along with being in clinic. In my AiM Method course, there are three live case studies where you will get to see how injury history plays out in the three cases and affects parts of their body that seemingly have little connection. But of course it is all connected and thankfully we have a map to help us with that little piece of the puzzle.
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