Compensatory Mechanisms

Today is going to be a gorgeous day, much like yesterday. I still felt horribly bloated and unwell yesterday, so even after I finished my long work day, I really couldn’t enjoy the weather. This beautiful spring weather lately has also reminded me how hard it is to work all day inside and ignore the strong pull to go out and have fun. Ah, one of the major losses incurred by growing up is losing the freedom to play as much as you’d like. Being saddled with normal adult responsibilities isn’t quite as frustrating in the winter or when the weather is bad, but it’s certainly a tougher reality when sunshine and warm temperatures beckon you on the other side of the window. The one nice thing even when indoors on days like today is that the house is no longer freezing. It is so much more comfortable and relaxing to hang out in a home that’s above 59 degrees; I finally feel like my tense shoulders have retreated down from my ears and returned to their healthy location.

My colonoscopy is rescheduled for a week from today and I must say, this time, I’m almost looking forward to it, since my stomach has been a never-ending painful nightmare since canceling the one last week. I’m more invested and subscribed to the need for the procedure immediately now that I’ve been so uncomfortable for eight days.

On Thursday, Comet will return to see the surgeon who repaired her ACL two weeks ago today. I hope that he is pleased with her progress. We get the sense that’s she’s healing well, but that’s mostly based on our intuition, since neither Ben nor I have experience with “normal” post-operative dog ACL rehabilitation. Our main concern is that she still is reluctant to fully weight bear on that limb when she’s standing around. Instead, she typically continues to disperse her weight over her other three limbs and lift the repaired leg off the ground. She will walk on the leg when she ambles along at a relaxed, slow pace, but nearly every time she’s standing for more than a couple of seconds, she shifts her weight totally off the leg and onto the other three. We aren’t sure if this is normal two weeks after the surgery, or if there’s cause for concern; moreover, perhaps it’s an issue we need to deliberately address with physical therapy, although it could be expected at this point and anticipated to go away on its own as she gets stronger and gains confidence in her leg.

The only other problem that’s concerning to us is that Comet still has a fair amount of external rotation on the hip of the leg that was injured. What this looks like is that as she’s walking towards the observer, her repaired leg looks a bit turned out from her body (kind of bow-legged), exposing more of the inner side of her thigh instead of having her knee tracking straight forward. My knowledge of biomechanics, kinesiology, and physical rehabilitation leads me to hypothesize that either this is due to atrophy in her hip and glute muscles from months of disuse, with a concurrent tightening of her external rotator muscles, or from a habitual compensatory mechanism (to help her gain stability) that became engrained over that time she was disabled by the injury.

It’s likely a product of both these factors, the latter makes sense when considering the practical implications of a torn ACL. The anterior cruciate ligament (ACL) provides stability to the knee and prevents translation of the tibia on the femur. Essentially, when Comet’s was ruptured, she had no knee stability. If she tried to walk or stand on the leg, it would totally collapse and buckle to the side. The only way she could gain stability in that leg was to rotate it so that the knee joint wasn’t aligned in the sagittal plane to flex. Biomechanically, the knee is considered a hinge joint because it flexes and extends only in one direction, like a door hinge. If it’s properly aligned but lacks stability and just buckles, it cannot provide any support. However, if it’s rotated out of plane, the forces through it won’t cause it to bend, so she can lock the bones and use it like a peg leg, hanging on the fact that the bones are incongruous there in terms of their alignment to buckle at the knee. It’s natural for the body to adopt compensatory mechanisms to work around the disability, so it seems very likely that Comet intuitively learned to rotate her leg to afford a bit more bony stability. I imagine this needs to be addressed through exercises targeted at internally rotating her hip back to its anatomical position and retraining her brain to assume the proper orientation of that rear leg. Again, we will see what the surgeon says. Maybe it’s advantageous for her to perpetuate this posture, as it might help reduce the demand on the ligaments; either way, we need to hear it from the expert.

I see a lot of the same behaviors mirrored in myself with my chronic pain, musculoskeletal issues, arthritis, and joint hyper mobility coupled with muscle tightness. I, too, adopt maladaptive postures and ways of moving to ease my pain and work with my limitations. Like Comet, I have all sorts of physical and psychological compensatory mechanisms in my life. Being autistic, I have learned ways to get around some of my sensory challenges, social hangups, emotional challenges, and communication issues. I will think about these today and consider how they help and hurt me.

It will be an informative appointment, and hopefully affirming that we are on the right path with her. I know the process still has many steps left to clear on her way to full function, but I’m happy with her progress so far.

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