8. Balance (Proprioception)

Poor Balance: the invisible cause of Osteitis Pubis

We have covered that the cause of OP is the biomechanical flaws which lead to the overuse of the adductors. We then covered that it’s the dysfunction of the Deep Front Line (DFL), the most important fascial/muscular movement chain that plays a major role in creating these biomechanical flaws. Finally we covered how poor activation/co-ordination of the ‘Core’ and ‘Glutes’ prevents the DFL, and therefore your movement patterns from functioning properly.

Now we are going to cover the role of your proprioceptive system; that is your sense of balance, in the development of OP.

Balance: the taken for granted sense

Of all our senses, balance is the most ignored. Yet it is vital to every movement we make. Our sense of balance is more complicated than you might think. This is because unlike your eyes or ears, your sense of balance is achieved by multiple systems across your entire body & brain. To maintain a good sense of balance; to move smoothly and safely you must have some awareness of the following.

  • Where you are in relation to the ground
  • Where each joint is in relation to each other
  • The relative strength and weakness of every muscle
  • Where you are in relation to other objects in your immediate area.

Seems complicated… it is! If we can look at it the system as a whole then we are able to simplify it. As a paleo man/woman your brain and body had keep you upright and moving through tricky, unstable environments. Additionally it wasn’t okay to just remain on your feet; you had to move, dodge and change direction in a milliseconds just to survive. To achieve this, your brain and body developed a multi-faceted system to keep us agile.

But what happens when your sense of balance isn’t as efficient as it used to be? Would you notice? Would it be obvious? The answer is yes and no.

Balance and grace: an unappreciated skill

Balance is more complicated than simply standing on one leg with your eyes closed. It’s the ability to make complicated movements in complete control. It’s the ability to be spinning in one direction, decide to stop immediately and reverse the movement. Its obvious when someone has a great sense of balance, they seem to move effortlessly. They move with ‘grace’, never out of control.

‘Grace’ is more important to your body than you think. Moving in a balanced and effortless way means that every joint is moving proportionately. Load and strain is being transferred efficiently across the body. One muscle or joint isn’t being exposed to or suffering through more load then it needs to. Shearing, buckling, bracing forces are kept to a minimum. Simply put; you avoid beating your body up.

Click here if you would like to book in for a free, 20 minute Skype consultation to talk about your case specifically.

OP Patients move clunky

OP patients are generally the opposite of graceful. It’s not that they are not good athletes. Most OP patients are great, powerful athletes. But they never move smoothly. They move ‘clunky’, relying on the strength of their muscles and joints to heave themselves in different directions. Over the course of a long training session, game, season this starts to wear you down. Till eventually the idea of changing direction at speed makes you nauseous. Till your groin hurts every morning, on every jog and everytime you get out of a chair. Till you have OP.

How did my movements become ‘clunky’

We live in a manicured society. Whilst sport is supposed to help develop well rounded bodies most sports don’t do this effectively. We run on flat, perfect grass fields. We don’t climb trees as kids, we don’t walk on unstable ledges. We wear shoes to enhance our stability and weaken our feet. In short our balance is not challenged regularly, so it atrophies.

Modern sport and exercise (running, gym etc.) challenge our muscles and cardiovascular systems. So they get stronger. Sports like basketball, football, soccer etc challenge us to be strong and powerful; so unconsciously we develop these aspects. Strength dominates our movements. We focus on doing something faster, more powerfully. We rarely focus on exactly ‘how’ we are doing it. Whether our technique in running, jumping, kicking, changing direction maybe hurting us. That is until we get injured.

Ligaments sprains and tears; our silent killers

Our body sends ‘proprioceptive’ messages constantly to our brains. Proprioceptive messages tell our brain where our joints, bones and muscles are in space.  We need information for any change in alignment, as well as how much weight/tension our tissue is under. Our brains integrate this proprioceptive information to create efficient movements. Our ligaments are packed densely with proprioceptors to aid this process. When we sprain or tear a ligament we are essentially disrupting this connection, cutting vital information in the planning of smooth, balanced movements.

Ligaments don’t heal well.  Typical rehab may not help.

Ligaments have poor blood supply; they don’t heal well. Fortunately the muscles around a joint can be strengthened, effectively taking over the lost function of the ligament, providing some sense of stability. Most rehab for a ligament injury focuses on making sure the joint is strengthened and stabilised. Balance work is usually an afterthought – a token effort not explained well.

And this is where it all goes wrong. If your ligaments are damaged then your balance and awareness of that joint is extremely compromised. It doesn’t matter when you walk or run in a straight line. It will matter when you start changing direction.

Take an ankle with poor proprioception as an example. If your body doesn’t have great awareness of where the ankle is in space it will brace and stiffen it to protect it. As you change direction it won’t rely on the ankle, instead sending the load upwards to the knee. The knee will now be responsible for transferring all the load and initiating movement in the new direction. Unfortunately the knee is not as efficient at changing direction as the ankle. Your body likes winning; you may not notice a massive change in your speed. But your efficiency suffers. Your movements become clunky. Your knee suffers the damage of completing a task it’s not designed for.

OP and balance

You will notice that we did not speak about OP specifically. This is because this pattern can occur for any injury. It’s just in the case of OP that the body begins to rely on the adductors; starting the pathological process of tension and dysfunction that leads to OP.

Can my balance be recovered?

If ligaments don’t heal well is there any hope? Absolutely. Muscles have proprioceptors, just not as many as ligaments. If a ligament has been damaged, the muscles around the area must be challenged and strengthened from a balance and proprioceptive perspective. They have to be stimulated to grow more proprioceptors. Balance work can’t just be an after thought, it must be a vital part of recovery.

Even if an injury occurred years before the joints function and movement can still be corrected by improving the proprioceptors in the muscles surrounding the joint. By correctly rehabbing the proprioception of a previously injured joint the body can be taught to correctly integrate it into movements. Movements can change from clunky back to smooth. Smooth movements can deload overused muscles, like your adductors, giving them the time to heal and recover. In short everything is reversible, with the right intervention, rehab and treatment.

Click here if you would like to book in for a free, 20 minute Skype consultation. Or continue reading to learn more.