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Mechanical Malfunction

Mechanical Malfunction

About
Kerrie Reed, MD - Author
I am a Sports Medicine physician specializing in the physical function of the body. Board Certified in Physical Medicine & Rehabilitation with a sub-specialty Board Certification in Sports Medicine, I have practiced in Chicago, IL, U.S.A for almost 15 years. In addition to my medical practice, I chair the Continuing Medical Education Committee of the American Academy of PM&R, sit on the Executive Board of the Illinois Society of PM&R, and serve as a faculty examiner for the American Board of PM&R Oral Board Exams. I have also written numerous articles about the concepts of Functional Health for many years. You can find out more information about me as well as physical function on my blog site: www.YourFunctionalHealth.com.

I have a very simple, interesting, and likely eye-opening fact about your body for you. It’s actually a central tenet of Functional Health: your body functions best when it can work like it’s meant to.

Yep, that’s it. Told you it was simple.

Don’t let the simplicity fool you though--this simple principle has major implications.  It is the singular basis for how and why most painful conditions and injuries occur (trauma notwithstanding). And more importantly, it provides the rationale for how to fix or, even better, how to avoid such problems in the first place.

Your Body is a Machine

First, to further explain the general idea, you have to understand that your body is essentially a piece of mechanical piece of equipment. With a typical machine, breakdown is typically the result of parts failure, abuse, and/or lack of proper maintenance, right? Well, it’s no different with your body, whereby pain and injury--a.k.a breakdown--are the direct result of dysfunctional parts, overuse, and lack of maintenance (e.g. exercise). So put in the proper context, the idea that malfunction eventually leads to breakdown isn’t all that radical. What’s radical is the realization that that concept applies just as much to your body as to actual machines.

The Consequences of Mechanical Dysfunction

Now, considering how intricately designed your body is, it’s no leap to say that any deviation from such a brilliant design is going to come with consequences. Those consequences typically boil down to two main things: less efficiency and higher injury potential.

“Less efficiency” just means that it takes more energy to perform the same movement. Walking with crutches is a perfect example of that. When you break your leg (i.e. have a dysfunctional part), you have to walk with crutches (i.e. function in a way that you’re body was not designed to), which takes a lot more energy than walking normally (i.e. is less efficient). (For those keeping score, it generally takes 2-3 x more energy to walk with crutches! No wonder you start sweating after just walking from the kitchen to the living room...)

 Regarding the second consequence, someone walking on crutches also has a higher risk of injury. They could develop a muscle strain due to the increased effort, knee problems from the increased stress of hopping on the healthy leg, or could even fall due to being off balance with crutches. The inescapable bottom line is that when things aren’t working right, the body is more prone to injury.

And the dysfunction doesn’t even have to be something as dramatic as a broken leg. Trying to run with a strained hamstring, brush your hair with a frozen shoulder, or walk with an arthritic hip are all more difficult than performing those same tasks with body parts that are functioning normally. And the risk of further injury, involving those same body parts or other ones, is increased. Pretty much anything other than “normal” function simply makes activities more effortful and injuries more likely.

 Obviously the severity of the consequences vary with the degree of the dysfunction, but the basic premise always holds true: your body works best when it’s allowed to work as designed. The natural extension of that tenet, of course, is that when your body can’t work like it was designed to, you're just asking for trouble.

Good to Know, But So What?

While these insights might make for interesting discussion, the more important issue is what can you do with this information. Fortunately (or perhaps unfortunately...), this information is wildly practical because physical malfunction is responsible for most back, neck, elbow, knee and other joint pain, not to mention ankle sprains, overuse injuries and just about every other physical malady.  The list of malfunction-related conditions is almost endless. Unfortunately, this article isn’t....so I’ll offer just a common example that illustrates the applications. Low back pain fits that bill.

While it’s natural to assume that low back pain must mean there’s a problem in the low back, it is rarely that straightforward in reality (it sure would be much easier for everybody involved if it were though!).True to our functional health tenet, low back pain is almost always the result of mechanical malfunction in the body. The catch is that the malfunction is usually somewhere other than the back itself.

For example, if your hips don’t rotate properly (due to arthritis, tight muscles, pain, etc), then your lumbar (lower) spine has to “pick up the slack” and rotate extra to achieve the movement you want. But the lumbar spine isn’t really designed for rotation, your hips are. That leads to undue stress on the spine and eventually injury. Whether that injury ultimately manifests as a herniated disc, facet joint irritation or muscle strain, the cause of that injury wasn’t a “bad back” per se; it was hips that weren’t working right. In other words, the injury occurred because your body wasn’t able to work as it was designed. (All of which brings up another corollary to our tenet: the thing that hurts is rarely where the problem is. But we’ll save that for another article)

As you might imagine, this general concept is particularly important when it comes to treating something like low back pain. And it explains why treatments aimed at the back itself--back strengthening, epidural injections, even disc surgery--rarely provide any long-term solution. Those things may help control symptoms for a period of time, but since the underlying problem remains, the pain will recur until the malfunction actually causing it is identified and corrected.   

While it often takes a professional to work out the nitty gritty details of complex physical dysfunction, there are a few basic but useful rules of thumb to keep in mind: 

  • The joint directly above or below the pain is very commonly a culprit.

             So with back pain, look at your hip and thoracic spine function. If either or both of those are limited (by inflexibility, pain or anything), you’ve got a good place to start. Similarly, if you’ve developed pain in the elbow, you better look towards your shoulder (e.g. limited motion, weakness of muscles around the scapula).

             This isn’t to say that the dysfunction only goes up (or down) one joint--a weak core and even a painful hip could contribute to the development of elbow pain--but the closest joints will almost certainly be involved if anything is.   

  • But, the longer the dysfunction remains, the more havoc it wreaks

       So a recent shoulder strain will often be an isolated problem. However, the longer it's there, the more your body will try to compensate, and the more toll it will take on other parts of your body. That's when it starts involving multiple joints, farther and farther away from the original injury. And that's when the pattern of dysfunction becomes much more complex and almost always require a medical professional to evaluate and correct.

  • So, if you know you’ve got a dysfunctional part, nip it in the bud

       Most of us tend to let aches and pains linger, figuring (hoping?...) they'll eventually work themselves out. And often they do if we just avoid aggravating them. But when something's clearly not resolving itself--e.g. muscle strain, painful ankle, restricted hip--make sure to get it treated. That will not only make that problem better, it will help avoid provoking other problems. 

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