Understanding Compensatory Movement Strategies After Neurological Injury

If you have experienced a neurological condition such as a stroke or brain injury, or have Parkinson’s disease or Multiple Sclerosis, you may have noticed that you move differently than you did before? Now you may rely more on one leg, use your arms to help you stand up, or have changed the way you walk. These changes are known as compensations.

The word “compensations” is often viewed negatively, with many people believing that any movement compensation is something that should be avoided, but it’s not quite that simple. Compensations are a natural response to changes in the body. They can be incredibly useful, particularly in the early stages of recovery, but they can also become barriers to progress if they are relied upon for too long. Understanding the difference is an important part of neurological rehabilitation.

What is a compensation?

A compensation is an alternative way of completing a movement when your body is unable to perform it in its usual way. Following a neurological condition, changes in strength, balance, coordination, sensation or muscle control can make everyday tasks much more difficult. Rather than giving up on the task altogether, your brain finds another way to achieve the goal.

For example, you might:

• Lift your hip higher to help your foot clear the floor when walking
• Rely more heavily on your stronger leg when standing up
• Use your hands to pull or push yourself up from a chair
• Lean with your trunk to reach instead of moving your shoulder
• Take shorter steps because they feel more stable

These are all examples of compensatory movement strategies

Why do we compensate?

Our brains are very adaptable. When one pathway is no longer working efficiently, the brain naturally looks for another way to complete the task. In many cases, this is what we want. A compensation can allow someone to continue walking, getting dressed, making a cup of tea or getting out into the community when they might otherwise struggle.

Without these adaptations, many people would lose independence far sooner.

However, it’s important to remember that a compensation is usually a solution to an underlying problem, it does not fix the problem itself.

When can compensations become a problem?

While compensations can be helpful, they aren’t always the most efficient way to move.

Over time, some compensatory strategies may:

• Increase the amount of effort needed to complete everyday tasks
• Lead to unnecessary fatigue
• Cause pain in other area
• Increase the risk of falls
• Limit the use of weaker muscles or affected limbs
• Reinforce movement patterns that become difficult to change

Our brains naturally choose the easiest strategy available. If one side of the body feels stronger or more reliable, we often continue to rely on it because it gets the job done. However, this can sometimes mean the weaker side has fewer opportunities to practise and improve.

This does not mean all compensations are “wrong”, yet they should be reviewed to make sure they are helping rather than holding you back.

Can compensations be reduced?

This is very dependent on the individual patient presentation, their functional level and how long ago the neurological injury occurred. One of the key roles of a neurological physiotherapist is deciding whether a compensation is helping or hindering.

Rather than simply trying to stop a movement pattern, we need to establish why it developed in the first place.

• Is it because of weakness?
• Poor balance?
• Reduced coordination?
• Muscle stiffness?
• Changes in sensation?

Or is it currently the safest way for someone to move?

Once the underlying cause has been identified, treatment focuses on addressing it wherever possible. This may include strengthening exercises, balance training, gait re-education, task-specific practice or strategies to improve coordination and confidence. As these areas improve, the need for some compensations may naturally reduce.

Are some compensations useful?

There are situations where a compensation remains the safest and most effective strategy.

For example, using a walking stick, wearing an ankle-foot orthosis (AFO) to manage foot drop, or learning a different technique to transfer safely may all improve independence and reduce the risk of falls.

The goal of neurological rehabilitation is not to eliminate every compensation. Instead, it is to ensure that each strategy is appropriate and most efficient for that individual, and supports their rehabilitation goals.