What Does Compensating Mean?

Let me start this post with an everyday example. If you stub your toe (and possibly break it) no one has to teach you how to limp and avoid using that toe. Your body automatically realizes there is something wrong and makes adjustments in the way you walk to avoid causing more pain. You might turn your foot one way or the other to avoid bending the toe. You might put very little weight on that foot. You might reach for the wall or a rail to help decrease use of that foot. You did not have to think about it, you just did it. You compensated for a situation and made a work-around.

Your baby does the same thing.

Here's a situation... torticollis. If your baby has a tightness on one side of the neck, this causes the other side to be weak. It causes a preference for turning the head to one side. It can also cause tightness in the trunk. Your baby is smart and will automatically go with the stronger muscles, turning her head to the easy side for all tasks including feeding, play, sleeping.

As she ages and is trying to learn more gross motor skills, she will continue to overuse the muscles on the unaffected side and will naturally use more compensatory strategies to get the job done. Some of the things I commonly see that start to occur are:

• Decreased use of one or both arms in weight bearing. Ie. baby does not want to push up on straight arms on her belly. Without that ability baby will have difficulty crawling and may try army crawling, 3 legged crooked crawl, or buttock scooting.

• Decreased confidence in the vestibular system - the system that helps us maintain balance. This may look like a baby who does not want to move from position to position ie. sitting to belly, sitting to quadruped.

• Extensor thrusting - throwing head and body backwards. Often happens in sitting but also seen in standing. This is an overuse of the extensor muscles which include the back muscles, gluts, calves. Often babies have difficulty activating core and flexor muscles (the abdominals) which are needed to sit and to standing in midline/balance. Their bodies know they need to use muscles but overuse the wrong ones making mobility difficult.

As I have talked about before, we don't want to see assymetries develop. We don't want the right side to be stronger than the left, or more used that the left (or vice versa). We want baby to use all their muscles and develop strength and motion evenly so she can do symmetrical tasks like sitting, crawling, walking, running. Compensations that develop, especially early ones, compound. Baby will continue to find more work-arounds which can cause delays. My advice is to seek help early if you see assymetries. A pediatric PT can help you with play that will encourage both sides to develop and skills to progress more naturally. Let's get back to that toe injury. It takes more effort to use that compensation and sometimes we decide that a task is too hard and we skip it. Your baby may also try this if compensating is too hard. That causes frustration which for a baby means crying. If your baby is resisting age appropriate skills, a therapist can help figure it out and get you back on track and participating more happily.