Physical and Psychological Parallels: Injury, Compensation, and the Principles of Healing
Injury
It was early 2020, just prior to the pandemic, and I had injured my back doing barbell squats. I had just finished a powerlifting program that had me lifting the most weight I’d ever moved before. Now I was struggling to sleep at night and get out of bed. There were days I could barely tie my shoes and getting in and out of my truck was excruciating. As I sat at home going into the lockdowns, with my garage gym prepared for whatever the future held, I thought to myself that with nothing but time on my hands surely I could get to the bottom of what I was doing wrong and use this time to rehabilitate myself.
I launched into YouTube physical therapy university, learning about moment arms, torque on the spine, bulging discs, anterior pelvic tilt, quad dominance, tight psoas muscles, and compensation patterns. One thing that struck me was learning how the muscles that support the spine can be triggered into a protective spasm that reduces flexibility and serves to guard the spine when injured or at risk. This explained my rigid posture, reduced flexibility, and how even when it went away, if I pushed just a little too hard in the gym my back would lock up again and I’d be right back where I started.
Imbalances and Compensation
I learned that I had been cheating my squats to lift higher weights with bad form. I had weak hamstrings and glutes but strong quads and lower back, an imbalance. So rather than maintain the same back angle out of the bottom of my squats I would pitch forward and compensate for the weakness in my hamstrings and glutes by shifting the weight onto my quads and hinging at my hips to make my back do the majority of the lift. It got me the highest weights I’d ever lifted but at the cost of exposing my spine to sheering forces that quickly took a toll. At this point, my body wouldn’t let me do this compensation pattern even if I tried, I had to go back to the drawing board and rebuild my foundation in a sustainable way.
Principles of Healing
This was humbling and a shot to the ego, but pain is the ultimate motivator to step back, take stock of a situation, and recalibrate. I devised a rehabilitation plan and carried it out, carefully monitoring how closely I could get to my limit with the new form without going too far and triggering the protective lock up response. I was pushing to the edge of my window of tolerance and slowly expanding it with the proper form while engaging a sustainable movement pattern. Over the course of a year, I built up my weaknesses to reduce the imbalance, trained the correct pattern, and added weight until I was back to my previous levels.
Why am I talking about rehabilitating my back when I’m a trauma therapist? Well, during the course of this personal project, I couldn’t help but appreciate the rich overlap and endless source of metaphors for the trauma recovery process. In principle, it was a very similar problem that required the same kind of techniques to overcome.
Parallels with Trauma
My metaphorical experience began with an imbalance and compensating and guarding against something to push forward in life. In my example this was underdeveloped muscles and kind of hacking my way forward in an unsustainable way. In the case of trauma this can be compensating for and guarding against the impact of an event or events that are too disturbing to fully face or process. The brain offers natural built-in mechanisms to try to contain and isolate disturbing memories, temporarily getting them out of the way in an attempt to function. This is like my pitching forward maneuver to shift the weight into a stronger position to temporarily get around an area that would have limited me otherwise. I was avoiding something while leveraging other strengths.
Once injured, I had a cascade of protective responses guarding the injury, preventing movement in certain ways, and placing me in acute awareness and hypervigilance to avoid reaggravation. This is similar to the flashbacks, intrusive thoughts, emotions, and sensations that begin after trauma, when the compensation strategy of avoidance wears thin, allowing the traumatic material to bubble up. Once it does, just like my back locking up to protect my spine, the brain and nervous system overcorrect, often forcefully, in response to re-exposure to trauma triggers. This can result in rigid and inflexible beliefs and behaviors, hypervigilance and anxiety about re-exposure, and depression and dissociative responses that immobilize in an attempt to protect the person.
Motivation and the Change Process
Fictional Finalism
This is all mapping in a parallel fashion thus far, but what about the point where I came to terms with my injury, recognized my compensation pattern had run its course, and rehabilitated my back? To tackle this, we’ll need to take the analysis a little deeper and get into theories of what motivates a person. One of them is Alfred Adler’s concept of “fictional finalism.” Alfred Adler was a psychoanalyst who studied with Freud. Fictional finalism is the belief that humans are strongly motivated to achieve goals and ideals, even when unattainable, to overcome an often unconscious sense of inferiority. Depending upon our upbringing, personality, and culture we imagine a fictional future scenario where we finally feel accomplished, whole, and superior. Who or what we compare ourselves to for this sense of superiority is based on personal experience. It’s often a moving target rendering the finality of this pursuit “fictional.”
When people have childhood trauma or PTSD, the discussion of motivation is often constricted to the diagnostic realm, consisting of the motivation to avoid trauma memories and triggers. But we have to remember that people with trauma in their histories are people, not diagnoses, and as such they come fully equipped with personalities and motivations that often keep them driving forward despite their trauma. This often requires the use of compensation patterns, work arounds, and the goals are sometimes heavily skewed by trauma. What we run toward is just as important as what we are running from.
In my metaphorical gym example, why was I loading up hundreds of pounds on my back and putting my spine at risk in the first place? I realize to those who share my passion for lifting this is probably not a mystery, but to those whose “fictional finalism” doesn’t involve being jacked it may seem just plain stupid. To shed light on it, part of my history was being bullied and made fun of as a child. I didn’t fit into any social groups or have any social strategies that scored me points at that time. Later on, I found things that gave me a sense of competence and skill, but as a child I found myself watching action movies with Arnold Schwarzenegger and Sylvester Stallone, thinking it sure would be nice to be an action hero instead of a vulnerable kid. My fictional finalism became, “if I could be like them, I could show up to the playground and no one would say a word to me about anything.”
Pain as the Great Persuader
Fast forward to my 30’s, my motivation for lifting was partially for health and fitness benefits, but I’d be lying if I said there wasn’t still a part of me completing my childhood mission to overcome a sense of inferiority. When I was injured, this became the test of how entrenched and pathological this motivation was versus being a benign and healthy way to strive for something. Fortunately, I found myself having the clarity and insight to take my injury seriously. I was willing to back off, identify the flaws in my approach, and lift lighter weights until I could safely handle heavy lifting again. I can’t feel too high and mighty though because I wasn’t paying attention and listening to my body until I was in a great deal of pain. For someone with a deeper and more obsessive need to continue with their drive toward the fictional goal, they may have either pushed until seriously injured or withdrawn into despair and shame feeling vulnerable and unprotected from their sense of inferiority.
It Works Until It Doesn’t
Coming back to the parallels with trauma recovery, people with trauma histories often have a strong fictional finalism narrative they are acting out that prevents exploration of their symptoms, listening to their bodies, or committing themselves to a recovery process until there is crisis or pain. This is not a judgment, as I wasn’t listening to the signs either, just an understandable observation I’ve seen in many clients. Fictional finalism in trauma survivors can manifest in the form of perfectionism and obsessive goals, feeling entirely responsible for the care of other people, holding themselves to impossible standards, or losing themselves in the drama of another person who provides a sense of identity and purpose for them. Sometimes this leads to recreating trauma in an attempt to unconsciously correct something in the past. These rigid pursuits serve a dual purpose of distracting from looking too deep internally where the memories and disturbing material reside and offering a sense of “if I could just get to this imaginary point in the future, I would feel whole, worthy, and safe.”
Much like my gym experience, it’s not until these compensation patterns fail to guard the original injury that the resulting pain and discomfort forces consideration that there may be a deeper issue, and a new strategy is in order. This is a painful and difficult experience, but if we look from a broader lens, it’s also the window opening for change to occur. If you were to ask me in the midst of my glory of lifting heavy on squats if I’d like to stop to fix my compensation pattern and heal the underlying injury I would have said, “Are you kidding, this is working.” If you ask a trauma survivor in the midst of getting a new promotion at work if they’d like to address their compensation pattern of working 80 hours a week and heal their childhood trauma, they’d probably say, “Do I look like I have time for that?”
Parallels to the Trauma Recovery Process
In this sense, crisis can be the warning beacon in our lives letting us know we are running out of ways to work around an imbalance, and it may be time to back up and go through the difficult process of healing and rebuilding. If we heed the warning, and accept that we’ve run out of the ability to “push through,” we are rewarded with a sustainable way forward. In my metaphorical example, when I started a rehabilitation process my strategy was threefold:
I created safety and stabilization for my spine to avoid reaggravation, and identified the resources I would need to build to create resilience for a new sustainable lifting form.
I slowly titrated up to my full capacity over a long time frame with gradual exposure to higher weight while using my new resources to practice a new form.
Over time, my new form became completely integrated into my lifting routines and I don’t have to put much effort into it now, it’s the new normal.
This is almost an exact parallel to the three-phase model of trauma recovery, which involves:
Creating safety and stabilization by learning how to find a sense of safety, employing coping skills to keep distress in a tolerable range, and avoiding reaggravation of the injury. Developing resources and filling in developmental gaps so that when exposed to the memories, the person is equipped to process and digest them instead of being overwhelmed and retraumatized by them.
Carefully titrating the dose of exposure to memories so that it reprocesses, builds resilience, and desensitizes the fear conditioning without triggering the full cascade of protective responses.
Once momentum builds and the majority of the trauma is reprocessed, the new skills, insights, and strategies are integrated into a new way of life that replaces the old compensation patterns.
Conclusion
Trauma isn’t something that most people come to feel grateful for, as it shouldn’t have ever happened in the first place. There is often a great deal of mourning in the realization that there were many missed years spent compensating, or just holding on trying to survive. But the growth that is experienced in the recovery process is something many people come to value and feel inspired about, seeing the change in themselves and recognizing the new possibilities that are now ahead of them. I felt that way about my recovery process, not the gym experience, my more important recovery from addiction and trauma. After writing this blog, I’m beginning to feel grateful for my gym injury because it put all of this into perspective for me and provided me with a metaphor I can continuously refer back to. But the real blessing for me here is no more back pain. Physical injuries are often taken more seriously than psychological and emotional trauma, but they are both very real and require commitment to a rehabilitation process for effective healing. If you ever find yourself at your wits end faced with the choice to grit your teeth and push on or conjure up the courage to reach out and ask for help, I highly suggest beginning your recovery process sooner than later. It’s always the right time to begin healing and as long as we’re alive it’s never too late.
Alex Penrod, MS, LPC, LCDC
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