How symptoms often arise away from where the real problem is

Our body is extremely good at adjusting to and compensating for all sorts of stresses. But our compensatory ability is of course finite.

Let’s take the example of a significant ankle injury incurred while running. The body immediately starts repairing any potential damage – as evidenced by the swelling associated with the inflammatory response. It also makes various adjustments to enhance the healing process. For example, some muscles will contract to stabilise injured tissues, while others will be prevented from contracting to minimise stress on these tissues. Our gait will change (we may start limping) and slight adjustments will become noticeable through most of the body. Eventually, our ankle will heal, yet it will most likely not regain its full, pre-injury mobility. This residual stiffness at the ankle is going to cause increased stress on functionally related structures such as the knee, the hip and the lower back. Over time, a lesional chain may develop, with a whole set of related structures showing some level of dysfunction as a result of the original ankle injury.

Another example of body adjustment is the protective ‘bracing’ that occurs around irritated tissues deep in the body. This is a natural response to minimise tension on and preserve the integrity of our vital organs and their associated structures (nerves and blood vessels). This bracing can be widespread in its effects and cause significant lesional chains, e.g. a left hip locked in a ‘turned in’ position to reduce tension on an inflamed stomach.

Symptoms such as pain may develop anywhere along a lesional chain. In the first example above, it may be that pain at the ankle has completely resolved after 2-3 weeks, but lower back pain suddenly develops a few months later ‘out of the blue’. The lower back may have been part of a lesional chain associated with the ankle injury. It may have been able to compensate for the increased mechanical stresses caused by an altered gait until a seemingly innocuous event such as bending forward to tie up shoelaces tipped it over into a symptomatic state.

Significant adjustments and compensations through the body is something we see a lot as Osteopaths. Often, I surprise people in showing them some marked and often more determinant tension or restriction not where their symptoms are, but rather somewhere else along a short or long lesional chain. As a result of lesional chains, working on the symptomatic area often only yields limited and short-lived improvements.

The concepts of compensation and lesional chains are central to Osteopathy. The idea of interdependency between different parts of the body – the body unity concept – defines one of the core principles of Osteopathy, together with the inter-relationship of structure and function discussed in another article.


Originally written by Nicolas Roost for LiveBeingFit (

2017-08-28T22:40:13+00:00 August 28th, 2017|Osteopathy|