For patients who require physical therapy, compensatory movements can be considered necessary formovement. In exercise therapy, it is important to be able to perform normal movements without compensatorymovements. To this end, it is necessary to understand why compensatory movements occur, and it is importantto have a thorough understanding of the kinematics of normal movement.

In functional impairment associated with tissue damage, compensatory functions are often used to supplementposture and movement. Especially in central nervous system diseases, it is difficult to recover from damagednerve cells. Therefore, compensatory behavior in which the patient uses excessive effort is often observed forthe purpose of early recovery of activity of daily living. In addition, orthotic therapy and the latest medicalcare (robotics and regenerative medicine) are also used to assist paralyzed limbs. Compensatory functionsare considered necessary functions, but their quality, quantity, and degree can also facilitate or delay therecovery of damaged tissue. Treatment using compensatory treatment includes excessive effort by the patient,orthotic installation for paralyzed limbs, and the latest medical care (robotics and regenerative medicine). Inany method, in order to obtain the maximum expansion of capacity with minimal compensatory function, itis important for the therapist to constantly evaluate the changes of the body with respect to the situation ofthe damaged tissue, and to approach dysfunction based on motor function evaluation. Here, I reconsider theessence of compensatory functions and their concepts from the perspective of physical therapy.

Compensatory movement is the use of motor patterns that differ from normal movement to accomplish a goal.It may suggest some underlying functional decline and may provide clues to identify the patient’s problems.On the other hand, for patients for whom surgery is not an option, compensatory movements are necessaryto maintain and improve Activities of Daily Living. Therefore, it is very important to have knowledge ofcompensatory movements in musculoskeletal diseases. To understand compensatory movements, one mustfirst know normal movements. In this article, we introduce some key points of normal and compensatorymovements related to musculoskeletal diseases.

Compensatory movements have advantages, such as enabling the performance of practical movements. On theother hand, they also have disadvantages, such as impeding efficient movement. In evaluation, it is importantto interpret movements that include compensatory movements. This paper outlines compensatory movementsfrom the aspect of evaluation.

In clinical situations, many patients have difficulty with standing up. Such patients perform standing up usingcompensatory movements. In such cases, it is necessary to analyze the movements and clarify the factors thatcause the compensatory movements. In this paper, normal and compensatory movements in standing up areexplained with examples. In addition, electromyographic data are presented to explain in detail what kind ofcompensatory movements occur.

Patients with shoulder joint dysfunction may perform compensatory motion using the glenohumeral joint,scapula, or trunk to accomplish the intended movement. It is necessary to consider which treatment strategyto pursue, improvement of normal movement or acquisition of compensatory function, depending on theintended goal. In this paper, compensatory movement caused by functional impairment of the glenohumeraljoint and scapula are used as examples. In addition, electromyographic data are presented and details of thekind of compensatory movement occurring are explained.

Trendelenburg gait, Duchenne gait, small steppage gait, circumduction gait, and the like are typical examplesof abnormal gait in walking motion. Hemiplegic patients with cerebrovascular disorders may show theDuchenne phenomenon during the stance phase of the non-paretic side in gait, and we hypothesized that it isa compensatory movement. We describe the impairment that causes the Duchenne phenomenon and explainthe interpretation of its movements. When considering compensatory movement of gait, we suggest that it isnecessary to perceive the motion three-dimensionally, as well as consider the phase of motion before and afterthis movement.

In this paper, we describe palpation of the iliac and internal oblique muscles and the electrode positions usedfor surface electromyography measurement. Also, the activities of the iliac muscle and the internal obliquemuscle were measured using a surface electromyograph. We hope that this report will be of some help inphysical therapy assessments and treatments in clinical rehabilitation settings.

In this study, we investigated the muscle activity that causes spinal and pelvic movements and changes inspinal and pelvic alignment when performing forward reaching in the sitting position at 0.5 seconds, which issimilar to the speed of the flexion phase of standing up movements. We measured the muscle activities of thelongissimus, multifidus and ilicostalis muscles, and the angular changes of the spinal column and hip joint of20 healthy men performing anterior reach motion in the sitting position. The results show that the activity ofall muscles weakened at the time of 20% from the start of movement and tended to increase significantly after40%. In addition, the angle change of the spinal column and hip joint showed flexion of the lower thoracicspine from the time of 20% to 40%, and after 40%, the anterior reach distance increased significantly as theflexion angle of the hip joint increased. The results of this study show that there is a difference in the purposeof exercise between the phase up to 40% of the time from the movement start and the phase that follows.

In this study, we measured the dynamics of the infrapatellar fat pad (IFP) associated with knee joint flexionin the postoperative period after total knee arthroplasty (TKA) using ultrasonography over the preoperative topostoperative period. We then investigated at what time point the dynamic decline of the IFP began to occur.The results suggest that the dynamics of the IFP had already decreased at one month postoperatively. Theresults also suggest that for postoperative TKA patients, intervention for the subpatellar fat body should beperformed within the first postoperative month, when the dynamic decline of the IFP begins to occur.

To clarify the effects of relaxation imagery on spinal motoneuron excitability, changes in the excitability ofspinal motoneurons were examined using F-waves during imagery of the sensation of weakness in the nondominanthand converted to the dominant hand. Twenty healthy participants recruited in the study. After resting for 3 minutes, F-waves were measured with the dominant hand (resting trial). F-waves during an exercise task with the non-dominant hand were measured in the dominant hand (exercise task trial). F-waves were measured in the dominant hand during a verbally instructed relaxation imagery task (imagery trial). The results show that there were no differences in the F/M amplitude ratios and frequencies between the resting and imagery trials, but there were differences between individuals. Relaxation imagery without an imagery strategy did not decrease spinal motoneuron excitability, but many cases of decrease were observed among the individuals, suggesting the importance of specifying the imagery strategy and imagery content.

In this study, we clarified the effects of differences in pressure stimulation intensity of an acupuncture pointon spinal motor nerve function, and examined whether Acupoint Stimulation Physical Therapy (ASPT) is effective in the absence of pain. In 20 healthy subjects (mean age: 20.29 years), ASPT was performed on Chize (LU5) on the lunar lung sutra, and F waves arising in the muscle groups on the ball of the thumb on the non-dominant hand were measured at rest before the ASPT trial, during the ASPT trial, and 0 min, 5 min, 10 min, and 15 min after the ASPT trial. The pressure stimulation intensity of the ASPT trial was set at two painthresholds, 100% and 50%. The results show that the amplitude of the F/M ratio was significantly reduced at 5, 10, and 15 minutes after the ASPT trial compared to during the ASPT trial at 100% intensity pressure stimulation, but there was no difference at the 50% intensity pressure stimulation. These results suggest that pressure stimulation with a pain threshold of 50% is unlikely to have an inhibitory effect immediately after stimulation. Therefore, the intensity of pressure stimulation of acupuncture points in clinical practice should be performed at the pain threshold level for the immediate suppression of the excitability of spinal motor nerve function.

We report a postoperative case of left recurrent shoulder dislocation with difficulty in performing the smash inbadminton. This case’s smash action had a slow swing and didn’t hit the shuttle at a high hit point. Therefore,physical therapy was performed for left shoulder joint 2nd external rotation range of motion limitation and leftshoulder joint horizontal adductor muscle weakness. As a result, the case became able to hit the shuttle at ahigh hit point with a quick swing, leading to practical use of the smash.

We report the case of a man in his 80s who presented with left hemiplegia due to atherothrombotic cerebralinfarction. The man turned to the right side and tried to get out of bed but could not. This is because hewas unable to rotate the body to the right and was unable to swing both legs out to the edge of the bed. Wehypothesized that the cause of his inability to rotate the body to the right was deterioration of trunk functionon the paralyzed side. Physical therapy evaluation revealed hypotonia in the paralyzed rectus abdominismuscle and paralyzed external oblique muscle. Physical therapy was performed to improve muscle tone in theparalyzed trunk muscles. As a result of physical therapy, the muscle tone of the trunk muscle on the paralyzedside improved, and the man was able to get up from the bed on the right side.

We performed physical therapy for a patient who presented with postural abnormalities as a symptom ofParkinson’s disease and who had pain in the right lateral shoulder when the right upper extremity was raisedand lowered. When the right shoulder joint was flexed while maintaining the right scapula elevated andadducted, pain occurred at about 70° and the movement was terminated. Even during the lowering motion,while maintaining the right scapula elevated and adducted, pain similar to that of the forward raising motionoccurred. The results of examination revealed decreased muscle tone in the left longest muscle and increasedmuscle tone in the left rectus abdominis muscle. In physical therapy, the patient practiced reaching movementsin a sitting position and pain was reduced during forward raising and lowering of the right upper extremity,leading to acquisition of movement.

A patient with right traumatic shoulder arthritis who had difficulty in reaching to the contralateral side wasevaluated with a focus on scapular alignment. Observation suggested that compensatory scapular flexion inthe ligature movement was unfavorable for the contralateral reaching movement. Physical therapy aimed atincreasing scapular extension enabled the patient to reach the left lumbar back and improved the patient'sability to tie a kimono obi.

We report the case of a postoperative patient with a left humeral neck fracture who complained of fatigue onthe lateral side of the left shoulder joint when performing a laundry operation with the left upper limb. Thepatient had severe type 2 diabetes mellitus and residual weakness of the muscles around the left shoulderjoint. The patient’s laundry motion was characterized by a consistent narrowing of the space between the leftrib cage and pelvis, and the left shoulder joint was positioned inferiorly. This alignment was thought to causefatigue in the left lateral shoulder joint, and we treated the patient accordingly. After treatment, the patient’sfatigue was reduced and endurance was improved.

We report the case of a patient with left thalamic infarction who showed right anterior instability in thedescending step movement. The patient had poor right hip adduction and weight transfer to the right lowerlimb during the step descent from the right apex to the right plantar foot. As a compensatory movement, thepatient’s trunk tilted forward to the right by flexion and abduction of the right hip joint while the right anklejoint was in plantar flexion. The problem was hypotonia of the lower transverse fibers of the right internaloblique muscle and the right medialis muscle, and physical therapy was performed for these muscles. Asa result, the patient’s right hip adduction between right foot apex and right plantar contact during the stepdescent improved, compensatory movements reduced, and stability improved.