revised: 11.21.23
introduction to cumulative injury
Cumulative injury describes injury that has been lurking around in the body for weeks, months, or even years that suddenly makes itself known. Usually it appears in response to a normal every day action, like bending over to tie your shoes, reaching for a plate from a shelf or moving suddenly in response to an environmental stimulus (like the doorbell ringing). The movement in and of itself is not significant enough to account for the resulting pain, spasm, movement limitation or tissue inflammation. Rather, it was the last straw. The final Jenga block to be added. The tipping point for our body’s ability to manage (cumulative) stress without insult.
Cumulative injury often starts as a low grade, nagging sensation. These first sensations usually feel like a nuisance and are often ignored rather than addressed. These complaints range from minor knee pain when running, throbbing low back sensations after driving for several hours, or neck stiffness and excess tension resulting in limited mobility. These injuries are usually considered par for the course.
holding patterns
Often overlooked is how these long-term and subtle annoyances may be indicators that whole body organization is compromised and needs a pattern update. Patterns of movement are real-time events woven from our past experiences. Generally, a pattern is something that occurs over and over again with repetition and in a predictable way. One name for a behavioral pattern that becomes problematic to our well-being is holding pattern.
Holding patterns are historical events that shape our tissues and neurobiology and were established as the best adaptive strategy available in the moment. Overtime, the adaptive response perpetuates a cascade of unfavorable changes that may result in any combination of structural, emotional or psychological changes. Broadly, cumulative injury may be a woven tendril within a holding pattern that limits our ability to participate in life with full capacity.
In this context, cumulative injury is not rooted neatly in physical injury to tissue. Our experience of injury and pain is far more complicated than localized inflammation or tissue trauma (check out the leading theory on pain here: neuromatrix theory of pain). We need to consider cumulative injuries beyond tissue damage and their symptoms as emerging from our holding patterns.
what is injury?
At a basic level, injury is understood to be physical harm or damage done to a living thing. Physical is a term that points to coming from our body, or sensed within our body. What is felt, or experienced within our body is influenced by sensory pathways and proprioceptive abilities along with a whole host of brain centers that form our subjective consciousness.
Along with our nervous system, we also have a body-wide communication system within the fascial matrix. Current research by Robert Schleip finds that there are 250 million sensory receptors in the fascial matrix (check that out here) sending information not only to the central nervous system, but also acting as a mechanosensitive communication network through the fascial architecture. The interoceptive and proprioceptive input from the fascia integrates in the insular cortex and forms the shape of our perceptions (beliefs, motivations, expectations) while giving rise to the felt-sense.
Our experience is shaped from these perceptual artifacts which, in turn, become the patterns of our behavior. As we move with the world, through our actions and interactions, our sensory receiving is the ground for our connection and somatic aliveness. The incoming sensory feedback (collected, transmitted, and integrated) presents the present to our perceptual awareness. Whether or not we catch the moment is up to our mental conditioning and somatic presence. This sensing-perceiving-acting cycle is the basic process underlying experiential learning and forms the storyline we live.
Injury as a physical manifestation has multiple dimensions. Injury as an experience of physical harm or damage can influence the function of our body systems in a number of ways. Cumulative injury that manifests as tissue stiffness, tension and inflammation may be attributed to structural, psychological and/or social factors. Cumulative injury and pain is usually far more complex than localized tissue damage alone.
cumulative injury and culture
Movement science recognizes repetitive movement injury as a cause for muscle imbalances and myofascial restrictions. Many jobs and occupations require hours of repetitive action to perform the work. Additionally, common to modern society is the addiction to work, or overwork, that brings with it mental and emotional dis-ease. And then there is the reality that full-time work in many industries falls short on providing the means for a safe and secure living due to the the uneven distribution of resources.
Our culture shapes us through belief systems, worldviews and identity politics. Our lived experience is felt through our understanding of self . . . an emergent phenomenon based on the interdependence of of our individual body within the collective body. A reductionist approach turns a blind eye to the multiple relationships underlying our body’s physical ailments; the internal and external forces in our lives cannot be teased apart.
Our personal histories, our experience of belonging and our socio-cultural milieu live within our body architecture. These very things are the forces that pattern our movement, our behavior, our lives. Cumulative injury presenting as non-specific low back pain, for example, is best addressed through a somatic lens with respect to the complex nature of a holding pattern.
I encourage movement teachers to expand their understanding of injury to include the continuous interaction of our biological, psychological, spiritual and social dimensions. In regard to movement education, an interdisciplinary approach born from somatic inquiry and practice is a safe and effective pathway for helping people with healing and repair. For many of us, a common denominator underlying cumulative injury is under-recovery.
chronic stress, under-recovery and adaptation
Unfortunately, living with and managing chronic stress is a norm for modern humans. Due to the dis-ease that chronic stress fuels, we often think of stress as “something bad” to experience. Yet it’s not that simple. Stress is an essential part of survival and adaptation. Good stress, or eustress, promotes positive change and growth within a system.
Eustress is:
1) the right amount of challenge
2) at the right time
3) with enough available resources to successfully meet the challenge
4) and with an opportunity to replenish resources afterwords.
An example of eustress is the preparation and successful delivery of a creative project that is well received. Eustress occurs in the proper training and performance of a marathon race. Even a difficult emotional situation, like a confrontation with a loved one, can be eustress depending on how you felt about the outcome. If the heated conversation meets resistance, and defense strategies appear in yourself and the other, most likely this event will be a distress to your system. A distress is an experience to the detriment of your well-being.
So what determines if stress will lead to growth or to depletion?
Stress is part of how we adapt and change as an individual, as a community and as a species. Stress becomes a pattern overload based on the volume (how much) and intensity (how fast) of the stimulus. Timing is also central to how well we manage a stressor. Did the stressor occur suddenly without the time to prepare? Are the stressors stacking up, one after the other, without an opportunity to recover in between?
So often, the challenge of stress comes from the experience of:
1) too much
2) too fast
3) and occurs too frequently.
When stress begins to stack up in our system (when too much is going on and when it’s all too overwhelming) breakdown on some level is bound to occur. Recall that part of the cycle of a eustress involves having enough available resources to meet the challenge. These resources include time, energy and support. Our neurobiological systems also need adequate time to recover and replenish our resources before the next stressor shows up.
One way to frame a traumatic experience is that it remains in our system as an unresolved stressor (and often lives outside of our perceptual awareness). In this way, trauma is unmetabolized, unresolved, stacked up energy that causes all kinds of havoc to our physiology and somatic aliveness.
Chronic stress and trauma retentions:
1) shift how we orient to the world
2) influence our coping strategies
3) underlie physical and emotional pain and discomfort
4) diminish our relational capacity
The good news is that we are nature and nature’s design includes inherent resilience. All humans experience some degree of distress and trauma. Fortunately, our power of resilience moves through us as a wave with the momentum of 4 billion years. Life’s hardships rarely end our ability to experience joy and other feelings of well-being. Based on severity and origin, there are different appproaches to healing past traumas, learning to manage the everyday ups and downs and navigating the unexpected storms to come. Somatic movement and inquiry can serve as a good companion for encouraging gentle healing and repair.
a pathway to healing and repair
When we are at ease our bodymind is mentally calm, emotionally steady and physically grounded. From a baseline of ease, we have a greater capacity for dealing with everyday stressors before feeling overwhelmed, frayed or anxious. From the perspective of the nervous system, a sense of ease and calm comes from accessing the rest and digest function of the parasympathetic nervous system (PNS).
Eliciting PNS tone provides:
1) physiological recovery
2) a felt-sense of inner stability and embodied support
3) access to creativity and unpredictability
One way to elicit the PNS is embodied active rest, or yielding. Yielding shifts activity from doing to being. This state of consiousness involves paying attention to sensing through our body. The transition from doing to being is simple, yet not always easy. For some folks, coming home to our body through the intimate practice of sensing is uncomfortable, awkward and intimidating. Sometimes, sensing practices reveal subconscious material. Somatic Groundwork is a trauma-informed method. Baked right into the movement system are grounding resources for support, cues that encourage personal sovereignty and intentional somatic containing.
Somatic Groundwork is an experiential and creative movement practice that is fascia-oriented. Through movement awareness, we experience the gift of feeling felt and influence changes in our primary regulatory systems- the fascial matrix and autonomic nervous system. The outcomes of practice include easing chronic symptoms from stress and under-recovery like pain, discomfort, and emotional dis-ease while generating positive changes in movement quality and function.