Compensation vs. Direct Effect

By Dr. Jason Slagel | May 9th, 2022

Hey guys! Right now, we are talking about the differences between compensation and direct effect. What I will do is I will go overcompensation and direct effect, and then at the end I will talk about why this matters. 

Let’s start with compensation. Compensation is where there is an underproduction in one area of the body somehow and then an overproduction to make up for that deficit in another area of the body. Another way to say it is a lack in one area creates excess in another area. Another way to say it is under working of one area of your body creates overwork in a different area of your body. This is different from direct effect.

Direct effect has to do with cause and effect. Compensation is this; a lack in one area creates over working of another area. I am going to give a couple of examples. The first example is a nonphysical example. Imagine there are two co-workers that are working side by side to get a certain amount done in a day and one of the workers slacks off and is kind of lazy. The other worker must work harder to make up for that worker, but one of the characteristics of compensation is that there are multiple different options for how the first thing can be dealt with. The second worker doesn’t have to work harder, that is not the only option. The second worker can report the first worker to the boss and the boss can make that first worker work harder.  Also, the second worker can say “Hey! Forget this, the work is just not going to get done.” In that case, there could be an underproduction of work overall.  So, there are different options, different ways of compensating for that first worker not doing their job or under producing.

Let’s move on to the next example of compensation. A twisted ankle creates a limp. This is not a cause and effect because the limp is not the only way to compensate for a twisted ankle. A different option would be to walk slower while still walking with a correct movement pattern. 

Another example is if a person is carrying a heavy suitcase on one arm.  You may have seen people in the airport with their arms sticking way out of the side to compensate for the extra weight.  But sticking your arm out to the side with a heavy suitcase in your other hand is not the only way to compensate. You can also put your arm back in your side and lean your whole body over. So, there are a couple of different ways to deal with this situation. But in this situation a lack of balance is creating an over excess amount of leaning or sticking your arm out.

One of the clearer examples is if someone suddenly goes blind. Let’s say that a person gets in some type of accident and damages their eyes, so they no longer work. Their other senses are going to become more sensitive, and they are going to pick up that slack.  For example, their hearing might sharpen or increase. They might be able to hear better because they are forced to use their hearing more.  This hearing improvement is a compensation from going blind, it’s not a direct effect. If you go blind your hearing doesn’t automatically get better, it doesn’t always work like that. There are a lot of different ways that your body can handle going blind and not all of them have to do with hearing improving. There are a lot of functional examples that are very common as far as compensation goes.

Now when we talk about functional examples that’s different from structural examples. Structural examples don’t typically have this compensation that we are talking about, structural examples deal more with direct effect.

Let’s switch over to direct effect, and you will see the difference here. Direct effect has to do with the cause effect relationship.  Now one of the characteristics of direct effect is that there are not multiple different ways of dealing with it like in compensation.  With direct effect there is one cause, and it is causing one effect, and that one effect must happen, there is no other option. Think of a light switch and a lightbulb. If you turn the light switch on or up, the lightbulb turns on.  That’s the only effect possible. It’s not like you turn the light switch on and then suddenly a cat appears.  There is no option other than the lightbulb turning on. If you turn the light switch down, then the lightbulb turns off. It’s just a direct effect.

A physical example with your body is this: if you get a cut, you bleed. The blood is not compensating for the cut, it’s just a direct effect.  Just like the lightbulb is not compensating for the light switch.  There is no compensation that needs to be done, there is no deficit, it’s just a direct effect. We can look at another example with the circulatory system.  When your heart pumps, your blood circulates. The heart pumping is the cause, blood circulation is the effect.  It’s not like your heart pumps and your bald spot on your head fills in.  There is nothing like that.  Your heart pumps and your blood circulates, it’s a direct cause-effect.  The blood circulating is not compensating for your heart pumping, it’s directly being affected by it.

Another example with your physically body is if you get a light in your eyes, your pupils will constrict. It’s a direct effect, nothing else is going to happen with your pupils.  Your pupils are not going to dilate, and your eyesight is not going to improve or diminish; it’s just light in the eyes, pupils constrict.

Hopefully that makes it clear the difference between compensation and direct effect. Compensation is an underproduction is creating an overproduction in a different area with multiple different options of how the compensation can occur.  A direct effect is one cause, one effect, no other options. 

Why does this matter? This matters because knowing whether it’s a compensation or a direct effect forms the intervention. Let me give you two examples.  If someone suddenly goes blind, like what we mentioned earlier, then the intervention is to help that person compensate well.  You don’t try to keep fixing the unfix-able eyes and ignore compensating, you help them to learn how to hear better, you help them learn how to read braille, etc.  On the other hand, if someone is bleeding you don’t try to compensate for that.  What you want to do is go to the direct cause and fix the cut.

As you can see whether it’s a compensation or a direct effect is going inform the intervention. In my office I look at if someone’s posture pattern is being caused by something called brain stem pressure.  So, I am looking at a direct cause and effect relationship. If I find someone where their posture pattern is being caused by brain stem pressure, then I fix that cause and take the pressure off the brain stem.  Now, this process is like a light switch and a light bulb. When I get pressure off the brain stem, the posture pattern automatically resolves. The person’s posture straightens up right after I get the pressure off the brain stem.

In review, with compensation there are multiple different options and underproduction in one area is causing an overproduction in another area. Direct effect is just a simple cause and effect relationship, one cause causing one effect just like a light switch turning on a lightbulb.

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