Tag Archives: pain

Loaded Adaptation, A Guest Post by Physiotherapist Blaise Doran

What springs to mind when you think of your own adaptability?  Do you think dichotomously about your physical self, and/or psychological self?  Would you say you were adaptable? And if you did, what would that mean, what would it look like, and how would you explain it to others? 

These are innocent enough questions, superficially.  If we paused to think, though, perhaps the concept of adaptability is a loaded one when examined in the context of the professions involved in (physical) rehabilitation.  I suggest we need to give it a bit more attention.

If we were to be pedantic, we all have the capacity to adapt, because we are constantly doing so; responding to stimuli that emanate from our internal and external environments.  Again, an apparently simple concept, and one which was a starting point for a Twitter thread relating to the term “maladaptive”, and why I find it troublesome.

For those who (perhaps wisely) do not use Twitter, here is a précis:  Maladaptive is a term that is commonly used in the context of the nervous system, and neuroplastic activity.  Its use has become popular when describing putative mechanisms that might explain observable and reported phenomena, particularly in the contexts of neurological and persistent pain rehabilitation. (The former is the domain in which I used to work, the later in which I currently work).  

My chief complaints when it is applied in relation to the nervous system might be summarised with the following points:

  • Maladaptive according to whom?
  • The complex systems within people are influenced by many internal and external stimuli, with dispositional loading arising from numerous factors (including, but not limited to, pathology, epigenetics, and environment).
  • The nervous system (as a case in point) simply adapts to the new order of things, so why the value-judgement of “badness” implied by the prefix mal?
  • Might it better be called “adaptive” or “responsive” neuroplasticity; or simply neuroplasticity?

Perhaps this argument may be viewed as a semantic, or even too fastidious.  We may run the risk, however of making loaded judgements based on entrenched concepts of statistical normativity injudiciously applied to a complex adaptive system.  

Some have rightly commented that the mal component of maladaptive may relate to the subjective experience that emerges from the neuroplastic changes, which have an impact on preferred function and participation.  The value judgement in this case is therefore being applied by the individual. This is an interpretation that makes sense up to a point (and it is not an entirely new idea, as this well-written essay expands upon.)  

I would suggest, then, that it would be more semantically accurate to call that an individual’s maladaptive experience (resulting from neuroplasticity).  After all, words matter.

About The Author

This is a guest post by physiotherapist Blaise Doran. Blaise works at the Royal Children’s Hospital in Melbourne in the paediatric chronic pain unit.

Blaise will be presenting for Beyond Mechanical Pain in Melbourne on Wednesday the 25th of September, 2019.

You can purchase tickets via the link below: