The Body Remembers What Was Never Fully Resolved

There is a psychological phenomenon called the Zeigarnik effect.

In the 1920s, psychologist Bluma Zeigarnik observed something interesting: waiters seemed particularly good at remembering orders that had not been paid for yet. But once the transaction was completed, those orders and details became easier to forget.

Her later experiments helped establish a broader idea:

“unfinished” or interrupted tasks tend to remain more accessible in our memory.

The popular interpretation is simply:

The mind tends to hold onto what still feels “unfinished”.

Since I have had the luxury of working with returning patients for multiple years, I have noticed that there is an interesting parallel in the physical body with this thought. Not because muscles literally "remember" an injury the way the brain remembers an unpaid restaurant bill. They don't.

But because the nervous system is constantly learning from experience.

And sometimes the problem that started the process resolves while the adaptation created around it remains.

Surgery Can Fix the Structure Without Instantly Erasing the Adaptation

Imagine someone has knee surgery.

Before surgery, perhaps they spent months dealing with pain. They stopped fully loading the leg. Their stride seemed shorter. They shifted more weight onto the opposite side. Certain muscles began contributing more while others contributed less.

Then surgery happens.

The damaged structure is repaired. We’ll say the mensicus or even the ligaments as an example.

And then the incision heals.

Rehabilitation restores “strength”.

Eventually, the surgeon says everything looks good.

But the person says:

"I still don't move the same."

The surgery may have successfully addressed the pathology without immediately reversing every movement strategy that developed because of it.

The body had months or sometimes years to learn how to function around the problem.

Those adaptations did not and will not disappear even after the original tissue damage healed.

In most cases, physical rehabilitation can reinforce the faulty adaptations.

This is one of the central ideas behind how I approach manual therapy:

Pain resolution does not always equal adaptation resolution.

Chronic Pain Can Create the Same Problem

Now imagine there was never surgery.

Instead, someone has dealt with back pain for five years.

Perhaps from a job that required them to sit all day or back pain that developed during pregnancy.

During those five years of pain, they have unconsciously changed thousands of movements.

How they stand.

How they sit.

How they bend over.

How they get out of bed.

How they walk.

How they breathe during uncomfortable movements.

How much weight they place through one leg.

Which muscles they recruit first.

Which movements they avoid entirely.

None of those decisions necessarily require conscious thought.

The nervous system is extraordinarily good at finding ways to keep us functioning.

That is adaptation.

And in the beginning, adaptation can be incredibly useful.

If something hurts, changing how you move can allow you to continue working, caring for your family, exercising or simply getting through your day.

The adaptation isn't necessarily the problem. It may have been part of the solution to feeling less pain.

The question is what happens later.

After your body has had enough.

What Once Protected You Can Eventually Limit You

The original problem may improve.

Inflammation may settle.

The injured tissue may heal.

Strength may return.

Imaging may even look reassuring.

But the body has accumulated thousands or millions of repetitions using the strategy that helped it through the difficult period.

Why would the nervous system immediately abandon something that worked?

From its perspective, that strategy was successful.

So the body may continue using it.

A person who protected the right knee may continue shifting toward the left.

Someone who guarded their abdomen following surgery may continue moving their trunk differently long after the incision heals.

Someone who spent months avoiding hip extension because it hurt may continue walking with a shortened stride after the original problem has improved.

Over time, compensation becomes repetition.

Repetition becomes adaptation.

And adaptation can become someone's new normal.

That doesn't mean every persistent pain problem is caused by an old compensation. Chronic pain is far more complicated than that. Sleep, stress, inflammation, tissue health, previous injuries, nervous-system sensitivity, medical conditions, activity levels, beliefs and many other factors can contribute.

But persistent adaptation is one piece of the puzzle that deserves attention. Yet often gets missed.

Then There Are Scars

Surgery introduces another variable that I find specially important clinically:

the scar itself.

A scar isn't simply a mark on the skin.

Surgery involves multiple layers of tissue. Depending on the procedure, skin, superficial fascia, deeper connective tissues and other structures may be affected.

The nervous system also receives an enormous amount of sensory information from the area during injury, surgery and recovery.

That doesn't mean every scar causes dysfunction.

But when someone has persistent symptoms following surgery, I don't think scars should automatically be treated as irrelevant simply because they are old.

They become part of the person's history.

And history matters when you're trying to understand how the body arrived at its current strategy.

The Question I Ask

When someone comes into my office with chronic pain, I don't only want to know:

"Where does it hurt?"

I want to know:

"What has this body adapted to?"

Previous injuries.

Surgeries.

Scars.

Repetitive work.

Sports.

Periods of immobilization.

Changes in activity.

Protective movement.

Years of loading the body in a particular way.

Even when the original event happened decades ago, it may provide useful context.

Then I assess.

I look at movement.

I compare sides.

I test how different muscles contribute.

I look for areas of persistent tension or altered recruitment.

And importantly, I retest.

If I address an area and the person's movement or muscle response immediately changes, that gives me information.

I'm not trying to prove that one muscle was the "root cause" of everything.

I'm trying to understand the strategy the body is currently using.

Where the Human Adaptation Model Fits

This is the idea behind my Human Adaptation Model (HAM).

HAM isn't based on the idea that the body is broken.

It's based on the opposite idea:

the body is extraordinarily good at adapting.

Injury creates adaptation.

Surgery can create adaptation.

Pain creates adaptation.

Repetitive movement creates adaptation.

Immobilization creates adaptation.

Our occupations, sports and daily habits continually provide inputs that shape how we move.

Most of those adaptations are useful.

Some disappear when they are no longer needed.

Others stick around.

My job isn't simply to chase the painful area.

It's to look for the adaptations that may be influencing how that area is currently being loaded and used.

Sometimes the most interesting finding isn't located where the patient hurts.

Manual Therapy Doesn't "Delete" the Past

I don't believe manual therapy magically erases an old injury.

And I would be careful about saying that we "release trauma stored in the tissues" or that touching a scar somehow deletes the body's memory of surgery.

The physiology is more nuanced than that.

What manual therapy can do is provide new sensory input.

It can temporarily change pain.

It can change perceived stiffness.

It can influence muscle tone and movement.

And when those changes are paired with movement and exercise, the person gets an opportunity to experience something different.

The body receives new information.

A movement that previously felt threatening may feel safe.

A muscle that wasn't contributing effectively may participate differently.

A joint may tolerate a position it previously avoided.

Then movement reinforces the new experience.

Manual therapy can help change the conversation. Exercise gives the nervous system an opportunity to practice the new answer.

Maybe the Body Needs Evidence

This brings us back to the Zeigarnik effect.

Psychologically, unfinished experiences can remain unusually accessible because they haven't reached completion.

Physically, I think there is a useful, not literal, parallel.

Perhaps an old protective strategy persists because the nervous system has never received enough convincing evidence that another strategy is now available.

The tissue healed.

The surgery succeeded.

The inflammation disappeared.

But the movement strategy that got the person through it remained useful enough to survive.

So instead of asking:

"Why hasn't my body gone back to normal?"

A better question may sometimes be:

"What reason has my body been given to want to change?"

This is my different way of looking at rehabilitation.

The Goal Isn't to Return to the Past

This is ultimately what I want patients to understand.

We're not trying to make your body forget what happened.

Your body adapted for a reason.

Those adaptations helped you get through an injury, surgery, painful period or repetitive demand.

They were part of your solution.

But solutions are context-dependent.

A strategy that was useful six months after surgery may not be the strategy you need six years later.

So the goal isn't to erase your history.

The goal is to give your body enough new information that it no longer has to rely on yesterday's solution.

Because sometimes what looks like dysfunction today may simply be the accumulation of adaptations that once made sense.

And sometimes healing the original problem is only the first step.

The next step is helping the body discover what it can do tomorrow.