The Nervous System Does Not Care About Perfect

Why changing the position is not the same as changing the strategy

Some of the most important things I have learned about the human body came from treatments that worked, but not for the reasons I thought.

Almost 12 years ago, a woman with cervical dystonia was referred to me because her massage therapist had noticed something unusual. It was not her neck, although that was the part of her body receiving most of the clinical attention. It was her pelvis.

When I assessed her, I found one of the most asymmetrical pelvises I had ever seen. One side appeared dramatically higher and more rotated than the other. What surprised me, however, was not the extent of the asymmetry. It was how quickly and easily it changed.

Within a relatively short period of time, her pelvis looked remarkably different.

As she was leaving, I offered a prediction that was perhaps more honest than reassuring.

“I think you are going to wake up tomorrow feeling one of two ways,” I told her. “You will either feel amazing, or you will feel as though you have been hit by a truck.”

The next morning, an email appeared in my inbox.

I no longer remember exactly what she wrote. After all this time, the details have faded. But I will never forget the subject line.

AMAZING!!!!!!!!!!!!!!!!!!!!!!!

About an hour later, another email arrived. This one was from a dentist I had never met. His name was Dr. Curtis Westersund, and he was leading the multidisciplinary team responsible for her care.

Much of that email has also faded from memory, but one question has stayed with me ever since.

“Where have you been all my life?”

That email marked the beginning of a friendship and professional collaboration that continues to this day. Much of the multidisciplinary work that has shaped the last decade of my career can be traced, at least indirectly, back to that patient and her remarkably crooked pelvis.

Clinically, however, the story was not quite the triumph those two emails seemed to suggest.

The result did not hold.

At the time, I was disappointed. Looking back, I am not sure why I expected otherwise.

Her pelvis had become dramatically more symmetrical in a single treatment. The change was real, and her response was extraordinary, but nothing about the speed of that correction suggested stability. Her nervous system had briefly experienced a different option. It had not yet learned to prefer it.

I was still thinking primarily in mechanical terms. The pelvis had changed position, so I assumed the challenge was keeping it there.

Today, I see a more important distinction.

We had changed the position. We had not yet changed the strategy.

Why would one brief experience outweigh years of adaptation, repetition and motor learning? The remarkable part may not have been that her body returned to its old pattern. The remarkable part was that it had been persuaded to leave it, even temporarily.

For much of my career, I believed some version of an idea I had heard from many influential teachers: the nervous system is always seeking perfection.

In different ways, rehabilitation pioneers such as Dr. Ida Rolf, Thomas Hanna and Pete Egoscue suggested that the body possesses an innate tendency toward balance, symmetry and more efficient organization. Given the right input, or with the right obstacles removed, the system would naturally begin finding its way back toward something closer to ideal.

It is an attractive idea. It also helped move rehabilitation away from treating muscles and joints as isolated parts. These pioneers taught us to see relationships and to respect the body’s extraordinary ability to reorganize itself.

But the story did not end there.

Vladimir Janda showed how the nervous system can become organized around predictable compensatory patterns. Movement is not merely organized; it is learned. Strategies become familiar and automatic, even when they are no longer serving the body particularly well.

Modern motor-control research has taken that idea further.

The nervous system is not necessarily searching for perfection. It is searching for a workable solution.

Consider what happens when you walk across an icy parking lot. Your steps shorten, your knees remain slightly bent, your trunk stiffens and your arms drift away from your sides. You may shuffle toward the car with all the elegance of someone carrying a full cup of coffee across a trampoline.

Nobody would describe that as ideal movement. Yet if it prevents you from falling, it has done exactly what it was supposed to do.

The same principle applies when the challenge is pain, instability, fatigue, unreliable sensory information or a body part that no longer feels trustworthy. The nervous system is not asking, “What is the perfect way to move?” It is asking, “What strategy gives me the best chance of completing this task under the circumstances I have today?”

It can shift load, increase stiffness, reduce movement or rely more heavily on a familiar pattern. The solution may not be elegant, and it may eventually become costly, but it can still make sense.

A patient may shift onto one leg because the other side feels unreliable. They may brace the jaw because stiffness creates predictability. They may rotate the pelvis because that position helps keep the head and eyes level.

A compensation is therefore not necessarily evidence that the body has failed. It may be evidence that the body found a way to keep functioning.

The trouble is that a useful short-term solution can become an expensive long-term habit.

Earlier in my career, when I saw an obvious asymmetry, I was much more inclined to ask, “How do I correct what I am seeing?”

Today, I am more interested in asking, “What is this pattern accomplishing?”

That does not mean every compensation should be left alone. Some overload tissues, reduce capacity or gradually trap the patient inside an increasingly narrow range of movement options. But before removing a compensation, we should understand what job it is doing.

Otherwise, we may take away the only solution the nervous system currently trusts.

Sean reminded me of that more recently.

I wrote briefly about his case in The Biomechanical Brain. He was profoundly hypersensitive, and there were legitimate concerns about possible hypermobility in his cervical spine. Everything about his presentation suggested a nervous system that had become exceptionally protective.

Looking back, I should have been more conservative with my corrective exercise selections at the beginning.

The exercises themselves were not necessarily wrong. In fact, they eventually became part of the solution. The problem was that I asked his system to accommodate too much change before it was ready.

His symptoms worsened before they improved.

It was the closest I have come in the past six or seven years to what clinicians sometimes refer to, rather inelegantly, as “blowing someone up.” It was an uncomfortable reminder that a well-reasoned intervention can still exceed what a hypersensitive nervous system is prepared to tolerate.

At first, I saw Sean’s reaction mainly as a dosing problem. I had chosen too much, too soon. That was true, but it was not the entire lesson.

His stiffness, guarding and altered movement were not simply defects waiting to be removed. They were part of the most effective protective strategy his nervous system could muster at the time. By asking for too much change too quickly, I may have reduced some of that protection before his system had enough confidence or stability to replace it.

He did not worsen because change was impossible. He worsened because the proposed change was not yet usable.

The cervical dystonia patient and Sean taught me opposite sides of the same lesson. In one case, a dramatic improvement appeared quickly but was not durable. In the other, a reasonable intervention produced more change than the nervous system was initially prepared to tolerate.

One new strategy was not yet stable. The other was not yet tolerable.

Neither problem could be understood by looking at mechanics alone.

This has helped me reinterpret the familiar patient who improves dramatically, then returns saying, “It didn’t hold.”

For years, I thought about that almost entirely in mechanical terms. What moved back? What tightened again? What weakened?

Those questions still matter, but they are incomplete.

The more important question is whether we changed the patient’s position or changed the patient’s preferred solution.

A dentist can create a new bite relationship. A therapist can restore movement to a joint. A chiropractor can change cervical mechanics. A corrective exercise program can improve pelvic alignment. Each intervention creates a new possibility, but the nervous system still has to decide whether that possibility is stable, useful and worth adopting.

A change that looks excellent in the treatment room may not yet be the solution the nervous system prefers outside it.

This is especially relevant in dentistry. Changing occlusion does more than change where the teeth meet. It also changes sensory information entering the nervous system and alters the relationship between a familiar motor command and its expected result.

The patient closes the jaw, but the contacts feel different. The nervous system must learn what that new relationship means and how to use it.

Some patients recalibrate quickly. Others guard, shift, clench or return to an older strategy. That does not automatically mean the dentistry is mechanically incorrect, nor does it mean the patient’s experience is imaginary. It may mean the intervention has created an adaptation problem the nervous system has not yet solved.

The same is true within the Alignment First Protocol, the corrective exercise system I developed. Improving pelvic position is not the final goal. We begin there because, in many patients, creating a more stable and symmetrical foundation makes further changes easier. More importantly, it often serves the deeper objective: giving the nervous system a better movement option, then helping make that option useful, repeatable and available across different contexts.

That is why assessment and retesting matter. We are not merely asking whether a joint moved or a muscle lengthened. We are asking whether changing one input altered the system’s chosen output—and whether the new solution remains available once the patient stops thinking about it.

A movement that can be demonstrated consciously has not necessarily been learned automatically.

We can create a better position without establishing a better solution. The patient may access the new pattern in the clinic, only to have the old one return at the workstation, in the gym, while chewing, during sleep or under stress.

The old learning was never erased. It remained available, waiting for familiar circumstances to call it back.

Lasting change therefore requires more than moving anatomy. The newer strategy has to become sufficiently useful, tolerable and well practised that the nervous system begins selecting it without constant supervision.

These days, when I see an asymmetry, I still want to understand whether it contributes to the patient’s problem. I still believe that improving alignment can create profound changes elsewhere in the body.

But before I try to remove the pattern, I ask a different question than I would have asked earlier in my career.

What problem is this solving?

Because if I do not understand why the nervous system chose the present strategy, I have very little chance of replacing it with something better.

The nervous system may not care about perfect. It cares whether the solution works.

Our job is to help make a better solution available, tolerable and eventually worth choosing.