Pain in the Chain

Many of you might remember the campfire song, “Dry Bones”, with the lyrics “the toe bone’s connected to the foot bone”, etc. This song is actually quite accurate and in fact, the Human Movement System (Kinetic Chain) is a scientific explanation illustrating the connection of the feet to the head.
The human movement system is made up of three interrelated components:
1. Muscular system- soft tissues
2. Skeletal system- joints
3. Nervous system- coordinates movements between muscle groups.
Do you have recurring injuries or experience only temporary relief from therapy (i.e. physical therapy, massage, chiropractic etc.)? If so, then your problem may lie elsewhere in the Kinetic Chain.
Evaluating the integrity of the Kinetic chain as well as knowledge of these interrelationships, can help us predict potential injuries and explain why a painful condition may not be responding to therapy.
A quick and easy way to identify dysfunction in the Human Movement System is by evaluating an overhead squat. The overhead squat looks at movement at the following Kinetic chain checkpoints:
1. Foot and ankle
2. Knee
3. Lumbo-pelvic-hip complex
4. Shoulder/cervical spine
5. Head
The Overhead Squat:
The overhead squat helps to identify postural distortion patterns. These patterns are characterized by muscles that tend to be overactive (shortened) and muscles that tend to be underactive (lengthened). Once these muscles are identified, preventing injuries or treating chronic painful conditions can be as simple as lengthening shortened muscles and strengthening lengthened muscles.
Stand facing a full-length mirror with your feet shoulder-width apart and pointed straight ahead and your arms raised overhead. Squat three times. Hold the pose at the lowest point in your third squat and take note of your body position at the checkpoints. Perform the movement again and have someone watch from the side and behind.
Common movement distortions include:
1. Feet turn out or flatten
2. Heels rise
3. Knees moves in or out
4. Shoulders elevate and/or arms fall forward
5. Low back shifts to one side, arches, rounds or there is excessive forward lean of the torso

Because of the interrelationship of the chain, distorted movements at any area will affect the entire chain. For example, lack of mobility at the ankle joint will result in compensation at the knees. Because the knees require stability, this could result in knee pain and dysfunction. The knees will compensate to allow more movement e.g. turning in or out, placing abnormal tension on muscles that attach to the pelvis and lumbar spine. The lumbar spine will compensate by an increase in the lordotic curve, causing an anterior pelvic tilt. This results in tension on the latissimus dorsi muscle which connects the low back to the shoulder. A tight latissimus dorsi muscle will alter the alignment and motion in the shoulder, potentially leading to shoulder pain and forward head carriage. At the top end of the chain, forward head carriage can lead to neck pain, headaches and other chronic painful conditions in the upper extremities.
Treating Kinetic Chain Dysfunction:
The first step in treating Kinetic Chain Dysfunction is identifying the involved muscles and joints. If there is chronic pain or recurring injuries, then it would be prudent to have a qualified health professional do this. Treatment can initially consist of manual therapies to correct muscle imbalance and joint dysfunction (e.g. trigger point therapy and mobilization/manipulation) and then progress to corrective exercise.
The National Academy of Sports Medicine (NASM) has developed a corrective exercise routine that consists of:
1. Inhibiting tight muscles by using foam rollers (self myofascial release)
2. Lengthening tight muscles through static stretching
3. Activating weak muscles through isolated strengthening
4. Integrating functional movements to coordinate and retrain optimal kinetic chain function
If you have chronic pain or recurrent injuries, remember “the bane of pain lies in the chain”.

Dr. Lecovin is a chiropractor, naturopathic physician, and acupuncturist. He graduated from The Los Angeles College of Chiropractic in 1990, earned a master in nutrition from the University of Bridgeport in 1992 and then went on to complete the naturopathic and acupuncture programs at Bastyr University in 1994. He holds additional certifications in exercise from the National Strength and Conditioning Association (NSCA- CSCS) and National Academy of Sports Medicine (NASM- CES and PES). He is also certified in sports nutrition (CISSN) by the International Society of Sports Nutrition.
Dr. Lecovin specializes in treating musculoskeletal pain. He integrates dry needling/trigger point acupuncture, soft tissue release, neuromuscular reeducation, joint manipulation, corrective exercise and therapeutic nutrition. In addition he combines exercise and nutrition for weight management and performance enhancement.

About the Author

Dr. Geoff LecovinNaturopathic Physician/Chiropractor/Acupuncturist/Certified Strength and Conditioning Specialist/Corrective Exercise Specialist/Performance Enhancement Specialist/Certified Sports Nutritionist/View all posts by Dr. Geoff Lecovin