Regional interdependence is a model of musculoskeletal examination and therapeutic intervention that identifies the source of pain through a series of general and specific movement observations, muscle testing and palpation.
Often times, the contributors of musculoskeletal disorders may not be as straight-forward as they appear.
Treating the site of pain, when it is not necessarily the source, would be analogous to using a sponge to clean up some water on the floor, without paying attention to the leak.
Examination of proximal and distal joints (above and below) in the same region of the pain and dysfunction is vital to the concept of regional interdependence.
The regional interdependence model focuses primarily on where the movement impairments present, which may be at the site of pain or at proximal or distal joints.
The area of pain is often compensatory with resulting inflammation. Addressing the inflammation with physical therapies, nutritional supplement and diet is important, but should be secondary to restoring normal function, be it stability or mobility at the dysfunctional areas identified through a functional examination.
How can you tell if your pain is coming from the joints above or below?
One of the easiest screens to perform is the Overhead Squat Assessment. Each joint region has specific biomechanical motions based upon structure, function and surrounding joints (both above and below).
Assessment of the kinetic chain can be done by systematically viewing the body at specific check points statically and dynamically.
These checkpoints include:
3. Lumbo-Pelvic-Hip Complex (LPHC)
4. Shoulder and cervical spine (Upper Body)
Compensations occur when a specific motion deviates from its normal path, resulting in impaired movements.
Movement impairments can lead to muscle imbalance, joint dysfunction and nervous system dysfunction.
The Overhead Squat:
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. turn 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.
By observing movement distortions, over active and under active muscles, joint dysfunction and nervous system imbalances can be identified and a specific treatment plan created.
If you have chronic recurrent pain, unresponsive to prior care a movement assessment and regional interdependence approach may provide the answer to our problem.