Analyzing the “Big Picture” At Mana Physical Therapy

Relative to musculoskeletal problems, “regional interdependency” refers to the concept that a complaint of pain or dysfunction in one region of your body (i.e knee pain) may be associated to a dysfunction in an unrelated anatomical region (i.e stiff hip joint).[1]    Although this concept is not ground breaking, it is crucial that we do not underestimate “the big picture” when assessing movement dysfunction in the human body.

Take patient A for example (we will call him Kramer).  Kramer enters your office with a script for right knee pain.  Kramer reports his chief compalint is pain and weakness in his right knee while ascending and descending stairs during work at his bagel shop and when entering his home.   He has X rays of his right knee which show minimal osteoarthritis.  This pain has been on and off for 2 months but progressively getting worse and more constant.

Often, difficulty with ascending/descending stairs is due to quadriceps weakness (the muscle in the front of your thigh), however, our hip, trunk, and even ankle can limit your ability to perfrom this functional task.  For example, if our hip rotators are weak or stiff, they will not have the proper balance of strength or motion to assist the quadriceps with the task.  If your trunk is weak, it will not provide the proper stable base to perform the task.  If your ankle joint is stiff, the force transmitted up your kinetic chain will ask your knee and hip to work even harder.

Commonly, pain in the knee is caused by poor function and weakness in the hip or trunk (and vice versa).  In addition, knee pain can also be amplified due to poor mechanics or lack of mobility in the ankle.   As a physical therapist, it is our job to assess the whole body to gain a true perspective of how your body system is performing (and not just focus on the body part that is painful!)

Here at Mana Physical Therapy, we are trained and certified in Selective Functional Movement Assessment (SFMA).  SFMA is a full body dynamic movement assessment that exposes small and large imbalances in your kinetic chain.  As a certified provider of SFMA, we will examine your whole kinetic chain and provide you with precise and specific corrective exercises to allow your body to perform at its maximum capacity.

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(1). Wainner RS, Whitman JM, Cleland JA & Flynn TW.  Regional Interdependence:  A musculoskeletal examination model whose time has come. J    Orthop Sports Phys Ther 2007; 37 (11): 658-660