Treating the Whole Person: Part 1 - Regional Interdependence

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One of the confusing yet fascinating aspects of the human body is that the area that hurts is not necessarily where the problem lies. In fact, the site of pain is often not correlated with the source.1 This is why simply treating the site of pain can be partially or sometimes completely ineffective, as often there is more going on.

At Integral Physical Therapy, all of our therapists believe in treating the person as a whole, not just focusing only on the site of pain. Our treatments are often guided by a concept known as regional interdependence.2 This is a rather fancy term, but simply put regional interdependence means that different areas of the body are related. If there is a problem in one part of the body, it can affect another area. On the flip side, successful treatment often requires that multiple body regions/systems are addressed.

One common example of regional interdependence is the relationship between the knee and hip. We know from both clinical experience and research that people who have knee pain are more likely to have weak hip muscles than those without knee pain.3 Why is this the case? It turns out that knee stability and positioning during common physical activities like running, jumping, weight lifting is largely influenced by hip musculature.4 If your hips are weak, it’s difficult to control your knee position during activity. Our therapists are aware of this relationship, so if we see a patient with knee pain, we always screen the hips as well. If we find weakness, we can prescribe targeted exercises to address it.

Another interesting example of regional interdependence was recently published in the Journal of Physical Therapy Science, where the authors looked at treating tennis elbow with shoulder exercises.5 Tennis elbow refers to pain on the outside of the elbow, and treatment usually includes exercises that specifically strengthen the muscles that attach on the outside of the elbow. However, the authors of this study found that using shoulder stabilization exercises resulted in the same improvements as traditional elbow exercises. Even though the exercises targeted the shoulder, elbow symptoms improved.

What these two examples illustrate is that even though one body region may be the source of pain, strengthening other areas may be helpful if not necessary for the condition to the improve. This can be tricky to figure out on your own, so if you’re having ongoing pain or difficulty moving the way you want to, it’s helpful to see a physical therapist who knows how to assess and address these problems.

References:
1. Campbell J, Harte A, Kerr DP, Murray P. The location of knee pain and pathology in patients with a presumed meniscus tear: preoperative symptoms compared to arthroscopic findings. Ir J Med Sci. 2014;183(1):23-31.
2. Sueki DG, Cleland JA, Wainner RS. A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. J Man Manip Ther. 2013;21(2):90-102.
3. Rowe J, Shafer L, Kelley K, et al. Hip Strength and Knee Pain in Females. N Am J Sports Phys Ther. 2007;2(3):164-169.
4. Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010;40(2):42-51.
5. Lee J-H, Kim T-H, Lim K-B. Effects of eccentric control exercise for wrist extensor and shoulder stabilization exercise on the pain and functions of tennis elbow. J Phys Ther Sci. 2018;30(4):590-594.