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Thoughts & Ponderings

Joint x Joint approach.

9/13/2022

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The human body is a complex thing. It has multiple systems and moving parts working together on a constant basis. Often when someone has pain, it’s narrowed to a specific area. “My back hurts”, “my knee hurts”, “My neck hurts”, etc.  This is the location of the pain, but maybe not the source/root of the problem.
When addressing pain it’s important to address the body as a unit. There are of course exceptions to this rule. If someone has a broken bone, torn ligament, or other traumatic injury, then yes, focus should be on that specific area, but don’t overlook how that injury can affect the rest of the body. When addressing musculoskeletal pain in the clinic, my first goal is to help reduce the pain to the area. This can be done by managing swelling and improving blood flow to the area to help repair any tissue damaged or under stress. When the pain is managed the next step is to have a look at the body as a system. I prefer movement assessments that utilize the joint by joint approach. 
The joint by joint approach looks at the body as a group of stacked joints, alternating stable joints and mobile joints. All joints require some degree of both stability and mobility. Individually specific joints may need more mobility, while others need more stability.  Working from the ground up: 
  • The foot primarily needs stability 
  • The ankle primarily needs mobility 
  • The knee primarily needs stability 
  • The hip primarily needs mobility 
  • The lumbar spine (low back) primarily needs stability 
  • The thoracic spine (mid back) primarily needs mobility
  • The Scapula (shoulder blade) primarily needs stability 
  • The glenero-humeral (shoulder joint) primarily needs mobility
The knee is a fairly straight forward joint, it hinges. Yes, technically it allows for a small amount of rotation, but in the grand scheme of things it is a “stable” joint. The joints above and below the knee, the hip and the ankle, have much more freedom of movement and fall into the category of a “mobile” joint. When these joints become restricted or immobile they become dysfunctional in their movement patterns. The amazing thing about the human body is that it wants to, and will, find a way to “pick up the slack”. Ok, the hips are not able to move the way we need it to? Let’s find that range somewhere else. This also applies to many other areas of the body, like the shoulder, ankle, spine, and so on.
An important skill to addressing these issues is knowing which joints to address. If you are having low back pain…is it being triggered by lack of mobility in the hips or thoracic spine? Or are you lacking stability/strength in the lumbar spine and core? If lack mobility in the joints above and/or below the pain is the issue, packing on piles of core strengthening exercises are unlikely to solve the problem. Conversely, all the bodywork and mobility drills a person can handle is unlikely to solve the problem if it’s coming from lack of strength and stability. Often, but not always, it’s a little of both that gets results. 
    This is important to keep in mind when recovering from acute/traumatic injury. Often the focus is on the injury. As I mentioned above, broken bones, muscle tears, etc. should be addressed first, but the body will also adapt to dysfunction if that injury requires casting or surgical intervention that limits weight bearing or movement restrictions while recovering.. If you tear a ligament and damage your knee, have it repaired and end up in a brace for a few weeks, what does that mean for the rest of your body? You now lost the function of your knee while it’s recovering. The body will adjust and attempt to “pick up the slack” in areas away from the injury, putting more stress on other muscles and joints. When the cast/brace is removed, or you are able to return to full weight bearing activities, often the body will continue with the new learned movement caused by the injury. Part of your rehab and recovery should be checking in on the movement patterns and functions of those other joints that could be affected and addressing those along the way. 
This can be an issue that is sometimes overlooked in the recovery process. This is why you find people that have had multiple procedures, injections, and surgeries and are still dealing with that nagging pain. The body is a whole and should be treated that way. 

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  • Home
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