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Regional Interdependence


Many of our patients come into Made 2 Move with back pain and wonder why our therapists take a look at everything from the way their hips rotate to the way their ankles flex and extend. They ask us, “Why are you looking at my hips and ankles, it’s my BACK that hurts, not my hips and ankles.” Or you come to your first session at Made 2 Move for knee pain and your PT starts testing your glute strength and ankle range of motion. At first, this may seem strange and unrelated to the issue that brought you to PT. You may think: “this PT is whack- did he/she even read my chart?! I have KNEE pain!”



This brings up the concept of regional interdepencnce. Regional interdependence is the concept that “seemingly unrelated impairments in remote anatomical regions of the body may contribute to and be associated with a patient’s primary report of symptoms” (Sueki et. al 2013).


What does this mean for patients in physical therapy? It means that a treatment targeting the hips could relieve your low back pain! Or a treatment targeting your ankle mobility could lead to that nagging knee pain going away during back squats! Let’s take a look into how the concept of regional interdependence can positively contribute to your healing and comeback from injury.


What is regional interdependence?

The concept of regional interdependence is not a new, trendy buzzword that is being thrown around on Instagram. Rather, regional interdependence is a concept that was being discussed in 1977 literature in which two researchers noted, ‘Dysfunction in any unit of the system will cause delivery of abnormal stresses to other segments of the system with the development of a subsequent dysfunction here as well” in regards to the pelvis’ role in sciatic (the big nerve running through your glute and posterior thigh) and low back pain (Sueki et. al 2013).


Essentially, regional interdependence is the notion that if you come in with knee pain, it is the job of your PT to examine the structures above, below, and around the knee. Is your ankle mobility optimal? Are your glutes and quads strong? It isn’t just about the knee. Similarly, if you have pain in the front of your shoulder, your PT should yes, look at the muscles that attach around the shoulder, but also at the muscles on your back and the way your spine rotates and bends.


One study set out to see if there was a link between hip range of motion/strength and upper body (elbow or shoulder) injury in high school baseball players. 85 out of the 135 baseball players studied reported having an elbow or shoulder injury in the past 3 years. Researchers noted that the 85 injured players had lower hip strength than their non injured coutnerparts (Hamano et. al 2021).The overarching premise about regional interdependence: it’s all connected.


This interconnectedness goes beyond just the muscles, tendons, bones, and ligaments. It is not purely mechanical ie. the body parts and their relation to one another. There is a neurological component as well. Pain reported by patients decreases in the knee following a hands on treatment to the hip. How is this possible? While the exact neurological pathway cannot be said with certainty, it is likely a combination of alterations in chemical release and your brain’s interpretation of the pain, all the way down to the neuronal level.


How is this relevant to my injury?

Now you may be wondering- okay but I literally have a (insert acute injury here), like a muscle strain or sprained ankle. Or you may have an overuse injury that you can’t recall a specific mechanism of injury. Regardless of the injury, the concept of regional interdependence applies.


You are coming back from a rotator cuff tear but can’t throw the baseball or pickup your racket yet? No worries, your Made 2 Move PT knows that the hip transfers power through the core and into the shoulder to throw the baseball or swing your tennis racket. Thus, while your shoulder is recovering, we can do core and hip strengthening coupled with non-provocative movements at the shoulder.


Another example is the T-spine’s relationship with neck and upper extremity pain. The T-spine is the spinal section below the neck, consisting of 12 vertebrae in the middle of your back. A 2015 study looked at the regional interdependency of the T-spine and its relation to this neck or upper extremity pain and found that when the PT applied mobilizations to the T-spine, it lead to an increase in range of motion and decrease in neck pain, even though the PT did not directly address the neck. (McDevitt et. al 2015).


Are you the runner with knee pain? The same concept applies! We can strengthen your hip, back, and abdominal muscles, make sure your ankle is absorbing forces properly, and balance your total volume. Addressing all these variables will likely lead to the knee being less aggravated.


Can we say for certain that all of these improvements in movement and decreases in pain are attributable to the regional interdependence of body systems and the treatment approach we applied? Of course not. That would be far too reaching of a statement. But the evidence is clear: everything in the body is connected in some way even if we can’t pinpoint the relatedness.


The Made 2 Move Approach

Utilizing a regional interdependence approach allows for a thorough examination by your physical therapist that will guide later treatment. Seeing the body through the lens of interconnectedness allows therapists at Made 2 Move to not miss a vital piece of your puzzle that could help speed up the healing process. Just looking at your site of injury is like driving with blinders on. You would never do this! Similarly, your doctor should never simply examine your site of injury. Examining all the structures around the site of injury to see if they are contributing to your injury allows you and your therapist to see your body and prognosis through an entirely new lens. Reach out to frontdesk@made2movept.com today to set up an initial evaluation!



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