Regional interdependence is a term that I first learned while taking a course called Selective Functional Movement Assessment (SFMA) back in 2011. It was a term that I was unfamiliar with, despite my many years of practicing as a physical therapist at the time. It helped me understand that the origin of pain in the body may or may not come from the area of pain. Sometimes you have to be sort of like a detective by tracing back when and where the problem actually originated.
While regional interdependence makes a lot of sense in theory, it can be challenging in everyday practice. After all, sometimes it's hard not to focus on the painful spot, especially when your patient is laser focused on that. It can also be difficult to convince them that you know what you are doing, and that you are not a moron when you’re looking at an area of the body that is far away from the pain!
I was humbled by this when I was struggling with two different patients, both with issues related to their right shoulder, and more specifically related to limited range of motion into external rotation. They both improved to a point. But I could not figure out why my treatments weren’t sticking.
So I decided to look outside of the painful area. In both cases, I examined further down the chain to see how the opposite left leg was functioning, from a neuromuscular standpoint.
One of the most effective ways to do this is by testing the body's "core" (pelvis, hips, spine, rib cage, etc.) using the Redcord suspension system.
With its red colored ropes, slings and bungee cords, most people think this Norwegian system is simply used for doing some cool suspension exercises. But in reality, it is a powerful assessment tool for neuromuscular function.
By looking at how multiple muscles work together as a unit in an “gravity controlled” environment, I could identify various weaknesses and dysfunction, without the interference of pain and compensation. Then I targeted those areas and it made all the difference. Both patients got their motion back without me even touching the shoulder!
The reason I know better now is because the testing protocol for the shoulder spells out what to test. It instructs you to look at the shoulder with three specific tests related to the scapular stabilizers. The protocol also states to look at the glut max, glut medius and hip adductors. It is literally spelled out for you.
The moral of my story is to not get lazy and keep doing what you’ve always done. That will only get you so far.
Make sure you look at the whole body. If you are not exactly sure where to start, follow the Redcord NEURAC testing protocols. They will have you working on areas you never thought would contribute to the pain. And that could be exactly what was missing from your treatment program.
At Activcore, we start where other physical therapists have given up. If you live in New Jersey and are searching for a more personalized approach to physical therapy, please contact me at Activcore Princeton to schedule a session.
Disclaimer: The views expressed in this post are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.