In order to appreciate this article from Dr. Craig Liebenson, we must first define regional interdependence.
"Regional Interdependence: Seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient's primary complaint. (Wainner 2007)" You must look both proximally and distally to the site of pain. It is important to note that this term is not the same as referred pain.
This article poses the question: could a neck dysfunction be related to a problem in the lower extremities? The forward head posture is commonly seen in many of our patients. They often present with hypertonus in the upper trapezius and suboccipital muscles. BUT is the neck hypertonicity the primary problem? What if the patient's symptoms are greatly different in sitting vs. standing? If the tension is lessened by sitting (without changing the upper quadrant in any manner), then the patient's symptoms changed simply by altering the position of the lower extremity. The author also states that you must look at other possible causes of neck dysfunction, such as faulty respiration. Potentially the patient breathes differently in sitting vs. standing so the common denominator may not be the lower extremity after all.
In all cases, it is extremely important to assess- correct (perform an intervention)- then reassess in order to determine to true origin of a patient's symptoms.
Wainner RS, Whitman JM, Cleland JA, Flynn TW. Regional interdependence: a musculoskeletal examination
model whose time has come. The Journal of orthopaedic and sports physical therapy. Nov
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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