Making a case for the Joint-by-Joint approach and understanding the differences between mobility and flexibility

Quite often, when we evaluate our patients, we need to ask ourselves two main questions: What is the problem and where is it coming from?  If we don't think about anything else but these two things then we have a system to start with.  For example, lets use a patient who complaints of anterior knee pain.  On paper, we already know what the problem is: anterior knee pain.  But is that really the problem?  If we assume that the patient's knee pain is the problem then we have already set ourselves up to miss something.  Let me explain.  

Anatomically we have the fat pad, patella tendon, reticular fibers, bursa, tibial tuberosity, etc.  Now if we assume that the anterior knee pain is the problem then we might think one of those anatomical structures is the pain generating source.  However, if we open up our minds then we realize that its never that simple. This is where the joint by joint approach can be beneficial.  Lack of dorsiflexion at the ankle alone could influence the patient's knee pain.  Or lack of strength in the hips.  Or lack of core control.  Or the patient's everyday activities (stairs vs jumping, etc).  Or maybe it's flexibility issues causing dysfunctional positions.  Or maybe its a biomechanical mobility issue.  See where I'm going?  

While I'm here lets make sure we understand the difference between mobility and flexibility because there still seems to be a lot of confusion out there.  Flexibility for all intensive purposes means length of the muscle while mobility means how a joint moves.  Understanding this is what separates physical therapists from personal trainers who might assume stretching the calves will correct loss of dorsiflexion without realizing it may be a mobility issue.  But thats another article for another day.   

So lets review the joint by joint approach that Gray Cook and Mike Boyle have both spoke about.  In this expansion of Cooks Movement book, he discusses some of the common myths about the joint by joint approach.  His explanations and examples really help you understand this approach.  


-  Brian

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