Written by: Dr. Eden Climo, PT, DPT
Have you ever had an injury that just seemed to linger despite your best efforts? Maybe you’ve tried icing, stretching, anti-inflammatories, rest/ice/compression/elevation. Perhaps you’ve even gone to see a doctor or physical therapist all who evaluated/treated your injured body part. Alas, here you are months later still battling with your residual symptoms. Why is it that nothing is “working”?
Well, to be honest there are many possible answers for that question. However an interesting place to begin starts with the concept of “regional interdependence”. It sounds fancier than it is. Stick with me here. “Regional interdependence” refers to the concept that there may be seemingly unrelated impairments in a different region of the body, which may contribute to, or be associated with your primary symptoms. To put this even more simply “The pain SITE does not always equal the pain SOURCE”.
When the picture to the left is examined, there are many abnormalities that become apparent to the trained eye. It would be impossible to say where this individuals’ pain site is without more information. It could be anywhere from the foot to the low back. BUT, for the sake of conversation let’s say that this person is having knee pain. Well, they’ve iced, Ibuprofen’d, rested, braced, received their home exercises (and actually DONE them), been told they have patellofemoral disorder, no wait.. meniscus involvement, just kidding… it’s probably bad arthritis so, sorry! That pain isn’t going anywhere. Well, just wait a minute; is that the end of the line?
Here is where regional interdependence may come into play as your “Hail Mary” pass. If no one has looked beyond your knee itself, they have missed the big picture. In this case there are several “seemingly unrelated” impairments that can and should be assessed and addressed in relation to the primary SITE of pain, the knee, which may indeed be the SOURCE of your dysfunction. This person may need a strengthening or mobility program for their hips, inserts for their shoes, yadda yadda, the list could go on but I won’t bore you! Until the source of the problem has been identified there may not be any, and certainly not long term, relief from your symptoms. This concept applies to every region of the body.
There is a huge amount of interplay between the bodies many systems. It is not always as cut and dry as the above example. There are fascial chains, motor control inadequacies, structural anomalies, stability deficits, mobility limitations etc. (Here I go boring you again.. but that is bedsides the point.)
The bottom line is that pain changes the way your body moves. The way your body moves plays a large role in how well you are able to function without pain. The time old question of teasing out “which came first the chicken or the egg” is the responsibility of your health care team in collaboration with your guided self-management.
If you feel that you’ve been treating the SITE of your pain and want to further explore what the SOURCE may be, make sure that you seek a healthcare professional who looks at you as a whole body system and not just a body part! Lucky for you, one of our highly trained therapists can do just that! And now instead of giving your PT funny looks as they may be assessing your hips/back when you’ve shown up for your knee pain, you know they are looking to fix the problem itself, not just the symptoms. It’s time to find the source.