What is regional interdependence?

What is regional interdependence and why do we need to know more about it? History is often the most prevalent factor for the exposure to future injuries. Many clients and surprisingly clinicians are often blissfully unaware of the impact of previous injuries on current and future injury scenarios. Here are five key examples of actual clients that I have worked with.

  1. Left sided lower back pain, not resolved with surgery, from 40 year-old scar, left by kidney removal at the age of 1.
  2. Ankle injury causing lower back pain.
  3. Appendectomy scar, decreasing core function, causing lower back pain.
  4. Ear piercing creating shoulder dysfunction on the opposite shoulder.
  5. Hyper –contracted toe muscles creating mobility issues in neck.

Of course there are more, hundreds, perhaps thousands more. For the evidence medicine biased people, I am not about to create theoretical models for you to shoot down with a lack of scientific literature. Although there are increasing studies that support the rationale for regional interdependence. There are also many methods of assessment that create adequate reasoning to show how restriction, lack of stability and dysfunction in one area of the body may have a significant impact on other areas of the body. SFMA (selective functional movement assessment), Gray institute, Anatomy in Motion and many other forms of assessment provide insights to how a lack of mobility and stability at the ankle has an impact on say mechanics of the knee, hip, spine, shoulder and head.

Many practitioners and clinicians have often been taught to view each issue in isolation, which to a degree can be helpful; As local problems can often be responsible for a global issue. Think a scar, such as a C-section, inhibiting core function, increasing dysfunction in the posterior chain not addressed by anterior chain function. But what about when symptoms persist? True, there are many factors that can contribute to pain and dysfunction that simply will not be addressed by massage/trigger points, needles and corrective exercise and I might suggest that some gains may serve as mask to the actual underlying dysfunction.

 

10264312_699027360144587_8762295179813694115_nYou may have observed the concept of regional interdependence after having a good calf massage. Ever noticed how good your neck feels after having your feet and calf massaged? There’s a clear fascial line between the feet and the neck as proposed by Myers in the superficial back line. There is also literature to support the concept of viscerosomatic pain referrals. This may include pre menstrual issues on back pain or gastro-intestinal dysfunction involved in headaches. To address these dysfunctions truly we need to get to the root cause of the issues. That neck often gets tight again after having those feet massaged as the compensatory muscles are overworking for an underworking area.

If perhaps the calf muscles are overworking due to a lack of function in their antagonistic muscles such as the dorsi-flexors or shin muscles. You may well see the neck tightness dissipate, when this relationship is addressed. Follow up mobility work may also be useful for the neck.

Determining mobility versus stability issues is paramount. A decrease in mobility may come from many sources such as:

  • A lack of stability -( how to determine video)
  • Breathing pattern dysfunction (a stability issue)
  • Biochemical – vitamin D/K2/A/calcium factors
  • Gluten –stiff person syndrome, A tentative link between the consumption of gluten and muscle stiffness.

Here we can see the futile task of mobilising joints via releasing and stretching muscles, when there exists factors that contribute to the lack of mobility, that will not resolve with mobilisations.

It’s important for the patient to bring a complete injury history to the table and for the clinician to assess the impact and hierarchy of all factors. Determining mobility against stability factors, improving motor control and treating via the suggestion of regional interdependence may be more beneficial than simply just treating overworked painful areas.

 

References:

 

  1. Cook, G et al. SFMA Course Manual. 2011
  2. Hadjivassiliou M1, Aeschlimann D, Grünewald RA, Sanders DS, Sharrack B, Woodroofe N. GAD antibody-associated neurological illness and its relationship to gluten sensitivity. Acta Neurol Scand. 2011 Mar;123(3):175-80. doi: 10.1111/j.1600-0404.2010.01356.x
  3. Myers. T. Anatomy Trains. Elsevier. 2014.
  4. Sueki D. G., Cleland J. A., Wainner R. S. A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. Journal of Manual and Manipulative Therapy. 2013;21(2):90–102. doi: 10.1179/2042618612y.0000000027