Being a great physical therapist involves various factors, and any clinician active in the clinic can tell you there is a fine balance between giving patients what they want and giving them what they need. As we know, this balance is different for each patient’s scenario and personality, as some patients are very open to letting the clinician lead the treatment, and some take a little more education and coaching to help them understand how what they think they want and what they need might be different.
Ultimately, our primary responsibility is to make sure patients accomplish their goals safely and efficiently. High-level manual therapy and exercise prescription skills are crucial, but even more important is the ability to identify the source of the problem.
Therefore, we need to focus on the correct structures to make the most of our skills. This brings us to the concept of Regional Interdependence.
Understanding Regional Interdependence
The location of a patient’s pain may not indicate the source of the problem, a concept known as Regional Interdependence –– which can be further divided into three concepts: Parts, Patterns, and Performance. A deep understanding of these concepts helps to better identify and treat the source of patients’ problems.
- Parts: Refers to the origin, insertion, and innervation of the structures we are examining.
- Patterns: Involves the coordination of these parts with other structures within the body.
- Performance: Pertains to the task or activity in which the patient plans to engage.
Implementing Regional Interdependence in the Clinic
The first step is to take a detailed patient history to apply these concepts in a clinical setting. Whether dealing with acute trauma or insidious onset pain, a comprehensive history helps guide us toward a more accurate diagnosis.
Additionally, a systematic assessment process that examines global movement patterns and identifies breakdowns or dysfunctions is crucial for evaluating movement.
Recognizing Compensations and Dysfunctions
Pain can change motor control unpredictably, leading to increased or decreased muscle activation around the painful area, depending on the task. This can cause subconscious dysfunctional movement patterns, eventually leading to conscious dysfunction and pain.
This concept drives the need to utilize Regional Interdependence when identifying the source of a problem.
Case Study: Patient Smith
Patient Smith experienced insidious onset right hip and medial knee pain six weeks ago during barbell cleaning and snatching. After resting for three weeks and taking NSAIDs, the symptoms did not improve.
Over time, right hip dysfunction can lead to valgus strategies at the knee or over-recruitment of other structures, causing tissue breakdown and pain.
A detailed history and assessment, such as the SFMA, can reveal a left shoulder motor control deficit, affecting the right hip due to the strong recruitment pattern and anatomical connection between the left shoulder and right hip.
Educating Patients on Regional Interdependence
It may be challenging to convince patients that treating the opposite shoulder is necessary to fix their hip and knee pain. However, through test-retest and effective manual/therapeutic exercise prescriptions, patients will quickly realize the problem has been solved.
By understanding and utilizing the concept of Regional Interdependence, physical therapists can provide more targeted and effective treatment plans for their patients.