Unit 6 - Regional Interdependence

Regional Interdependence: Wainner

“Seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint.”

Regional Interdependence: Sueki

“A patient’s primary musculoskeletal symptom(s) may be directly or indirectly related or influenced by impairments from various body regions and systems regardless of proximity to the primary symptom(s)

Regional Interdependence: Bialosky

complex and could be driven by a neurophysiological response

Specifics

• Distinct from referred pain

• Could focus on impairments in proximal or distal segments

• Could focus on peripheral, spinal cord or supraspinal mechanisms

• May help to partly explain variability in patient outcomes

Application

• Strong evidence indicating usage

• Need for symptom modulation (High severity and irritability)

• May be an option to manage patients with maladaptive beliefs (anxiety, pain catastrophization, fear avoidance beliefs)

• Patient has a significant history of MSK conditions/impairments

• Severe MSK impairments are identified during the evaluation

• Patient progress plateaus

Common Regional Interdependencies

• Thoracic spine and cervical spine

• Thoracic spine and shoulder

• Cervical spine and elbow

• Cervical spine and wrist

• Lumbar spine and hip

• Hip and knee

Thoracic spine and cervical spine

• across the span-- neck pain with mobility deficits, coordination impairments, and other conditions

• thoracic thrust manipulations more than non-thrust or mobilizations have a significant impact and increased outcomes for those with neck pain.

Cervical spine and elbow

primarily, the evidence is showing, for lateral epicondylalgia

Cervical spine and wrist

conditions such as carpal tunnel syndrome (median nerve compression in spine)

Lumbar spine and hip

hip-spine syndrome where treating the hip can improve outcomes for low back pain and different conditions of the lumbar spine

Hip and knee

• primarily for patellofemoral pain syndrome

• increasing strength and neuromuscular control of the gluteal musculature, the hip external rotators, and the quads. And the idea is that by increasing strength and neuromuscular control there, then you're improving the ultrabiomechanics