Author: Dr. Shannon Russell, DPT, CSCS, USAW-1

 

Think you have a “bad back”? Maybe it’s time to check your knees and hips instead!

Sometimes pain is not always what it seems. The body is a very strange and complex system and each part has an influence on one another. We think of body “parts” but the truth is we always move as a whole. Sometimes when one body part is not moving in the way that it should, a different area can pick up the slack. This term is called regional interdependence, and is defined by Physiopedia as “the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint”. 

So, what does that mean in English?! This means that even though your knee hurts, the problem may not actually be your knee, but it’s actually the ankle you’ve sprained 20 times. Or perhaps your low back pain is not a low back issue at all, but the real issue is your hips are not moving in the way that they should! 

As you can see in the picture above, certain joints are designed for “stability” while others are designed for “mobility.” What does that mean exactly? Mobile joints, like your hips and shoulders, allow for a lot of movement through large ranges of motion in many different directions. Joints designed for stability, like your knees, have less movement. Think of how your knees primarily move front to back, with limited side to side and rotational movements. 

However, when we have an injury to a body part, sometimes this diagram with alternating mobile and stable joints can get flipped. Let’s talk about a soccer player who sustains an ACL tear and how this knee injury might influence movement in the rest of the body. The knee, a “stable” joint, now has one less structure holding it into place. It loses stability, and suddenly there’s movement where there shouldn’t be. This causes the body to create compensations elsewhere to make up for this deficit. If the knee now has more movement, we need to look for stability elsewhere. Here is where we may start to lose movement at the hip, as it tries to make up for the lack of stability now happening at the knee. This chain of events can continue  up and/or down the body. If the hip now has less movement, but we still need to do things like sit, run and jump, which all require significant motion at the hip, what body part do you think will compensate next? If you guessed the low back, you’d be correct!

Over time if this pattern continues, we may start to see the low back take up more motion than it should, which means your low back muscles are working overtime. They are placed under a stress that they are just not used to and are not apt to handle, leading to low back pain. Pretty crazy that in this situation, what might be a complaint of “low back pain” could have actually stemmed from a pre-existing knee injury! 

Our bodies are  really good at figuring out ways to get around injuries and pain by compensating elsewhere in order to adapt to our lifestyles. As a result, sometimes this means our low back pain or shoulder pain might not be a back or shoulder problem at all. It’s important to zoom out and take a look at the body as a whole in order to find out where your pain is actually coming from. Otherwise, you may get stuck in an endless cycle of  treating a “back” issue that isn’t really a back issue. You’re essentially treating the symptoms but not the disease. If any part of this story sounds familiar, be sure to consult a licensed professional who will hear your main problem and zoom out! 

Reference: https://www.physio-pedia.com/Regional_Interdependence#:~:text=Purpose%20%26%20Definition,-The%20purpose%20of&text=Simply%20put%2C%20regional%20interdependence%20is,with%2C%20the%20patient’s%20primary%20complaint.