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Often, we find ourselves trying to find the reasons why patients may be experiencing pain. There are many factors that can influence clinical presentations and its important for clinicians to be able to recognize these variables. A thorough subjective reception and detailed physical examination will help generate potential hypotheses to be tested.
Patients’ who are experiencing pain may tend to function and move using a compensatory pattern. The compensation is most likely due to the individual experiencing a particular impairment or pain. The practitioner is then tested to find what is causing their patient to function and move in such a manner. A helpful framework would be to implement regional interdependence.
Evidence suggests there are relationships between different body regions that will assist with clinical decision-making.1 For example, an individual’s low back pain may be due to some imbalance in the hip musculature. Therefore, the weak hip may cause the low back to compensate, and thus resulting in pain. The common thought process was to think along the lines of a biomechanical model. However, literature has demonstrated that there may be more contributing factors that play a more prominent role.
A regional interdependence model can identify contextual factors and allostatic responses that can affect a patient’s recovery during the rehabilitation process thus recognizing fear avoidance, pain catastrophizing, functional mobility, and pain.2 Meaning, we need to not just analyze the biomedical model, but explore the other systems of the body and how that may have an impact on the clinical presentation. The systems to consider are2:
Sure, the musculoskeletal system plays a big role, however, there are other considerations to keep in mind. Pain and disability can be the result of other systems. Symptoms can be referred from other anatomical structures including the nervous system, vital organs, and biopsychosocial factors.
Receiving a thorough subjective interview and past medical history will provide most of the information needed for the initial evaluation. This information can then be applied during the physical examination to understand the mechanism of symptoms, and what stimuli is needed to manage those symptoms. The hypotheses of the practitioner can be appropriately tested to determine the best course of treatment.
We want to understand how these relationships can affect how individuals’ function and participate in everyday activities. Uncovering this information will be extremely helpful for the clinician to be able to develop a plan of care, and an appropriate self-management program for the patient.
Article Written By Eric Trauber, PT, DPT, OCS, CSCS, FAAOMPT
References
Sueki DG, Cleland JA, Wainner RS. (2013). A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. Journal of Manual & Manipulative Therapy, 21(2):90–102.
Wainner RS, Whitman JM, Cleland JA, & Flynn TW. Regional interdependence: a musculoskeletal examination model whose time has come. Journal of Orthpaedics & Sports Physical Therapy, 2007: 37(1): 658-660.