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Why do a Whole Body Assessment?

Physiotherapy is evolving ... come and experience the difference.

The simple answer to this question is that where you feel your pain may not be where the pain is coming from. Stated in a different way, the primary problem that is driving your pain may be remote from the place you feel your pain.

Most people are familiar with the term “referred pain”. This is a clinically recognised condition where nerve signals (associated usually with inflammation) are misinterpreted by the brain to be coming from a different place. “Sciatica” is a common example of nerve mediated pain that is misinterpreted by the brain to be coming from the back of the leg, whereas the source of the pain is usually in the lower back.

To take this concept one step further, there is a growing body of evidence (Wainner et al 2007, Sueki et al 2013, Cibulka 1999, Porter et al 1997) that suggests seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint.

This is called the Regional Interdependence Model of musculoskeletal dysfunction. Put simply, it is the theory that the body is interconnected, and impairments or dysfunctions in one region can influence other anatomically remote regions

So if we were to only examine areas close to or around the area of your pain, we could potentially be missing other regions or structures that may be contributing significantly to your condition. This is likely to lead to a poorer result, not getting completely over a condition, or a problem taking a long time to recover. We want the best results for our clients, in the quickest possible time, so we make no assumptions and examine the whole musculoskeletal system. Performing this assessment first also avoids possible back tracking later on looking for other alternative sources of the problem when a client is not responding to treatment.

We have many clinical cases where we have been very surprised to find the primary driver to a client’s condition is quite remote from the site of their symptoms.

These results were achieved with a careful clinical reasoning approach based on objective measurements, with treatment and re assessment clearly showing the link between 2 separate areas of the body.

How can these results and occurrences be explained?

Modern neuroscience research goes a long way to provide an explanation of the Regional interdependence model.

You  can read further about the neuroscience behind RI here.

 

References

  1. Wainer RS, Whitman JM, Cleland JA, Flynn TW. Regional Interdependence: A musculoskeletal examination model whose time has come. J Orthop Sports Phys Ther(2007); 37(11): 658-660.
  2. Sueki DG, Cleland JA, Wainner RS(2013): A Regional Interdependence Model of musculoskeletal dysfunction: research, mechanisms and clinical implications. J Man Manip Ther 21(2):90-102
  3. Cibulka MT(1999): Low back pain and its relation to the hip and foot. J Orthop Sports Phys Ther 29(10):595-601.
  4. Porter JL, Wilkinson A.(1997): Lumbar -hip flexion motion. A comparative study between asymptomatic and chronic low back pain in 18-36year old men. Spine; 22(13): 1508-13.