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Getting Better...Better - Part 3 - The Joint-by-Joint Approach


Last time, we unpacked the differences between actively managed joints and passively managed joints, and, that even when a load is managed, HOW we manage it makes all of the difference.


This time we are going to look at some of the potential consequences of allowing passively stable patterns to become primary movement strategies.


Shirley Sahrmann stated that "Maintaining or restoring precise movements within the systems of the body is key to preventing or correcting musculoskeletal pain."


Whether it is due to injury, postural or anatomical variations, or repeated physiological sympathetic stressors; when these precise movements are not primary strategies(read: ACTIVELY STABLE), joint segments often rely on compensatory movement and motion in order to move and manage load(read: PASSIVELY STABLE STRATEGIES), resulting in relative stiffness in adjoining segments. While Sahrmann unpacks this in her book Diagnosis and Treatment of Movement Impairment Syndromes, Michael Boyle and Gray Cook have since introduced an system that allows a more simplistic view of these concepts, called the Joint-by-Joint approach.


Simply put, each joint segment has a tendency to fault towards becoming excessively mobile or excessively stiff as a compensation to poor, passive patterns. These tendencies often are impossible to resolve without clearing and addressing the faulty patterns above and below each segment. When one joint is passive and dysfunctional, you have to assume that all the adjoining segments are passive and dysfunctional as well, otherwise all of the efforts you put into mobilizing or stabilizing a specific segment will be for naught.


The body will always take the path of least resistance, and old, faulty, familiar patterns that are upstream and downstream of the newly stabilized or mobilized joint, will ALWAYS take precedence unless properly addressed as well. Consider that a knee cannot do what it is supposed to do, no matter how strong it is, if the hip and the ankle are both excessively stiff due to the brain's dependence on passive strategies, and visa versa.


As we are looking to identify and fix the passive patterns that can so often be the cause of pain and dysfunction, it is often helpful to consider the typical needs of each joint segment as laid out by the Joint-by-Joint approach.


Joint — Primary Need

Foot — Stability

Ankle — Mobility (sagittal)

Knee — Stability

Hip — Mobility (multi-planar)

Lumbosacral — Stability

Thoracic — Mobility

Mid/Low Cervical — Stability

Upper Cervical — Mobility

Scapula — Stability

Gleno-humeral — Mobility


While these are very general guidelines applied to large segments, these same principles apply to each and every articulation in the human body. Identifying and addressing these needs and compensations are some of the first steps to restoring the precise movements that Sahrmann states are key to preventing and correcting pain and dysfunction.


Of course, it depends on the context - different people have different goals, different anatomy, and different medical histories. Next week, we will discuss the muscular repercussions of Joint-by-Joint Dysfunction and how to identify the precise movements(joint centration) that Sahrmann talked about.


As always, the goal being to help make you better. Better.

If there is any specific topic you would like to see addressed or if you have any questions feel free to reach out to me(Jon) directly at jh@summitrehabkc.com or contact our clinic at 816-554-6003.


Thanks for reading!!


#getbetterbetter #physicaltherapy


-Sarhmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. Mosby, St Louis, 2002

-Cook, G. (2010). The Joint-by-Joint Concept/Expanding on the Joint-by-Joint Concept. In Movement(Vol. 2, pp. 319-329). Aptos, CA: On Target Publication.



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