In last month's newsletter, we introduced the concept of regional interdependence in the body. A woman has a routine knee meniscal repair (menisectomy) and later as part of her physical therapy exam, gets a much needed movement assessment of her lumbar spine and pelvis during walking.

This month, we will highlight an upper body example of regional interdependence in the body. Consider this scenario: Rob is a 40 year old father of two boys who injured his elbow throwing balls over the course of three months to his older son who is trying out for youth league baseball. Rob saw his doctor who diagnosed him with tendonitis of the elbow.

During his physical therapy exam, Rob informed his physical therapist his elbow hurt "all the time" and especially when doing any activity using his elbow, hand and even his shoulder, like taking a shower and changing the oil and filter in his car. The common extensor tendon, or tendon on the outer elbow, was slightly swollen and quite tender to touch. Straightening the elbow and twisting it were the most painful movements, and were somewhat limited in their range of motion. Given the diagnosis and the obvious signs around the elbow joint, it would make sense to begin treatment at the elbow. However, Rob's physical therapist also took the time to watch Rob throw, and perform several movements of the shoulder, like elevation and rotation to assess where else in the kinetic chain a movement problem could be occurring.

As it turned out, Rob's glenohumeral joint, or the ball-and-socket joint of the shoulder had 50% less than the "norm" for degrees of internal rotation. The muscle that powers that movement, the subscapularis, one of the rotator cuff muscles, was surprisingly weak, especially since Rob is a former collegiate ball player. When Rob elevated his arm, his therapist noticed that Rob's shoulder blade (scapula) didn't appear to rotate upwards as much as normal, and less than the other side. Two very important scapular muscles, the lower trapezius and serratus anterior were quite weak when tested.

After the physical therapist explained his findings, Rob volunteered that indeed, he was not surprised that his shoulder was not performing well. He also asked the therapist if the problems with his shoulder could explain why his neck was sometimes stiff in the morning. In fact, the physical therapist described how a disordered scapular position maintained by overly tight and/or weak muscles can put excessive strain on the cervical joints.

At Advance Physical Therapy, our therapists will perform a thorough and accurate examination of your problem area. We also promise to  "connect your dots" so you can get back to whatever you enjoy as quickly as possible, without fear of familiar or new injuries at any link in your kinetic chain. Give us a call today to set up your evaluation.