Everything is connected
When I first started as a physical therapist, I took tons of continuing education courses. I threw myself into all of the evidence-based research courses that I possibly could. After doing this for about a year post-graduate school, I began to notice a theme in the courses. Most of them compartmentalized the body, and I could appreciate each joint more, knowing how each structure had its own purpose and mechanics to give our bodies the movement; however, there was a bigger picture that I was missing. How that joint fit into the design of our bodies and worked with other tissues and structures so that it could allow us to have normal movement was the component that I needed to complete the puzzle.
As a PT, I sometimes wish I had an “off” switch on noticing people’s movements and gait patterns. The worse place to take a Physical therapist to, is a mall. I can literally pick apart a person’s gait pattern and tell them exactly where their imbalances are stemming from based on how they are moving. One theme that is a constant in balancing out the body is the pelvis. The longer I am a therapist, the more vital I realize balancing out the pelvis is to retrain the entire body. I actually cringe thinking of how I used to treat areas of the body by compartmentalizing them (yes, I’m guilty of doing ridiculous things, like thera-band exercises with the foot) but it’s how they taught me and I’m grateful to say that I haven’t done ankle thera-band strengthening in years!
Now that I am aware that the bodies movement patterns really do begin at the hip, I treat accordingly. Even when I have a patient with shoulder pain come in to see me, I am looking at the pelvis and the core. Why? Because the entire shoulder complex (scapular and glenohumeral joints) rely on the core to be balanced so that they can rest and function in a position that they are not compromised. For instance, I had a patient come to see me because of unrelenting right sided shoulder pain. No matter how many scapular squeezes or postural awareness exercises she would do, the pain would not stop. Well, you can probably guess what I found. Her right shoulder was being pulled into internal rotation & protraction because her left sided abdominals were not “turning on.” This lead to a left sided rib outflare which can occur for several reasons. For her it was because she was not contracting her left transverse abdominus muscle which attaches into the costal cartilage the same way as the right side. This core dysfunction lead to a compensation pattern in her shoulder. So, we must treat the core in order to improve the shoulder. The point of this article is to say that the body really is all connected. My goal at the end of someone’s program is really focused on restoration of entire bodily movement patterns, and I hope this is the future of PT and orthopaedic medicine in general.
If you have a specific joint issue that has not yet been fixed by traditional methods, always look at the pelvis and core for unseen imbalances, and seek a knowledgeable whole body PT to help get to the bottom of your issues.