Regional Interdependence

Question 1

What does “regional interdependence” mean?

Answer 1

Differing body regions are biomecanically and neurophysiologically interdependent and impairment in one region can contribute to impairment in another, particularly if persistent

Question 2

Significant lower strength in what 3 areas can lead to persistent neck pain?

Answer 2

• Neck
• Shoulder
• Scapula

Question 3

What two lower extremity regions can lead to persistent neck pain?

Answer 3

Lower hip and low back strength

Question 4

Co-existing low back pain is a risk factor for what?

Answer 4

Neck Pain

Question 5

What is an example of a central mechanism?

Answer 5

Motor cortex

Question 6

Normal muscle activation is related to what? (give an example)

Answer 6

• The activity being preformed
• Ex: Recruiting what you need when you reach over head: flexors, abductors, and ER contract concentrically while eccentrically contracting muscles (extensors, adductors, and IRs) balance things out
• All relax at rest

Question 7

What is the most common segment for joint dysfunction?

Answer 7

C5-C6 … because of hypermobility/ instability and age related joint changes

Question 8

What could cause an imbalance with reaching over head?

Answer 8

• Excessively recruiting the internal rotators that share innervations from C6 with C5
• ER should be working and IR should be balancing
• C6 is now causing a joint dysfunction and an inhibition of the ERs

Question 9

What happens when the IRs are over working when reaching over head?

Answer 9

• The humeral head is pulled anterior and into IR
• This creates an excess tension and compression under the long head of the biceps tendon
• Now the ERs cant efficiently move the humeral head and greater tubercle out from under the acromion
• This causes an impingement of the supraspinatus and the long head of the biceps tendon (that could ultimately lead to a tendinopathy)

Question 10

Think about a C2-C3 joint dysfunction with over head reaching, what is being excessively recruited and what could this cause?

Answer 10

• Excessively recruited scapular elevators that share innervation from C3 with C2, this is a C3 joint dysfunction
• This causes the scapula to elevate or creates elevation compensations
• It also creates excess tension and compression underneath the supraspinatus tendon and potentially an tendinopathy

Question 11

If you have a inhibition of the scapular depressors due to a C2-C3 joint dysfunction what might happen?

Answer 11

• The scapula wont depress efficiently
• Impingment especially with greater than 150 degrees of flexion
• Supraspinatus and long head of biceps tendon will become impinged
• May lead to a tendinopathy or GH and AC joint hypermobility/ instability … if the scapula cant move other areas will try to compensate

Question 12

Inhibited muscles develop what at rest?

Answer 12

Protective hypertonicity (aka a tightness)

Question 13

What can you do for inhibited muscles that will only be temporarily helpful?

Answer 13

Symptomatic interventions such as dry needling, modalities, etc.

Question 14

You should always address a patients _____ and involved tissues

Answer 14

Mechanics

Question 15

There is a growing body of evidence that states that treating adjacent areas, particularly the spine can influence what?

Answer 15

Outcomes at another area that may seem unrelated