Head, Shoulders, Knees and Toes… Everything is Connected


Author: Justine Cosman, PT, DPT : Doctor of Physical Therapy, Business Owner, Associate Professor, and Blog Contributor. Explores common client questions and helps find solutions for every day functional health concerns, and then some. Loves empowering others, seeking adventure, and learning every day. Learn more about Justine on Google+.


The body is a complex, functioning unit. If we were to break down something simple, such as giving your buddy a “high-five,” it requires more than just a simple shoulder movement. The hand and elbow must bend or extend to meet the other hand. The torso must also rotate to aide with momentum and allow for proper shoulder blade movement. At the same time you may be shifting weight through your legs to follow through with contact. With this idea in mind, think about how you would do the same motion if you had shoulder pain every time you reached up above your shoulder 75 degrees? The motion would be less fluid. There would likely be less follow through. The torso may tilt to make up for the height difference… the list goes on. In other words, one seemingly local issue affects the surrounding joints of the body.

Let’s get a little more complex with a recent patient case:

After a few sessions for treatment for a gentleman’s hip pain, we learned that about 2 years ago he had significantly stubbed the toe of the same leg. This information helped us to piece together why he was walking in a “toe-out” position and was therefore getting improper gluteal activation, as he was moving forward over the affected leg. Although the stubbed toe did not directly cause his hip pain, we can hypothesize that through repetitive, altered mechanics with walking (think about how many steps you take in a day) that it was slowly wearing on the already present osteoarthritis in his hip. This repetitive stress was not pain provoking until one jolt he experienced, which was the onset of his pain. Guess what happened when we tested his toe? It was still painful after about 2 years, but this was unbeknownst to the client, as he had been able to modify how he moved for so long to avoid the pain.

Physical therapists are movement system specialists.

In one way, this is an incredible feature that our body has! It is known as kinematic redundancy – i.e. we have multiple ways and patterns to get from point A to point B, using different joints and muscles to get there. This adaptation is a great survival tactic: something hurts, find another way to get there or face risks. Luckily for the majority of us, we do not have to worry about surviving against external factors every day, but these compensations continue to occur. Our brains are so skilled at re-wiring our bodies’ patterns that in as little as 30 seconds after an injury, our brain has changed to meet the new demand.

What happens when the pain goes away? Well, if it is brief, most of the time the body is able to return to its prior level of function with little issue. If the pain lasts a longer time, let’s say even 2 weeks, then these compensations may continue to manifest themselves in our daily movement patterns. Some are just fine. Others can actually set us on the path to re-injury or new injury due to altered body mechanics that put other tissues at risk.

In other words, if you have had pain that has lasted an extended period of time, it is better to get yourself assessed sooner rather than later. It is much more time and cost effective to manage an acute/recent injury than a chronic condition, although both are important to address. Physical therapists are movement system specialists. We are trained to break down biomechanical movement patterns and promote best movement practices specific to your body. If you have any questions regarding prior injuries or concerns regarding current symptoms, please feel free to contact us. Be proactive in your health and we will give you the tools to keep you moving in the right direction!

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