Most of us got our first exposure to anatomy and physiology via a classic children’s song. Let’s take a quick jog down memory lane (and feel free to sing along), “Your ankle bone is connected to your shinbone. Your shinbone is connected to your kneebone. Your knee bone is connected to your thigh bone...” While we all fondly remember this famous little ditty, it did not teach us about the vital system that actually connects all of our body’s tissues together (bone, muscle, artery, nerve and organs) – the fascia.
Fascia is tough, gristly membrane (think sausage casing) that surrounds and supports your muscle, bone, nervous and organ tissues. It forms a continuous spider web-like network that connects the tips of your toes to the tip of your nose. Without the support of the fascial system all of your bones would collapse to the ground. Every cell in your body, regardless of location and type, is interconnected via the fascial system. If you are familiar with Thomas Myer’s brilliant book Anatomy Trains, which identifies and illustrates the body’s numerous myofasical (muscle and fascia) slings, then it becomes quite easy to see why a shoulder problem could actually be a hip issue instead.
My primary job as a physical therapist is to locate the source of musculoskeletal problems not just treat the site of symptoms. That is why it is important to understand the concept of primary restrictions(think cause) and secondary restrictions (think effect). Just take a look at the picture on the right. It clearly illustrates the concept of a primary and secondary restriction. The client's chief complaint is a tight, painful Left shoulder. However the true cause of their shoulder pain is a chronically tight and non-painful Right hip.
In this scenario, the myofascial dysfunction in the Right hip represents the primary restriction while their symptomatic Left shoulder is a secondary restriction. Exercise and manual therapy applied to solely to the shoulder would only provide temporary relief of this client's shoulder pain. Successful resolution of the problem hinges upon a practitioner’s ability to locate and resolve the primary restriction. It's quite likely that many excellent practitioners would have missed the connection between a non-symptomatic hip and a painful shoulder unless they consistently employ a holistic assessment and treatment strategy. As a chronic pain specialist I’ve resolved many painful shoulders, backs and neck problems without directly treating the site of pain. As a famous physician once said, “He who treats the site of pain is lost.”
By Jeremy R. Baber, MSPT, CSCS
Images from: Google images