Remember when you were a kid and you heard that old song…”The knee bone’s connected to the leg bone…the leg bone’s connected to the hip bone…”?  Well, guess what?  It’s true!  The body really is a series of bones that are connected and inter-dependent.  That means that the movement of one bone or joint often depends upon the movement or position of another.

Rarely does any part of your body function by itself.  One key concept you must understand is that in order for you to have normal function, you must start with something called proximal stability.  Proximal stability simply means being stable or able to control your body starting at the center of your body and moving outward.  At the heart of this concept is your ‘core’ or trunk.  Your ‘core’ is your lower back, abdominal muscles and pelvis.  This ‘core’ builds a base from which your hips, knees, ankles and feet will all function below your core.  The shoulder blades, shoulders, elbows, wrists and hands all function from the upper half of this ‘core.’   

Let’s go back to ‘normal function’ for a minute.  Whether you reach for a gallon of milk in the refrigerator or are walking up a set of stairs, if you don’t have stability from the center and every part moving outward then you will not be able to accomplish your task.  Think about standing on wet, slippery mud while reaching into a lake to pull your friend safely to shore.  You probably don’t feel too confident standing on slippery mud, do you?  Just standing there wouldn’t be so bad but when you add the tasks of first reaching and then pulling your friend, you realize there’s a pretty good chance you’ll slip and fall in the mud while your friend won’t be rescued.  Same concept…if your ‘core’ isn’t stable or your shoulder blade isn’t stable, etc, then your arm won’t be able to accomplish its task.

Now that you understand this concept, another important part of the connected, movable chain of bones (Kinetic Chain) is that when an injury occurs, you need to step back and look at the ‘Big Picture.’  Did your injury occur because you were not stable at your core?  Let’s say you are having pain in your wrist.  Rather than immediately treating the pain, step back and look for the cause of that pain.  Sure, there will be times when you injure something and there is no other cause but you still need to make sure you haven’t missed something.  Did you have some shoulder weakness that caused you to change the way you were lifting something at work?  Did this awkward movement eventually cause an injury?  Did you have a bruise on the ball of your foot that caused you to walk upstairs differently and create some knee pain around your knee cap?

Human beings have an amazing capacity to compensate.  Sometimes we compensate long enough that we develop abnormal movements that last long after an injury is ‘gone.’  As we go through life, these abnormal movements get layered, one on top of another, much like the layers of an onion.  As physical therapists, we must evaluate the movements we see with what we know to be ‘normal’ and peel away the layers until we come to the root cause.  Once we find it, we must re-train all the parts to regain normal stability and movement along the Kinetic Chain.