We typically think about the body as being composed of many inter-related systems. For example, we understand that the nervous system controls the movement and sensation of the musculoskeletal system. What is more rarely considered however is that the musculoskeletal system can be broken down into a series of smaller subsystems which then work together as the body moves.
As we move the strain is dissipated very widely though-out the body’s tissues. If you watch a footballer kick a ball you’ll notice that their arms are held out to the side and tensioned. In this way, they can transmit a lot of power into the ball. Asked to kick the ball while only allowing their arms to hang limply by their side and the strength with which they can kick the ball would be drastically reduced.
A good example of one of these subsystems I’m describing would be the knee, ankle and foot. Interestingly as the knee bends and straightens the shin bone rotates quite notably which then influences the movement of the ankle. As we walk or run our foot goes from being in a locked position, so it is strong enough for us to push off, through to being unlocked and supple so that as we land the strain is effectively dispersed. When this system is working normally the rotation of the shin aids the foot in moving backwards and forwards between these two functions, that of being a ridged leaver for push-off, to being a malleable adaptor for a soft landing.
When a physiotherapist is confronted with a painful problem of the knee for example it makes sense to first make sure that the knee, ankle and foot subsystem is working properly. In fact, it works best to think of it as a problem of the knee, ankle and foot system and not just a knee problem. This is because the movement of these joints are so interrelated if something goes wrong within this joint system much of the stress which should normally be transmitted up to the rest of the body ends up causing significant overstrain and ultimately damage somewhere within the knee, ankle or foot.
Recognising the subsystems such as the knee, ankle and foot or elbow, wrist and hand and then working first to restore normal movement within the system is highly effective because relieved of damaging overstrain the body’s tissues typically heal remarkably quickly.
From the patient’s perspective equipped with this knowledge and directed by their physiotherapist they can work to stretch any tight tissues within the system, strengthen week muscles and gently get stiff joints to move again more normally.
In the limbs, above each subsystem is a ball and socket joint, which can accommodate a wider variability in movement and beyond that lays the spine. Here again the spine should be considered as a single unit and not broken down into component parts such as the lower back (lumbar) mid-back (thoracic) or neck (cervical). The most commonly overlooked function of the spine is its role in helping to disperse strain throughout the rest of the body.
Unfortunately, as we age and due to poor posture of lot of people end up with a fairly stiff spine by the time, they reach their early thirties. Again, without the suppleness to dissipate stress efficiently throughout the spine subsystem damaging overstrain occurs within the system typically resulting in a painful neck or low back.
Recognising the subsystems of which the musculoskeletal system is comprised and working first to correct problems within the sub-system transforms the effectiveness of physiotherapy treatment in many cases.
Recognising that the human body is beautifully designed to dissipate strain safely throughout its whole as we move and restoring this ability when it becomes disrupted through injury or neglect is the hallmark of modern physiotherapy.
John Wood, Lead Physiotherapist and Clinical Director of Sheffield Physiotherapy
