Muscles and joints have the capacity to activate and move individually, with a particular action; a concept often echoed within the field of exercise science and academia. Although not an entirely fallacious statement, the body, however, does not abide by such rules when interacting with the environment. Instead, muscles, joints, fascia, and the sensorimotor system communicate and interact with each other in a complex, highly orchestrated, and harmonious fashion; a concept known as coordinative structures (Magill, 2011).
Furthermore, and most importantly, a natural byproduct of these events is movement, an ingredient essential to survival. If one acknowledges that movement is the product of many muscles and joints, one can also conceive that a break along the kinetic chain can induce/exacerbate impaired movement patterns. Thus, understanding how to uncover the cause of pain and dysfunction is an essential first step in resolving the same. Therefore, the following will consider such a process through a concept known as the joint-by-joint approach (JBJA).
Aberrations within the human movement system can and do occur, frequently disrupting the flow of movement patterns. Movement-based principles and interventions submit that painful and symptomatic tissues are often the byproduct of poorly generated movement patterns. Conversely, it is also understood that pain can cause/reinforce poor movement patterns. In essence, both scenarios feed into deeper pain and dysfunction, a concept known as the chronic musculoskeletal pain cycle (CMPC) (Page, Lardner, & Frank, 2010). Thus, it is of the highest importance that one uncovers the weak link in movement sequences.
The JBJA is a convenient and quick method to consider the contribution of the kinetic links, which contribute to a particular movement. At its root, the JBJA acknowledges the site of pain/dysfunction (i.e., the knee). However, and more importantly, JBJA will consider the influence of the joints above and below the symptomatic region (Boyle, 2016). JBJA continues its perspective by stating that although each joint needs full range of motion (i.e., mobility) and smoothly controlled motions/motor control about the joint (i.e., stability), different joints tend to lose some of these qualities in a predictable fashion (Boyle, 2016).
Mike Boyle and Gray Cook submitted that upon closer inspection, trends occurred from one joint to the next (i.e., joint by joint): the foot tended to lack stability, the ankle tended to lose mobility, the knee lacked stability, the front of the hip lacked mobility, the back of the hip lost stability, the low back lost stability, the thoracic spine lacks mobility, while the cervical spine lacks stability, the shoulder blades lack stability, while the shoulder joints lack mobility (Cook, 2016). Thus, a deficient pattern of mobile and stable segments is seen along the kinetic chain.
Such knowledge is useful as a method of probing deeper into movement patterns, when deemed necessary. An efficient method of assessing/screening motion is to look at large, robust movements first, as the body controls many joints and motions at once and as a whole (i.e., coordinative structures)(Magill, 2011). If a pattern looks adequate, there is no need to look deeper, thereby saving time and effort. If, however, a pattern is deficient, one can implement JBJA to critically break down which links may be causing/exacerbating the symptomatic region.
In conclusion, the JBJA is a tool, which helps exercise and medical professionals determine the extent to which other joints may be influencing a symptomatic joint and surrounding musculature. At its center is the consideration of how joints above and below may feed into the CMPC, while acknowledging that the body controls movements a unit, and not individual segments. By fusing a macroscopic and microscopic approach, one can see the “forest and the trees” as both segments and patterns exist, playing a symbiotic role in resolving movement impairments.
References
Boyle, M. (2016). A joint-by-joint approach to training. Retrieved from http://www.strengthcoach.com/public/1282.cfm
Cook, G. (2016). Expanding on the joint-by-joint approach. Retrieved from http://graycook.com/?p=35
Magill, R.A. (2011). Motor learning and control: Concepts and applications (9th ed.). New York: McGraw-Hill.
Page, P., Lardner, R., & Frank, C. (2010). Assessment and treatment of muscle imbalances: The Janda approach. Champaign, IL: Human Kinetics.
-Michael McIsaac