The joint by joint approach is a concept coined by Gray Cook, which looks at the body as a whole and then breaks it down into individual regions of stability and mobility. Our bodies can be viewed as a stack of several joints, all in which have different designs (structure) that allow the body to move in specific ways and handle different demands (function). An example of this, is the joints that make up our knee in fact do not look the same or act the same as the joints in our shoulder. Each joint, or series of joints, in the body are designed to carry out certain duties specific to what it is being asked to do. With that being said, these joints are also prone to specific tendencies of dysfunction which can lead to injury and pain. Having the knowledge of how certain joints are supposed to act serves us as a guide to properly assess and treat these areas in a particular manner.

First thing we should know is that there is an alternating pattern between joints of stability and mobility. For instance, the ankle needs to be mobile, the knee needs to be stable, the hip needs to be mobile, meaning the low back needs to be….. stable and so forth all the way up the kinetic chain of joints.

 What is mobility? Mobility is how far into a range of motion a person can move but while controlling it. This can easily be seen as an equation.

Mobility = flexibility + motor control. Being flexible without the control can lead to instability and increase the risk of injury. Having motor control but no flexibility means you are stiff and cannot move as well as you could.

 What is Stability? Stability can be thought of as the ability to resist any unwanted changes to their current position or motion. It is the ability to maintain the desired position while staying still or maintaining the desired motion while moving.

 So what can happen if the joints are not functioning as they should? If our joints do not have these characteristics, they will start to function in a way different than to what that specific joint is intended for. Once this happens it can be termed as joint dysfunction. When we have some sort of dysfunction, our brain realizes it and ends up creating a compensation pattern within the body to accommodate the dysfunction in order to be able to carry out daily movements despite the fact it may be in a faulty manner. Our bodies are excellent at compensating and creating new patterns to function in order to accomplish a task without thinking about long term consequences. Our body will compensate wonderfully until it doesn’t. This is usually when we experience pain or injury. When our joints do not function the way they should, whether short term or long term, our brain realizes this as a “threat”. This can turn on a response by creating pain and/or muscle tightness “guarding” to bring awareness to the areas and to prevent further movement. This ultimately is trying to reduce the potential risk of the threat. Another way our bodies can adapt to joint dysfunction, especially in terms of long standing instability of a joint (when an area is not stable enough and does not have adequate motor control) is that it can create bony deposits in an attempt to create more stability…. This is an example of osteoarthritis.

Through this Joint by Joint approach we can see each joint’s needs and tendencies of dysfunction.

So, how does this concept even work? The easiest way to explain it is through a common example of low back pain which is all too familiar for most of us. Let’s start by looking at what the low back (lumbar spine) primary need is---- Stability. Now let’s look at the joints both above and below the lumbar spine to see what they should have----Mobility. So if we find in the assessment that the low back has a loss of function, there is likely a loss of function in the joint below and even potentially above. In the case of the lumbar spine, it’s the hips and thoracic spine. In other words, if the hips and thoracic spine are lacking mobility, the lumbar spine will compensate and move more than it is meant to. When the intended mobile joint (hips/thoracic spine) looses mobility, the stable joint (lumbar spine) is forced to move as compensation, becoming less stable and potentially painful.

Having a practitioner who knows how the body is supposed to function and understands that there usually is an underlying dysfunction in one joint that can lead to pain somewhere else. This allows the skilled physician to properly asses and figure out the root cause of the problem. There will be a more thorough examination of the site of pain, but as well as, the joints above and below. There won’t be the rabbit holing by a practitioner of chasing pain but actually treating the root cause - the “why” behind your pain.

If you are currently in pain or have experienced pain which seems to keep coming back, it’s time to get properly assessed so you can start to learn and understand why, as well as, what you can do to control and manage it on your own.