The Joint By Joint Approach is a common underlying theme in functional rehab. This term was coined by strength coach Michael Boyle and Gray Cook, PT in an article posted on Michael Boyle’s Strength Coach.com. Others, like Charlie Weingroff, DPT, have popularized the term over the years. An excellent synopsis of the theory is on Gray Cook’s website and will also offer other reading suggestions. In a nutshell the Joint By Joint approach sees the body as a stack of joints with alternating regions with more importance on mobility and regions where stability is more important. Here is a chart of the major joints as they are seen in this view.
Ankle — Mobility (sagittal)
Knee — Stability
Hip — Mobility (multi-planar)
Lumbar Spine — Stability
Thoracic Spine — Mobility
Scapula — Stability
Gleno-humeral — Mobility
From this perspective, we see that most musculoskeletal dysfunction occurs when motion is lost in a region that inherently needs mobility. The body then compensates by seeking to gain more mobility from a region that is more suited for stability. This often leads to overuse syndromes which affect areas like the knee, low back and elbow.
The origins of the Joint By Joint theory can be found in Vladimir Janda’s Layer Syndrome, AKA Stratification Syndrome.
The Layer Syndrome, in turn, speaks to the Upper and Lower Crossed Syndromes which involve the cervical spine and hip area. Janda noted that certain postural habits lead to adaptive shortening of muscles with resultant reflexive inhibition of the antagonists. Phil Page, PT and Clare Frank, DPT have put together an excellent site at MuscleImbalanceSyndromes.com which chronicles the work of Vladimir Janda and offer texts and continuing ed opportunities.
To learn a bit more on these approaches, check out the links and read up. StrengthCoach.com is an invaluable source of ongoing, cutting edge material from the strength, performance and rehab communities. Another excellent resource for those more of the rehab bent is SportRehabExpert.com. Joe Heiler, PT has constructed a wonderful site there, with clinician oriented videos, podcasts, interviews and continuing education opportunities.