Several months ago, I first mentioned my theory on the kinetic chain ripple effect. I discussed my thoughts on how certain areas of the body may influence other areas throughout the kinetic chain, but have different impact based on how far away the two areas are. The kinetic chain concept in itself is nothing original or exciting, as this has been popularized for almost two decades now by several people in the form of functional rehabilitation and manual therapy techniques. Two very influential people in this area have been Chris Powers and Tom Myers, who have shown the influence the hip has on the patellofemoral joint and the influence of the fascia throughout the body, respectfully. But the differing impact based on proximity is something that I think is often overlooked.
While the kinetic chain concept is both simple yet profound, I sometimes feel like the concept is taken to the extreme at times. I have had a recent conversation about this on Facebook, which prompted me writing this post. One could certainly argue that since everything is connected, a small adaptation at the big toe of the left foot could lead to an injury of the left shoulder. But before we jump to conclusions, I think we should consider what I call the “kinetic chain ripple effect.”
Kinetic Chain Ripple Effect
The kinetic chain ripple effect is a really simple theory. To simply summarize, the kinetic chain can transfer influence throughout the body, but the effect is minimized the further away from the source that you get. This is exactly like the ripple that occurs after throwing a rock in the water. The closer you are to the area of impact, the larger the ripple. As the ripple travels, it’s effect is reduced the further it gets away from the origin. Hence the name, the kinetic chain ripple effect.
The Kinetic Chain Ripple Effect and the Human Body
How can we apply this to the human body? Any dysfunction (and that is intended to be vague and include weakness, inhibition, instability, tightness, hypomobility, fibrosis, and many other dysfunctions) is going to have it’s biggest impact on the joints closest to it’s origin. Take a look at the photo to the right (which I tinkered with in Photoshop for an hour!).
In this photo, the “ripple” is occurring in the left hip. As you can see, this will have a much greater impact on the lumbar spine and left knee than it would the left foot or right shoulder. This is why there are numerous studies that have been published discussing the influence of the hip of patellofemoral pain and low back pain while the influence of the hip on shoulder and upper extremity pathology has been mostly theoretical and difficult to demonstrate definitively.
I think that the majority of us now understand the kinetic chain concept and know that we need to evaluate more than just the location of symptoms, but also the related areas within the kinetic chain. That was one of the first aspects we all learned about evaluation skills, right? Assess both proximal and distal?
Based on the kinetic chain ripple effect, we should probably work our way both proximal and distal along the kinetic chain away from the source, identifying any contributing factors. While our emphasis should be placed on identified dysfunctions that are closest in proximity, we shouldn’t stop at the closest joints.
Once we have address dysfunctions close to the symptoms, we can then reassess both the the symptoms and dysfunctions along the kinetic chain. If symptoms are resolves than we know that we have likely alleviated the current problem. If symptoms are simply reduced, we may need to go further along the kinetic chain.
So next time you have someone with right shoulder impingement and a tight left hip, carefully assess the joints in between before jumping to conclusions. I am sure you’ll find that dysfunctions closer in the kinetic chain, such as the scapula and thoracic spine, are contributing more to the shoulder dysfunction than the hip. Address these first and work your way through the body like the ripple in the water, embracing the kinetic chain ripple effect concept.