The Joint by joint approach, victims and villains
This approach basically suggests that as we move we need certain joints to be stable while others are mobile. From the bottom up, we need a stable foot, mobile ankle, stable knee, mobile hip, stable lumbar spine, mobile thoracic spine (rib cage), stable neck and shoulder blade, mobile shoulder joint and so on down through the elbow, wrist and hand. This stands to reason in my eyes when we look at the anatomy of the joints, if we look at the knee, it is basically a big hinge, which moves predominantly through flexion and extension, although we can develop some small degree’s rotation in it. In comparison consider the hip, which is a ball and socket joint, the very nature of the ‘ball’ at the top of thigh bone should give an indication that the joint should move in multiple directions, which a healthy hip joint can quite happily do!
This approach to movement is quite relevant in today’s society. People are sitting for longer periods of time, what this leads to is joints which should be mobile becoming stiff, the ankle, hip and thoracic spine, while we then ask more of joints which should be stable, the foot, the knee and the lumbar spine. This is where victims and villains come into it, the site of the pain is not where the problem is. Take for example the knee, non-traumatic knee pain, patella-femoral pain syndrome or ilio-tibial band pain, very rarely is problem in the knee, it is just the victim of altered joint function either above it at the hip or below it at the ankle and foot, either one or both being the villain! So we could try and treat the knee, hopefully get some symptomatic relief, or we could look at the bigger picture, working out where the villain is and correcting that painless dysfunction which will then help the ‘stabilise’ the knee in the long run.