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  • Writer's pictureRobin R Varghese, PT.

Understanding Regional Interdependence in Musculoskeletal Physical Therapy Assessment : A Comprehensive model in PT Assessment and Intervention.

What is Regional Interdependence?

  • There is an interdependence that exists between regions of the body, as well as, other systems(1).

  • The term ‘regional interdependence’ or RI has recently been introduced into the vernacular of physical therapy and rehabilitation literature as a clinical model of musculoskeletal assessment and intervention. (1)

  • If a patient’s presentation is unclear or if the response to intervention is less favorable than expected, practical application of the regional-interdependence model may add clarity to the patient’s clinical picture and guide subsequent interventions (1)

  • With respect to musculoskeletal problems, regional interdependence refers to the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint(1).

  • It describes the clinical observations related to the relationship purported to exist between regions of the body, specifically with respect to the management of musculoskeletal disorders.(1)

  • The revised definition of RI acknowledges that biomechanical and neurophysiological factors may account for musculoskeletal responses seen in conjunction with treating impairments, but it expands upon the previous definition and includes the provision that various body regions and systems may contribute to these observed musculoskeletal responses and their associated clinical outcomes and likely also include other factors(1) 

The concept:

  • RI was initially defined and proposed as a part of a basic manipulation skills education developed by Wainner et al. in 2001.(1)

  • The concept of RI stemmed from the review of literature during which they observed that regions of the body appeared to be musculoskeletally linked.(1)

  • Erhard and Bowling had alluded to this concept in 1977 when they stated: ‘Dysfunction in any unit of the system will cause delivery of abnormal stresses to other segments of the system with the development of a subsequent dysfunction here as well’.(1)

  • The primary interest of RI has been physical manifestations (typically pain and range-of-motion) involving the musculoskeletal system.(1)

  • The mechanisms underlying these primary manifestations can be much more complex involving other physiological systems(1).

  • Any condition or disorder initiates a series of responses that involves multiple systems of the body. Not only musculoskeletal but also neurophysiological, somatovisceral, and biopsychosocial responses occur when a disorder or condition disrupts homeostasis(1).

  • Examination of proximal and distal joints in the same region of the reported pain and dysfunction is vital to the concept of regional interdependence. It is important to remember, that regional interdependence is different than referred pain(2).

  • In the revised model of RI, it is proposed that not only neurophysiological and musculoskeletal structures but biopsychosocial and somatovisceral systems can all potentially affect the function of the musculoskeletal system(1)

  • The formalized concept of RI is relatively new and was originally derived in an inductive manner from a variety of earlier publications and clinical observations. However, recent literature has provided additional support to the concept.(3)

The redefined concept of RI proposes that:

  • Response(s) to a disorder or condition and the associated clinical outcome(s) are not limited to local and adjacent regions of the body but can involve a neuromusculoskeletal response that may be more widespread.

  • Multiple systems respond to impairment and may influence the function of the neuromusculoskeletal system and associated symptoms(1)

Why is Regional Interdependence important in Physical Therapy?

  • Regional interdependence is part of the rationale behind the use of thrust manipulations for regional conditions. Recent research has shown that there may be a neurophysiological change that produces an improvement in pain and outcomes in musculoskeletal disorders. While local treatment is usually the first approach to rehab, the regional interdependence model can be utilized for persistent and chronic pain.(2)

  • The regional interdependence model of examination allows the PT to go beyond traditional, often vague, and even sometimes misleading musculoskeletal diagnoses, and provide optimal care to their patients.(2)

How is Regional interdependence a viable option for PT examination and intervention planning?

Here are a few examples of regional interdependence at work:

1. Interventions aimed at the hip have been used to treat:

2. Interventions aimed at the lumbar spine have been used to treat:

3. Interventions aimed at the thoracic spine and ribs have been used to treat:

4. Interventions aimed at the cervical spine have been used to treat:


  • In 1955, Steindler proposed a model based on a kinetic mechanical engineering model. He termed this relationship the ‘Kinetic Chain’ and in his model, he described the body as a series of interconnected joints where the movement of one joint directly effects the movement of other joints above and below. His model is based primarily upon the biomechanical relationship between regions of the body. For example, decreased dorsiflexion in the talocrural joint can produce biomechanical compensatory changes in knee, hip, and lumbar spine.(1)

  • Current research has shown that regional interdependence can be affected not only by other regions in the musculoskeletal system but impairments from varying body systems and regions.(3)

  • Given the role of the lower extremity in the kinetic chain of the baseball throwing motion, lower body deficits may affect the kinematics of the upper extremity and play a role in the elbow injury of baseball players. Specific lower extremity deficits were found to be independent risk factors for elbow pain and injury in throwing athletes at certain levels of play. Additionally, prevention programs designed to correct deficits in identified risk factors were effective in reducing the incidence of elbow injury in youth athletes.(4)

  • Despite the growing interest, controversy exists regarding the relevance of the RI model in physical therapy research and practice. Therefore, RI warrants further examination and scientific scrutiny(1)

Recommended video:

For a better and easy understanding of RI, we recommend you to watch the following video.

At Valley Healing Hands, we provide the best Physical Therapy treatment for all musculoskeletal, orthopedic, and neurological conditions. We provide an atmosphere developed for all our patients with a one on one ratio for the best quality of care needed for maximum outcomes. Our physical therapists are highly qualified and will plan an individualized treatment routine, customized to your specific needs. Our patients are highly satisfied with our services. You can learn about what they have to say about us here and get connected to us here. Our patients love us and you too will! We are with you!!!


  • Regional Interdependence: A Musculoskeletal Examination Model Whose Time Has Come J Orthop Sports Phys Ther 2007;37(11):658-660. doi:10.2519/jospt.2007.0110


  • A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications J Man Manip Therapy,  2013 May;21(2):90-102.DOI: 10.1179/2042618612Y.0000000027

  • Regional Interdependence and the Role of the Lower Body in Elbow Injury in Baseball Players: A Systematic Review, Jordan Deal, et al American Journal of sports medicine, Volume 48, Issue 14, April 16, 2020


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