Proximal stability before distal mobility

If you have ever been a patient of mine, you have probably heard me talk about certain treatment principles that I strongly adhere to.  One such principal is  “Proximal stability before distal mobility” which simply refers to the fact that we must first have good mobility and strength along our core (mid-line structures along our spine) before we can maximize our extremity function (distal mobility).

In developmental terms, babies are born with great mobility, but very little stability (muscle control). Babies first develop head and trunk control and strength. They then start to roll over and eventually start sitting up.  Only after they gain good control of their trunk, do they start to reach with their arms and eventually pull themselves up to start the walking process.

How does this concept apply to the treatment of musculoskeletal pain? This developmental concept supports the rationale for the evaluation, treatment, and strengthening of the mid-line structures first before evaluating and treating the extremity.  For example, the client with shoulder pain will need to have the thoracic spine (middle back and ribs) evaluated and treated before the shoulder is worked on, even though the “pain” may be located in the actual shoulder region.  Remember, we are taking a structural approach to treatment, not pain driven.

The same can be said about chronic hip, knee, or ankle pain where the lumbar spine would need to be addressed first. Can the lumbar spine (lower back) provide first the mobility and then the stability needed for proper lower extremity (leg) function?

Therefore, any unresolved upper or lower extremity pain may need to have mid-line structures treated first to maximize functional gains.