A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications

Abstract

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. The underlying premise of this model is that seemingly unrelated impairments in remote anatomical regions of the body may contribute to and be associated with a patient's primary report of symptoms. The clinical implication of this premise is that interventions directed at one region of the body will often have effects at remote and seeming unrelated areas. 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. The primary purpose of this article will be to further refine the operational definition for the concept of RI, examine supporting literature, discuss possible clinically relevant mechanisms, and conclude with a discussion of the implications of these findings on clinical practice and research.

Keywords: Physical therapy; Regional interdependence; Rehabilitation.

Figures

Figure 1

Regional interdependence involves the coordinated and integrated action of multiple systems including musculoskeletal, biopsychosocial, neurophysiological, and somatovisceral.

Figure 2

The allostatic process is responsible for the regulation and integration of biopsychosocial, neurophysiological, somatovisceral, and musculoskeletal responses.

Figure 3

Multiple systems can contribute to a musculoskeletal response by the body. Both local and remote responses occur, but the Regional Interdependence Model represents remote responses by the body.