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  • Writer's pictureNate Oliveira

Pain vs. Function

The vast majority of people that come into my chiropractic office are there because they want to fix an area that is in pain. Most commonly it's knee pain, low back pain, neck pain, or shoulder pain. They're looking for a sports chiropractor to tell them what's wrong with said body region, Obviously, it's important to assess these areas and to identify what is the body tissue that is causing the pain signals to fire up to the brain. But equally important is to assess the surrounding regions to identify if there's a dysfunction that is causing the painful area to be more prone to damage or poor movement.

This is important because of the concept "regional interdependence". This term essentially means that each sequential region of the body functions together in a coordinated fashion, both biomechanically and neurologically, and that if there is dysfunction in one area it can propagate into other areas. Going a little deeper, some areas of the body are meant to be more stiff while other areas are meant to be more mobile. For example, the shoulder girdle is designed to express a high degree of movement while the trunk and thoracic spine area is meant to be relatively more stiff/stable. This is so that the flexible shoulder has a stable base (the trunk) to function and operate off.

When you look at the entire body, you can see that these regions of mobility and stability alternate, creating an alternating chain of mobile segments that are connected to stable ones. (In the technical definitions, a "mobile" segment is one that is able to express motion in more than one plane of motion, while a "stable" one is a joint that expresses motion in one plane primarily. Don't get too caught up on this.)

So if someone presents with shoulder pain, it's very important to look at the surrounding regions, like the thoracic spine, opposite hip, etc. in order to see if the true dysfunction is somewhere other than the area that is painful. You may be asking "how do you know what to look for? There are some many other places it could be!"

You'd be correct in that assumption! Almost anywhere in the body could be a source of dysfunction. Further, it may not be a mobility issue but a stability issue. It might not be a joint problem but a soft tissue problem. It mig

ht not be either but a brain control issue.

This is why it's so important to have a comprehensive assessment that is able to capture which one of these elements it could be and where it could be coming from. This is why I use the Selective Functional Movement Assessment (SFMA) - a clinical whole body movement assessment for those who are experiencing musculoskeletal pain. It essentially asks your body a non-verbal question - can you take each major joint complex through its "full" range of motion and can it do so without pain? This is not an answer that the brain/body can fake. If there are any regions that are deemed "dysfunctional" (i.e. it can't go through it's full range of motion) or are painful, the SFMA is able to identify them and give you further directions to differentiate if there is a mobility dysfunction or a motor control problem.

This clearly identifies what is the area(s) of dysfunction that is contributing to the source of pain. When these areas are identified, a clear roadmap for rehabilitation can be developed. You are not doing thoughtless shoulder exercises when in fact it is a spine mobility problem or a weak core issue.

I run this on all of my patients to gain clarity on what their movement proficiencies are, what needs to be addressed, and also as a metric for improvement.

If you are interested in receiving an SFMA, please contact me at for a free screening assessment! I would be honored to be a part of your movement and health journey.

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