The Kinetic Chain Ripple Effect

Several months ago, I first mentioned my theory on the kinetic chain ripple effect.  I discussed my thoughts on how certain areas of the body may influence other areas throughout the kinetic chain, but have different impact based on how far away the two areas are.  The kinetic chain concept in itself is nothing original or exciting, as this has been popularized for almost two decades now by several people in the form of functional rehabilitation and manual therapy techniques.  Two very influential people in this area have been Chris Powers and Tom Myers, who have shown the influence the hip has on the patellofemoral joint and the influence of the fascia throughout the body, respectfully.  But the differing impact based on proximity is something that I think is often overlooked.

While the kinetic chain concept is both simple yet profound, I sometimes feel like the concept is taken to the extreme at times.  I have had a recent conversation about this on Facebook, which prompted me writing this post.  One could certainly argue that since everything is connected, a small adaptation at the big toe of the left foot could lead to an injury of the left shoulder.  But before we jump to conclusions, I think we should consider what I call the “kinetic chain ripple effect.”

 

Kinetic Chain Ripple Effect

The kinetic chain ripple effect is a really simple theory.  To simply summarize, the kinetic chain can transfer influence throughout the body, but the effect is minimized the further away from the source that you get.  This is exactly like the ripple that occurs after throwing a rock in the water.  The closer you are to the area of impact, the larger the ripple.  As the ripple travels, it’s effect is reduced the further it gets away from the origin.  Hence the name, the kinetic chain ripple effect.

 

 

The Kinetic Chain Ripple Effect and the Human Body

kinetic chain ripple effectHow can we apply this to the human body?  Any dysfunction (and that is intended to be vague and include weakness, inhibition, instability, tightness, hypomobility, fibrosis, and many other dysfunctions) is going to have it’s biggest impact on the joints closest to it’s origin.  Take a look at the photo to the right (which I tinkered with in Photoshop for an hour!).

In this photo, the “ripple” is occurring in the left hip.  As you can see, this will have a much greater impact on the lumbar spine and left knee than it would the left foot or right shoulder.  This is why there are numerous studies that have been published discussing the influence of the hip of patellofemoral pain and low back pain while the influence of the hip on shoulder and upper extremity pathology has been mostly theoretical and difficult to demonstrate definitively.

I think that the majority of us now understand the kinetic chain concept and know that we need to evaluate more than just the location of symptoms, but also the related areas within the kinetic chain.  That was one of the first aspects we all learned about evaluation skills, right?  Assess both proximal and distal?

Based on the kinetic chain ripple effect, we should probably work our way both proximal and distal along the kinetic chain away from the source, identifying any contributing factors.  While our emphasis should be placed on identified dysfunctions that are closest in proximity, we shouldn’t stop at the closest joints.

Once we have address dysfunctions close to the symptoms, we can then reassess both the the symptoms and dysfunctions along the kinetic chain.  If symptoms are resolves than we know that we have likely alleviated the current problem.  If symptoms are simply reduced, we may need to go further along the kinetic chain.

So next time you have someone with right shoulder impingement and a tight left hip, carefully assess the joints in between before jumping to conclusions.  I am sure you’ll find that dysfunctions closer in the kinetic chain, such as the scapula and thoracic spine, are contributing more to the shoulder dysfunction than the hip.  Address these first and work your way through the body like the ripple in the water, embracing the kinetic chain ripple effect concept.

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17 Responses to “The Kinetic Chain Ripple Effect”

  1. Great post Mike. It seems like it has become much more “fashionable” in the last few years to find causes of pain far from the area where symptoms are experienced. I myself often have patients whose hip or back pain is stemming from compensations secondary to an old ankle sprain. Though this is not a an uncommon scenario, it’s much more common for the cause of symptoms to be closer to the area of pain and this post is good reminder of that. Thanks for all the great info.
    Jarod Carter PT, DPT, MTC

  2. Mike great post. I’ve also thought about the kinetic chain in this way for the past couple years. I would only add one addition to your description. When thinking of the kinetic chain and the ripple effect we need to think about what is acting like waves throughout the system. I believe, as I’m sure many of you would, it is energy. In pitching we are transferring energy (mainly rotational) from the lower extremity up through to the arm. Each joint, which has the ability to product a torque or moment, can be thought of as another set of waves in the water. What we know about the physics of waves is that timing is everything. If waves meet at the right time they will double in size and if at the wrong time they will cancel out completely. With pitching a variety of dysfunctions (as you called them) can throw off the timing of the waves and cause them to cancel instead of doubling. When these waves are cancelled then the distal segments must work harder to compensate for the lost energy. This may be one way an injured big toe can cause injury at the shoulder. Just my way of looking at it.

  3. Walt Lingerfelt June 7, 2011 at 12:55 pm

    Establishing sound theoretical concepts and trying to make biomechanical connections to identify the pathoanatomic dysfunction in a given region are certainly important; however, they are just that…theoretical. I think Mike is right on, we have much more evidence to establish these links between regions closer to the site of pain and unless treatment focused on the areas “closer to the original ripple” aren’t affecting a change, then I usually try not to chase too many rabbits at one time.

  4. Great post! I agree with you Mike on this. I find it easy to be trying to figure out the vague dysfunction that could be leading to their symptoms. Many times it is better to first treat the obvious and stay closer to the site of injury. However, in some cases, I think working from the ground up can be beneficial. For example dealing with over pronation which is causing back pain. Deal with this distal instability first before weakness in proximal hip abductors. Or, dealing with a posterior pelvic tilt posture which is causing increased thoracic kyphosis and in turn leading to cervical pain. If we try and increase T/S mobility without addressing the pelvis, we will be fighting an uphill battle.
    I love your posts- keep them coming!

  5. Great representation of dysfunction sir. I like to use the leaky roof analogy that has become so prevalent. I still feel like more coaches and therapists need to adopt this philosophy.

  6. Great website.
    I’ve lived and breathed the ripple effect for a few years now.
    I had reoccurring subluxations of my kneecap for many years – and surgeon once told me when I was a naive 17 year old that if I didn’t get it fixed I’d eventually develop hip and back problems. I thought he was crazy.
    Then sure enough, 15 years later…and after my last injury, I started having niggling back pain – which eventually exploded in to non-stop spasms…then neck pain, then weird ankle pain, and then clunking in my hip. Really the main issue is that unstable kneecap prevented me from walking normally and performing any exercises with my leg full extended – so my glute medius conked out. That one muscle has a profound effect on gait.
    I had my knee surgically stabilized 1 year ago. With aggressive rehab, the kinks are slowly ironing themselves out.

  7. I was curious if you ever thought of changing the structure of your site?
    Its very well written; I love what youve got to say.
    But maybe you could a little more iin the way of content so people could connect with it better.
    Youve got an awful lot of text for only having 1 or 2 images.
    Maybe you could space it out better?

  8. Hi there! This is my first visiut to your blog! We are a collection of volunteers and starting a new initiative in a community in the same niche.
    Your blog provided us useful indormation to work on. You have
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