• Michele Mahmood, PT, DPT

Joint by joint approach

Updated: Sep 22

When I became interested in Physical Therapy I was 14 years old. I was fascinated by the human body. My parents remember me asking for anatomy books and body chart posters to hang in my room. I was obsessed with learning about the human body...the joints, muscles and the movements they created. Being an avid athlete throughout my youth fueled my desire to know EVERYTHING about how the body worked and what happens when it's not working. My obsession lead me to PT school so I could expand my knowledge in order to help people recover from injuries and keep their bodies healthy to allow them to do the activities they love to do.

Isolated Injury

When I was younger, I truly thought every injury was isolated...a sprained ankle was from rolling it during a soccer game, a pulled muscle was from over exerting yourself in a race, a shoulder injury was from pitching too much during baseball practice. To an extent, this train of thought was nourished throughout my undergraduate education. It wasn't until PT school that my perspective began to shift.

Mind Blown

Learning about Gray Cook's Joint by Joint approach to the body was mind blowing. It changed my entire perspective on how I viewed the human body and how injuries occur and can be prevented. If you are not yet familiar with the joint-by-joint theory, be prepared to take a quantum leap in thought process. Physical Therapist Gray Cook has a gift for simplifying complex topics. In a conversation about the effect of training on the body, Gray produced one of the most lucid ideas I have ever heard.

His analysis of the body is a straightforward one. In his mind, the body is a just a stack of joints. Each joint or series of joints has a specific function and is prone to predictable levels of dysfunction. As a result, each joint has particular training needs.


Is this a stability problem or a mobility problem?

This picture demonstrates the simplicity of this thought. The first thing you should notice is the joints alternate between mobility and stability. The ankle needs increased mobility, and the knee needs increased stability. As we move up the body, it becomes apparent the hip needs mobility. And so the process goes up the chain–a basic, alternating series of joints.


The primary illustration is in the lower back. It's clear we need core stability, and it's also obvious many people suffer from back pain. The intriguing part lies in the theory behind low back pain - the new theory of the cause: loss of hip mobility.






Loss of function in the joint below - in the case of the lumbar spine, it's the hips - seems to affect the joint or joints above. In other words, if the hips can't move, the lumbar spine will. The problem is the hips are designed for mobility, and the lumbar spine for stability. When the intended mobile joint becomes immobile, the stable joint is forced to move as compensation, becoming less stable and subsequently painful.


Get a movement screen!

Analyzing movements and assessing the ENTIRE body is the only way to truly treat and prevent injuries. The distance runner with chronic knee pain may not have a "knee problem" but probably an "ankle/hip problem". This approach is vital to effectively understanding and ultimately "fixing" dysfunction which leads to pain/problems. In my opinion, EVERYONE needs a movement screen at least ONCE a year. Do yourself a favor and GET A MOVEMENT SCREEN!

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