Pain and Regional Interdependence

BY: David Newman
POSTED June 8, 2022 IN

So your back hurts, has done so for years.  Maybe you are having headaches, but the scans of your head don’t show anything.  What gives?  In a simple world, if your pain was the site of the problem, treating that pain would be a breeze and you wouldn’t need to see a musculoskeletal specialist.   In this blog, I want to introduce you to a concept called regional interdependence and its key to achieving breakthroughs in your health.

Let me tell you a secret about myself:  My kids make fun of me all the time, calling me “nerd” because I love to learn.  Additionally, I am fascinated by the human body.  Learning about it is so interesting to me.  First off, it is a testimony to our Creator.  We are made in His image, so that alone is just cool to me.  But from a health perspective, there is so much we know and so much we have to learn.  Studying the body in chiropractic school was filled with many highs and lows.  Spending countless hours memorizing microbes for Microbiology or chemical reactions in Biochemistry were not the highlights of my educational experience.  However, spending years studying the human body gave me the appreciation of how complex we truly are.  Take pain for instance.  We all have felt pain at least once in our lives.  Some of you may have experienced it from a fall playing sports.  Others may have been involved in a car accident.  Maybe you can’t recall the activity that was the trigger, but now your head or back hurts “out of the blue.”  Pain doesn’t have to have its origin from a physical event.  Just look at the teenager who broke up with their boyfriend/girlfriend and they feel the pain of that event.  So pain can manifest from an actual physical activity, or even as the result of non-physical ones.

From a musculoskeletal perspective, pain serves a purpose.  Pain is a signal that tells you something is wrong.   Put it this way: if you couldn’t feel pain, life would be very difficult.  There is actually a congenital (something one is born with) disease called CIP (Congenital Insensitivity to Pain).  Those with CIP have a genetic mutation to the SCN9A gene (kind of cool scientists can pinpoint a disease to a specific gene) which totally prevents them from feeling any pain.  At first, you may be thinking ‘that would be great-never to feel any pain..ever.’  However, think about it.  When you were little and fell off your bike speeding down the hill and broke your leg, the pain in your leg signaled something was wrong.   What about the time you were not looking and placed your hand on the hot stove?  If you couldn’t feel pain, you wouldn’t have pulled your hand away.  So pain, while not a pleasant sensation, actually serves as sort of a watchman for you.  It can tell you of some serious problem or danger that, if you are not aware of, can lead to some very bad outcomes.  One other thought on pain. It is not just a sensation one feels.  Pain has an effect on the actions of your life.  It can directly and indirectly impact you, in a positive or negative way.  The former heavyweight boxing champion, Mike Tyson, once said “Everyone has a plan until you get punched in the face.”  Pain can alter the course of your life.

Now that we understand the importance of pain, let’s go a little further.  Just because you feel pain in one area, it doesn’t always mean that area is the problem.  One concept we often talk about at our office is the difference between the source of pain and the site of pain.  We won’t go into details of all the types of pain because that won’t tell you right here what the problem is, if you are currently having pain.  It is good knowledge to have, but for now, just take away that concept that where if you are experiencing pain in a certain part of your body, the source of the problem may lie in a different area.  Likewise, the source and site may be the same as well.   Going back the idea of how complex we are, I want to introduce a term that may be new to you.   The term is called Regional Interdependence.  The revised definition of Regional Interdependence, RI, refers to the concept and clinical model that a patient’s primary musculoskeletal symptom(s) may be directly or indirectly related to or influenced by impairments from various body systems regardless of proximity to the primary symptom(s).[1]    So why is this concept important?  If you have a specific issue in one area of your body, you need to see someone who understands RI, and not only understands it, but has systems in place to identify the source of your problem.   How does this work?   From an organizational standpoint, the body can be classified by cells-tissues-organs-organ systems.   Oftentimes, we get caught up in compartmentalizing these when dealing with pain or problems of movement.  For example, a patient may have pain when lifting their shoulder when they try to lift their arm over their head.  What happens sometimes is the healthcare provider will do their examination solely on the affected shoulder.  That examination is certainly warranted, but what happens if the problem is originated in the neck?  If the problem is in the neck, is it a mobility or a stability/motor control one?  Is there a system or way to actually determine that neck problem? The answer to that would drastically affect which proper treatment should be rendered.   Now, let’s take that same patient with the neck problem, but let’s say that shoulder pain has not yet manifested.  Is there a way to determine the neck problem and address it BEFORE the shoulder dysfunction manifests?  Yes, there is, but it requires the understanding of RI and a way to assess problems that are not only painful, but those that are non-painful and yet dysfunctional.   I hope this gets you thinking a little more about your health from a different perspective today.

In our next article, we will dive deeper into this discussion.  For now, if you have any questions regarding this article or about how we may be able to help you with your health needs, please call us at 267-544-WAVE(9283) or email at


  1. Sueki, D. G., Joshua , A. C., & Robert, S. W. (2013). A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. The Journal of Manual and Manipulative Therapy, 90-102.
Dr. David Newman is the sole owner and operator of The Head and Spine Pain Center of PA. Dr. Newman graduated from the Palmer College of Chiropractic’s Florida campus in 2015 with academic and clinical honors. Specifically, Dr. Newman graduated Magna Cum Laude and Salutatorian of his class. He is trained on a variety of chiropractic techniques including, but not limited to, Palmer package, Gonstead, and Diversified techniques.
Migraine, Migraines, Headache, Headaches, Head Pain, Migraine Headaches, Migraine Relief, Headache Relief, Tension Headache, Tension Headaches, Migraine Headaches, Migraine Headaches Relief
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  • EPIC Upper Cervical Chiropractor in Trappe / Collegeville, PA

    The Head & Spine Pain Center proudly provides EPIC Upper Cervical and traditional full spine chiropractic in Montgomery County, Pennsylvania in the areas surrounding Trappe and Collegeville. We offer painless, non-surgical technology for the treatment of severe headaches/migraines, back & neck pain, vertigo, disc herniations, sports injuries and performance, as well as other neurological conditions.
    M, W, TH : 9:30AM – 1PM ; 3PM – 6:00PM
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