In a patient with multiple dysfunctional regions, what is the recommended initial sequencing of manipulative treatment?

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When multiple regions are dysfunctional, the body’s movement is best restored by a distal-to-proximal sequencing. Start with the most distal, largest regional dysfunction so you can influence the proximal segments through the kinetic chain. Addressing the pelvis and thorax first sets a solid base for motion, rebalances diaphragmatic and rib cage mechanics, and reduces compensatory patterns that would obscure corrections higher up the spine and cranium. Then progress cephalad, reassessing after each region to guide the next steps based on how the tissues respond. Treating proximal regions first can lock in maladaptive patterns and make further corrections harder, and treating everything at once or choosing regions at random lacks the systematic leverage that distal-first sequencing provides.