Myth busting – “My back has gone out” and “I’m misaligned”.

I often hear theses terms and I completely understand why patients say this however, it conjures up the wrong image of what is happening.

If patients perceive therapists as putting “things back in place”, this may lead to disappointment as often things aren’t a quick fix. In some circumstances, a quick click in the correct place can make the world of difference and may be perceived as a miracle cure, as if something has been “put back in place”. Often though, there is an underlying injury and an inflammatory process at work and the body needs time to heal. As Osteopaths we help remove obstacles to this healing and create a better environment to speed up the healing process.

For a joint to properly “go out” requires significant trauma and would be a dislocation, which would require medical intervention such as in the case of a dislocated shoulder.

As therapists, we are feeling for restriction and asymmetry of motion in a joint. Imagine you have four vertebra in a row; where the vertebra meet they form joints, so in this case there are three joints between the four vertebra. These joints are held together by ligaments which control how far the bones can move before they dislocate. These ligament are very strong and, as I mentioned before, it would take considerable traumatic injury to do this. These joints are also crossed by multiple muscles and these control the joint movement.
As therapists, we contact the joints and move them from side to side, looking for equal joint play or range of motion. This is very small. When a joint gently gives in one direction but not the other, this indicates a restriction. The patient often perceives this area as tender and having “a bruised feeling”. In reality, “being out” or “misaligned” is abnormal restricted movement at a joint. On a biological level, the muscles that control the joint movement have become stuck in a contracted state. This bracing can be a defence mechanism in response to injury in order to protect an area, or may occur due to repetitive stress and poor biomechanics.

So what are we doing when we “put joints back”?

When therapists use adjusting/clicking techniques, we are never putting anything back in, as nothing was out in the first place. What we are trying to do is restore movement to a joint. The click its self is the by-product of the technique, not the be all and end all of the technique. The aim is to put in a very quick, sharp movement to the restricted joint to over-ride the tension in the deep muscles surrounding the joint. If you like, resetting it back to its default setting with the correct tension in the muscles either side of the joint, allowing equal motion.

For those who do not like the idea of being clicked, or where there are contraindications to this approach, there are other approaches that can be used to restore joint movement such as mobilisation and stretching, and the use of massage techniques and dry needling (acupuncture) to reduce the muscle tension around a joint.

If you are someone who has never had back pain before and then suffer an acute episode, it can be very painful and alarming. Even if you have experienced back pain in the past, understanding what is actually happening in your body can help to reduce the fear factor associated with these painful episodes.

For further help with any back related problems give us a call on 01202 47 44 77

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