Many people come to us describing their hips/back to be “out of place” or “misaligned”. This phrase has been popular and used by manual therapists, doctors, the media and others.
I can totally understand why it feels like this, when you have pain, your body doesn’t feel right, it doesn’t move as well, you feel stiff, tight and sore. Or if you have an acute pain, and struggle to move in a certain direction. It can certainly feel it something is out of place. However, did you know that our spinal joints and hip joints are some of the strongest joints in the body, as we discussed on episode 47 with Mark Laslett, and whilst they technically can “go out of place” this isn’t without significant trauma. Such to the extent that you would be highly unlikely to be walking into a clinic.
Spinal manipulation is often recommended from others or thought of as a treatment to pop a joint back into place, or to realign spines.
However, spinal manipulation (the cracking associated with chiropractors, osteopaths and physiotherapists), doesn’t actually realign joints or put joints back into place, although it can certainly feel like it does.
This largely comes from historical models of treatment, Chiropractors Osteos and other professions who offer spinal manipulation used to use a Bone out of place model. When a patient came into them with pain, we told people that a their spine was out of line, and we’d pop it back into place, and people often felt an immediate improvement in pain. However research has moved on a lot since then, we now now that manipulation doesn’t work in that way, as I mentioned above your bones and joints don’t actually go out of alignment.
So what if you feel better from manipulation? Many people do! Thats not a problem at all, its great, if you have found something that improves your pain, and allows you to function well, then great. We know manipulation, when appropriately used is good for a short term improvement in pain, similar to a stretch or a massage.
Manipulation can act like a mechanical pain killer, a temporary solution to decrease pain allowing you to improve your function, and importantly move more and back up those changes with some exercises.
So why is this a problem, what does it matter if you think your hips are out and you have to visit someone to get them realigned?
We started this podcast to improve myths, we aren’t setting out to make anyone feel bad, or that they’ve done something wrong.
The reason we want to change the narrative, is false beliefs can promote what we call, fear avoidance behaviour, ie you may now be afraid of doing certain activities for fear of your back “going out”, and then dependancy on a certain practitioner to help put it back in. When this should never be the case, as clinicians and therapists we should be helping you with is improving your resilience, empowering you ie letting you know what you can do, not what you should be avoiding, then coming up with a plan to help you achieve that.
Our job as clinicians and educators is to show you that us Human beings are incredibly resilient, and our spine and hips can cope very well with the day to day stresses that we place on it.
If you would like to read more around this topic, have a read of a similar blog post from David Poulter here
Stanton, T., Moseley, G., Wong, A. and Kawchuk, G., 2017. Feeling stiffness in the back: a protective perceptual inference in chronic back pain. Scientific Reports, 7(1).
Bialosky, J., Bishop, M. and Penza, C., 2017. Placebo Mechanisms of Manual Therapy: A Sheep in Wolf’s Clothing?. Journal of Orthopaedic & Sports Physical Therapy, 47(5), pp.301-304.