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The Lego Effect: Dispelling a Chiropractic Myth

 

“Is it out, doc?!?”

This age-old chiropractic question, or something similar, is posed to me quite frequently in my busy downtown Toronto practice.  Is a bone out of place?  Have the 2 sides of a joint shifted out of “alignment?”  I am always a little baffled at how I should approach the response – do I answer accurately, and launch into a biomechanical or evidence-based anatomy & physiology lesson?  Do I side-step, or deflect, the question because the “correct” answer is one that requires a) too much time to properly explain and b) might not interest the patient in the least?  Or do I politely oblige, despite the semantic inaccuracy, because I know that it’s not really the terminology that matters, but more that a sound therapeutic approach will be applied?

The truth is, “it” (referring to a bone/rib/vertebra/joint) isn’t “out” of place.  It never was and never has been (In fact, if it was literally out of place the person would likely be in the ER and not at Wellington Healthcare). All too often, it seems, people have the idea that the human skeleton is akin to a giant structure comprised of miniature lego blocks that a chiropractor can “click,” “pop,” or “crack” (more on this topic in a future post) back “into place.”  I can only assume that this notion was born out of more antiquated chiropractic models or concepts and, due to simplicity of explanation, has been perpetuated for many years in the chiropractic field.  Again, the truth is that this view of the human body is entirely too elementary and, in essence, literally false.

Let’s take the human skeleton for instance – a wonderfully complex network of 24 vertebral bones (33 including the sacrum and coccyx) and soft tissues that, in any one vertebral joint, are supported by a vast array of strong ligaments, spinal muscles and intervertebral discs, not to mention the shape of the vertebrae themselves.  These structures combine to support, stabilize, and control the relatively small amount of movement that occurs at the articulation between 2 vertebrae – not to mention collectively house and protect the spinal cord.  The gross movement of the spine as a whole is a result of the combination and coordination of these relatively subtle individual motions, making the structure an intricately complex, fluid and interconnected system of moving parts – NOT, as it seems many people think, a series of individually functioning bones that shift and slide into and out of place at will.

When an individual experiences mechanical back pain, the type that a chiropractor, physiotherapist or massage therapist treats on a daily basis, it is generally a result of an injury, irritation or damage to one of these structures – ligaments, muscles, joint capsules or surfaces, fascia, etc. – which results in a chemical reaction that stimulates nerve fibres, culminating in the perception of pain.  In many cases, the body will also attempt to protect itself with a reflexive tightening (or spasm) of the local muscles and tissues surrounding the injury in order to avoid further damage.

When considering a manual therapeutic approach to this type of injury, let’s say a chiropractic manipulation and/or one of many soft-tissue techniques, a therapist typically aims to achieve a few goals:

1) decrease the nervous system’s protective response to the injury
2) promote more efficient healing of the injured tissue, and better structural quality of that tissue
3) decrease pain and inflammation
4) improve the biomechanics of the injured area through decreasing muscle tension and increasing synovial fluid production in the affected joints.

Now, obviously, this brief explanation is not a completely comprehensive overview of the body’s response to therapy – however it does illustrate the complexity of mechanical injuries and the subsequent approach taken by an appropriately trained therapist.  The take home point is this:  when you are experiencing pain that interrupts your ability to function normally, have the issue assessed by someone that understands your body’s fundamental biomechanics and can formulate a sound approach to fixing your problem.

Oh, and leave the Lego to the romper room ;)