Myth series: Am I out of alignment?
Updated: May 6
How to know if YOU'RE really in need of a chiropractic adjustment
This is a longer read and most likely will frustrate most providers that read this. I have told patients and providers before, "I have opinions and you're probably not going to like them."
This question is one I get frequently from patients or curious individuals. The answer is no, not at all. Not even a little. Time for some background into my profession so this makes sense. There are two types of Chiropractors within the profession: straight and mixer. The straight chiropractors follow philosophical views that were established when the profession began. They focus on the spine and the innate abilities of the body to heal itself, with manipulation of the spine being the center of the treatment. The term mixer means nontraditional ideas are also implemented into the practice. Physical therapy, Graston technique, massage and dry needling to name a few.
The first group believe bones move out of alignment and that manipulation will put them back into a better alignment, allowing the nervous system to communicate more effectively and reduce/resolve disease. The better bone position allows the innate of the body to flow. (I feel foolish typing those two sentences). Those in the straight chiropractor group often use x-rays and measure different bone landmarks to find what needs adjusted. Or they may use a thermometer type of device that runs along the spine to indicate where it is out of alignment, reading the over active area which is causing the dysfunction. Both are part of a static assessment system, meaning the patient is not moving.
The second group of Chiropractors utilize different therapies to provide care for patients. This includes spinal manipulation, the soft tissue techniques mentioned above and motion assessments. I follow an evidence-based approach using movement assessments, manipulation, dry needling, soft tissue manipulation, DNS and McGill method. Since I have broken the traditional view, I fall into the mixer definition.
If bones don’t move out of place, why do providers still continue to circulate this belief and I have to explain why it is not real?
There are 19 Chiropractic colleges in the USA and roughly 6 have an evidence-based curriculum. Possibly 1 or 2 more but the majority are still pushing the philosophical approach that includes static beliefs. So, every year we have a new crop of providers guided by traditional, static beliefs, instead of these old ideas dying with providers that retire. When I get a patient in my office that asks this question or they are hesitant to have their neck adjusted because of a previous provider, I know they went to someone who chooses to practice this way.
Time to make other providers angry at me again. Those providers who choose to use the static approach are not using current best practices, have not included or focused on evidence-based care and, arguably, are not using the gold standard of care within the profession. Patients are going to providers who are knowingly and wrongfully choosing to not practice medicine at a competent level. I use this analogy with patients. Could you imagine going to the dentist and they still recommend copious amounts of alcohol to reduce the pain while your tooth is knocked out with a hammer and chisel?
Bones can go out of alignment. What, you just said they can’t!? Yes, if you are involved in an accident where enough force to your body causes bones to move. Car accidents, falls off ladders or a hit with a sledge hammer will cause bones to go out of alignment. At that point, you are a trauma patient and will most likely need surgery.
We in the manual therapy world understand that the body moves as a unit and retraining the brain to control movements is the key for treatment. For example: if I assess a patient with low back pain, I use a motion assessment on the back followed by a movement screen with a breathing assessment. That combination will tell me how the patient is moving, which gives me the necessary information to understand how and why they are causing the injury. Using a movement-based approach and treatment are, in my opinion, the best to resolve complaints for patients. Fun fact about taking x-rays of the spine: the most common findings are crooked spinous processes. You feel these if you touch the “bumps” on another person's back or see them when a person bends forward. Basing your treatment plan on how a patient is lying on a table vs how the patient spends the rest of the day moving makes no sense.
If I assess the person with the low back pain I mentioned above, I may determine the reason for the pain is a hip that is structurally different on one side. The structural difference causes extra movement to travel into the spine causing an overload to tissues which results in an injury. Watching this particular person perform a reverse lunge followed up with a quadruped rock (pictured below) will reveal a problem with the hip. From there, I go into an orthopedic assessment of the hip which reveals the structural abnormality. The treatment plan will be drastically different than a provider who uses a static approach.
Have you been hit by a large amount of force? Then, yes, you are out of alignment. If you have not experienced any type of large force you are not out of alignment. I hope you enjoyed reading this post. Bonus points for me because I didn’t use profanity or go on a rant.