As chiropractors, we often hear patients explain to us that their pain is due to something being “out”. For example, it’s common to hear phrases such as “my back went out again”, “my hips are out”, or “I can feel my neck is out”. Upon examination however, we find that there are other, more accurate reasons causing their symptoms, which give the perception that there is a bone or joint out of place.
Traditionally, when chiropractic was in its infancy over 100 years ago, chiropractors believed that a person’s pain and other disease symptoms were the result of a pinched nerve and interrupted nerve communication within the body that would occur after a spinal bone literally slipped out of position and compressed an adjacent nerve root. This was known as a subluxation and was represented by a “bone-out-of-place” model that was analogous to a garden hose being kinked, impeding water flow. Unfortunately, this is an over simplistic explanation. Today’s research has instead replaced this model with a multifactorial evidence-based model which suggests that a person’s symptoms are the result of restricted joint motion and its physiological consequences.
When a patient’s complaints are truly due to a joint problem, we commonly find that their symptoms are because one or several joints are lacking normal motion. This meets the American Chiropractic Association’s modern view and definition of a subluxation, which is “a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health”. These restricted joints can be thought of as getting “stuck” in a certain direction and may result from poor posture, trauma, stress, muscle tension, or disease. When these restrictions occur, there is an inherent biomechanical dysfunction when we try to move or use the involved joints. This is a type of physical stress which can result in numerous problems. There will often be inflammation and pain at the joint, muscle guarding or spasm, and adjacent nerve root irritation which together result in the patient’s presenting musculoskeletal symptoms. In chronic cases when a joint is fixated for a prolonged time, it becomes prone to early degenerative changes since the body will begin to lay down more bone and remodel at the areas of abnormal load and stress. Adhesions may also develop surrounding the joint, as part of this process, and spinal discs may become more narrowed and prone to herniation or other injury. In addition, synovial fluid which lubricates and nourishes the joint’s bony surfaces, becomes stagnant and more viscous.
In the end, joint restrictions should be treated whether there are symptoms present or not and chiropractors are the best professionals trained to identify and correct such problems. Treatments vary but will often include some form of spinal/joint manipulation that best suits the patient’s needs. Chiropractic care thereby reduces pain symptoms by restoring normal joint range of motion, lowering localized inflammation, and limiting potential for future joint dysfunction.
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