Are my bones “misaligned” or “out of place”??? A commentary on a controversial topic in Chiropractic, and providing a better understanding for what a chiropractor does
It's a question that is asked in a majority of chiropractic offices in the United States every day - “Hey doc, how's my spinal alignment?” or “Doc, are my bones out of place?” Two questions of perception, philosophy, and belief – rooted in a physical sensation of discomfort or pain, and visually affirmed by a “high shoulder” or a “short leg”, but shrouded in controversy amongst the medical community - claims of quackery and negligence are derived from the public's perception that a chiropractor “puts bones back in place”. Certainly there are two sides to this story, a story that deserves further exploration.
How did the chiropractic profession come to be known as the “spinal alignment, posture, and ergonomics experts”? To first begin to explore this topic, we must travel back in time, to the year 1895 – the apparent “formal beginning” of the profession of Chiropractic. Daniel David Palmer (aka “DD”), founder of the Palmer College of Chiropractic, lived in Davenport, Iowa, as a Magnetist (an alternative energy-based healing practice). One day, he met a janitor by the name of Harvey Lillard, who had impaired hearing in one ear. As the story is told, DD provided the first “chiropractic adjustment” to Harvey's spine, based on the hypothesis that a misaligned vertebral segment was the source of Harvey's hearing disorder. After the DD's treatment was complete, and Harvey's spine had been “realigned”, his hearing was said-to-be miraculously restored. This story is one of cloudy-details and of much controversy, but nonetheless, is the foundation of the profession of chiropractic.
Since the time of DD Palmer and Harvey Lillard, some 120 years, the profession of chiropractic has evolved, as has science and our understanding of the human body.
Take a moment, before reading any further, and go and look at yourself in a mirror – look at your face from side-to-side. Examine your eyes, your lips, ears, hairline, the shape of your jaw (and you can continue this exercise with the rest of your body if you desire). Is your face perfectly symmetrical? The rest of your body? Is it exactly the same from side-to-side?
It is possible that I am an anomaly, but likely not - just human. The answer to this question for myself is a profound “no”.
Next, I pose the question: Why would your spine be any different than the rest of your body? When born or developing in utero, should your structure be completely symmetrical? Based on the presumption the it likely should not be, if a doctor takes an X-ray of your spine, and one vertebra appears to be a little to the left or right of midline, who's to say that isn't just your normal anatomy? If we delve further into this question, and look at the anatomy of the spine, we know that each and every vertebral level is complex and detailed.
Let's take, for example, the C6/C7 vertebral levels. If you examine the anatomy from the deepest levels possible, these two vertebra are connected to each other by the Intervertebral disc, which lies in between the bones – it is a ligament, which is very dense, fibrous, and strong in nature. On the front of the vertebra, another strong ligament known as the ALL runs north-to-south, the PLL lies within the vertebral canal and does the same, further connecting these levels. Further, the joints that allow for movement of the spine are encapsulated and interconnected. There are also the intertransversii ligaments (2), ligamentum flavum (2), Nuchal, and intraspinous ligaments at this and every spinal level of the cervical spine. The Longus colli muscle attaches directly onto the vertebral bodies, the scalenes muscles attach onto the transverse processes of the vertebra, and the the list goes on (see here https://www.youtube.com/watch?v=NrZF-zlhFwI for visual description)...
Now, given this information, and assuming that your spine was perfectly aligned to begin with, how would it become misaligned or go “out of place”? What would be the cause of this problem?
If we conclude, based upon our knowledge of the anatomy of the spine, that our spines are stable, resilient structures, it would make sense that, in order for a misalignment of a vertebral level to occur, a significant degree of muscular spasticity or significant trauma would have to occur, creating ligamentous instability – almost “jarring” the vertebra loose. In either of these instances, would adjusting the spine be indicated? Likely not in most cases, and in many instances it could even cause harm.
So if a chiropractor is not adjusting my bones back into place, what exactly are they doing?
The problem that arises in many instances when it comes to spine pain, a feeling of “misalignment”, or general discomfort, is not due to too much movement, leading to “a bone out of place”, but in fact, a lack of movement in the joints of the spine. This immobility of a spinal segment (think of it as the equivalent of a stiff knee, ankle, or shoulder) creates a neurological cascade of events to occur, that can lead to pain, muscular tension, and altered movement patterns. While our understanding of what we are treating has changed over the last 100+ years has changed, the efficacy of “the chiropractic adjustment” has been demonstrated in instances of patients with spinal joint pain. So when treating this joint pain, tightness, discomfort, or lack of motion (initially thought to be a misalignment), we are facilitating motion in the joint - back to its normal, healthy, movement patterns. If its a little left of center, I would say that's where it should be:)
I invite commentary on this topic, whether for or against my argument, from patients and chiropractors alike. I understand this topic challenges the core beliefs and tenants that many hold true when it comes to Chiropractic, and while it may offend some, I hope it educates many more.
Brandon S. Osborne, DC
Central Jersey Spine & Rehabilitation Center, LLC
47 W Broad St
Hopewell, NJ 08525
Serving the Pennington, Hopewell, Lawrenceville, Skillman, and Lambertville, NJ communities in Mercer County.