Do joints really go out of alignment?

In the musculoskeletal world, there is a fascination with structural alignment. If you’ve seen someone who works in this field (physical therapist, chiropractic, massage therapist, body worker, etc) chances are that someone has mentioned that the pain you experienced was because of some sort of deviation from “normal alignment.” Common examples include: misaligned or rotated pelvis, ribs popped out of place, slouched posture, low back going out, and many more.

Logically, these explanations of why we experience makes sense with the therapies we use to correct them. Rib out of place? Pop it back into place. Rotated pelvis? Manipulate it back to neutral. Slouched posture? Sit up right. Sounds easy, right?

Explaining pain as if we are playing with Legos and that the simple answer is to adjust, mobilize, push, pull, or poke the joint back into place is flawed. Joints are more like Jenga blocks held together by a rubber band. Within a normal range of motion, the rubber band holds the joint together. If the rubber band is stretched too far (which is what would happen if joints went out of place), we would be left with an unstable stack of Jenga blocks. Simply putting the joint “back into place” wouldn’t increase the stability of the joint. The joint would continually go out of place allowing for a never ending loop.

While I am not arguing that people experience relief from having their joints adjusted, mobilized, pushed/pulled on, or poked, we should change the way we explain how manual therapy techniques work. The biological aspect (structural part) to pain comprises only a portion of the pain aspect. There are psychological and social aspects that also factor into a painful experience.

One thought is that manual therapy techniques could reduce the threat of a certain position or movement which decreases the pain. This would be similar to holding a child’s hand when going through haunted house. By having someone or something to guide them through the haunted house, the haunted house becomes less threatening. Since the main function of pain is for protection (whether or not there is tissue damage), reducing the need for protection of the tissue or area can also decrease the pain.

Another possibility is that manual therapy can stimulate receptors (in the skin or muscles) which can alter the painful experience. An example of this can be when you hit your elbow on something. You typically rub or compress your elbow and the pain decreases. Rubbing or compressing the elbow stimulates receptors in the skin and muscles which can result in reducing the pain.

While joints can certainly become dislocated (for example, shoulders), it doesn’t appear that joints frequently become misaligned or “go out of place.” The problem with strictly enforcing the misaligned or out of place model is that it creates a fear of movement because the joint will become misaligned or go out of place again (creating a never ending cycle). Instead, we should focus on using manual therapy techniques to encourage movement using the explanations described above.