Your spine is (probably) not misaligned

Your spine is (probably) not misaligned

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Many clinics, therapists and chiropractors offer posture scans, spinal scans and spinal checks

But do they have any value?

The short answer is, not much (for most people). They can even have negative value – where people are wrongly led believe they have a health issue because their spine is ‘not aligned’. The slightly longer answer goes something like this…

A small number of people have a medically-significant curvature in their spine. This condition is called scoliosis. If you have a true scoliosis, you don’t need a spinal scan or a posture check to tell you so. It’s pretty obvious…

Scoliosis can cause significant issues and may require surgery or pinning.

For everyone else, there is very rarely any clinical significance associated to a ‘misalinged’ spine. Even if you do have a slightly curved or ‘misalinged’ spine this does not necessarily explain any pain you may be experiencing, Nor does it increase your future risk of problems.

Patients who visit physical therapists because of chronic pain are often misled to believe that their pain is due to some kind of deformity in their posture or fragility in their spine. (They may not be told this directly but that’s the perception they come away with.)

Back pain is often attributed to mechanical (how you move) or structural (how you’re built physically) problems. Tilted pelvises, leg length differences, ‘trapped’ nerves, flat feet, ‘bad’ posture, ‘tight’ musculature. ‘Weak’ cores, asymmetric movement and ‘misaligned spines’…the list goes on.

Sometimes these physical characteristics may be relevant. But it’s perfectly possible to have all kinds of imbalances, misalignments and other issues and be pain-free. Just as it’s possible to be ‘aligned’ but in pain. The clinical evidence shows that the importance of most of these biomechanical ‘issues’ is often over-stated. There are various problems associated with a ‘mechanical’ theory of back pain including:

  • ‘Structural’ explanations for chronic pain are generally unsupported by scientific research.
  • Experts disagree on the significant physical markers (making reliable diagnosis difficult).
  • Structural diagnoses are often difficult to do anything about even if you can agree on them in the first place.
  • Patients who are given the idea that postural imbalances are “serious” are likely to fall foul of the ‘nocebo’ effect whereby they expect to have problems and this becomes a self-fulfilling prophecy
  • Exclusively focusing on biomechanics can stop us from considering more useful models of understanding and managing pain

Picture of a pencil with an eraser on the end rubbing out the word 'pain' to indicate pain relief

To understand chronic pain and to recover from it effectively, both patients and practitioners need to stop trying to think of the body as a machine that malfunctions.

The reality is far messier!

Physiology (especially neurology and biochemistry); psychology and emotional processing; lifestyle choices (nutrition, activity levels). All have at least at much impact on back pain as ‘spinal misalignment’ and likely more.  Medication side effects, fatigue, cigarettes and alcohol and being really out-of-shape are all more important risk factors for pain than any ‘spinal misalignment’.

Then, there’s the way chronic pain is increasingly considered to be a disease in its own right. Pain itself is much weirder and more useful to understand than the many mechanical glitches that supposedly cause it. We often think of pain as a uniform thing. We measure it in terms of how bad it is (severity) how long it has gone on (acute/chronic) and where it is felt in the body (back pain? headache?) However, clinicians and researchers are increasingly understanding that the underlying causes and nature of pain are many and varied. If you can’t identify what type of pain you are dealing with it’s going to be very hard to treat it.

There are at least several subtypes of pain:

Nociceptive / inflammatory pain:

Results from tissue damage or inflammation e.g. a sprained ankle. Anti-inflammatory treatments generally work well.

Neuropathic pain:

When pain-sensing nerves themselves are damaged or malfunctioning, so they send unwarranted (by the local tissue status) pain alerts to the brain. Nerve damage can occur from injury or from illnesses like diabetes or shingles. For this type of pain anti inflammatory strategies don’t work because they don’t target the damaged nerve signalling.

Nociplastic / central sensitisation pain:

pain which is not accompanied by any nerve or tissue damage in the place that hurts, but the central nervous system’s pain-sensing processes (within the spinal column or brain) are over- sensitive. Fibromyalgia is an example. Find out more in this excellent article..

Find out more in this excellent article.

The very long answer to the first question (do spinal scans, posture checks and the like have any value) is really very long! (too long for a single blog post!)

And it’s also very personal.

The value of any test or assessment is very much determined by the personal health history, symptoms, and health goals of each individual.  If you’re suffering with chronic pain, or if you’ve been told you have a ‘misaligned spine’ or a ‘poor posture’ and you’re worried about what that means, the short answer is ‘not much’. If you’d like a more personal and expert answer, you know where to find us…

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