Sticks and stones may break your bones but words will hurt you
Verbiage is important… especially when it comes to our joints
Verbiage is important not just in the physical therapy world but in all professions.
Let’s first tackle a misconception from our medical community. Your spine, hips, SI joint are not out of place. They do not need realignment unless they are dislocated. This would mean that you experienced trauma or have significant hypermobility connective tissue dysfunction, like Ehlers Danlos syndrome (EDS). Dislocation by definition means “disturbance from a proper, original, usual place or state.”
In my clinical practice, I find a majority of the time there is a strength imbalance or a significant adhesion (visceral pull) creating a functional leg length or asymmetry of movement with trunk side bends, shoulder overhead movement (flexion or abduction), ankle pointing (plantarflexion). Once we correct the adhesion and give the body a gentle nudge to work through the restriction there is no longer a strength asymmetry or movement dysfunction. When we retest, the patient has regained full strength and full movement symmetrically. Clients are always fascinated that they regain their motion and/ or strength; even better when it is pain free.
We need to understand and educate more about joints mechanics. Joints have space that allow movement for 2 or more bones to glide on one another and allow the body to move. Physical therapists (PTs) can mobilize joints that are stiff (ex: adhesions). There are varying degrees of mobilizations that can provide pain relief and increased movement (example: bunion, knee cap or frozen shoulder). At the end of the day, every joint has a pathological and anatomical limit. The important thing for you, is that your provider know how the musculoskeletal, fascial tensions (stressors), and visceral connections (like c-section and vasectomy procedures in the picture above) work to allow improved body mechanics for long term results.
If you manipulate a joint or dislocate to the anatomical limit- the autonomic nervous system responds. It will tighten and spasm muscles (this is the fight response) in an effort to protect you; but it also requires less energy from the body. When this happens, you can strain/ sprain a muscle, tendon or ligament. If you are manipulated to this limit the muscles and tissues will pull you back and recoil to their known location. The body and nervous system is that smart. This is why Dr. Kenzo Kase, creator of kinesis tape, used kinesis tape after his manipulations on volleyball players because he could not get his manipulations to hold.
This is a good picture to show decreased movement/ glide in the joint space when loaded by the body in standing.
My patient population has asked the following questions:
What happens when you hear cracking (a chiropractor for example). And what does that adjustment do?
This is called a cavitation. Chiropractors manipulate (grade V mobilization) and it varies state to state if PTs can perform grade V mobilizations. The difference is verbiage. During thrust manipulation, the pressure within the joint cavity decreases. This leads to gases within the synovial fluid to pass into the joint cavity. As the gas moves it creates a bubble. It moves from an area of high pressure to low pressure. Once the ‘bubble’ reaches the joint cavity the pressures equalize. This causes the bubble to collapse or explode causing a click or popping sound (cavitation). This can become addictive to the brain because of the serotonin that is released when the nervous system relaxes. We have to exercise caution when to use manipulation/ thrust techniques as manual therapists because it can also create hypermobility issues within the joint when it is repetitively stretched to the anatomical limit (especially in anyone with a connective tissue dysfunction).
What do I call it when my hips are twisted, like as in, when I stand up out of the saddle my right knee hits my handlebars and my left knee is miles away, and then I see my Physio wizard M.A.T. guy And he pushes on my SI joint a little and pulls on my left leg and then has me do a thing where I push against my bent right knee while I lay on my back and then do clamshells and magically my hips are aligned and I am no longer hitting my handlebars, if we do not call this alignment or adjustment, then what is it?!
I would encourage you to talk to your medical professional as I am not the one evaluating you. They are having you perform a muscle energy technique. Perhaps they are also performing mobilizations (joint or soft tissue). In what you are describing, I would refer to it muscle strength imbalances. You more than likely clip in & out on one side of the bike creating an asymmetry. Much like horseback riders come on & off the saddle on one side, swimmers can breathe to one side, baseball throws with one arm and swings the bat in a dominant direction, you golf in a dominant direction rotating the body, soccer players tend to kick with a dominant leg. This is without knowing what else you do unilaterally throughout the day to strengthen one side of your body.
Chiros are the only professionals I am aware of that use the terminology “adjustment”. While they are adjusting your body, this can be misleading (just like MRIs) and can cause people to think their bones are out of place or their hip or disc may literally pop out of its place. I have had multiple patients tell me their biggest fear is that their spine will crumble after getting MRI results or seeing chiro. None of this is possible unless you have an extremely advanced, rare bone eating cancer in your spine. The body is a miraculous healing machine even with osteoporosis and stress fractures in the spine that heal on their own (pictured). I have heard not so good thoughts when I have asked patients what their biggest fear is (which takes us down a rabbit hole of pain science I will not go down in this blog). I have spent far too much time in my office de-catastrophizing verbiage and jargon other professionals have used. We have to be careful with our words because they can cause harm too.
Above all, we have to remind patients that our bodies are very intelligent healing machines. Sometimes we just need a little education, visceral manipulation to help the body move past the restriction, some gentle mobility and guidance for the nervous system with strength imbalances.
Always remember, the body leave clues.
This is not medical advice. You should always consult your healthcare practitioner(s) for medical advise and what is best for your care. The purpose of this blog is to centralize and share information while connecting with others.