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Your Spine Does Not Go Out Of Place

It is a common report in the physical therapy clinic that a patient’s spine or hips go out place. This belief is followed by a need for the patient to seek healthcare practitioners that can simply “put their bones and joints back in place” using manual force through joint manipulation or adjustment. This results in lifelong visits and dependency for continuous adjustments as the spine continues to go “in and out of place”. What if I told you that this concept of the spine going out of place is not true and has been scientifically disproven through multiple studies?

In actuality, your joints and bones do not easily move in and out place unless there is a large traumatic force causing a
dislocation, which is a medical emergency. This belief can be quite detrimental to patient recovery and facilitates a dependence on a healthcare professional, requiring monthly and sometimes weekly “adjustment” to put bones and joints back in place. In addition, having this belief creates a fear of movement which then causes avoidance of particular motions that ultimately hinder recovery. Both of these factors result in a worse prognosis for the patient and can actually do more harm than good. Our bodies are much stronger and more resilient than we think. Studies have shown that it takes over 1000 pounds of force to deform fascia (a connective tissue covering) by only 1%! Performing a joint manipulation/adjustment cannot come close to the amount of force to put a joint “back in place”.
Tullberg et al. performed a study on joint position in patients with one sided low back pain involving the sacro-iliac joint (better known as the SI joint). He performed joint manipulations/adjustments to the SI joint and measured the position of the joint pre- and post- manipulation to assess if the joint was moving in and out of place. The findings of the study were that there were positive changes in terms of pain, but no change in joint position in any of the participants of the study!
What patients are actually feeling when they perceive a bone or joint to be out of place is a combination of unilateral low back pain, a lack of muscle stability in the low back area and a reluctance of the body to fully bear weight on the affected side, secondary to pain. Joint manipulations can be a useful technique to decrease pain and improve movement, however, the effects are only temporary in nature leading to the need to be continuously “adjusted.” Patients who are experiencing low back pain actually require a combination of manual therapy techniques, such as manipulation, followed by specific exercise and strengthening techniques to address pain and weight bearing/muscle instability to facilitate long term changes in pain. There is a large growing body of evidence through research on the positive and sustainable impact that physical therapy has on patients with low back pain.
In conclusion, it is a scientific fact that your joints are unable to go in and out of place so easily and that the adjustments or manipulations received are a temporary change in pain. Our bodies are much stronger than we think and are capable of the long term changes. Patients with low back pain require appropriate strengthening and stability in combination with manual therapy techniques. Schedule an appointment with BREAKTHRU Physical Therapy and Fitness for a free consultation for assessment of the low back and the development of a treatment program aimed to reduce or eliminate your low back pain, teach independent management of your low back pain and to facilitate a return to normal activities that may be currently hindered by your pain!


-Dr. Brandon Fredhoff PT, DPT