I had a new patient today who has been in three motor vehicle accidents in the past year and a half. In each of the accidents her vehicle was struck from behind. I have no way of knowing whether she has simply been ridiculously unlucky or if there is more to this story.
Formerly an elite volleyball player, since the last accident she has at times been reduced to crawling from room to room in her home.
It is currently very fashionable for people to be told that the reason they have pain is that the muscles are “weak” or they don’t “fire”. Did the muscles of this young lady’s back and neck become “weak” due to her injuries? The short answer is ‘yes’.
Her weakness stems from at least three different factors:
1. Muscles that are overstretched due to a whiplash-type injury spasm in self-defense. This state of constant contraction is fatiguing.
2. Neurologically these muscles become more sensitive to external stimuli and inhibited from contracting as they would normally. Both of these are additional self-defense adaptations.
3. All kinds of things in the human body don’t work properly when the skeleton is misaligned, including your muscles. In spite of receiving care from quite a large number and wide variety of practitioners over the past 14 months she presented to me with a pelvis that was rotated far too far forward (approx. 30 degrees of anterior rotation) and with the left side of her pelvis approx. ½” higher than the right.
While there is little I could do regarding the first two issues, normalizing the two pelvic alignment problems is literally what I do best. When you get the hips, pelvis and spine into a reasonably neutral position good things start to happen with the neuromuscular system. Movement is more complete, easier and more comfortable. Muscles become “stronger”. They don’t magically grow, but because the nervous system is less compromised the muscles are simply better able to do what they are designed for when the framework to which they attach is properly positioned. You become more “flexible”. Mobility seems to improve because improved alignment allows the body to relax much of the muscular clenching it has been doing. You have more energy for the same reason. These muscles that have been compensating to add stability have day jobs. Now that they aren’t working 24/7 compensating, the energy they were burning is yours to use at your discretion. Maybe now you are not quite so tired at the end of the day. There are so many advantages to neutral joint alignment you may decide to never settle for less in the future.
Many of the corrective exercises this patient has been prescribed to date have been of limited value. Because alignment has been so compromised, efforts to improve flexibility and strength have been unsuccessful.
It has come to be widely accepted that asymmetry in the body is “normal”. However, it is also generally accepted that joints that are ‘centrated’ (articular surfaces of the joint are perfectly aligned) are more stable and healthier than misaligned joints. I believe that it is the relationship between those two issues where the real answer to most chronic pain resides. How can we successfully manage the comfort and performance of an incredibly complex set of structures (muscular system and skeletal system) that are being managed by an incredibly complex set of systems (nervous system, endocrine system, cardiovascular system, etc…) where everything impacts everything else?
Begin with alignment. Alignment of the skeleton is relatively easy to manipulate. Helping joints to be as centrated as possible improves the health and comfort of those joints, while it also helps to normalize other physical systems (such as the cardiovascular and nervous systems) in the surrounding tissues and the body as a whole.
Unrelenting pain can wear you down emotionally as well as physically. Anyone who has battled with chronic pain knows this only too well. A couple years ago I had a patient admit to me that in the darkest moments of her over twenty years of chronic shoulder pain, she had actually considered ending her life. It was shocking and heart wrenching to hear. As a person who sees the effects of chronic pain every day, but doesn’t have any, this was shocking. It was an unexpected glimpse of a degree of desperation I had no frame of reference for. The irony about that case was that she had had all kinds of different therapies performed on her painful shoulder, but nobody had ever included her lower body in their assessment. Misalignment of her lower body was causing her upper body to compensate in a variety of ways, one of which was to pull her right shoulder down. A shoulder that is trying aggressively and persistently to get closer to the hip is not a shoulder that can function well or feel comfortable. Eliminating the misalignment in her lower body caused an almost miraculous improvement in her shoulder pain. Magic? No. Systematic, logical application of biomechanical principles to normalize alignment of the skeleton. In chronic pain cases there are no guarantees, but I am optimistic that normalizing the pelvic position of this new patient today will help to ensure that she doesn’t have any of those darkest of thoughts.
Whether or not we can achieve alignment perfection in this particular case, thousands of patients have shown me that, in the words of Vince Lombardi, “if we chase perfection we can catch excellence.”
Yours in health,
Geoff Dakin BPE RMT
Calgary Registered Massage Therapist
I like to think that I am technique agnostic. I’ve seen many practitioners become so attached to specific techniques that their identity is forever linked to that technique. In a situation like that often the person becomes very resistant to accept any other method(s) as being appropriate or even useful. I’ve long told patients that if filling their pockets full of sardines would eliminate their pain, I would have my cupboard stocked full of sardines. Ridiculous, I know. The point I would like you to take away from this is that as long as you are respecting the fundamental principles involved, the actual techniques you are using are not terribly important. As a result, I don’t like to call myself a neuromuscular therapist, although that is the manual therapy system I use the most. I am a massage therapist. However, telling people that is usually more confusing to them than clarifying. I use floor exercise just as much as I use massage techniques. I believe that bony misalignment in the body is the most fundamental and most overlooked cause of pain in the body. My specialty is teaching people how to eliminate misalignment in their bodies. If a label is required, then that is the label I prefer.
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