Tuesday, August 20, 2013

Do backs 'go out'

Can your back 'go out'?

The old model for SPINE (which is still used a great deal) was 'bone out of place'.  It made sense.  Hard bone, soft nerve, ouch.  Then someone applies a force to a joint, it may feel better and (particularly if we hear a pop) we connect the dots.

"My bone was out, it hurts, it's pinched a nerve, I heard it pop back in, now it feels better = bone out of place."  It feels like this, it sounds plausible and to cap it off even health practitioners (and specialists) still believe this to be true.  And if they don't they are not sure how else to explain it.

The trouble with this theory was this - there was never any evidence for it.  Short of fracture and dislocation there is NO evidence that we can put a displaced joint 'back in'.

So what on earth is happening? 

The model is now multifaceted and the research supports that MOST changes are due to neurophysiological changes (changes in the nervous system when physical modalities are applied (exercise, joint manipulation, etc) .  A big one is normal proprioception or 'joint position sense' which can be disrupted by injury, lack of use and pain.  Even if we ignore all of the other effects this deficit in the brains ability to properly sense and therefore control and protect the spine is reduced.

Physically based treatments aim to 'leverage' or target these deficits thus improving this innate body function.

The following research from the Physiotherapy profession illustrates the failure of the 'bone out of place' model to explain the effects we see.


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