Buckle up for this one boys and girls! I am climbing high up on my soapbox for this one. Yelling it out across the mountains for all to hear!
The past two weeks have had me up in arms. I have been waking up with rebuttals and stressing over the topic of “structuralism”. Let me define structuralism for you in the terms of Paul Ingraham, “Structuralism is an excessive preoccupation with the biomechanical boogeymen.” In other words, the belief that all pain is precipitated by mal-alignments, posture, and tissue damage.
This topic all came about when I was contacted by a company to help implement their new scanning device. Their technology was defined to me as ” 20 Nikon cameras taking 3D images of my body.” Sounds interesting doesn’t it! This 3D image provided information like Body Mass Index, Body Fat Percentage, and Alignment “issues”. Oh boy, I am getting fired up just thinking about it!
This idea that “your out of alignment” and putting you back into alignment to get rid of your pain has long been debunked by an outstanding number of research articles over the last 30 years. The question that comes to mind is, why do healthcare professionals and individuals continue to hold onto this model so strongly even when there is hefty amount of research against it? One reason I feel we continue to sport the alignment theory is it’s easier to grab onto something tangible as the cause of pain. It makes intuitive sense that these asymmetries are the cause of your pain and quite frankly an easy sell.
An example of structuralism happened to me a few months back. My new year’s resolution for 2019 was to treat myself to a massage once a month. Nine months into 2019 and I am ashamed to say it has only happened this one time. Anyhoo, I was enjoying my massage and when the kind gal got to my neck, she made a comment that sent me into a whirlwind of irritation. She explained, “Your neck is really out of place. You should probably see a chiropractor to have it put back in.” Wait…what, in a matter of seconds, I could drop dead from my vertebrae compressing my spinal cord or kinking my vertebral artery because it is “out of place”? A bit dramatic I know but you get the point.
I struggle with this terminology of “being out of a place”. What does that actually mean exactly? Anatomically, if your vertebrae was “out” even just the slightest bit, it would be nestled up nice and close to your spinal cord and that may not go so well. In addition, leg length discrepancies, anterior pelvic tilts, and the infamous one shoulder higher than the other do not cause pain and injury, the research tells us time and time again that it just isn’t so.
A well-known study looked at MRI results of 3,000 individuals ranging from ages 20-80 years old. All these individuals were asymptomatic meaning they had no back pain. What they found was 37% of these individuals that were 20 years old had signs of degenerative disease and 96% of asymptomatic individuals in their 80’s had degenerative disease! This is a huge support AGAINST the structural theory for the cause of back pain.
I could get nerdy on you at this point and dive into multiple other studies going against structuralism but I won’t bore you!
Now I will back petal slightly and say the biomechanical model isn’t completely irrelevant. For example, if you had a fractured bone or a ruptured tendon, your nervous system would send that info up to the brain and the output of the brain (affected by many considerations) would strongly support that something structurally was going on. Many years down the road, after the tissues have healed and you are still experiencing pain, we may start to think the thing contributing to this pain is a bit more complex. Let’s take a deeper dive into what things may be contributing to pain.
In our body, we have sensors called nocioceptors. Nocioceptors respond to physical, chemical, and temperature stressors. These nocioceptors are highly sensitive which is a good thing for protection! When these nocioceptors respond to a stimulus, the information is sent to our spinal cord and our sensors within our spinal cord act as a secretary. The secretary decides what is important and then either stops the signal in its track or sends it up to the boss, the brain. The brain doesn’t just sound the pain alarm but rather takes in information from previous experiences, current stressors, lifestyle behaviors etc. to determine if the threat is warranted. If it does suspect a threat, the alarm is sounded, muscles will tighten, and different inflammatory chemicals will be released.
Now sometimes information can get mixed up and information in the spinal cord can get through that may not necessarily be a threat. Also, if the system is already ramped up by a stressful day at work, the boss was super grouchy, and then you walk into your house and the kids are hanging from the chandelier you are already amped up. This highly sensitive scenario also explains why emotional factors, stress, coping strategies, nutrition, physical habits, and social connectedness plays a HUGE role in whether or not someone will continue to experience chronic pain. A very simplified explanation of how our body experiences pain but the importance is, it is multifactorial and depends on a lot of different conditions.
When you get a manipulation or an adjustment, you may hear a “pop” or cavitation. Is this actually the bones moving in your back, probably not. Am I a proponent to having your back cracked…YES but probably not for the reasons you may think. Research shows that if you have acute back pain, then spinal manipulation is recommended. So what happens when your back pops? Within the joint, you have pressure changes during a cavitation that implodes tiny gas bubbles (think about when you pop a finger you feel like you have release of pressure) This change in the joint stimulates nearby nerve endings. These nerves send a signal to your brain that is different than the pain signal your brain is getting from that same body part. At this point, you may have relaxation of the muscles surrounding the joint, a different neural input, and increased blood flow to the area. This my friends is why you feel better after a cavitation. Also, if you have strong feelings that cracking your back will help, your expectations of that helping also increases your chances of getting better after a manipulation.
When I think about the misinformation that this new technology is proclaiming to individuals it disappoints me. It is going in the exact opposite direction as research is suggesting we should go. The point is, we may need to dial back this idea that being in correct alignment is the end all be all to pain dysfunction. Structure plays a role to a certain extent but lifestyle factors such as a healthy diet, mental toughness, sleep, physical activity, and connectedness may play a larger role in the long term in combatting pain.
Woo…that feels so good getting it off my chest :)! I hope you have an excellent week! Seize the day!