By Anthony Dileo, Osteopath at The Neighbourhood Clinic
The truths about your back being out
Have you ever been told your back, your neck or your hip is out? Ever stop to think about what “out” means? Is it dislocated, locked, out of alignment or is it out searching for a better body!
The word “out” can be loosely used by some professionals but it is nowhere to be found in any medical text and it can be a misnomer when describing a medical problem. Poor terminology can create poor psychological associations with pain. The ongoing effect of poor word association can have a flow on effect on recovery and/or can create long term misinterpretations of a medical problem.
Why is the word “out” being used?
A person describing their own pain may be indicating their pain severity or a feeling of being unable to move due to pain (e.g. waking up with a stiff neck may described as “my neck is out”). In the case of a professional it may be used as a laymen’s term descriptor of alteration of alignment in any part of the body.
Can the spine go “out” in your back?
If the word “out” is referring to dislocation then this is extremely rare and often associated with severe trauma. When referring to “out of alignment” then yes it can go out of alignment but this descriptor really needs to be carefully communicated. You only need to glance at the natural world to see that perfect alignment is not necessary for perfectly normal function. Things can shift in and out of alignment naturally and without pain.
If your back isn’t out then why can’t I move?
Most people have at some stage had an innocuous injury or have woken up with a stiff neck or back. This is more likely the end result of a culmination of some sort of strain pattern, a pre-existing injury, or delayed response to a strain. When tissues get stressed whether through trauma or strain they have a threshold or set point to what stress they can withstand. When the threshold is passed then the body will respond with our own repair mechanisms to the area to start work on repair. Areas under repair do not repair well with movement so it may feel painful or stiff.
Can it be put back in?
Clearly we have established that the word “out” may be a misnomer so having a practitioner put something back in may not necessarily be the case. Bones are held together tightly by ligaments and joint capsules. Have a feel for the strong tension holding your bones together and it is easy to see we are rarely moving things back in as such. Furthermore think about how if something has been “put back in” that it amazingly stays there when we get up and walk around.
The feeling of something being “put back in” may be a sense of freedom of movement from a released tension. Most manual treatment aims are to free tissue tension and movement to allow the body to restore the health of the dysfunctional area. This is a basic principal of osteopathy.
Part of osteopathic management of pain and chronic pain can sometimes be re-educating a patient on misconceptions of pain and dysfunction and free people of poor associations with their pain. Some common misconceptions and terminology presenting to the clinic are:
“I have been told my hip is out” - The hip is connected to the pelvis with strong ligaments and sits in a deep socket. Out is a strong word, ask for elaboration.
“I have been told I have a scoliosis” - about 90% of scoliosis is of unknown cause and may be a transient finding. Ask your practitioner to elaborate
“My rib is out” - Ribs are connected by strong ligaments. Strained may be a better word.
“My glutes are not firing” - There are approximately 20 muscles associated with direct hip movement let alone the number of indirect ones. Glutes not firing sounds amazing but unless your glutes are holding a gun it may be a very poor choice of words in some cases.
“I have tight hip flexors” - The hip is too complex for this simplistic definition. Many muscles make up the hip flexors including their attachments to the whole back. Which specific muscle is tight and why?
“My shoulder is always out” - Did you know that the shoulder of your dominant arm is commonly lower than you non dominant arm? This is one example of many where normal anatomy proceeds what can be misconceived.
“I have a short leg” - Many people with leg length discrepancies live normal lives without any intervention. It may be, but isn’t always, the cause of peoples problems.
“My neck is compensation for something” - Your neck is connected to the rest of your spine. It’s always compensating for something.
“I have arthritis” - So does most of the population to some degree. Ask for elaboration.
So the next time some tells you your back is out or your hips are out ask them what they mean. We know how one part of the body can’t move without another part so is the whole body out?
We all know the power of words. One word can change how we feel, how we act, how we move, and how we exist in our environment. Words as descriptors of pain or health problems can hold enormous weight. So is your back really “out” or has it been there the whole time?