Your back isn’t “out”

Sometimes as chiropractors we can be so lazy. Especially in how we explain things to patients. We say things like

  • Your spine is out of alignment
  • Your back is too flat/curved
  • Your neck is stuck
  • Your hip is out
  • Your pelvis is tilted
  • One leg is longer than the other
  • Your arches have collapsed
  • Your disc has slipped (see previous post for a big rant on this one!)

As often happens in a healthcare profession (HCP), we’ve developed our own little language to talk to each other about the things we treat. And because we’ve all gone through the same training, we understand what these short-hand terms mean and the implications of them.

But sometimes we make the mistake of assuming that patients know what we mean by this. But some interesting research over a decade ago demonstrated that the use of medical jargon, or even just a poor explanation, can lead to patients getting a very different idea of what is wrong with them. In this study, doctors gave a diagnosis to a patient, and then the patient was asked by researchers afterwards to recall as much as they could about the diagnosis and describe what they thought it meant. Doctors who used the word “neurological” in the explanation (which means anything to do with the nervous system – the brain, spine and nerves in the body) gave patients the impression that their condition was progressive (ie. would only get worse and not better). Patients who heard the word “chronic” (meaning lasting longer than 3 months) interpreted it as “incurable”.

But the real danger in this scenario is not just that the patient mis-understands their condition. The real risk we run is that patients will change their lives based on the information that HCPs give them, and they can end up much worse-off as a result.

We are the problem

Let me tell you about a patient of mine – we’ll call him Paul*. Paul was in his mid-30s when he came to see me. He had been seeing a chiropractor I knew well in another part of the UK, who had recommended he continue his care with me when he moved to Cheshire. When I asked him about his previous treatment, this is what he told me:

“I got some pain in my back while I was running a 10k. When I went to see the chiropractor, he told me both my hips had dislocated and he put them back in again. Since then I’ve had regular treatment and he keeps putting my hips back in place. I’ve stopped running because I don’t want them to dislocate permanently, but my back isn’t really much better.”

As I said before, I know the chiropractor who treated him. He’s a competent, evidence-based and ethical chiropractor. And I know there’s absolutely no way that he told Paul that both his hips were dislocated, but this is what Paul heard from his explanation. As a result, Paul stopped exercising.

A multitude of research tells us that exercise is the best thing you can do for your back and inactivity will almost certainly make back pain worse. Not only that, just think about the impact on Paul’s life when he stopped running. Doubtless his fitness decreased; perhaps gained weight; he may have spent less time in fresh air and nature; and maybe he doesn’t even see his friends from his running group any more.

So there is a real danger when we mis-communicate a diagnosis like this that we change the trajectory of a person’s health. We actually can be the cause of serious problems down the line. If Paul had continued the way he was, he may have put himself at increased risk of cardiovascular disease, diabetes, osteoporosis, several types of cancer and mental health problems.

Chiro-translate

So, returning to that list above, let me give you a translation of what your chiropractor really means! (And you might also want to look at the video explanation on my Facebook page here)

Broadly speaking, the statements fall into 2 categories:

  1. Statements about movement – These are comments about joints being “stuck”, “fixated” or “restricted”, and it might also include comments about joints being “out of alignment”. What is actually happening, is that the joint no longer has a full range of motion so instead of moving 100% of it’s normal motion, it actually moves something like 50-80%. The joint does still move, so it’s not “stuck” or “fixed/fixated” in one placed, and in every other respect the joint is perfectly healthy and does still function, but it probably feels a little stiff. Manual therapy (like the treatments chiropractors do) has been shown to be really effective for restoring movement in these joints. But sometimes we make the patient feel like their spine is fused at that spot, and always will be.
  2. Statements about shape/symmetry – These are comments about spines being too curvy or flat, feet having fallen arches or collapsed arches or high arches, one hip or shoulder being higher than the other, etc. The first thing to say about these measurements is that they’re not very easy to define. For example, there is a huge variety in the shape and size and combination of the 3 arches in a person’s foot. But there isn’t really a fixed definition of how high is too high for an arch. So it falls into the category of the “expert eye”/”looks a bit high/low/flat/collapsed to me” – which can be very different between healthcare professionals. This is sometimes helped by comparing side to side – as in the case of one shoulder or hip being higher than another. The second thing to say is that, when we make statements like this as chiropractors it is VERY rare that we are actually talking about the shape of your skeleton. A lot of times we might just be talking about your general posture, how you hold yourself, or muscle tension in an area making it look bulkier or higher than it actually is. But we run the risk of making patients feel like their skeleton is going to be permanently mis-shapen and lead them to worry unnecessarily.

But the most important thing to say about these 2 categories is that neither of them IN AND OF THEMSELVES are predictive of pain or poor function. When assessing a patient a chiropractor needs to take into account medical history, family history, occupation, hobbies, accidents/injuries… as well as a lot of non-physical factors like the patient’s past experience of healthcare, their beliefs about their pain and their mental health. And after this, the postural and motion assessment forms just one part of a thorough examination.

You know what I mean?

There really is no excuse for HCPs to be lazy in their approach to communicating with patients. So if your chiropractor or physiotherapist or doctor says something you don’t understand, please feel no embarrassment in interrupting and asking them to make themselves clearer. A clinician worth his salt will not be offended at you attempting to understand your condition better – good ones would welcome it.