Monday 15th July 2019
I read an article recently in a respected massage journal where a therapist was talking about cricked necks – you know the thing – you wake up one morning and can’t turn your head without excruciating pain and have no idea how it happened! You went to bed pretty much ok, and now you just have this awful pain which stops you looking over your shoulder. In this article, one of the suggested causes for these cricked necks was a ‘bone being out of place’. Now some people might call me a pedant for taking issue with this phrase but if you read on you’ll find out why.
Practitioners like Massage Therapists, Osteopaths, Chiropractors, Physiotherapists (in fact this does apply to any medical professional) are in an incredibly powerful and privileged position. As patients you come to us for help – when you are in need and cannot sort yourself out you seek someone out who hopefully can help you make sense of what has happened, and help you back on the road to recovery. This requires a therapeutic relationship to occur between patient and practitioner – one based on mutual trust and respect, but there is generally a knowledge and therefore power imbalance. In most cases the practitioner will have more knowledge of the body and what the symptoms may indicate than you the patient and will use that to guide you to recovery. You have to trust that what they tell you is right and in your best interests. It can be hard as a patient in that situation to know how to question what you are being told, as the person telling you has more knowledge than you! Therein lies the power imbalance.
Vertebrae out of alignment? What about the ligaments? How’s my spinal cord in all this?
So let’s go back to this cricked neck explanation of a ‘bone being out of place’. What could that actually mean? What would you think if someone told you the acute pain and lack of movement in your neck was caused by a bone being out of place? Let’s go inside the neck for a minute – the bones they are talking about must surely be the spine – the vertebrae – are they suggesting your vertebrae have moved? How can that be? What does that look like? Aren’t they supposed to protect the spinal cord? If they’re ‘out of place’ does that mean the spinal cord is at risk? And how did they get out of place in the first place? Aren’t there ligaments and other structures in there which help hold things ‘in place’? So if something is ‘out of place’ does that mean I’ve damaged or torn something else for that to happen?
All these are the kind of questions it’s fair to assume you might start wondering about – having been told your symptoms are caused by a ‘bone out of place’.
So what next – if the pain and limitation of movement is caused by a bone out of place, then surely it has to be put back into place in order for my pain to go and the movement to come back. Sounds logical. That’s what the practitioner will do, right?
But. If you understand that bones don’t just move out of place, that it’s perfectly natural and healthy and normal for bones to be able to move around a little within a joint – to have room for a bit of rotation, a bit of a tilt, a bit of a twist here and there, then how does that fit into this whole idea of symptoms being caused by a bone being ‘out of place’? Are we then talking about dislocation – where a bone literally does move completely out of it’s normal position within the joint – a condition which is usually extremely painful and related to loss of movement and caused by some kind of trauma or force like a fall or an accident. Well that’s not likely to have happened overnight, not unless you’re a really adventurous sleep walker. So I think we’re safe to say this phrase ‘bone being out of place’ does not refer to dislocation!
“muscle spasm… underlying inflammation… unhappy nerves…”
So let’s get down to some reality now! I think it’s fair to say that when you wake up with a ‘cricked neck’ the chances are your bones are pretty much in the same place as they were when you went to sleep. There’s probably a lot of muscle spasm – tension in the muscles around the area, and maybe some underlying inflammation and unhappy nerves as a consequence. All of these things are enough to account for the acute pain you experience, and limitation of movement.
“We understand pain much better than we did 20 years ago…”
We understand pain much better than we did 20 years ago and we have much better imaging techniques available now which means we can be sure that some of the things we used to believe and say are now wrong – like discs for example – they don’t slip! We also know that pain does not give us a good and reliable reflection of the health of your tissues – so you can have lots of pain for only a small amount, or even no, damage to your tissues. And we understand the mechanisms behind this too. We also understand how what you believe about your own body and the causes of your symptoms can make a difference to how painful it can be. Go back to the questions we talked about earlier – if you are sitting there with an explosion of questions and confusion about what you’ve been told – if you’re now worried that your spinal cord could be at risk if that bone doesn’t go back in place, if you’re thinking that the only way to keep this pain away is to maintain posture and alignment and that the only way to do that is to have someone put it back in place again – it could be fair to assume that there will be some anxiety or fear even, around this whole issue. And if your practitioner doesn’t explain this to you fully or give you chance to ask the questions you need to, to get reassured about your situation, you may walk out of the treatment with more questions than answers.
“…because LANGUAGE MATTERS!”
I hope you can see why I’ve been such a pedant about this now – because language matters! Because communication is so important between you and your practitioner; because you being informed about what’s going on inside your own body is essential and because what’s going on with your own body should always be explained to you in ways that make sense to you, without the use of medical terminology and you should always have the chance to ask questions!
“…my mission to spread the word about pain…”
Through my 15 years’ experience of working with patients with complex, persistent and acute musculoskeletal conditions I’ve learnt just how vital language is – patients have taught me the power of language and I’ve been guilty of being careless with my words in the past. I try my best to be more careful these days! And I too hung on to some out-dated views on pain until I saw the light… so I know there are still practitioners out there who work with old views and opinions about this kind of thing, or who are not fully aware of the power of language. This drives my mission to spread the word about pain – to improve people’s understanding of it, and to encourage my peers to think about the words they use with their patients – because it matters! I run Workshops about Pain and Injuries and I love giving talks about this subject too.
You can get in touch with me about this kind of thing through my Facebook pages: ReflexOrthoMassage or Logic Pain Education where you’ll find loads more no-nonsense vlogs and info all about the latest in pain science and research, or my websites: www.reflex-om.com and www.logicpaineducation.com. I strive to keep the things I put on my sites well-informed and up to date but if you do find anything amiss or would like to chat about how it may not fit into your understanding of the subject drop me a line and lets get talking! If you would like me to come and talk to a group of people you know – get in touch – send me a message or email me: firstname.lastname@example.org.