Advocacy

And the Worst Explanation of the Cause and Treatment of a Back Injury Goes to…

The practitioner who told Tiger Woods his “sacrum went out”.

From USA TODAY Sports’ Steve DiMeglio:

“I feel good,” said Woods, who flew to the Bluegrass State from South Florida on Wednesday morning. “Once the bone was put back in, it’s all good. The inflammation has been down, I’ve had range of motion. As you saw out there, I got my speed, my power.”  (read in entirety here)

From the press release, it appears Tiger Woods was told his Sacrum popped out of place.   Yes, he was told this bone,  popped out of placed.

In this separate press release, the reporter stated it “snapped out of place“.  Ouch!

Karim Khan, from the British Journal of Sports Medicine, wrote a very eloquent  response to these extraordinary claims.  Read it here.

Overall, we need to quit speaking in these wrong terms and hold our own colleagues accountable.  Press releases, such as the ones above, only leads to further indoctrination of non-scientific, societal beliefs.

 

 

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8 replies »

  1. As a practicing chiropractor, kinesiologist, and massage therapist, I couldn’t disagree more! Sorry Mr. Khan, bones shift and “go out of alignment”. We are generally speaking of millimeters, but they still shift. Resetting the joints to proper alignment and mobility, when needed, will cause a dramatic change.
    Is the shift causing a pinched nerve? probably not, but is the shit “pinching/compressing” a structure that shouldn’t be? Yes. And, is the shift causing muscles that move bones to go into pain/spasm because the muscles are trying to move a bone/s which are shifted/restricted and therefore cannot properly function? Of course.

    Now, should Tiger address any muscle imbalances or other problems that might have led to the shift? Of course. Could you also reset the bony alignment with myofascial stretching/exercise or other and correct the same problem? Yes.

    Just because you think that “the sacrum went out” is an unlikely diagnosis, it doesn’t mean it’s wrong. It may very well be right. Particularly since you didn’t evaluate the patient.

    I believe the problem arises with lay people using terms so that “they” can understand, and that there is a lack of a uniform definition used amongst the different set of specialties (chiros/pts/physio/ortho/etc). I mean, there are some textbooks out there still teaching that the SI joint does not move! Clearly whoever wrote that never worked on patients.

    I could relate multiple stories of patients who come in “out of alignment”, get treated and drastically improve, but I think this would not convince you. The only thing I can say is that they only reason that chiropractic/osteopathy and other “bone aligning” techniques exist is because there is a need that wasn’t filled with any other technique.

    Dr. Eric Nepomnaschy – Chiropractor
    http://www.baychirosantamonica.com

  2. Eric, I could not disagree with you more.

    Language is important.
    Darlow, Ben, Anthony Dowell, G. David Baxter, Fiona Mathieson, Meredith Perry, and Sarah Dean. “The Enduring Impact of What Clinicians Say to People With Low Back Pain.” The Annals of Family Medicine 11, no. 6 (November 1, 2013): 527–34. doi:10.1370/afm.1518.

    There is a big whole in the literature when it comes to the biomechanical model of understanding musculoskeletal disease. I’m not saying that techniques/methods do not work but there is a hole in the foundation of how we think it works.
    Lederman, E. “The Fall of the Postural-Structural-Biomechanical Model in Manual and Physical Therapies: Exemplified by Lower Back Pain.” Journal of Bodywork and Movement Therapies, 2011.

  3. Sorry, but bones do come “out of place”. When I first graduated PT school and a patient told me they could feel a vertebrae out of place, I thought they were wacko. Now 13 years later, more experienced, more fascially restricted, I myself have poppped out of place. ….C2 loves to rotate right…and my right pelvis just loves to rotate forward and in! Ouchy poo!! I know first hand…and ive felt it on others and helped them fix it. 9f course, stabilization us key after you get it back in.

    • Thanks for reading Theresa. I tend to avoid the term “fix” because it is very operative, often indicating some form of structural repair. I tend to prefer the term “guide” or “assist”, because it is much more interactive and follows Occam’s Razor.

      I am not sure I understand how your experience led you to begin noticing rotations? Do you suspect confirmation bias could be at play?

  4. Eric, by the sound of your argument you are way in favor of the biomechanical model when it comes to SIJ dysfunction. This amazes me as you are a chiropractor, whose profession was founded on the “law of the nerve” by David Daniel Palmer himself. What we are learning more and more about manipulation is the neurophysiological benefit of the techniques, not so much the biomechanical change we thought we were achieving. It’s the reflexive relaxation and gating of the nociceptive tract that eases the spasm and reduces the pain respectively. Furthermore, if the sacrum was “out” this would tend to suggest a spondylolisthesis at L5-S1 which research shows are inherently stable and do not progress in most cases, which you could also reason do not reduce either… Telling a patient you are going to put their sacrum back in alignment is like saying you will reduce their spondy which is ridiculous. I agree with Joe that we need to watch our words and believe me… I’m guilty as charged. We all need to improve upon the way we educate patients as it has a great impact on how they feel and perceive their prognosis for getting better as the articles in this thread I’m sure speak to.

  5. I thoroughly agree @omtpttalk! I get so many clients coming to see me who have previously seen other health professionals who state they are desperately ‘malaligned’ and need ‘clicking’ back into place! In fact one heavily pregnant lady told me recently that she had seen a chiropractor who had told her that by manipulating her joints, he would indeed make more room for her baby to grow comfortably… the mind boggles.

    Furthermore, some ‘malalignment’ is normal of course. We are not born perfectly symmetrical, and for most people that works just fine. They don’t get symptoms or problems despite living a life of ‘malalignment’! I have seen several people over the years who have tried an orthotic to correct leg length discrepancies for example, and it has made their symptoms much worse. We must treat the individual! : )

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