I Threw My Back Out & Other Myths
Has another chiropractor ever told you your rib is out? Or you threw your back out? Or your legs are uneven? Because every week our patients come in with these supposed diagnoses. These are painfully inaccurate descriptions that come from trying to turn a complex topic into a simple explanation.
A big part of a doctor's job is to translating complex medical concepts into easily understood language. There is a a certain balance that we need to achieve when explaining diagnoses to patients. It should not be too complex, but also not too simple.Some doctors (usually younger, newer graduates) are eager to demonstrate their knowledge and often over-explain, or use unnecessary scientific jargon. This leaves the patient confused about their diagnosis and unable to explain to others what's wrong with them.
Other times, the doctor oversimplifies information using technically inaccurate concepts. This is far more common because it's easier to explain. Unfortunately, now the patient is highly confident in explaining this diagnosis and treatment, however their understanding is completely wrong.
The Real Problem
To me, the oversimplified explanation is the worse one. The patient now carries this misinformation with them for years to come, if not the rest of their life, to all their future medical appointments. This misinformation shapes their perspective on what the solution looks like. So now any new doctor worth his salt has the challenging task of helping the patient unlearn wrong information, and embrace a new, more nuanced understanding. So right now, I am going to prove my worth to you for absolutely free, by discussing the top three most common bogus diagnoses our patients tell us they've received or believe they have.
1. I Threw My Back Out/My Rib is Out of Place
Where did it go? Where did you throw it? In the trash? I never understood this phrase. I'm guessing that the implied ending of the phrase is "out of alignment." Want to put someone in chronic pain forever? Tell them they are out of alignment and the only way to be pain-free is to be "in alignment." This is no such thing as perfect alignment. No one is perfectly symmetrical. Human bodies are made to move and adapt to the forces placed on it. By trying to achieve perfect alignment, you are creating a problem that can never be fixed.
What is really meant by this phrase? Most likely that you sprained or strained a muscle, ligament, or intervertebral disc in your back and there is acute pain. When we adjust your spine for this condition, we are not aligning your spine! There is no "bone out of place." If your bones were truly "out of place" they would break, dislocate, or you would be paralyzed. None of which are things that chiropractors treat. We are restoring proper motion into fixated areas. When your muscles are tight and in pain, they prevent your joints from moving like they normally would. We are simply getting those areas to move again.
The same thing applies to "my rib is out of place." No, it isn't. It may be sprained or fixated, but trust me, it did not dislocate out of place. That would be unbearably painful and you'd be calling an ambulance, not a chiropractor. The main problem I have with this terminology is that the oversimplification of the problem leads to the oversimplification of the solution. If the patient thinks of this diagnosis in terms of "the bone is out of place" then the obvious solution would seem to be "adjust the bone back into place." Seems simple enough, right? This obviously isn't how it works. Otherwise a patient who has had back pain for 20 years can simply "get it popped back in" and be fixed 5 minutes later. This is of course completely unrealistic. The patient may leave thinking that their treatment was ineffective when in fact they had completely delusional expectations of what a realistic treatment plan looks like.
2. I Have a Short Leg
So does 90% of the population. Anything less than about a half inch we consider insignificant and has no effect on function. Humans are relatively asymmetrical and your body is more than capable of adapting to such a small difference. Only about 0.1% of the population has a leg length discrepancy of over three quarters of an inch. Even Usain Bolt has more than a half inch difference, as well as scoliosis, and how is that affecting him? He's the fastest human on the planet in history and most accomplished track and field athlete of all time. My point is that the chance of you having a leg length discrepancy effecting your function is possible, but extremely unlikely.
My second issue with this diagnosis is that actual leg length is rarely measured accurately. Unless your doctor took an x-ray of your body from the waist down, or pulled out a measuring tape and measured from your pelvis to your ankle, your leg length was not measured correctly, if at all. Most patients tell me that their doctor laid them face down and then bent each leg at the knee, comparing the alignment of the heels of legs straight versus legs bent. Measuring with their eyes! Do you think that you can accurately measure a 3-foot object to within a quarter inch just by eyeballing it? I doubt it! And if you think you can, here's a research article showing that this method is by far the most inaccurate method of all leg length tests.
My final issue with this diagnosis is that even if you could accurately measure the legs and decide that one side is at least three quarters of an inch shorter than the other, the short area could be from multiple different areas. Is your femur (upper leg) longer than the other? Or is it the tibia (lower leg)? Is your pelvis lower on one side compared to the other, making one leg appear short even though it isn't? Narrowing down the problem this way is almost impossible. It's much more effective to measure your movement patterns and see if there are any weird compensations in the way you move your body.
3. The Sciatica is Coming from my Leg
Sciatica is a back problem, not a leg problem. Nerves that are being compressed in your back travel through your legs to your feet. If the nerves are being compressed from the source, you may feel pain anywhere along the nerve pathway in the leg. However, the leg is not the source of the problem and you will never get better if you just keep stretching your legs. In fact, with sciatica, stretching your legs and hamstrings can often make symptoms worse.
I like to use an analogy to explain sciatica. Imagine you have a water spigot connected to a garden hose. You squeeze the handle at the end of the hose and water comes out. Great, everything is working. Now one day, you squeeze the handle and no water is coming out. You take off the handle, replace it with a new one, still no water. You try to slide a stick up the hose, maybe it's clogged. Still no water. Then you look at the hose and notice near the top that the hose is kinked. No matter what you do to the end of the hose or the handle, you aren't going to get water until you unkink the hose at the top.
In this analogy, your intervertebral disc compressing the nerve is the kink in the hose, the hose itself is your nerve, and the handle you squeeze to spray water is your leg. Even though there's pain in the leg (no water), you're never going to fix the problem just working on the leg (spray handle). You need to unkink the hose (decompress the nerve at the disc) to fix the problem.