Bone Out of Place?

The Truth about Malalignment: What it Means and Why it is Important…


Ever been told you have a bone out of place? Ever wondered how it got that way or what that really means? As a Chiropractor, I hear this phrase A LOT, and while I can see the thought process behind why this is used to explain Malalignment, it is somewhat of a misnomer; oversimplified and most often, technically incorrect. I am a sucker for technicalities, and passionate about educating people about their bodies, how they move and what it all means when they aren’t moving right.

In light of this, this post will attempt to simply relay what it means to be “Malaligned”, why it matters, how it can cause painful conditions, and how Chiropractic treatment can help.

Let’s start at the beginning. The notion of “bone out of place” is not accurate enough to be used as a blanket term to explain malalignment. While there are certain conditions where this phrase does apply (such as *scoliosis and *listhesis), it does not effectively explain the mechanics of what’s happening in the joints of the vast majority of people with malalignment. So what does “malalignment” of the spine mean? The joints connecting the vertebrae of your spine allow for 6 degrees of motion: forward bending, backward bending, side bending to each side, and rotation to each side. Sometimes, one or more vertebrae can become “stuck” or “jammed” along the route of its natural range of motion, causing excessive rotation, and or rotational displacement relative to the vertebrae above, below.

The sacroiliac (SI) joints (which connect the sacrum at the bottom of your spine to your pelvic bones) have complex movement patterns which occur around a number of different axes, and can also become “stuck” in any one position within their natural range. This “locking” of joints somewhere along the course of their natural range is what we refer to as “Malalignment”.

Since SI joints are integrally connected to the vertebral column, and their motion occurs naturally during movement patterns of the spine, pelvis, and legs; it is logical and inevitable that malalignment in one area often leads to malalignment in the other. This is often in a “chicken or the egg” situation, as it is not always easy to determine which came first!

As bones act as attachment and insertion sites for muscles, tendons, and ligaments; it is easy to see that malalignment of bones and joints will result in asymmetries of:

  1. Weight-bearing
  2. Muscle bulk and strength
  3. The tension in muscles, tendons, and ligaments
  4. Joint range of motion

The resulting abnormal positioning of these various tissues makes them vulnerable to injury as they are not able to optimally deal with the mechanical forces passing through them. Thus, ironically, the individuals with malalignment who take part in physically demanding work or athletic activities are at increased risk of injury to their musculoskeletal system as it is already subjected to abnormal biomechanical forces!

Now that we know what it means, the question must arise: When and why does it start?

It may come as a surprise to you that according to Wolf Schamberger, Author of “The Malalignment Syndrome”, malalignment is present in 80-90% of the adult population and is responsible for 50-60% of those suffering from back pain! A few of the common instigating factors causing your body to become “out of joint” (so to speak) are:

  • Trauma: Trips, falls, collisions, bumps, etc.
  • Compensatory patterns due to tissue injury: Disc bulges, nerve root irritations, etc
  • An anatomical leg length difference: The bones in your one leg are structurally longer than the bones in the other

Interestingly enough, however, new cutting-edge research points to the fact that most cases of malalignment are more likely developmental problems determined at the level of the spinal cord, brainstem, and cortex! This accounts for why so many of us tend to become malaligned without any of the instigating factors mentioned above playing a role.

To simplify, malalignment can be likened to driving a car with poor wheel alignment. It is sometimes difficult to determine exactly when and where the wheels became wonky, and you often won’t even notice it. It won’t stop you being able to drive your car, and you may drive many weeks, months or even years (hopefully not years) without it ever affecting you. One day, however, when an external variable is added to the equation (such as rain, needing to slam on brakes, having smooth tires) your car will be much more likely to spin out of control due to the underlying issue of poor wheel alignment.

This is where Chiropractors and many other forms of manual therapy come in. This is what we mean by “finding the cause” of your injury. Obviously it is important to treat the injured tissue and assist the healing process in the affected area, but in my opinion, it is infinitely more important to determine why the injured tissue got injured in the first place!

Treatment of malalignment is an intricate process and involves:

  • Identifying the malalignment pattern and vulnerable tissues
  • Restoring movement in, or “unlocking” affected joints
  • Relaxing tight muscles
  • Strengthening weak muscles
  • Providing pain relief, inflammatory control and assisting healing in injured tissues
  • Advice on building and maintaining musculoskeletal symmetry

Furthermore, due to the suggested component of malalignment that is stored in the brain, specific body conditioning of the inner and outer core to increase the stability of the pelvis and spine, together with postural and balance training is an essential component to a true holistic musculoskeletal approach!

At the end of the day, achieving and maintaining a healthy, strong, well-aligned musculoskeletal system is achieved through the dedication and commitment of both you and your therapist! Or in the words of Thomas Jefferson: “If you want to have something you have never had, you need to do something you have never done”.

Take control of your body, take control of your health!

Move Well. Live Well.