Alignment / Misalignment: Why we use this terminology when talking about back pain

Alignment / Misalignment: Why we use this terminology when talking about back pain

At Pelvipro, like everyone else in the physiotherapy profession, we are really focused on helping to give people control of their own back pain through the biopsychosocial (BPS) model.

However, although we are all aiming for the same result, various practitioners approach the process in different ways, depending on how much emphasis they give to each of the biological, psychological and social elements of the BPS approach.

When addressing the psychological aspect of pain, a lot of emphasis has been put on the terminology used. Certain wording now seems to hold certain taboos. ‘In’ and ‘out’ of alignment or ‘misalignment’ are deemed by some therapists to alarm patients. At Pelvipro, led by our experienced physio Chris Aldred, we see these terms as really useful to giving patients control. If to be ‘misaligned’ holds the power to cause a patient to feel out of control, think of the power that is held in arming them with something they have on hand 24/7 that ‘aligns’ or ‘re-aligns’.

Read on to find out in more detail the reasons why we have chosen to use this terminology around ‘alignment’. We’ve based our conclusions on our Chris’s 20 years of clinical experience, as well as research, trials, scientific tests and patient testimonials.

Physiologically, when you get back pain three things happen:

  1. Muscle inhibition happens.
  2. The pelvis which is balanced on the two femora is pulled over to one side more than the other, through muscle tightness or weakness.
  3. There is a change in the forces acting on the tissue structurally supporting the lower back. Ligaments can overload, muscles can overwork, and aggravation can ensue.

We have deliberated on the terminology to use for number 2 above: When the pelvis sitting on top of the femora is pulled more to one side than another. We have finally settled on the word ‘misalignment’. We are fully aware that, in some schools of thought, this word refers to movement of the sacroiliac joint (SIJ), a notion which others passionately object to.

However, when we use the word ‘misalignment’, we are merely using it as the position on which the pelvis sits on the femur. Here’s a link to a video describing Chris’s beliefs on the SIJ.

For the sake of clarity of understanding for patients, ‘misalignment’ is the terminology they use and we find great satisfaction in giving them the independence to turn their perceived misalignment into alignment. Besides, ‘alignment’ is such a descriptive yet mild noun, something you can do with wallpaper or the stickers in your son’s footy sticker album.

Misalignment and Pelvipro

We have a sizeable network of physiotherapists, personal trainers and Pilates instructors. They all assess using three special tests to demonstrate altered patterns of movement around the lumbo-pelvic-femoral region (misalignment). Pelvipro resolves all three of these tests (re-establishes alignment).

We have run trials in order to demonstrate the relationship between the resolution of these special tests and our patients’ perception of their lower back symptoms. We used Core Outcome Measurements in accordance to IMMPACT. The following link will take you directly to some of our findings.

Pelvipro was developed because my clinical experience taught me that resolution of these special tests had a majorly positive effect on my patients, both physiologically and psychologically. Pelvipro offers a home exercise that patients can use to resolve these three tests at home. This is an essential part of their perception of control.

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