Perfect Alignment Doesn’t Exist. Here’s Why!

Perfect Alignment Doesn’t Exist. Here’s Why!

The never-ending continued propagating myth that perfect alignment is necessary is entirely wrong. Some of the more common types of hocus pocus that you’ll find on the internet and through google searches claim the ability to speculate that a majority of your joint pain and pathology is due to misalignment of the body. They state: for you to resolve your pain and pathology, you must be perfectly aligned. Otherwise, this will cause long term pain and issues as you get older. Some of the common myths that “cause your pain” include: 

  • Your shoulders sit unevenly. 
  • “Overpronation of the foot”, which causes knee collapse (valgus), which eventually leads to shoulder and neck pain 
  • Leaning, slouching, favouring one side is the root of all your pain and dysfunction in your lower back and hips. 

But one of my lungs is smaller than the other… 

Unfortunately for the pundits, basic human anatomy already suggests that we are “out of alignment.” The anatomy of our body is already sufficient evidence to suggest that we can live and be alive without “perfect” and proper alignment. For example: 

  • The left lung is smaller than the right due to the placement of the heart, which: 
  • Is placed slightly to the left in an area named the cardiac notch

One interesting way that we can further elaborate on the complexity of the human body and the “asymmetries” that are present throughout is subdividing the ‘abdominopelvic cavity’ (basically the space from the abdomen/bottom of the sternum to the bottom of your pelvis). The subdivisions are named the right upper quadrant (RUQ), left upper quadrant (LUQ), right lower quadrant (RLQ) and left lower quadrant (LLQ) (Marieb & Hoehn, 2019). 

  • RUQ: Right portion of the liver, gallbladder, right kidney, the smaller part of your stomach 
  • LUQ: The left portion of your liver, larger portion of the stomach, the pancreas, spleen and left kidney 
  • RLQ: Appendix, part of the small intestines, the cecum, right ureter 
  • LLQ: Majority of the small intestine, some of the large intestine, left ureter 

(LibreTexts, 2020)

As you can see, the contents of each quadrant of the body are different. There isn’t an identical distribution and allocation of organs that perfectly balances and aligns the body. Around us, there are even more common sense examples of imperfect alignment being completely healthy, including: 

  • Being right-handed or left-handed
  • Driving a car (especially a manual car) 
  • Which hand we hold our coffee in 
  • Getting out of your bed or sleeping on one particular side of your bed 

Unbelievable, “imperfect” and amazing athletes 

Adam Meakins is currently (as of 24/08/20) making a fantastic series on Instagram (@adammeakins) called: Amazing Asymmetries. The concept of the Instagram posts outlines individuals who are asymmetrical due to: 

  • Limb deficiencies 
  • Genetic variations 
  • Spinal scoliosis

This is a fantastic representation of how those with predefined “imbalances” and “asymmetries” can perform at the very highest levels of their sport. Even without these imbalances, there are various examples of one-sided or one-handed sports. One of the most notable and evident is tennis. Some of the most famous tennis athletes including Rafael Nadal, Novak Djokovic and Roger Federer don’t switch hands when they play tennis to “optimise” their symmetry and are still able to dominate at their sport. 

Photo by Zoë Reeve on Unsplash

Other examples include: 

  • Baseball
  • Archery 
  • Basketball
  • Soccer 
  • Volleyball 
  • Golf

So what does this mean clinically? 

Not much… Trying to “optimise” and create perfect alignment is an imperfect practise and shouldn’t be pursued. Unfortunately, there are still many clinicians that strive by this mantra and will ask you to see them over and over again because they feel the need to achieve this impossible standard. 

Instead, clinicians should be focusing on the root of your problem/issue and identifying the direct and clear reasons to why you may be suffering pain and pathology. Often, we may be directed to look away from just the pain and pathology site, as various factors can affect pain, including: 

  • Stress (e.g. looking after three young children, or approaching deadline for work) 
  • Sleep (e.g. less than 8 – 10 hours of sleep) 
  • Other health concerns (e.g. heart health, liver health, kidney health) 
  • Negative beliefs (i.e. Doctor told you you needed surgery, injections or multiple scans)  
  • Red flags
  • Bad medical advice (who should you see? A doctor or a physiotherapist)

Stop, and continue. 

Go live your life without worrying that your left foot drifts slightly more than your right. Lift your kids into the air without worrying about that left arm that rotates internally marginally more than the other. Go and squat down to reach for something in the bottom drawer and disregarding the 2 degrees of scoliosis you have in your lower back. 

Worrying about unnecessary and over-detailed analysis of every fault in your body is exceptionally detrimental, unhealthy and completely unnecessary. If your health practitioner directs you to do this and suggests that you come in every few weeks or months for a tune-up… Then a consultation with a new practitioner might be recommended. 

References: 

  • Marieb, E. N., & Hoehn, K. (2019). Human anatomy & physiology (Eleventh edition.). Pearson Education, Inc.
  • LibreTexts, 2020. 1.4F: Abdominopelvic Regions. [online] Medicine LibreTexts. Available at: <https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book%3A_Anatomy_and_Physiology_(Boundless)/1%3A_Introduction_to_Anatomy_and_Physiology/1.4%3A_Mapping_the_Body/1.4F%3A_Abdominopelvic_Regions> [Accessed 16 August 2020].

My knee cracks and pops! Here are three reasons why you DON’T need surgery

I recently had a patient who had come in for a consultation with minimal knee pain. When he came to me, he was worried, distressed and anxious.

Why? 

Because his doctor had told him that he might need a total knee replacement, as the cracking in his knees “…didn’t sound good”. However, this is an absurd notion, and this blog post is here to help you understand why. Fortunately, knee cracking, popping and snapping sounds in the knee are a common and completely normal process in the knees.

Physiological vs pathological sounds 

The vital differentiation in knee sounds is the presence of ‘painful sounds’ versus ‘non-painful sounds’. In more formal terms, physiological (normal knee sounds) versus pathological knee noises (Song et al., 2018). In most cases, many individuals have normal physiological knee noises, which are associated with: 

  • No worsening of sounds or increased symptoms (such as loss of ROM, increases in pain, decreases in functional ability) 
  • No association with a history of injury 
  • Sporadic or inconsistent noise characteristics (e.g. Usually the most common way to describe this is: “It sometimes cracks, but other times doesn’t.”) 

Pathological noise is often associated with symptoms such as: 

  • Swelling and effusion in and around the joint
  • On injury, a loud “POP” sound with pain was noticed 
  • Consistent cracking with careful examination 

A proper assessment and diagnosis will need to be completed by your physiotherapist to create an accurate diagnosis of your knee pain. In this situation, a trip to the doctor is not always necessary, as physiotherapists can assess and diagnose your knee pain and other surrounding tissues.

What EXACTLY causes noises in the knees? 

Physiological Knee Noise

The exact origin of normal, physiological knee noises is variable. Some proposed mechanisms include: 

  • Buildup or bursting of tiny bubbles in the synovial fluid 
  • Ligaments and tendons may stretch as over a small bony lump and then snap back into place – causing the clicking sound 
  • Catching of the synovium or physiological plica
  • Hypermobile meniscus 
  • Discoid meniscus 
  • After surgery 

(Song et al., 2018)

The buildup of cavitation bubbles in the synovial fluid of the knee joint is the commonly circulated explanation for knee joint noises. The sudden collapse of the bubble during regular joint movements can create the “popping” sound. The nature of this sound is sporadic due to the air buildup, which means that immediately after cracking your knee, it’s often hard to reproduce the same sounds again. 

Pathological Knee Noise 

There are many causes of pathological noise, which include degenerative changes (i.e. osteoarthritis), pathological plica, patellofemoral instability, pathological snapping knee syndrome and post-surgical crepitus (Song et al., 2018). 

The Osteoarthritic Knee 

The general characteristics of osteoarthritis may cause crepitus in the knee secondary to osteoarthritis—namely, gradual loss of cartilage, development of bony spurs and cysts. Crepitus in the knee can be synonymous with symptoms of patellofemoral osteoarthritis. 

It comes at no surprise that greater severity of knee osteoarthritis is highly correlated with more significant pain levels and decreased functional abilities (Neogi et al., 2009; Sowers et al., 2011). Those with the highest pain had a higher likelihood and severity of pathological abnormalities such as: 

  • Full thickness cartilage defects 
  • Synovitis 
  • Complex or mascerated meniscus tears 
  • Large osteophytes 

(Neogi et al., 2009; Sowers et al., 2011)

However, exercise can slow the progression and development of knee osteoarthritis (Bosomworth, 2009). In some cases, there is an associated improvement in pain and function in those who perform regular moderate exercise compared to those who engage in sedentary lifestyles (Bosomworth, 2009). 

So what is the management of knee noises and/or osteoarthritis? 

Managing ‘noisy knees’ really does depend on the underlying reason and the presence of physiological knee noise vs pathological knee noise. Like many other joints or spine-related pathology/pain, the most significant factor for knee noise may be the psychological factors associated with the sound or feeling. For those who don’t understand the fundamental reasoning behind knee noise, they may have anxious and negative thoughts, which can lead to decreased self-confidence, avoidance of movement/exercise and just general heightened sensitivity to any stimulus around the knee. Unfortunately, many times this may be compounded by your surrounding family and friends (unintentionally) when they make comments such as: 

  • Those knees make you sound 20 years older 
  • You have old people’s knees
  • Your knees sound arthritic
  • That doesn’t sound good for your knees 

It is important to remember that knee noise isn’t something we need to worry about unless there are painful or functional changes to your knee. However, you should attend an appointment with your local physiotherapist if you have ongoing concerns.

Have a look at my knee taping guide and knee pain guide to get you started if you have concerns about your knee pain!

Final thoughts

Knee noises are scary if you don’t know what causes them. Most noise in your knee is generally non-painful physiological noises, which are naturally occurring sounds that happen in almost every person’s knees. If you have ongoing pain or functional limitations associated with the noise, then the recommendation would be to seek out your local health practitioner to get it checked. 

In the meantime, it’s important to keep moving and keep exercising as you can! As this has the best chance of delaying chronic conditions like osteoarthritis of the knees. 

Do you have noises in your knee? 

References

  • Bosomworth N. J. (2009). Exercise and knee osteoarthritis: benefit or hazard?. Canadian family physician Medecin de famille canadien, 55(9), 871–878.
  • Neogi, T., Felson, D., Niu, J., Nevitt, M., Lewis, C. E., Aliabadi, P., Sack, B., Torner, J., Bradley, L., & Zhang, Y. (2009). Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies. BMJ (Clinical research ed.), 339, b2844. https://doi.org/10.1136/bmj.b2844
  • Song, S. J., Park, C. H., Liang, H., & Kim, S. J. (2018). Noise around the knee. Clinics in Orthopedic Surgery, 10, 1 – 8. 
  • Sowers, M., Karvonen-Gutierrez, C. A., Jacobson, J. A., Jiang, Y., & Yosef, M. (2011). Associations of anatomical measures from MRI with radiographically defined knee osteoarthritis score, pain, and physical functioning. The Journal of bone and joint surgery. American volume, 93(3), 241–251. https://doi.org/10.2106/JBJS.I.00667