In my experience most patients are inherently aware of this concept before they ever set foot in my office. There is also a very large contingent of doctors and therapists who don’t appreciate or understand the importance of joint alignment.
The feeling of misalignment
At some point in your life (maybe your day) your knee, shoulder, wrist, elbow, ankle, hip, back, neck etc. has suddenly become limited in their normal motion. You feel resistance, locking, pain or pressure right in the joint preventing you from moving further. Maybe you try to check your blind spot and you feel like something in your neck blocks you. You try to squat down and stiffness quickly develops in your knee to prevent you from completing that movement.
Many times (by many health professionals) this gets chalked up muscular tightness. You can’t turn your neck because the muscle is tight or is in spasm. You can’t complete a squat because your quads are tight. This might explain mild cases where you can feel a stretch develop and slowly work through that tightness. You typically don’t feel that pain at the joint.
This can be a complicated topic and is often missed during assessments. Your knee joint makes for an excellent example with a lot of research behind the concept. It’s construction leaves it to act much like a door hinge, pivoting primarily around just one axis with some extra cushioning inside. If the top and bottom of the joint line up well the movement is typically free of crunching or creeking and at the end of bending or straightening there are two cartilage surfaces still in contact with one another. If the door hinges are installed correctly there’s good contact between the metal pieces and they slide well over one another.
Quite commonly misalignment will develop at the knee joint where the shin bone is turned outwards compared to the thigh bone. This is commonly seen in Helfet’s test when the tibial tuberosity (center-line of the shin bone) is too far lateral compared to the center of the knee cap. Because of this subtle twist the cartilage surfaces don’t align perfectly and so towards the end of straightening or bending those cartilage surfaces slide off one another forcing your to stop your movement. Those cushions between bones are being repeatedly pinched. Now one half of the door hinge is slightly angled. It creeks as it opens since now only parts of the hinge are touching with far greater pressure.
Normal reactions to joint pain
Joints have powerful control over their surrounding muscles. They contain nerves that are highly sensitive to any compression or stretching of it’s tissues or cartilage. Joint misalignment compresses and tensions those tissues causing signalling to muscles in the area to relax or tighten to try and improve the joint position. This is where many assessments start and finish. “You can’t squat fully and your quads have become tight, they must be preventing you from squatting fully. Let’s do some stretches.” Too often the underlying issue is missed. Correct the knee alignment and the signalling to other muscles fades. Quads get back to a normal length and tension without unnecessary work.
Long terms changes
Quite often misalignment develops without traumatic injury. A long day at costco, vigorous hike or a hard leg day can often be enough. This will leave people assuming their joint is unaffected despite their pain because there was no trauma. So they deal with the issue for weeks or months. They stretch, they exercises, they deal with the pain. That joint has been signalling surrounding muscles to fire harder or stop firing for days or weeks. The tissues of the joint have been bearing higher than normal tension and the cartilage has been repeatedly rubbed hard in certain places. Why do you think it’s so common to develop arthritis in just one knee even if you’ve never had a significant knee injury?