When I meet clients for the first time and they explain why they are coming to physical therapy, often they have their own words to explain their ailments.  Sometimes the descriptors are generational or regional colloquialisms like, “Mah leader’s tore” (usually a tendon problem) or “Ah’m all stove-dup.” (Usually they’re stiff from the chronic effects of osteoarthritis). “He’s got d’sugar” (He has diabetes).

Sometimes people just don’t understand terms.  I hear “roter cup” and “rotary cup” a lot for rotator cuff. “Sciatica,” which specifically means pain generating from the sciatic nerve, gets inculpated for any leg pain from the back to the big toe.  Many bad headaches get mislabeled as “migraines.”   Everybody has TMJ, in fact we have two temporomandibular joints, and not everyone has jaw pain, facial pain or TMJ disorders.  There are many people who think a “fractured” bone is worse than a “broken” bone when really they’re the same.

There are terms that are used, I know the meaning, but I don’t know the origin, such as, “I’ve got a crick in mah neck.” “I’ve got a charlie-horse.” “She’s double jointed.” “I gotta hitch in mah get-along.”

Sometimes physical therapists use euphemisms to describe body parts which can confuse patients.  I know a physical therapist who was going to assess gluteal muscle strength and he asked his patient to squeeze her ‘cheeks.’ At first he was worried about the exceptional weakness in her buttocks, only to look up to see the patient mashing her face in between her hands.  I think physical therapists should use the correct terms and not be so prude.

There are some terms regarding the spine that are perpetuated by practitioners that create inaccurate images and then are repeated throughout our culture that really ‘get my goat.’  The first is “my joint is out of place.”  If a vertebral joint is really out of place than the unfortunate individual would most likely be paralyzed from kinking or severing the spinal cord. If it’s a joint other than from the spine that “is out” then it’s dislocated and has a very disfigured presentation. Our joints frequently get stuck and stiff.  If you take a radiograph (x-ray) of your spine, nobody has a perfectly aligned spine.  But that does not mean something is out of place. I prefer an analogy to a dresser drawer.  The drawer opens and closes along a track.  Sometimes the drawer becomes “cockeyed” and the drawer sticks.  It’s not out of place.  It’s in its normal location. It’s just not moving the way it’s supposed to move.  If the drawer was really “out” then it’d be on the floor with all of the socks would be dumped out. When you say your back “went out,” Patty always wonders “with whom?” Your back is not out. Your joint is not out.  It might be stuck. Why it’s stuck, or feels stuck, is part of your physical therapy evaluation.

The next term, I have no idea why it continues to be used, because we’ve known the real anatomy for scores of decades. When people say “He’s got a ‘slipped disk” I cringe.  DISKS DON’T SLIP! (They’re not jelly doughnuts either). Many people have this idea that the disk is like a water wiggler precariously perched between back bones and… one false move…WOOSH! “The disk slipped and my back went out!”

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On the contrary, the outer portions of the vertebral disk are fibers similar to a radial tire and those fibers are tethered to vertebrae above and below, meshing with the bone tissue.  Below is an image I found on the internet that depicts a cross section of a vertebral segment anatomy pretty well.

The fibers can tear, bulge, and extrude.  The fibers can even tear from the bone, causing a small fracture (break) in the vertebra.  The disk can get fatter or thinner as it breaks down, but they definitely don’t slip! If you are having back pain, whatever is causing your back pain (it may not be the disk) and no matter how you describe it, come see us at Back To Motion and we’ll help you figure it out and get you ‘back to motion’ and moving forward.

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