Can Your Bones Be Out of Alignment?

Dr. Adrian Pujayana

One of the most common complaints about pain that I hear is, “My spine is out of alignment!” Although this may feel true, it’s not always accurate.

There are varying degrees of alignment in all of our joints — in our ankles, knee caps, shoulders and especially the spine. There also are varying degrees of function that are associated with the misaligned joint system, and you’ll know that by the loss of range or even the pain that is associated directly with a joint or its affected regions.

This subluxation complex takes place often for many of us without notice and is a phenomenon that is understood as a joint system that is not completely dislocated, resulting in some degree of dysfunction and even pain. The correction often is perceived as a maneuver or manipulation technique that places a joint that’s in “Point A” into “Point B.”  Again, not wrong, but not entirely accurate. Here’s why:

The osseous (skeletal) system cannot move independently from the muscular system. At the same time, the shape and wear-and-tear that characterizes the skeleton and the joints will influence how the entire body mechanism will operate under the stress of gravity, daily activities, or athletics. Both the skeletal and muscular systems depend on one another for proper function, and one can cause an imbalance to the other.

When I perform a procedure to address a misalignment, what I’m doing is restoring function to a region. Therapeutically, this could include manipulation technique, but more likely, I’ll need to address the muscular-system layers to facilitate any procedures into the osseous system. What this means is that it is possible to have a joint adjustment and still be misaligned, and quite possible to have massage therapy performed and still have the problem of movement dysfunction.

Clinical studies have shown that combination therapies like myofascial release, therapeutic massage and manipulation therapies together can yield synergistic outcome for pain relief and for restoring or enhancing movement. However, I consider manual therapies such as the above mentioned to be two-dimensional in modality. To be complete, there are two other areas that I often need to address that can bring a third and fourth dimension of care. 

The third dimension … movement. By placing an active component into the therapy, we move from passive to active treatment modes, allowing the individual to perform movements in “safe zones” to minimize atrophy and to reorient movement patterns.  Loading such as gravitational forces, elastic band integration or weight lifting are part of this dimension of care. Corrective movements such as rehabilitation are vital for restoring what feels misaligned.

The fourth dimension … cognitive and autonomic control. Every feat of athletic greatness has been performed with the individual in optimal mental and reflexive control of the central nervous system. This dimension of care is achieved as a balance between coaching, training and individual response to stress and conditioning. Cognitive and autonomic control of movements is not just for athletes, but certainly is required for performing under pressure or high-intensity situations. For the rest of us, this dimension needs to run efficiently to perform occupational tasks, recreation and athletics in order to prevent bad habits or dysfunctional movements.

It’s not always ideal to address all the dimensions of care at the same time, or to expect a provider to be an expert in all of these domains. But the more we address these dimensions, the more quality of care an individual receives.

So enter the third and even fourth dimensions and see if you are still “misaligned.”

Dr. Adrian Pujayana has been providing drug-free solutions for health and wellness to adults, athletes and youth since 2000 through his private practice at Family Chiropractic Center of South Pasadena, a place for strength training and nutrition-based health care. For comments, you can reach him at