Crooked vertebra
It is 1981 when the doctor Sickesz (1923-2015) publishes the book 'Orthomanipulation: the treatment of deviations in the position of vertebrae and joints'. In it she describes, among other things, 4 ways in which a vertebra can be crooked. In 2006, the Association of Physicians for Orthomanual Medicine published an updated version in which no less than 11 position deviations were mentioned. This concept has been criticized from various quarters: skewed vertebrae do not exist. Do they exist or not?
Scoliosis
First of all, we will have to determine what is meant by a crooked vertebra. Search engines almost exclusively produce stories and pictures about scoliosis on 'skewed vertebra'. Scoliosis is a sideways curvature of the spine that causes one or more bends. This occurs in a mild form in almost everyone and does not cause any complaints. There are only problems with a few with extreme forms. Sometimes the cause lies in a disorder of the spine or disorders of the nervous system and/or muscles. A point with scoliosis is that the meandering line of the spine is generally well followed by the bony parts: the vertebrae.
Slipping - spondylolisthesis
When a vertebra slides off (forward relative to the lower structure), there is a weakening or absence of part of the vertebra that causes it to lose its grip to stay in position. There is also debate whether this can also be congenital. In some gymnasts, for example, the vertebral arch breaks due to bone fatigue. Wear and tear such as in aging processes can also play a role in slippage due to the thinning of the articular cartilage and a more stooped posture. With a certain degree of slipping, complaints of sensory disturbances, pain or nerve failure can arise.
Fracture - collapse fracture
The vertebral body is depressed at the compression fracture and gives a wedge shape. This is usually due to osteoporosis. Sometimes due to a serious accident. This usually gives severe back pain for a number of months, after which the complaints can decrease. The spine itself, however, has now acquired a greater forward curvature, which increases the pressure on the other vertebral bodies. This creates an additional risk of another collapse fracture in osteoporosis. In addition, the stronger curved shape gives more back muscle tension to stay upright: a source for another type of back pain. The collapse fracture thus gives a crooked vertebra in the sense of deformation.
The orthomanual misalignment
The orthomanual misalignment of a vertebra originally meant that a vertebra assumes a different position between its upper and lower neighbors (see also Orthomanipulation). This can be a rotation about the spine axis, or a tilt about a fore-aft axis, or a shift to the side, or otherwise. Anatomically/technically speaking, this is not possible. Example: take 3 checkers and stack them on top of each other. Now turn or tilt the middle disc and see what happens: the top disc moves and changes position. The same goes for tilting or shifting the middle disc: the upper disc will always move along. Something similar is happening in the more complex spine, where joints, intervertebral discs, ligaments and muscles make the whole even stiffer, which also affects the lower vertebra. And not just the neighboring vertebrae: the reaction can go even further up the vertebral column, both upwards and downwards.
Reviewing the skewed vertebra
However, there are two points on which the concept of oblique vertebra can be nuanced. In the first place, orthomanipulation does take into account at certain points the influence of the qualities of neighboring vertebrae, sometimes up to a few levels higher or lower. This can be seen in the diagnostics: certain misalignments of one vertebra can indicate an altered position of another. This can also be seen in the treatment: treatment of one vertebra prevents treatment of another (skewed position and/or vertebra) in the same session. Only after a break can the treatment of the other be continued. This has been determined experimentally. Unfortunately, there is no theoretical basis for this.
The second point is that in certain positions of the spine, especially towards bending, the play (technically termed joint play) between vertebrae increases. There is a position in each joint in which this play is maximum and where the tension on, for example, the ligaments is minimal. This position is also known in manual therapy and manual medicine as: maximally loose packed position (MLPP). A slight skew position is possible here without including the neighbours, for example due to unilateral muscle tension, such as when lifting on one side. Now suppose that in this situation the vertebral column is stretched again, then it is conceivable that this vertebra will get stuck between the neighbors (compare a drawer that is crooked in the cupboard). This activates all kinds of receptors in the region, possibly resulting in complaints.
Conclusion
The orthomanual concept of the skewed vertebra needs revision. This renewed concept fits better with prevailing ideas about blockages of a vertebra (the loss of mobility and thus function) than the original concept of Sickesz. It also provides a more solid explanation for the origin of complaints. In further elaboration, it cannot be ruled out that the original starting points for diagnosis and treatment of a deformed vertebra will have to be updated.
Sources
Sickesz MA. Orthomanipulatie: de behandeling van afwijkingen in de stand van wervels en gewrichten. Stafleu 1981.
Nascholingscommissie VAOMG. Orthomanuele Geneeskunde. Deel II: De Standafwijkingen. VAOMG 2006.
https://www.medicalnewstoday.com/articles/190940.php
https://www.amphia.nl/-/media/Amphia/Folders/Orthopedie/6071-Spondylolisthesis.pdf
Medagam NR et al. Rare Case of Bilateral Pure Facet Joint Dislocation of Upper Lumbar Spine without Facet Fracture: A Case Report. JOCR 2018. May- June; 8(3): 58-60.