Structure Function: The Problem in its Approach by Manual Therapists Today



Written by Elliott Reid, Osteopath and Personal Trainer at The Revitalize Health and Fitness Clinic, Gravesend. Follow Elliott on Twitter


Structure Function has been a term used by osteopaths for over a century. The principle is that a structure influences the way something works. I.e. a door hinge (structure) will dictate the way the door swings. However modern therapists are still applying a structure function approach to treatment in a way that is missing the cause of disease, rendering in ineffective.

Spinal Alignment

Those who have visited an phyisotherapist, chiropractor or osteopath before, may have heard the practitioner say that a joint is out of alignment. This is a term dating to when the best explanation for disease was mal-positioning of a joint.


Here we can see a spine that, as normal, is not perfectly straight

However as explained by researchers and therapists such as Karl Lewit, these “misalignments” are completely inconsistent as they can be reversed simply by turning your head or spine one way and back again.


So why does it feel better after the manipulation?

Well, manipulation itself can provide pain relief due to local neuromuscular reflexes. It doesn’t however mean that it has reversed an asymmetry. Secondly, the notion that a practitioner can “realign” your spine is a powerful message and may induce an equally as powerful placebo effect


But a better aligned spine is surely a more functional one

No not really. Your spine will spend the majority of the time out of alignment. Why? Because one of our main advantages as human beings is being able to handle dexterous tasks between each limb. If we weren’t able to “misalign” our spines, we wouldn’t have a Roger Federa, Muhammad Ali. In fact, we probably wouldn’t be able to make it out of the Congo 200,000 years ago.


Granted, not a real x-ray, but imagine the torsion this skate boarder is experiencing on a daily basis

So to conclude

Rotations and misalignment are completely normal in spinal mechanics. However, if you are in neck or back pain and need to see someone, the vast majority of Osteopaths today are completely up to date with the rejection of this approach, so pop into the Revitalize Clinic or your local Osteopathic clinic.


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