Detailed guides to painful problems, treatments & more

Hard palates, rolled shoulders, and exotic structuralism

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Some skeptical friends pointed out this impressive “not even wrong” theory that a dysfunctional state of your hard palate causes poor posture:

Tried everything to improve your rounded shoulders? Bet you haven’t checked your hard palate yet. The cruciform suture (or cruciate suture) is the joining of the palatine bones on the roof of the mouth. When restricted, it often results in weakness of both posterior deltoid muscles which can lead to increased internal rotation of the shoulders. Go figure.

Citation needed! But no such citation exists, or ever could, because it would be like trying to provide a citation for “faeries are real.”

Speaking of citing, I am not linking to the source here, because my point is not to pick a fight or call anyone specific out. My goal is to highlight this type of idea for my own readers as an unusually vivid example of the type of seriously flawed reasoning that permeates manual therapy (massage, chiropractic, and even physical therapy to some extent).

And it’s just been a while since I’ve had a good old fashioned rant.

Three major errors

The median & transverse palatine sutures. Their intersection is, very rarely, referred to as the cruciform suture.

The “joining of the palatine bones” is not the cruciform or cruciate stuture — it’s the median palatine suture. The cruciform suture is an extremely obscure term (note its absence even from this very detailed reference), which refers to the intersection of the median and transverse palatine sutures. But this is trivial pedantry compared to multiple serious errors:

  1. “Restriction” is meaningless. The palatine sutures are not “joints,” do not move, and cannot be restricted even if they did, and would be impossible to measure objectively or reliably even if they did, and impossible to correlate with shoulder posture even if they did. But they don’t! All of this is an even more ludicrous version of the discredited claim that the largest skull sutures can be manipulated (see craniosacral therapy).
  2. Subtle mobility restrictions of skull sutures have no conceivable mechanism for making any muscle “weak”… and certainly not the deltoids.
  3. You could paralyze your posture deltoids, and your shoulders would not roll forward. Those muscles simply don’t do that. Also, so what? Poor posture is a seriously over-rated villain anyway. And you can double the so-what factor if it’s just a symptom, as this claim clearly implies.

Those three errors are all manifestations of one larger one…

Exotic structuralism

Structuralism is the excessive focus on causes of pain like crookedness and biomechanical problems — an old and inadequate view of how pain works, but it persists because it offers comforting, marketable simplicity that is the mainstay of entire styles of therapy.

It’s one thing to exaggerate the clinical importance of real asymmetries and movement dysfunctions, but exotic structuralism exaggerates the importance of dysfunctions that don’t exist in the first place.

But people believe this shit. People sell it, and people buy it. And there are a zillion dot-connecting theories like this, all of them relying on the appearance of deep and sophisticated knowledge of the body: we all know that “everything’s connected,” and so there’s an industry of people who claim to have special knowledge of how everything’s connecting. They really don’t. Even vanilla structuralism is mired in the inscrutability of “basic” biomechanics, confounded by countless variables we can’t master.

Go figure!

“Go figure” is an amusing cherry on top of that bullshit sundae. It tries to add a soupçon of legitimacy with a little hapless, folksy insinuation that the information came from somewhere, anywhere, other than straight out of the author’s arse. “Don’t shoot the messenger,” it declares. “I’m just passing on the strange but undeniable truth.”

Good grief.