Detailed guides to painful problems, treatments & more

Weird bones are normal

 •  • 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 PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Many massage therapists, chiropractors, osteopaths, and physical therapists are taught to rely on feeling the tips of vertebrae to judge the condition of the spine (not all, but many). That’s certainly what I learned. In my early years as a baby Registered Massage Therapist, circa 2001, I would actually try to determine what spinal joints were “out” based on the position of the spinal bone bumps.

That makes me roll my eyes so hard these days. 🙄 Because now I know that you just cannot count on bones being nice and tidy and regular. They are no way to judge the position of vertebrae!

For instance, a new study by Fausone et al measured the lumbar spinous processes in 16 cadavers and found them to be quite variable in length.

Note the significant differences in the size of the spinous processes of these lumbar vertebrae. This photo is from the collection of Paul & Suzee Grilley & is used with permission. They are all intended to “show the normal variation in human bones. None of them are pathological.”

People just have funny bone shapes, and that has been shown in many ways over the years — this is just more specific confirmation in the case of the lumbar spine. So it’s doubtful that anyone can find a “clinical positional fault of a vertebra through palpatory exam.” That’s a small statement that, if true, has large implications for many professionals. A major bummer for them.

This lumbar study is identical in spirit to a 2008 paper (Preece et al) about the shape of the pelvic bones, which was also all the heck over the place, which undoubtedly makes assessment of pelvic tilts highly unreliable. (And which I also used to do, arg, cringe.) Not that it’s even worth trying, crookedness being so overrated as a problem.

Read more about anatomical variations! There are many clinically relevant ones, and it’s become one of my favourite themes over the years.