Weird bones are normal
Manual therapists (massage, chiro, etc) are often taught to rely on feeling the tips of vertebrae to judge the condition of the spine. Obviously, many are trained better and know better. Not all, however! And I have known all too many who do in fact have this simplistic view.
And it’s certainly what I learned. In my early years as a baby Registered Massage Therapist, circa 2001, I would seriously 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 understand that you just cannot count on bones being nice and tidy and regular. It is therefore effectively impossible to judge minor variations in the position of vertebrae.
For instance, a 2022 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 and Suzee Grilley and 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 more specific confirmation in the case of the lumbar spine. So it’s extremely 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 were also all the heck over the place, and 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 generally overrated as a problem.
Read more about anatomical variations. I’ve been collecting examples for my whole career. There are many clinically relevant ones, and it’s become one of my favourite themes over the years.
Déjà vu? Yes, this post is a re-run (originally published June 24, 2022). However, I never just re-publish exactly the same thing: I always make some improvements, and sometimes it’s a lot.