Subluxation: Factors That Worsen It and How to Prevent It

What makes subluxation worse?

Subluxation, a partial or incomplete dislocation of a joint, can be significantly worsened by continued mechanical stress, improper movement patterns, insufficient muscular support, and neglecting a structured rehabilitation process.

Understanding Subluxation: A Foundation

A subluxation occurs when the articulating surfaces of a joint are no longer in perfect alignment, but the joint remains partially in contact. Unlike a full dislocation, where the joint surfaces completely separate, a subluxation maintains some degree of contact. This misalignment can lead to pain, instability, reduced range of motion, and potential damage to surrounding ligaments, tendons, and cartilage. Common sites for subluxation include the shoulder (glenohumeral joint), patella (kneecap), and vertebrae in the spine. Understanding the factors that contribute to or exacerbate this condition is crucial for prevention and effective management.

Key Factors That Can Aggravate a Subluxation

Several elements can turn a mild subluxation into a more problematic and persistent issue, increasing pain, instability, and the risk of further injury.

• Continued Mechanical Stress and Overuse:

  • Repetitive movements: Engaging in activities that repeatedly stress the affected joint (e.g., overhead throwing for a shoulder subluxation, deep knee bends for a patellar subluxation) can prevent healing and perpetuate instability.
  • Overloading the joint: Lifting heavy weights, carrying excessive loads, or applying forces beyond the joint's capacity can further compromise its integrity and lead to increased displacement.
  • Ignoring initial symptoms: Pushing through pain or discomfort signals that the joint is under stress. Continuing activity without addressing these warnings can worsen the subluxation.

• Improper Movement Patterns and Biomechanics:

  • Compensatory movements: When a joint is unstable, the body often adopts abnormal movement patterns to avoid pain or compensate for weakness. These compensations can place undue stress on other structures or perpetuate the faulty mechanics that led to the subluxation in the first place.
  • Poor lifting or exercise technique: Incorrect form during strength training or daily activities can place asymmetrical or excessive forces on the joint, exacerbating misalignment.
  • Asymmetries: Pre-existing muscular imbalances or anatomical asymmetries can predispose a joint to subluxation and make it more vulnerable to worsening under stress.

• Lack of Muscular Support and Stability:

  • Weak surrounding musculature: Muscles provide dynamic stability to joints. If the muscles surrounding a subluxated joint (e.g., rotator cuff for the shoulder, vastus medialis for the patella, core muscles for the spine) are weak or fatigued, they cannot adequately support the joint, making it more prone to further displacement.
  • Impaired proprioception: Proprioception is the body's sense of its position in space. Injury to a joint can impair proprioceptive feedback, reducing the body's ability to instinctively stabilize the joint during movement, leading to increased instability.

• Acute Trauma or Re-Injury:

  • Sudden impacts, falls, or twists: A new acute injury to an already subluxated joint, or a joint with a history of subluxation, can easily cause further displacement or even a full dislocation due to compromised structural integrity.
  • Previous injury history: A history of subluxations or dislocations indicates pre-existing joint laxity or instability, making the joint inherently more susceptible to worsening with even minor stressors.

• Inflammation and Swelling:

  • Increased pressure: Swelling within the joint capsule can increase pressure, contributing to pain and potentially pushing the joint further out of alignment.
  • Pain inhibition: Inflammation often leads to pain, which can inhibit the activation of surrounding muscles, further reducing dynamic joint stability.
  • Chronic inflammation: Persistent inflammation can lead to tissue degeneration and weakening of supporting structures, making the joint more vulnerable over time.

• Poor Posture:

  • Sustained asymmetrical stress: Especially relevant for spinal subluxations, prolonged poor posture (e.g., slouching, forward head posture) creates sustained, uneven pressure on vertebral joints, preventing them from maintaining proper alignment and potentially worsening existing subluxations.

• Inadequate Rehabilitation or Premature Return to Activity:

  • Skipping rehab exercises: A structured rehabilitation program is vital for restoring strength, stability, and proprioception. Failing to complete prescribed exercises leaves the joint vulnerable.
  • Returning to activity too soon: Resuming strenuous activities or sports before the joint has fully recovered its strength, stability, and range of motion significantly increases the risk of re-injury or worsening the subluxation.

• Underlying Joint Conditions:

  • Hypermobility syndromes: Conditions like Ehlers-Danlos syndrome cause generalized joint laxity, making individuals inherently more prone to subluxations and dislocations, and thus more susceptible to worsening with everyday activities.
  • Arthritis: Degenerative joint diseases can alter joint mechanics and weaken supporting structures, making subluxations more likely and harder to manage.

Recognizing Signs of Worsening Subluxation

It's crucial to be aware of the signs that a subluxation may be worsening:

• Increased pain: A sharp, burning, or aching pain that intensifies with movement or at rest.
• Greater instability: A feeling of the joint "giving way" or being less secure.
• Reduced range of motion: A noticeable decrease in the ability to move the joint through its full arc.
• Increased swelling or bruising: New or worsening inflammation around the joint.
• Clicking, popping, or grinding sounds: Audible cues indicating increased friction or instability within the joint.
• Nerve symptoms: Numbness, tingling, or weakness in the limb, which could indicate nerve impingement.

Strategies to Prevent Worsening and Promote Joint Health

Proactive management is key to preventing a subluxation from deteriorating:

• Prioritize Proper Biomechanics: Seek guidance from a qualified fitness professional or physical therapist to assess and correct movement patterns, especially during exercise and daily activities.
• Strengthen Stabilizing Musculature: Implement a targeted strength training program focusing on the muscles that support the affected joint. This includes a strong emphasis on core stability for spinal issues.
• Improve Proprioception and Balance: Incorporate exercises that challenge balance and joint awareness (e.g., single-leg stands, balance boards) to enhance the nervous system's ability to stabilize the joint dynamically.
• Listen to Your Body: Respect pain as a warning signal. Avoid pushing through discomfort that feels sharp or unnatural.
• Manage Inflammation: Utilize RICE (Rest, Ice, Compression, Elevation) in acute phases. Gentle, pain-free movement can also help reduce swelling in chronic cases.
• Maintain Good Posture: Be mindful of posture throughout the day, especially if the subluxation is spinal. Use ergonomic aids if necessary.
• Follow Professional Guidance: Adhere strictly to any rehabilitation protocols prescribed by a physical therapist or medical doctor. Do not rush the recovery process.

When to Seek Professional Medical Attention

While many subluxations can be managed conservatively, it's imperative to seek professional medical attention if you experience:

• Persistent or worsening pain that doesn't respond to rest and self-care.
• Inability to bear weight on a lower limb or use an upper limb.
• Visible deformity or significant swelling around the joint.
• New or worsening numbness, tingling, or weakness.
• Recurrent subluxations, indicating chronic instability.
• Any concern about the integrity of the joint or surrounding structures.

Conclusion

Subluxations, by their nature, indicate a degree of joint instability. While they can be painful and disruptive, understanding the factors that can worsen them empowers individuals to take proactive steps toward prevention and effective management. By addressing mechanical stressors, improving muscular support, adhering to proper rehabilitation, and listening to your body, you can significantly reduce the risk of exacerbating a subluxation and promote long-term joint health. Always consult with a healthcare professional for an accurate diagnosis and personalized treatment plan.