What Bones Are For

I've been researching and writing about rib pain in pregnancy. It's an interesting subject, but in trying to write about it I found I kept bumping against a fundamental misconception about what bones are for, and how they function in the body. We tend to think: skeleton is to body as frame is to house. That's certainly how I thought of it, before I went to massage school. What are bones for? Well, to hold your body up, obviously.

It's a perfectly sensible thing to think, but it's quite wrong, and it insidiously distorts how we think about the body and its discomforts. If you've seen a model skeleton, or a real one, it's immediately apparent that the thing can't stand up. It needs to be wired firmly together. So we amend our idea of a frame to include the ligaments. Okay, we say, it's like a frame nailed together, or lashed together, with ligaments.

But we're still wrong, because the damn thing still won't stand up, without a post to support it. As you push it around, and try to imagine making it stand up, it becomes quite clear that the skeleton, admirable though it is, would be a disaster as a frame. That's not its function at all. The bones are not really there to support weight. What supports your weight is your muscle and connective tissue. The real function of bones is almost the opposite of our naive conception: they're as much there to keep us from stretching, as to keep us from collapsing. They're spacers. For the arm to work properly the wrist and the elbow have to be kept a certain distance apart. That's what the bones are for.

Most joints of the body come apart easily, if you remove the muscle and connective tissue. There is, for instance, no bony reason why our arms don't simply come off: they're held on entirely by muscles, ligaments, and tendons. If you've ever had to lug a heavy suitcase through an airport, you'll know that you can't simply hang the suitcase off your bony frame and walk along comfortably, taking the weight on your legs. Not even with a shoulder strap. Your neck and shoulder muscles start screaming bloody hell. The bones are not analogous to a house frame at all.

Why does it matter? Well, because if it's painful to move a joint, we tend to think that something must be out of whack with the frame. The bones are deteriorating, or maybe the ligaments have been overstretched. Our doctors will take x-rays and helpfully tell us we have osteoarthritis (which means, in English, "you're in pain, and there are some bones near the painful place.") Or tendonitis ("you're in pain, and there are some tendons near the painful place.") Or that we have bursitis, whether we do or not. And they tell us that the only thing to do for it is to take painkillers. Our chiropractors will tell us that our bones are subluxated and need to be repositioned, which may or may not be true: what is certainly true is that bones, ordinarily, only stay subluxated if the muscles are pulling them out of position.

Most pain is muscular in origin, and can be treated by 1) rest and 2) massage to resolve knots. It should be the first explanation for pain that we look for, since it's by far the most common: instead it's often the last.