Chiropractic Techniques & Adjustments:
It’s not hard to understand the confusion about what a chiropractor does and why there is so much variation in chiropractic techniques and adjustments. At my alma mater Parker College of Chiropractic (now Parker University), they teach nine different chiropractic techniques. The intent is to give the future chiropractors a balanced education.
All of these techniques have some merit in reducing patients’ neck pain, low back pain, and headache other musculoskeletal symptoms. However, the inconsistent treatment recommendations based on different techniques can make it very difficult to understand what chiropractic is. This inconsistency is arguably one of the biggest current issues slowing the proliferation of chiropractic. The reason it is such a problem is that many of these techniques are due to subjective evaluations. Some of them literally don’t even look at or touch your spine.
I realize that I don’t know everything.
No one does. I am also a healthy skeptic when it comes to many of the techniques that claim to be chiropractic. The first thing we need to do is understand what the foundation of chiropractic is. Chiropractic is founded on the fact that the spine can negatively affect the human body when it is abnormally shifted. This abnormal movement or position of the spine is called a subluxation.
A subluxation of the spine is similar to a dislocation but less obvious and often less severe. Dislocation of a joint is almost always caused by an injury and is when one of the bones, be it vertebra, humerus, femur, etc., is displaced from joint. Dislocations are almost always an emergency situation that needs to be addressed immediately. When a bone is dislocated it can cause severe pain or restrict blood flow resulting in nerve damage or requiring amputation. A subluxation is when the bones are partially dislocated from the joint. Think Dislocation = Acute and Subluxation = Chronic.
How do you measure and therefore treat a subluxation?
This is where the source of disagreement between many of the chiropractic techniques lies. Most chiropractic techniques rely on subjective measurements and analysis to determine the existence of a subluxation. They are so rooted in subjective evaluation and treatment that they rarely do objective diagnostic tests like x-rays. Even when they do x-rays many of them never take another x-ray. This is ridiculous. If you take x-rays to evaluate a problem then why wouldn’t you follow up with more x-rays to determine any improvement?
The reason most chiropractors don’t take follow up x-rays is that they don’t expect change. Primarily because their technique can’t effectively change a person’s spinal structure. This would be like a surgeon taking an MRI to determine the need for surgery. They find a disc bulge and do surgery (not that it’s necessary if you get structural chiropractic) and then never do another MRI to compare. The same comparison could be made with blood work. You’re not just going to treat the patient until the symptoms change without following up with another blood test.
The most common example of subjective evaluations in chiropractic includes using muscle tests or leg length analysis to determine the presence of abnormal spinal movement. Most muscle tests use the deltoid to test a change in muscle strength directly after testing the body. An example of muscle testing is applying pressure to a specific area of the body or using a force on the body to make an assumed subluxation better or worse. If the right pelvis is rotated backward and you push the right side of the pelvis forward, hypothetically an uneven leg length would become even or a muscle would test strong. Push in the direction of abnormal movement, backward in this example, and the uneven leg length discrepancy would worsen or a muscle test would become weak.
It’s not hard to see the subjective nature of these types of analyses is. Granted research supports these types of testing but overall it is sorely lacking and not highly objective. To become officially objective then the test should be standardized using objective measurements.
Inducing a force into a specific area of the body will cause the body to respond in a way that changes the grade of muscle strength or leg length presentation for a short time immediately after. These muscle tests or leg length analysis are used prolifically in traditional chiropractic. I’m not saying their use is dangerous or that you can’t alleviate common musculoskeletal symptoms like neck pain, back pain, headaches etc. while using them. However, there is research that questions the validity and reliability of these tests.
Traditional chiropractic is made up of a conglomerate of many different techniques and styles of analysis and adjusting. The one thing they all share in common is that they, like orthodox medicine, focus primarily on the elimination of subjective symptoms. Granted they do this using a very safe form of treatment when compared to most drugs and surgery. The fact still remains that many of these techniques rely heavily on the chiropractor’s ability to feel where the spine is and how it is moving. This method of analysis and reevaluation is often all that is necessary to help the chiropractor determine what vertebrae to mobilize, but not always. This is why so many patients can see great benefits from traditional chiropractic care using nominal evaluation and analysis. This, however, is not typically what is necessary to correct the cause of the problem and in fact, can exacerbate some abnormal spines
This is the most commonly used chiropractic technique. Most chiropractors utilized diversified to attempt to mobile joints in the spine and pelvis. The “pop” and “crack” noises that are so often associated with chiropractors is a result of the wide utilization of diversified adjusting. Diversified adjusting relies almost exclusively on palpation of the spine. When a joint or vertebra is felt to not move as well as those around it or is less mobile in a specific direction, it is adjusted.
This technique is the most popular low-force chiropractic technique. No manual (by hand) adjusting is done with Activator technique. Activator uses only a
specific Brand of adjusting instrument called, you guessed it, an Activator. There are a few different models but they are all just a spring load hand instrument used to tap the spine, pelvis, joint, etc. to elicit enough force to move the vertebrae. This technique is often used for chiropractors who are physically unable to adjust manually or for the elderly. Despite the overwhelming safety of manual adjustments, Activator is widely used as a “safer” method to avoid injury and appease patients ignorant of chiropractic safety or those who just prefer a softer adjustment. Think of being flicked, gently. That’s what an Activator feels like.
Activator uses leg length analysis to determine the need for an adjustment after a “challenge”. The chiropractor pushes gently into one area at a time and then checks the legs to determine any change. If there is a change in the apparent leg lengths, an adjustment is performed in the correlating area.
This Technique is also dependent on a specific adjusting product. The Proadjustor uses an electrical instrument that uses light impulses to measure the amount of movement in each vertebra. Depending on the resistance to the impulse it determines a need for an adjustment. This a good objective way to determine poor joint mobility. However, all adjustments are done with the force going from back to front and the overall shape and structure of the spine, which has a direct effect on its mobility and neuromuscular balance, is never addressed.
This chiropractic technique centers on the “drop” adjustment. This method of adjusting uses different drop mechanisms built into a table to assist with adjusting. There are many different styles and brands of tables that offer drops. The widely used drop mechanism allows the chiropractor to thrust at a high speed, using less force than an adjustment without the drop. The thrust initiates movement, the fast drop carries the joint through the remainder of its range of motion.
Basically, a small piece of the table supports your head or back or pelvis, but just barely. Once the chiropractor adds a small thrust it let’s go and drops down a few centimeters and the supporting drop piece and the chiropractor’s thrust stops abruptly. To simplify it, this helps to “reset” the nervous system which is holding the spine via the muscles in a specific position. Think of smacking an old TV with bad receptions only way more precisely done. The technique as a whole does rely on certain muscle and joint challenges measure via leg length inequality to determine the need for an adjustment.
Most chiropractors incorporate the drop adjustment into their treatment even if they utilize a different method for measuring the need for the adjustment. The drop adjustment started with the Thompson technique. However, its effectiveness of the drop adjustment has surpassed the techniques analysis.
There are a great many techniques “chiropractors” use that exists outside of the current and documented science. That’s not to say that these other treatments do not have validity or benefit. The problem is that many of them, like many MDs, will use their title and status to support their claims. This is a particularly big problem for chiropractic for a couple of reasons.
- Most chiropractors seek answers outside of orthodox western medicine because they see the danger and ineffectiveness of the corrupt medical model. Some of us continue to rely on science and others rely on philosophy or the art of their treatment.
- Chiropractic still has difficulty agreeing on an objective definition of a subluxation. Corrective Chiropractic utilizes the most research chiropractic technique in the world which has a very specific spinal model that can be measured via x-ray. Most other techniques rely almost exclusively on subjective analysis.
- Chiropractic started with a philosophy that has been proven by science but many chiropractors still choose to rely almost exclusively on that philosophy instead of growing or changing. This happens in all science fields.
B.E.S.T. – (Bio-Energetic Synchronization Technique)
This is one of the most popular “no-force” techniques. B.E.S.T. is centered about energy balancing of emotional issues. I have a healthy respect for things I don’t understand or know. That being said I’m not sure I feel that this chiropractic technique, like others, should be practiced under the scope of chiropractic. While it focuses on balancing neurological energy. There is zero research to show how to measure normal or that the treatment effects this consistently and in a positive manner. Because of its reliance on emotional maladies, it seems more suited to psychology than chiropractic who are supposed to be the spinal specialist.
This technique focuses more on structure than most other traditional techniques. While Gonstead does rely on taking x-rays it has yet to be able to show research validated spinal normal or consistently reproducible changes in the structure to objectively measure improvement. This is likely because the regular adjustments rely on a Nerveoscope which is an instrument that measures differences in temperature on either side of the spine. If a change is noted then that side is adjusted with help from the x-ray analysis.
Many of the adjustments are very difficult to master as Dr. Clarence Gonstead created many of the adjustments to suit his acute rheumatoid arthritis in his hands.
Corrective Care is anything that addresses the CAUSE of the symptoms. The cause of most spinal problems, especially those that result in low back pain, neck pain, headaches, disc bulges, etc. is an abnormal spinal structure. These abnormalities can be due to posture, injuries, developmental imbalances, repetitive movements, lack of movement, congenital defect, etc. The change in the structure or alignment of your spine must be measured on a minimum of two separate occasions. In order for a comparison or measurement of change, to be determined. Chiropractors by definition are spine specialists. The best way to effectively and objectively measure the spine and compare it to an ideal spinal model and the initial spinal structure before care is via x-ray. A digital posture analysis can be used in conjunction with, but NEVER in place of, x-rays.
The identity of chiropractic is very inconsistent because many chiropractors focus their practice and treatment on, pain, symptoms, “emotional subluxations”, STIM, Ultrasound, roller table traction, toxicity/detoxification, detox foot baths, cold light laser, etc. God forbid hair removal or any other treatment or service that doesn’t result in objective measurable changes in the condition that are causing the patient’s problems. Some of these things are not bad treatments, but they are not corrective. They do not treat the cause of the problem.
Typically the cause of low back pain, headaches, neck pain etc. is an abnormal structure. There are certainly other conditions that can and do improve with corrective chiropractic care. In some instances, the cause of organ dysfunction can be from an abnormal spinal structure. This is why there are so many anecdotal and case reports of chiropractic patients who have significant changes to their health when they receive chiropractic treatment. Some of the most common examples include allergies, erectile dysfunction, infertility, GERD, digestive disorders, bed wetting, asthma, etc.
It’s often very hard to find a corrective chiropractor because they’re providing numerous and non-corrective based services for financial gain. This builds distrust and a lack of respect for all chiropractors. Until chiropractic colleges prioritize true corrective chiropractic care, which utilizes and necessitates full spine x-rays and objective analysis. Patients will continue to be confused about what chiropractic is and how it can help. Confusion is to be expected when there are so many contradicting statements from both MDs and DCs about what chiropractic is and does especially corrective chiropractic.
In My Opinion
The chiropractic profession needs to focus primarily on corrective spinal care. Instead of pain or symptom-based chiropractic care. Or worse completely subjective care and treatments that do little if anything to directly change the spine in an objective manner. Unfortunately, most chiropractors have to rely on post-graduate training if they want to be a truly corrective care chiropractor. Currently, Chiropractic Biophysics is the authority in corrective chiropractic. They are the most researched chiropractic technique in the world. While being the only technique to have developed an objective ideal model of the spine using peer-reviewed research. It is essential to first determine what a normal spine is so then you can determine if someone has an abnormal spine. Then measure and compare the two.
We could then offer some secondary services like nutrition or weight loss. Services that actually improve the function of the human body instead of just eliminating symptoms.
I think that it’s awesome that we can help patients with weight loss or nutritional issue (I certainly attempt to help my patients with whole food supplements). There is certainly a need considering the massive failure of the medical community to help patients. I just worry that so many DCs do SOOOOO many other things that are so subjective. It seems like this happens more in our profession because we come out of school practically incompetent in our ability to analyze and treat spinal abnormalities.
I know many use cold-light lasers, which is awesome at helping reduce inflammation but it’s supplemental to the corrective care. Many other DCs use it exclusively for treatment because they are inept in offering true corrective care. As a result, patients don’t improve and their cold light laser or other services become primary services instead of secondary. This makes it confusing for potential patients who become ever more unsure of what chiropractic is. I see and hear most traditional symptom-based DCs call themselves corrective and in my opinion, 90% of them are not.
This inconsistency becomes a barrier for new patients and hurts us all. You can’t educate someone who has preconceived ideas about a profession that cause then to believe all chiropractors:
1. Don’t know what they are talking about
2. Don’t have their best interests in mind
3.Can’t be trusted
These three issues are perpetrated by many MDs and only confirmed when HUGE variations in services are presented for chiropractic.
This problem is magnified exponentially by DCs who treat using techniques that have literally no objective measurements, evaluation or treatment.