Table of Contents
- The Importance of Choosing the “Best Fit” Chiropractic Adjusting Technique for You
- 9 Factors to Consider When Choosing Your Chiropractic Adjusting Technique
- Your Primary Goal is to Be Ready to Adapt, Develop, and Embrace the “Art” of Practice
- A Word About The Smart Chiropractor
The Importance of Choosing the “Best Fit” Chiropractic Adjusting Technique for You
The heart of chiropractic care is the adjustment.
It’s the intervention that defines our uniqueness in the healthcare market and the basis for much of what we do.
The chiropractic adjusting technique a doctor chooses to use day-in and day-out in practice is one of the most important clinical decisions they can make.
Matching the right chiropractic adjusting technique (or, perhaps, a combination of techniques) to one’s philosophy, body type, clinical goals, preferred practice style, and personal physical capabilities can make all the difference between a fulfilling or frustrating career in chiropractic.
So, how do you get started?
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9 Factors to Consider When Choosing Your Chiropractic Adjusting Technique
In 30+ years of teaching and speaking with thousands of doctors from new grads to long-practicing veterans, I’ve compiled a list of several key factors all chiropractors should take into account when doing the work of determining the “best fit” technique for themselves.
So, without further ado, let’s dive into the essentials.
Here are some basic “whys” you should answer when choosing the right chiropractic adjusting technique for you.
1. Your Chiropractic School Training
The college you graduated from would have trained you in philosophy, theory, approach, and methodology to practice chiropractic.
The degree to which you accepted or rejected what was taught affects how you practice.
Your college’s chiropractic adjusting technique curriculum and your experience with chiropractic practitioners will most likely have had the most significant influence on your choice of chiropractic adjuting technique for future practice.
Extracurricular activities, including technique clubs and seminars, can also figure in your practice technique preferences.
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And then the quality of the training you received certainly also affects whether or not you decide to utilize the chiropractic adjusting techniques you learned after graduation.
I myself have observed countless doctors gravitate away from practicing actual chiropractic adjusting techniques in favor of alternative focuses like rehabilitation, soft-tissue therapies, nutrition, and other objectively more esoteric approaches simply because they never fully developed the skills needed to deliver an effective adjustment.
Did You Know
Research by Triano has shown it takes 1-5 years of continuous practice to develop proficiency in a chiropractic adjusting technique.
Much of you skill development in practicing chiropractic, or any healing art, comes from on-the-job training and continuing education.
Many doctors often continue to do only what they were taught in chiropractic school (even decades after graduation).
Your college’s responsibility is to train you and your classmates to be good beginners and to, really, be safe for public consumption.
They give you an essential skill that you are then set to grow and expand on as as you practice in our profession over time.
Remember that as you visit this particular “why.”
That said, let’s talk philosophy.
2. Your Healing Philosophy
Determining your chiropractic healing philosophy boils down to how you view your role as a doctor.
Do you see yourself as a facilitator or an interventionist?
If you approach your care as a facilitator, you will utilize chiropractic adjusting techniques that work the patient’s innate healing ability and attempt to facilitate it. This includes many light-force and so-called non-force techniques, as well as educational methods.
On the other hand, if you approach your care as an interventionist, you will utilize techniques that demand a body response that it can’t achieve independently. This includes most of the thrust and non-thrust techniques we employ.
How you answer this “why” ties directly into our next area of focus: your clinical goals.
3. Your Clinical Goals
In the practice of chiropractic, there are several stated outcomes that we as doctors strive to achieve:
Common Chiropractic Clinical Goals
- Pain reduction
- Vertebral subluxation correction
- Improved segmental mobility
- Locomotor or neurological functional improvement
- Changes in global spinal alignment
Each of these requires some analysis or metric to determine if the goal has been achieved.
Chiropractic adjusting techniques appropriate for one purpose will be less effective for another.
Knowing the clinical results you’re aiming for in advance is essential for choosing the best adjusting technique to help to get there.
That said, here’s something you’ll find interesting.
A 2013 paper by Triano, Budgall, et al. reviewed the experimental literature on the most common methods that chiropractors used to determine the site or sites of their manipulations.
Their findings were then compiled into a broad spectrum of research-based recommendations, from unfavorable to most favorable.
Among those recommended as favorable included: pain provocation tests, motion palpation, leg length inequality, manual muscle testing for nerve root levels, and regional range of motion.
So, when defining your clinical goals, be smart and consider how you’ll mesasure those goals.
This will help you better identify the “best-fit” chiropractic adjusting technique for you.
Once you’ve identified those basic clinical goals, you’ll want to line those up with your healing philosophy and adjusting rationale .
4. Your Adjusting Rationale
As a doctor of chiropractic, you’ll need to break down the actual “how” behing accomplishing your now-defined clinical goals.
For instance, do you view the spine and locomotor system as a closed kinetic chain or as a series of independent segments?
In the former, dysfunction in one region can be a causative factor in the pathophysiology in another region local or remote to it.
Your approach here would be to focus on finding the dysfunctional kinetic chain “lynchpins” and to then remove or reduce them to improve the entire global system.
This requires a more comprehensive set of chiropractic adjusting techniques and clinical tools than someone who subscribes to the latter view.
In the latter, the assumption is that joint complex abnormalities and pathologies are more locally entrenched and require more clinical emphasis.
The focus here is on directing care on a region by region basis with local resolution.
Hopefully by now you’re getting a feel for how interconnected the “whys” of your education, philosophy, goals, and adjusting rational are.
Now, let’s shift gears from the mental to physical side of choosing your “best-fit” chiropractic adjusting technique.
5. Your Body Type and Physical Capacities
Obviously, you’ll want to consider your height, weight, limb length, muscular development, gender, and overall physical health as you work to make a fit between you and your chiropractic adjusting technique.
A side posture adjustment is performed differently for a long-legged chiropractor who is 6’2″ than one who is 5’3″.
Likewise, a female doctor tends to have less upper body strength and needs to use her hips and legs to generate adjustive forces more than her male counterpart.
Aging and injuries also play a role.
Like all older athletes, older practitioners need to be more attentive to their body mechanics and physical conditioning.
Utilizing adjustment aids such as drop pieces, tables that have a breakaway, moveable sections, and traction ability, and the use of adjusting instruments can help make up for these concerns.
Now, let’s refine this idea a bit further…
6. Your Psychomotor Aptitude
Every doctor of chiropractic will vary in the amount of natural coordination and ability to perform specific chiropractic adjusting techniques.
While some have an instinctive affinity for any number of techniques, others may have to work consistently and patiently at developing the skills that high velocity, low amplitude adjusting (HVLA), and others require.
This is especially true of end range techniques.
Good technical skills are not a gift conferred by nature’s lottery on a few chosen individuals.
It is obtained and maintained by consistent and intentional practice.
Malcolm Gladwell simplified and popularized Anders Ericsson’s work when he wrote about the “10,000-hour rule.”
Namely, it takes an average of 10,000 hours of “deliberate practice,” which involves continually pushing oneself beyond one’s comfort zone to become world-class in any field.
Adjusting skills are no different.
What’s more, there is a range in tactile sensitivity doctors possess to develop advanced palpation literacy.
High levels of specific kinesthetic understanding are needed for the diagnostic palpation of motion segments, craniosacral motion, muscle tone and tension, skin texture and tone, etc.
I use the guiding adage, “If you can’t feel it, you can’t heal it.”
Some doctors exhibit such exceptional acuteness in their palpation skills it can seem they are almost psychic.
Often more intuitive than conscious, this is a form of tacit knowledge – the kind of knowledge that is difficult to transfer to another person by writing it down or verbalizing it.
One caution I want to offer when trying to model a particular technique expert or “guru” is to be aware that there is oftentimes a mismatch between their capabilities and your own.
Many master practitioners develop their style and methods of adjusting empirically, which can be idiosyncratic.
They may not harmonize with your particular characteristics or be readily transferable to a broader audience.
At the end of the day, the best techniques to learn are systematized to the extent that the general student and professional community can effectively learn them.
So, once you’ve examined your chiropractic knowledge and physical capabilities and skills, what’s next?
Well, we’re not done looking at you yet, Doc!
7. Your Personal Experience
It goes without saying that despite what you may have determined in examining the above “whys,” you’re ultimately most likely to adopt a specific chiropractic adjusting technique as your own if that specific technique has helped YOU.
If you’re a new grad, it may be that a charismatic teacher or exemplar of a particular method impressed you.
If you’re a veteran still practicing in the trenches, you may have had success with that technique earlier in your career.
Direct personal experience is a strong influencer and often is relied upon more than any other factor.
It’s up to you to determine how to effectively combine or bridge the gap between your experience and your current mental perspectives and physical capabilities as your career progresses.
Remember, Doc – success in your practice is in large part tied to identifying your “best-fit” chiropractic adjusting technique.
And that recurring idea of “best-fit” takes us to our next key “why” in that process…
8. Your Preferred Practice Style
An often overlooked aspect that goes into selecting your technique is your business model and practice style.
If you have a goal to see 50 patient visits in an 8-hour day, using a technique that requires 15-20 minutes of direct patient contact time will create a conflict.
If you have small adjusting rooms, it’s challenging to get the additional knee-chest and pelvic bench tables in them to practice Gonstead.
If you want to see pediatric patients, you need techniques different from adults.
The same is true for treating a patient population of athletes, pregnant women, geriatrics, or chronic systemic disorders.
My advice is to start with the “end” in mind and choose a technique that aligns with your global practice objectives.
Further, you may decide to use a branded technique in your practice for business and marketing purposes.
This can serve as your flagship approach or an ancillary offering.
It is advisable to make sure any clinical procedures you adopt are not incongruous with your primary methods or your practice’s philosophy and modus operandi.
So, finally, let’s take a quick look at some of the current research that’s out there for you to consider when doing the work of determining your “best-fit” chiropractic adjusting technique.
9. Current Research Studies and Findings
There are few studies on the effectiveness of specific manipulative and adjustive approaches to inpatient care.
Most use the term “spinal manipulation” without identifying the particular technique utilized.
Recent Adjustment Efficacy Study Highlights
- “The boot camp program for lumbar spinal stenosis” by Carlo Ammendolia, DC, Ph.D. has shown evidence of effectiveness. A combination of HVLA manipulation, soft tissue and neural mobilization, lumbar flexion distraction, and manual muscle stretching is used in this program.
- The NUCCA technique of Atlas adjusting has been found to reduce blood pressure in patients with hypertension.
- HVLA diversified side posture spinal manipulation, flexion-distraction manipulation, and lumbar mobilization, all of which demonstrate positive effects on patients with chronic low back pain.
- HVLA cervical manipulation with rotation to the opposite side and lateral flexion to the same side of the affected arm is useful for patients with cervical disc herniation with upper extremity neurological findings.
- Side posture HVLA manipulation involving rotation is effective for patients with lumbar disc herniation.
- Ross has shown that segmental specificity is not as critical in delivering a thoracic manipulation as was previously assumed.
Your Primary Goal is to Be Ready to Adapt, Develop, and Embrace the “Art” of Practice
Ultimately, it is you, the practitioner, who chooses and develops your practice style and adjusting techniques.
You should plan on adapting and developing with your ongoing learning and experiences of practicing the art of chiropractic adjustment and changes in your physical condition and practice goals.
Like all arts, how you choose to practice is both a means to an end (in this case, healthier patients) and an expression of you, the artist.
Over time you will go through phases of learning, doing, modifying, innovating, forgetting, and relearning.
Dr. Frank Langiolotti, one of my technique instructors at NYCC, would frequently say, “That’s why they call it practice – because you never get it right!”
Choose well, and you will practice with passion and excellence!
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