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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 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 technique or techniques to one’s philosophy, body type, clinical goal, practice style, and physical capabilities can make the difference between a fulfilling or frustrating career in chiropractic.
In 30 years of teaching and speaking with thousands of doctors, I’ve encountered several factors determining a “best fit” technique for an individual doctor.So how do you choose the right chiropractic adjusting technique for you?
Here are some for you to consider.
Chiropractic School Training
The college you graduated from 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.
The college’s chiropractic technique curriculum and your experience with chiropractic practitioners have been found to have the most significant influence on your choice of chiropractic technique for future practice.
Extracurricular activities, including technique clubs and seminars, also figure in your practice technique preferences.
The quality of the training you received also affects whether you utilize the techniques after graduation.
I have observed numerous doctors gravitate away from practicing adjusting techniques and into alternative procedures like rehabilitation, soft-tissue therapies, nutrition, and more esoteric approaches primarily because they never developed the skills needed to deliver an effective adjustment.
Research by Triano has shown it takes 1-5 years of continuous practice to develop proficiency in an adjusting technique.
Much of the skill development in practicing chiropractic, or any healing art, comes as on-the-job training and continuing education.
I’ve come across many doctors who continue to do only what they were taught in chiropractic school even decades after graduation.
Our college’s responsibility is to train us to be good beginners and be safe for public consumption.
They give us an essential skill set to grow and expand on as we practice our profession.
The critical distinction in healing philosophy is whether you view your role as a facilitator or interventionist.
If you approach your care as a facilitator, you will utilize 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.
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.
In Chiropractic, there are several stated outcomes that doctors strive to achieve:
- Pain reduction
- Vertebral subluxation correction
- Improved segmental mobility
- Locomotor or neurological functional improvement
- Changes in global spinal alignment
All of these require some analysis or metric to determine if the goal has been achieved.
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 way to get there.
A 2013 paper by Triano, Budgall, et al. reviewed the experimental literature on the most common methods that chiropractors used to determine the site of manipulation.
They found they fell 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.
Doctors need to consider the overall theory of how they’re trying to accomplish their clinical goals.
An essential distinction is viewing the spine and locomotor system as a closed kinetic chain or 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.
The approach here is to find the dysfunctional kinetic chain “lynchpins” and remove or reduce them to improve the entire global system.
This requires a more comprehensive set of techniques and clinical tools.
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.
Body Type and Physical Capacities
A doctor’s height, weight, limb length, muscular development, gender, and physical health are considerations in making a fit between the technique and their body.
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.
Doctors vary in the amount of natural coordination and ability to perform specific techniques.
While some have an instinctive affinity, others may have to work consistently and patiently at developing the skills that high velocity, low amplitude adjusting (HVLA), and other techniques 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, intentional practice.
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.
Similarly, 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 when trying to model a particular technique expert or “guru” is 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.
The best techniques to learn are systematized to the extent that the general student and professional community can effectively learn them.
You are more likely to adopt that technique as your own if a certain technique has helped you; a charismatic teacher or exemplar of a particular method has impressed you; early in your career, you have had success with it.
Direct personal experience is a strong influencer and often is relied upon more than any other factor.
An often overlooked aspect in 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.
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.
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.
Some that do include:
- “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 are 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.
Embracing The Art of Practice
Ultimately, it is you, the practitioner, who chooses and develops your style and techniques.
These adapt and develop with your ongoing learning and experiences of practicing the art of the chiropractic adjustment and changes in your physical condition and practice goals.
Like all arts, it 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!