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Chiropractic News

February 2011

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Why instrument adjusting?

Top 10 Reasons Why You Should Incorporate Todayís Fastest Growing Chiropractic Technique

Instrument Adjusting has grown to become one of most commonly used techniques in todayís chiropractic practice, second only to Diversified type manual spinal manipulation (National Board of Chiropractic Examiners Survey, 2000). From their benefits of ease of use to providing added safety to a patient encounter, adjusting instruments have provided a new dimension to chiropractic practice. Likewise, instrument adjusting has expanded the range of conditions and patients that can now be more easily managed with chiropractic care. So, why all of the buzz about Instrument adjusting? Here are the top ten most popular reasons why you should incorporate Instrument adjusting into your practice.


#10. A Mechanical Advantage
From the outset, adjusting instruments were developed to provide the clinician with a mechanical advantage for more efficient chiropractic adjustments. Biomechanically speaking, chiropractic adjustments are delivered to move the bones of the spine. If there was a way to move the vertebra the same amount as you can manually, but with less force would you be interested?


F = ma


Newtonís Second Law is force equals mass times acceleration. Adjusting instruments take advantage of the acceleration part of the equation in providing large accelerations with a substantially s m a l l e r mass. In contrast, to achieve force manual adjustments require the use of more mass (weight) because of our physical limitations in achieving accelerations. Increasing the speed component of chiropractic thrusts has been found to be associated with the elicitation of neuromuscular reflexes thought to be related to the mechanisms underlying successful treatments.1-3 Instrument adjustment speed also allows you to deliver the thrust faster than the patientís natural tendency to tighten up and resist the adjustment.


√ = F/a.


Stress is another consideration among the mechanical advantages of instrument adjusting. In continuum mechanics, stress is a measure of the average amount of force exerted per unit area, where stress equals force divided by area. When we contact the spine with our hand (pisiform) the surface area over which the force is produced is relatively large compared to the stylus of an adjusting instrument. Thus, the resultant stress that is felt by the tissue with manual adjustments are appreciably less with force being the same. Adjusting instruments can achieve an appreciable stress to the spine, while keeping the forces relatively low due to their small contact area with the patient. By having such a small surface area contact, less force is required to achieve the same stresses that are imparted to the spine with manual adjustments. Appreciating the concept of stress together with the understanding of the high accelerations achieved with instrument adjusting and its easy to explain how studies have shown that the same amount of intersegmental bone movement can be achieved with instrument adjusting as manual techniques.4,5 Itís clear that the mechanical advantage of adjusting instruments can make for more efficient adjustments.


#9. Safety
Chiropractic adjustments are extremely safe. Still, there are instances where you may have a concern of manually adjusting a particular patient. For instance, you may not want to provide higher forces of manual adjustments to an elderly patient with osteoporosis. Likewise, you may not impart rotatory cervical spine adjustments to a patient with dizziness or signs of cerebrovascular disease. Low force instrument adjusting techniques can be delivered in the prone neutral position, thus enabling you to administer care with peace of mind in some situations that you may feel uncomfortable applying manual techniques.


#8. Easy Incorporation Into Your Existing Technique
The National Board survey cited above also revealed that the average chiropractor uses about five different chiropractic techniques in combination in their practice. Instrument adjusting can be easily incorporated into your existing technique repertoire. You may want to adjust the upper cervical spine and TMJ of a headache patient with an instrument, yet perform manual methods on their thoracic and lumbar spine. Alternatively, you may want to adjust the shoulder in a rotator cuff syndrome patient with an instrument instead of using a drop piece. Instrument adjusting can be incorporated into your existing techniques.


#7. Evidence-Based Care
A number of studies have investigated instrument adjusting for its effectiveness and have found it to be equivocal to manual adjusting techniques.6 In other words, in a number of clinical trials instrument adjusting fared just as well as manual adjusting techniques in reducing pain and improving function in pain patients seeking chiropractic care.7-11 Ongoing research into the basic science and clinical study of instrument adjusting is being conducted that has quantified vertebral motions, electromyographic responses, and neurophysiological responses associated with instrument adjusting.12,13 Providing evidencebased care is important for your own self-confidence, as well as the confidence of your patients.


#6. Increase The Range of Patients You Care For
Instrument adjusting allows you to care for a broader range of patients. The low force setting makes adjustments easier for pediatric adjusting as well as providing a quick and effective method to manage children. If youíve ever had a child squirm on the table, you understand how important it is to be fast. Instrument adjusting also enables you to care for patients in their senior years. With the aging of the baby-boomer population, more and more seniors will be seeking care, and using a technique that is well suited for them is important in the growth and sustainability of your practice.


#5. Expand The Range of Services You Provide

/>Perhaps you currently donít adjust the feet of patients with plantar fasciitis. Maybe you have been concentrating on the spine and donít do much with extremity adjusting, or patients with anterior rib pain, TMJ dysfunction, shoulder problems, and the list goes on. Incorporating instrument adjusting into your practice allows you to care for a broader range of conditions and will create a buzz among your patients and in your community. Want to be known as the top doc in your town? Fix a frozen shoulder. Sooth a plantar fasciitis in a patient who was told that they needed surgery on their foot and would have to take 6 weeks off from work to recover. Youíll quickly see your practice fill up with more and more patients who have sought you out because of the range of conditions you are able to help with.


#4. Adding Technology to Your Practice
Itís a technological age, and adding instrument adjusting into your practice gives a feeling of technology in the practice. Explain to your patients that the adjusting instrument that you are about to use is much faster than you can adjust them manually with your hands and that you can target just the right areas specifically with the tip of the stylus. Your patients will be impressed with your choice to stay current with the times by adding technology to help them heal. You can breathe new life into your practice with the exciting technology of instrument adjusting.


#3. Easier on the Patient
Because of the extreme speed and lower forces generated with instrument adjusting, the adjustments are easier on the patient. This equates with less side-effects, such as muscle soreness, and increased pain during the treatment or afterwards. Adjustments which are easier on the patient increase patient satisfaction, compliance and patientsí willingness to refer others. Make your patients more comfortable by incorporating instrument adjusting.


#2. Speed up Your Adjusting Time
Many times Iím asked what I think about a particular soft-tissue technique that takes 20-30 minutes to administer. My response is, I think itís great, but you had better be charging $150.00 a visit for your time. Understandably, if we could achieve the same, if not better, clinical results while speeding up the time it takes for you to provide care, you would be more efficient with your time, not to mention the patientís time. Instrument adjusting, when done properly, is fast and effective allowing you to care for more patients each day in a shorter amount of time.


#1. Easier on You
The number one benefit of instrument adjusting just may be prolonging your practice career. I cannot tell you how many chiropractors come to our seminars to learn our instrument adjusting methods because of the physical nature of caring for patients. Chiropractors come to us who have hurt their own backs, wrists and shoulders from years of manual adjusting. Others have had carpal tunnel problems and even surgery themselves from pulling a spring-loaded adjusting instrument for years.


Instrument adjusting is easier on you, plain and simple, and with the new technology of the Impulse family of adjusting instruments, you can stop beating yourself up. Not only are instrument delivered adjustments usually performed with the table in a higher position, so you are standing upright all day as opposed to bending over, you also donít need to generate the high forces with your own body, because the instrument does the work for you. Decrease the risk of injuring yourself and prolong your practice career with instrument adjusting.

References

1. Herzog W. On sounds and reflexes. J Manipulative Physiol Ther 1996;19:216-8.


2. Herzog W, Conway PJ, Zhang YT et al. Reflex responses associated with manipulative treatments on the thoracic spine: a pilot study. J Manipulative Physiol Ther 1995;18:233-6.


3. Suter E, Herzog W, Conway PJ et al. Reflex response associated with manipulative treatment of the thoracic spine. J Neuromusculoskeletal Syst 1994;2:124-30.


4. Colloca CJ, Keller TS, Harrison DE et al. Spinal manipulation force and duration affect vertebral movement and neuromuscular responses. Clin Biomech 2006;21:254-62.


5. Colloca CJ, Keller TS, Moore RJ et al. Intervertebral disc degeneration reduces vertebral motion responses. Spine 2007;32:E544-E550.


6. Taylor SH, Arnold ND, Biggs L et al. A review of the literature pertaining to the efficacy, safety, educational requirements, uses and usage of mechanical adjusting devices: Part 1 of 2. JCCA J Can Chiropr Assoc 2004;48:74-108.


7. Gemmell HA, Jacobson BH. The immediate effect of Activator vs. Meric adjustment on acute low back pain: a randomized controlled trial. J Manipulative Physiol Ther 1995;18:453-6.


8. Yurkiw D, Mior S. Comparison of two chiropractic techniques on pain and lateral flexion in neck pain patients: a pilot study. Chiropr Tech 1996;8:155-62.


9. Wood TG, Colloca CJ, Matthews R. A pilot randomized clinical trial on the relative effect of instrumental (MFMA) versus manual (HVLA) manipulation in the treatment of cervical spine dysfunction. J Manipulative Physiol Ther 2001;24:260-71.


10. Keller TS, Colloca CJ. Mechanical force spinal manipulation increases trunk muscle strength assessed by electromyography: A comparative clinical trial. J Manipulative Physiol Ther 2000;23:585-95.


11. Shearar KA, Colloca CJ, White HL. A randomized clinical trial of manual versus mechanical force manipulation in the treatment of sacroiliac joint syndrome. J Manipulative Physiol Ther 2005;28:493- 501.


12. Colloca CJ, Keller TS, Gunzburg R. Biomechanical and neurophysiological responses to spinal manipulation in patients with lumbar radiculopathy. J Manipulative Physiol Ther 2004;27:1-15.


13. Colloca CJ, Keller TS, Moore RJ et al. Effects of disc degeneration on neurophysiological responses during dorsoventral mechanical excitation of the ovine lumbar spine. J Electromyogr Kinesiol 2008;18:829-37.

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