Why instrument adjusting?
10 reasons why you should incorporate this technique
By Christopher J. Colloca, DC
Instrument adjusting has become one of the most commonly used techniques in today’s chiropractic practice.
It is second only to diversified-type manual spinal manipulation, according to the National Board of Chiropractic Examiners Survey of 2000.
From ease of use to providing added safety to a patient encounter, adjusting instruments have provided a new dimension to the chiropractic practice. Likewise, instrument adjusting has expanded the range of conditions and patients that can now be more easily managed with chiropractic care.
Following are the top 10 most popular reasons why you should incorporate instrument adjusting into your practice.
10. A mechanical advantage. Biomechanically speaking, chiropractic adjustments are delivered to move the bones of the spine. Newton’s Second Law is force equals mass times acceleration (F = ma). Adjusting instruments take advantage of the acceleration part of the equation in providing large accelerations with a substantially smaller mass.
In contrast, 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 patient’s natural tendency to tighten up and resist the adjustment.
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 (? = f/a).
When you contact the spine with your 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 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 forces relatively low due to their small contact area with the patient — thereby less force is required to achieve the same stresses imparted to the spine with manual adjustments.
Appreciating the concept of stress 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
9. Safety. There are instances where you may have a concern of manually adjusting a particular patient. 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.
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.
8. Easy incorporation. 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.
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 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
6. Increase 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. Instrument adjusting also enables you to care for patients in their senior years.
With the aging baby-boomer population, more seniors will be seeking care, and using a technique well-suited for them is important in the growth and sustainability of your practice.
5. Expand range of services. 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, or sooth plantar fasciitis in a patient who was told they needed surgery and would have to take six weeks off from work to recover. You’ll quickly see your practice fill up with patients who have sought you out because of the range of conditions you are able to help with.
4. Adding technology. Explain to your patients that the adjusting instrument you are about to use is 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.
Adjustments which are easier on the patient increase patient satisfaction, compliance, and a patients’ willingness to refer others.
2. Quicker adjusting time. Understandably, if you 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 patient’s 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 the prolonging of your career. Chiropractors have hurt their own backs, wrists, and shoulders from years of manual adjusting; others have had carpal tunnel problems and even surgery from pulling a spring-loaded adjusting instrument for years.
Instrument adjusting is easier on you, plain and simple. 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 don’t 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.
Christopher J. Colloca, DC, is the CEO and founder of Neuromechanical Innovations, a Chandler, Ariz.-based medical device manufacturer of the Impulse family of chiropractic adjusting instruments that provides postgraduate training to chiropractors around the globe. He can be reached through www.neuromechanical.com.
**To see the references used in this research, visit www.ChiroEco.com/instrumentadjusting.