Integrating instrument adjusting in your practice
By James W. Gudgel, DC, PT
Thousands of chiropractors have incorporated instrument adjusting into their practice to provide easy and effective care for patients. For many DCs, the switch to an adjusting device arose because they had developed hand-wrist-arm problems from the spring-activated adjusting instruments they were using. These doctors and others have told us that they had developed physical limitations or injuries from their previous adjusting technique. Still others have become intrigued by the benefits of multiple repetitive thrusts delivered at to restore normal oscillation of the vertebra or extremity joint that Impulse adjusting affords.
Multiple studies prove the effects of the adjustment are validated and what actually happens when an adjustment is given is demonstrated. This research puts to rest the previously held notion that an adjustment moves a bone from point A to point B, thus “putting it back in place.”
The Arrival of Computerized Adjusting Technology
Some adjusting instruments are now equipped with an accelerometer sensor in the nosepiece connected to an internal computer micro-chip that measures bone movement and oscillation frequency. In this manner, the instrument moves simultaneously samples the amount of movement as well as its oscillation frequency (the speed of its rebound) in real-time during the adjustment. Information from the adjustment is thus interpreted by the device signaling the subsequent adjusting thrusts to commence in synchronization with the same speed that the joint complex is currently oscillating.
As the adjustment with these instruments begins to change the neuromechanics of the joint complex, the joint “releases” and the bone movement and oscillation frequency also increase. As this occurs, in real-time the pulsing thrusts from the instrument speed up to match the new increased bone movement and oscillation frequency (sweeping anywhere between 4-12 Hz). This feature maximizes the bone movement and oscillation frequency. When the sensor detects no further change in the oscillation frequency the instrument stops thrusting and emits a “beep” telling the doctor that motion has been maximized, defining the adjustment.
Instrument Adjusting Audible
With any new technology there is a small learning curve. First, the doctor needs to understand the signal “beeps” that the instrument emits. As mentioned earlier, a single beep indicates that the instrument has sensed that maximum mobility has been reached during the pulse train of the adjustment. The instrument then stops pulsing. From a biomechanical perspective, we have evidence of improved mobility; yet, this may not necessarily indicate that the necessary clinical results have been obtained. The beauty of this approach is the clinical evaluation is used to identify improvements in objective findings using the Medicare P.A.R.T. system. The clinical findings are just as important as the biomechanical response that the instrument reads. Thus, the instrument can be used to enhance your technique, not replace it.
Different Patients Have Different Frequencies
Based upon the doctor’s examination of the patient, and the patient’s age, sex, and physical characteristics, the doctor will have a “feel” for the likely mobility of that patient’s joints and tissues. You would expect a young, flexible female patient to have a relatively higher rate of bone movement and oscillation frequency. Let’s say for instance that you have determined that this patient has an L3 subluxation. Yet, upon applying the IQ to L3 and the instrument pulses slowly (usually
less than 6 cycles per second) and a single audible beep is emitted after several pulses. Yes, the instrument has sensed that improved mobility has taken place pre-post, but one would have expected a much greater amount of bone movement and oscillation frequency in this patient. After re-checking the clinical indicators that necessitated the adjustment, the doctor should re-contact L3 and apply a second adjustment. More often than not the instrument will pulse much faster, or may start off slowly and then speed up considerably before beeping and stopping.
The doctor can also apply the instrument to a level above or below the subluxated level to sample what is the “normal” amount of movement and frequency in a non-subluxated joint. The doctor should then expect the subluxated level to achieve this same amount of movement and frequency. If it does not, then the doctor should suspect a high degree of muscle guarding or underlying other problems such as structural damage, fusion, or pathology.
On other occasions, the instrument may pulse a few times, stop, and not emit a beep. This indicates that the joint did not attain a significant increase in movement or oscillation frequency. This could be due to an incorrect line of drive or contact point on the part of the doctor, or could indicate a high degree of underlying muscle guarding, joint fixation, fusion, etc.
You may also find that that sometimes during the adjustment the speed of the pulses will slow down instead of speed up. This indicates that the muscles are tightening up and trying to protect the joint. The likely cause of this is that the instrument force setting is too high for this area in this particular patient. In this instance, simply moving to the next lowest force level should yield better results.
Understand that that muscle spasm or hypertonicity (with internal trigger points) may prevent the joint from releasing. If after two or three repeated adjustments to a joint the amount of bone movement and oscillation frequency does not reach the expected levels (see point one above), it may be likely that muscular resetting work are necessary. For instance, as we teach in our clinical trainings, a sacroiliac lesion will produce hypertonicity in the ipsilateral quadratus lumborum and biceps femoris muscles. After adjusting these muscles, after readjust the subluxated SI joint will usually release and oscillate at a much higher and normal frequency.
Patients Tune-In to the Adjustment
One interesting clinical observation is that patients quickly “tune in” to what is happening during the adjustment. They quickly learn what it means when the pulse frequency is slow, when the instrument fails to beep, or beeps once or twice. Further, they feel the release that is obtained when the instrument pulses fast and beeps once. They also feel the reduced pain and stiffness, along with increase ROM that occurs immediately after the joint is adjusted and doctor re-applies the clinical test for that area.
A major benefit of this interaction is that the patient becomes a “participant” in the treatment process and actually looks forward to the improvements that they obtain during the adjustment process. They “know” when the adjustment was successful or not as both of you receive immediate feed-back. The immediate improvement patients experience with this instrument and technique, unlike other techniques where the patient may feel no improvement after the adjustment or may even feel worse necessitating that the doctor go through an elaborate explanation of why the patient did not feel immediate results.