Chiropractic Adjustments: Pros and cons of manual vs. Instrument-assisted

Perhaps one of the biggest decisions that you must make just starting out in practice will be if you prefer to use manual or instrument-assisted adjustments.

Both types of adjustments have their pros and cons. Fortunately, there is a large body of research comparing manual adjustments to instrument-assisted ones that can help you determine which one is right for you.¹

Manual adjustments

Pros: Perhaps the main advantage for manual adjustments can be found in the linguistic basis of the word chiropractic itself. It is derived from two Greek words: Chir, meaning to use the hands; and praktikos, meaning to practice.² In essence, the work that you do involves using your hands.

Your first experience in chiropractic school performing any adjustment on an actual patient almost certainly involved a manual adjustment. You learned how to “read” a patient’s musculoskeletal system with your hands, which may still be your best guide to diagnosis and treatment. Therefore, manual adjustments are beneficial because they take you back to the root of why you became a DC—to heal people with the use of your hands.

Another distinct advantage to manual adjustments is that you will not have to worry if your adjusting instrument is not functioning properly. There are no parts to break down, run out of power, or become obsolete. Everything you need to perform adjustments is right there at your fingertips.

Cons: By the same token, use of your hands may also be the main disadvantage for performing manual adjustments. If we look at manual versus instrument-assisted adjustments strictly in terms of the physics, manual adjustments require either more force than an instrument adjustment over a smaller area or the same amount of force as an instrument adjustment but over a larger area.³

All of these extra forces required for manual adjustments can take a toll not just on your patients, but also on you. Over time, your hands, wrists and arms will get sore.⁴ Furthermore, manual adjustments often take more time than instrument-assisted adjustments because it may be more difficult to access the target joint with the hands than with an adjusting instrument. This may eventually add up to bottom-line money being lost because of that extra time needed for each patient.⁴

Instrument-assisted adjustments

Pros: As previously noted, one of the main advantages for instrument-assisted adjustments is that each adjustment can deliver the same amount of force as a manual adjustment, but focused on a smaller area. This, in turn, benefits both you and the patient in terms of physical effort.^3,4

There is also a solid body of evidence showing that instrument-assisted adjustments are at least as effective as manual ones and have the benefits of increased accuracy and decreased amount of time needed per adjustment.^1,4 A 2012 article published in the Journal of the Canadian Chiropractic Association performed a meta-analysis to determine the effectiveness of adjusting instruments.⁵ Meta-analysis papers pool together the findings from smaller papers on a specific topic to determine if there are patterns of similarity to the results. In the case of this paper, the researchers looked at the results of eight papers and found that “reported benefits to patients with a spinal pain and trigger points.”⁵

Cons: There are some initial costs that come with using an instrument-based adjusting system above and beyond just the purchase of the instrument itself. You may need to go through training, either in person or online. You will likely want to purchase a service contract (particularly for computer-based instruments), and there may also be maintenance and repair costs to consider. These can be rather daunting for a chiropractor just starting out in the profession.

You may also not feel as confident in performing adjustments if you cannot actually feel the joint shifting back into proper alignment with your hands. There is often a certain reassurance in actually feeling the sublaxations being corrected under your fingertips.

Ultimately, you must decide for yourself if you want to only do manual or instrument-assisted adjustments, or a combination of the two. Each has its pros and cons, and you will decide what those will be for your specific needs.

References

1. Instrument adjusting AKA mechanically-assisted adjustments.org. Accessed 4/13/2016.
2. Origin of chiropractic. Merriam-Webster.com. Accessed 4/13/2016.
3. Instrument adjusting vs. manual adjusting, part one: The physics. Chiropractic Economics Accessed 4/13/2016.
4. Instrument adjusting vs. manual adjusting, part 2: Bottom-line benefits. Chiropractic Economics Accessed 4/13/2016.
5. Huggins T, Boras AL, Gleberzon BJ, et al. Clinical effectiveness of the activator adjusting instrument in the management of musculoskeletal disorders: a systematic review of the literature. J Can Chiropr Assoc. 2012;56(1):49-57.