The use of devices and instruments to assist in the delivery of the chiropractic adjustment is nothing new and dates back to the dawn of the chiropractic profession.
Most chiropractors today have discovered that instrument-based adjusting is a valuable adjunct to have available for any practice.
Some chiropractors opt for instrument adjusting as a primary technique approach and adhere to strict guidelines of the technique developer, while others use adjusting instrumentation in a less formal fashion to occasionally substitute where hands-on manual approaches may not be safe, desirable, or appropriate.
Surveys within the profession show the vast majority of chiropractors in practice today own at least one adjusting instrument and routinely use it in at least some form in their practice. Yet, there is still no uniform, profession-wide consensus on when and how these instruments can and should be used.
Perhaps this is because any chiropractic method that is new and breaks from the traditional “hands on” approach is expected to be viewed critically and should be. Yet, in the words of the famous German novelist, poet and scientist, Johann Wolfgang von Goethe,
“We should be prepared to welcome new truths, even though they threaten to overturn beliefs which we have entertained for years and have handed down to others.”
You can think of chiropractic adjusting instruments not as a substitution for our manual skills, but rather an added dimension to assist our cognitive functions as doctors of chiropractic as well as our hands. In the same way that a microscope does not replace our eyes, newer chiropractic adjusting technology does not render our hands obsolete but rather, provides us with a window into our patient’s spinal segmental and tissue functionality.
We now have access to forms of information that were never available to us before. This is particularly true for the newer generation, computer-assisted adjusting devices that can greatly enhance knowledge and augment the precision and accuracy available among adjusting options.
Those new to instrument adjusting can follow a simple set of criteria to easily evaluate any chiropractic instrument or instrument-based approach in five minutes or less. With this process, we can easily categorize and understand the essential elements of any adjusting instrument or instrument-based approach using these six considerations:
Is the instrument considered a tool or technique?
In other words, is the instrument a tool that can be integrated into your existing practice style and philosophy or is it a comprehensive technique system that requires re-engineering and replacing most of your current assessment and treatment procedures?
A tool is much easier to adopt than a technique. As a general rule, the less that you need to change, the easier it will be to integrate the instrument-based approach into your practice.
Is the instrument a simple mechanical device or does it embrace a newer generation of computer-assisted technology?
Early on, before computers and digitization were commonplace, adjusting instruments were limited to simple mechanical spring driven devices. The downside was that they were severely constrained in certain ways, including the inability to control pre-load (i.e., forces delivered by the instrument varied depending on how firmly the instrument was held against the tissue).
Computer technology now allows for precise and accurate control over pre-load as well as precise control of the therapeutic forces delivered by the adjusting instrument. Current technology allows for an almost limitless option of electronic and computer control over these aspects as well as resonant frequency, end points, and any other factors that might be considered important. This provides you with much improved functionality over many of the earlier simple mechanical adjusting devices.
Does the instrument provide both assessment and treatment options or is it limited to treatment only?
A great deal of clinical diversity exists within the chiropractic profession in deciding how, when, and where a patient requires adjusting. No instrument, whether computer-based or otherwise, can make this decision for you.
But newer, computer-assisted instrument technology can help your decision making by providing you with valuable insights such as tissue stiffness (durometer), tissue frequency (hydration), segmental mobility (hypo/hyper), and segmental motoricity.
In turn, measurements of this type can assist your decision-making process when assessing how to approach a given patient’s care. When considering an instrument that provides both assessment and treatment options, become familiar with the clinical information the instrument provides and be sure this is in sync with your practice style and chiropractic approach.
Does the instrument deliver a single thrust/impulse or both single and multiple thrusts/impulses?
By design, the earliest handheld adjusting instruments were limited to providing only a single impulse or thrust. Modern computer-assisted adjusting instruments as well as handheld electrically powered instruments provide you with the option of delivering either single or multiple thrusts depending on the clinical objectives desired. An instrument that can deliver both single and multiple thrust options provides many advantages.
If the instrument is designed to deliver multiple thrusts/impulses, are impulse frequencies fixed or does the instrument provide the benefit of variable frequencies?
The chiropractic profession has yet to validate the specific thrust and impulse frequencies best suited for spinal adjustment or soft tissue and articular reflex changes. This will come as we grow to understand this technology in a better way.
For now, those who suggest that an adjusting instrument should be limited to a certain finite frequency or force are swimming upstream with their argument. So, it makes sense to leave your options as open as you can here.
A further benefit of the most advanced computer-assisted adjusting devices is that they are capable of determining resting tissue frequency and then generating a matching sub-harmonic of that frequency to allow the adjustment to be delivered “in phase.” As our understanding of the nervous system and related reflex response expands, instruments offering a wider frequency range clearly provide more flexibility.
Are thrusts or impulses generated by the instrument vibration or percussion-based?
Though similar in some respects, vibration and percussion are not the same and should not be confused with each another. Vibration occurs when a time-varying disturbance (load, displacement, or velocity) is applied to a mechanical system. In contrast, percussion implies that a finite quantity of motion is delivered to a mechanical system in an infinitely small portion of time.
Another way to illustrate this would be comparing a woodpecker tapping on a tree (vibration) to using a hammer to drive a nail into a piece of wood (percussion). Since each have distinct characteristics, ask the manufacturer whether the instrument is vibration or percussion-based and that it is best suited for your particular clinical needs.
You can easily break down and evaluate any chiropractic instrument or instrument-based approach by considering the six criteria listed above. Your success in practice and your clinical outcomes depend on embracing the instrument and approach that you feel most comfortable with and that best matches your current practice philosophy and technique approach. This quick guide can assist any chiropractor to looking at the myriad of choices in the marketplace to make a more objective decision.