Learn why patients appreciate a gentler approach.
By Arlan W. Fuhr, DC
Every practicing chiropractor will tell you that the adjusting technique that received the most emphasis in their college studies was the diversified technique, along with instruction on extremity manipulation. And while the diversified technique can be a highly effective treatment method, it can also cause significant fatigue to the chiropractor and discomfort and anxiety for some patients.
A case of need
To understand the value of an alternative approach — specifically, instrument adjusting — it is important to understand its evolution. Nearly five decades ago, I was a young and eager chiropractor setting out to become proficient in the technique I had learned in college. But shortly after entering private practice, I realized that the technique I was using did not adequately serve patients with extremely acute conditions.
An enlightening moment occurred when a patient was brought in by two of his friends. As I tried to move the patient on
his side to give him a lumbar roll, the patient screamed in pain. The chiropractic experience was unsuccessful for both
doctor and patient that fateful day, and thus began the search for a technique that could benefit patients with even the
most challenging problems.
The search was further motivated by the needs of patients who were elderly and suffering from osteoporosis, as they
simply could not tolerate a hard adjustment. So, with both the acute and elderly patient in mind, the development of a
new technique began. An approach known as directional non-force technique (DNFT) was the catalyst for the eventual creation of a light-force instrument technique. Richard Van Rumpt, DC, an expert at DNFT, appreciated my fear of hurting a patient with hard adjusting and showed me how to create a fast thrust using thumbs as the contact on the patient and locking elbows together to initiate speed and force.
This new lightforce thrust technique was embraced by patients, whose trepidation
about a hard adjustment was thereby eliminated.
So, for the next three years, I made thrusts by hand — literally — until my elbows hurt so badly I could no longer continue. The physical pain had simply become unbearable, so despite soaring patient satisfaction, a real solution was still elusive. I had to extend my practice life and find a technique that would be comfortable long-term for both myself and my patients.
Enter the instrument
The goal was to create something that would administer a repeatable thrust into the patient and make sure the thrust was as consistent at the start of the day as it was at the end. After several failed attempts at developing a mechanical adjusting instrument, a dentist who was also a patient of mine suggested customizing a piece of dental equipment. The device was a surgical mallet used for splitting wisdom teeth, but with some modifications, it could also be made to provide a repeatable thrust to the spine and extremities.
For four years, the modified dental mallet was my instrument of choice, until it became apparent that something was needed that was engineered specifically for chiropractic adjusting. Decades later, several generations of instruments are now widely available that match the needs of the chiropractor and are supported by clinical trials.
The research conducted on these instruments has also enabled the profession to actually understand how the instrument works on the body and why it is so effective.
From the patients’ perspective, once the instrument was introduced it was evident that many patients preferred it over the chiropractor’s hands. In fact, patients tend to believe the adjustment is more consistent because the instrument is always the same; whereas the hands can deliver slight variations from one adjustment to the next.
Also, patients who have an aversion to hearing the sounds of their bones moving during hard adjustments flock to practices that use an instrument. The instrument’s gentle nature especially attracts geriatic patients.
The senior citizens in my community had a strong word-of-mouth network, and would tell their friends to go to the chiropractic clinic where the DC uses a “little clicker,” because following the adjustment, “you’ll have no pain and feel better when you leave.” While referrals are important to anyone building a practice, the viability of instrument adjusting has since been further reinforced by published case reports on instrument adjusting for geriatric populations.
Broadening the patient base
Until the instrument was introduced, pediatric patients were a rarity in chiropractic circles. Instrument adjusting is highly effective in treating colic, and mothers tell one another about their baby’s success with this approach.
Also, pregnant mothers suffering from low back pain, but concerned that a hard adjustment might impact the growing fetus, have found relief from an instrument adjustment.
Suddenly, low back pain went from something an expectant mother had to tolerate to something from which she could be freed, with no worries about the health of her baby.
New mothers will also come for an instrument adjustment post-delivery to alleviate pain in the tailbone caused during labor. During labor and delivery, when the baby crowns, it can cause the coccyx to become subluxated, rendering new mothers unable to sit comfortably.
Pubicbone pain is also a side effect of childbirth, and both these conditions can be easily treated with the adjusting instrument while the new mother recovers from childbirth. Using an instrument to address pubic bone pain was especially important because the area of concern can be easily and accurately targeted with the instrument. In addition, peer-reviewed
papers and case studies published over the years on the efficacy of instrument adjusting for women’s health issues and for the needs of children have provided additional support for the approach, beyond patient endorsements.
Postsurgical patients may be the most surprising. During the time when instrument adjusting was being developed, most surgical patients were having complete fusions of the lower back to correct spinal problems. The surgery was traumatic and often unsuccessful, and hard adjusting was difficult for those patients to endure.
A study of these patients revealed that it took about four years for symptoms to recur, and the problem was typically the vertebra above the fusion, as it was now the vertebra in motion. If you saw a scar upon initial examination of a patient, the first question was if the surgery was four years ago, and the patients were amazed at our predictive
These patients usually sought chiropractic first because they were hesitant to undergo a second difficult surgery. In most cases, using the instrument to adjust these patients brought them relief and enabled them to avoid future surgeries.
The introduction of instrument adjusting dramatically expanded the patient base for chiropractors because, for the first time, individuals with more sensitive needs or specific anxieties could undergo an adjustment. Light-force care opened up a whole world for chiropractors and their patients who desired an alternative to allopathic medicine but were not comfortable with previous chiropractic experiences.
Letting the instrument, instead of your body, do the work for your patients allows you to extend your practice life. Not only does instrument adjusting create satisfied patients, but in today’s economy, where many doctors are working well beyond traditional retirement years, retaining your stamina and practicing without joint pain are invaluable.
Arlan W. Fuhr, DC, is credited with developing the Activator Method Chiropractic Technique, a widely used instrument adjusting technique, and the associated Activator Adjusting Instrument
Recognized worldwide for his contributions to the chiropractic profession, Fuhr is also the cofounder and CEO of Activator
Methods International. He can be reached through activator.com.