An overview of the study of instrument adjusting
Nearly 40 years ago, Drs. Scott Haldeman and Jay Triano, along with a small collection of college presidents, attended the National Institute for Neurological and Communicative Disorders and Stroke (NINCDS) Conference, and, at that time, there were no clinical trials on chiropractic or manipulation.
Those esteemed visionaries lamented how unscientific the chiropractic profession appeared to the greater scientific community, and dedicated themselves to improving the availability of research to provide evidence of chiropractic’s efficacy.
Much progress has been made since that fateful conference in 1974. Today, a commitment to research endures, as doctors have recognized how necessary research is to the ongoing acceptance of chiropractic into traditional medicine.
Despite limited resources, doctors and academics have joined together to publish a surprisingly useful and credible collection of high-quality scientific papers. In fact, any doctor who attended last year’s World Federation of Chiropractic (WFC) biennial congress would agree that some of the research presentations rivaled the finest of any scientific or research conference.
The evolution of technique research
Jim Cox, DC, DACBR, is considered one of the earliest to focus on research as a way to support flexion distraction technique, and those interested in pioneering research on instrument adjusting viewed Dr. Cox as a mentor.
He set the standard with regard to proving the effectiveness of instrument adjusting; his case series that studied more than 500 patients suffering from sciatica and reported positive results with flexion distraction established a benchmark for the breadth and scope of technique research.
The first recognized research on instrument adjusting commenced in 1986, when the National Institutes of Health (NIH) awarded a $50,000 grant to study the safety of the Activator adjusting instrument.
Funding for similar studies required an affiliation with a major university, so the study was moved to Arizona State University where Dr. Jack Winters was seeking projects within the newly-formed Biomechanics department on that campus.
Becoming involved with a recognized research institution opened more doors to chiropractic research, as the principals managing these studies, including myself, could attend major scientific conferences and get an overview of where the research needed to lead.
Much was learned from that first NIH grant, and while the research process was overwhelming at times, it also led to better knowledge about how to secure funding for future studies.
For example: Prior to submitting a grant proposal, a pilot program with a peer-reviewed published paper was required by the NIH. The grant-making body needed to see some progress and have an understanding of the purpose of a given study before funding would be offered.
As previously mentioned, being associated with a major university was also an asset, as the NIH recognized the research capabilities of such institutions which lent credibility to the process. More than two decades have passed since that first grant, and to date, the NIH has provided nearly half of a million dollars in funding to study instrument adjusting. Research begets research, and ongoing clinical trials help grow the possibility for future trials.
The relationship between research, adjusting, and patient care
How does this research affect you and the profession? There was a time when doctors simply looked to their peers to determine how best to approach patient care; they evaluated the strongest, most successful clinics, and assumed the techniques used at those clinics were best.
But in today’s world, where all fields require evidence to make decisions and establish truths, simple clinical observation no longer suffices as adequate proof. Published data from third-party researchers and respected academics is what students and doctors seek as they determine the best way to treat patients.
And that same data is sought by other healthcare professionals looking to find ways to relieve their patients when traditional medicine fails. As doctors, you must trust findings, not feelings, and research gives you the power to do so.
One of the most controversial topics in the chiropractic profession centers on what technique works best for a given condition. The two most significant studies on this topic have been led by Dr. Woods, who studied the neck, and Dr. Gemmell, who studied the low back.
The neck study compared an instrument adjustment to a diversified rotary break technique, which was published in Journal of Manipulative and Physiological Therapeutics (JMPT), Volume 24 Number 4 May 2001. Woods’ conclusion was that both techniques have beneficial effects with reducing pain and disability and improving cervical range of motion.
The other study was a randomized controlled clinical trial by Dr. Hugh Gemmell which compared an instrument adjustment to a Meric adjustment on patients with acute low back pain. His conclusion was that there was no advantage of one procedure over the other for the reduction of pain. This was published in JMPT Volume 18, Number 7,
Sept. 1995. The findings in these two studies are very important to chiropractic on the whole; they aid us in understanding our patients’ needs and help us make confident decisions regarding our approach.
Case studies also provide substantial information to doctors and students. Recent graduates of chiropractic colleges do not have a broad scope of clinical experience to relate to their college curriculum. Because that clinical experience takes years to acquire, both students and new graduates can benefit greatly from case studies conducted by more experienced practitioners, especially for complex or unusual cases.
Earlier this year, a paper was published on bed-wetting and bowel incontinence in The Journal of Chiropractic Medicine (2010 Issue 9, pages 28–31). The study, titled “Chiropractic management of a 5yearold boy with urinary and bowel incontinence” by Keith R. Kamrath, concluded that after five instrument adjustments and a follow up, the patient’s problem resolved for six months.
When the problem recurred, a second course of treatment was administered and the problem resolved. A case such as this helps other clinicians proffer the most effective treatments to their own patients.
Integrating chiropractic into the healthcare landscape
Beyond helping practitioners determine the best treatments for their patients, research also advances the acceptance of chiropractic among allopathic physicians and other healthcare professionals.
Demonstrating proof of concept to skeptical providers was the catalyst for this growth, and today instrument adjusting is embraced throughout the facility as an effective treatment for patients with musculoskeletal issues.
Continuing to challenge ourselves and the profession to build on the body of research that has been amassed in the past four decades is crucial. Research leads to
acceptance and better patient care, making it the lynchpin for complete integration into the healthcare landscape.
Arlan W. Fuhr, DC, is the co-founder and CEO of Activator Methods International. A practitioner and researcher for more than 40 years, Fuhr is widely acknowledged for bringing instrument adjusting to the chiropractic profession.