The heart of Chiropractic care is the adjustment. It’s the intervention that defines our uniqueness in the healthcare market, and the basis for much of what we do. The technique a doctor chooses to use day-in and day-out in practice is one of the most important clinical decisions they can make. Matching the right technique or techniques to one’s philosophy, body type, clinical goal, practice style, and physical capabilities can make the difference between a fulfilling or frustrating career in Chiropractic. In 30 years of teaching and speaking with thousands of doctors, I’ve come across several factors in determining a “best fit” technique for an individual doctor. Here are some for you to consider.
Chiropractic School Training. The college you graduated from trained you in a philosophy, theory, approach, and methodology to practicing Chiropractic. The degree to which you accepted or rejected what was taught affects how you practice. The college’s chiropractic technique curriculum and your experience with chiropractic practitioners have been found to have the greatest influence on your choice of chiropractic technique for future practice. Extracurricular activities, including technique clubs and seminars, also figure in your practice technique preferences.
The quality of the training you received also affects whether you utilize the techniques after graduation. I have observed numerous doctors gravitate away from practicing adjusting techniques and into alternative procedures like rehabilitation, soft-tissue therapies, nutrition, and more esoteric approaches primarily because they never developed the skills needed to deliver an effective adjustment.
Research by Triano has shown it takes 1-5 years of continuous practice to develop proficiency in an adjusting technique. Much of the skill development in practicing Chiropractic, or any healing art, comes as on-the- job training and continuing education.
I’ve come across many doctors who continue to do only what they were taught in Chiropractic school even decades after graduation. Our college’s responsibility is to train us as students to be good beginners and to be safe for public consumption. They give us a basic skill set to grow and expand on as we practice our profession.
Healing Philosophy. The key distinction in healing philosophy is whether you view your role as a facilitator or interventionist. If you approach your care a facilitator, you will utilize techniques that work the patient’s innate healing ability and attempt to facilitate it. This includes many light-force and so-called non-force techniques, as well as educational methods. If you approach your care as an interventionist, you will utilize techniques that demand a response from the body that it can’t achieve on its own. This includes most of the thrust and non-thrust techniques we employ.
Clinical Goal. In Chiropractic there are several stated outcomes that doctors strive to achieve: Pain reduction, vertebral subluxation correction, improved segmental mobility, locomotor or neurological functional improvement, and changes in global spinal alignment. All of these require some type of analysis or metric to determine if the goal has been achieved. Techniques appropriate for one goal will be less effective for another. Knowing the clinical results you’re aiming for in advance is essential for choosing the best way to get there.
A 2013 paper by Triano, Budgall, et al, reviewed the experimental literature on the most common methods that Chiropractors used to determine the site of manipulation. They found they fell into a wide spectrum of research-based recommendations, from unfavorable to most favorable. Among those recommended as favorable included: pain provocation tests, motion palpation, leg length inequality, manual muscle testing for nerve root levels, and regional range of motion.
Adjusting Rationale: Doctors need to consider the overall theory of how they’re trying to accomplish their clinical goals. An essential distinction is viewing the spine and locomotor system as a closed kinetic chain, or as a series of independent segments. In the former, dysfunction in one region can be a causative factor in the pathophysiology in another region local or remote to it. The approach here is to find the dysfunctional kinetic chain “lynch pins” and remove or reduce them to improve the entire global system. This requires a more comprehensive set of techniques and clinical tools. In the latter, the assumption is that joint complex abnormalities and pathologies are more locally entrenched and require more clinical emphasis. The focus here is on directing care on a region by region basis with the goal of local resolution.
Body Type and Physical Capacities. A doctor’s height, weight, limb length, muscular development, gender, and physical health are considerations in trying to make a fit between the technique and their body. A side posture adjustment is performed differently for a long legged Chiropractor who is 6’2 than one who is 5’3. Likewise, a female doctor tends to have less upper body strength and needs to use her hips and legs to generate adjustive forces more than her male counterpart.
Aging and injuries also play a role. Older practitioners, like all older athletes, need to be more attentive to their body mechanics and physical conditioning. Utilizing adjustment aids such as drop pieces, tables that have breakaway, moveable sections, and/or traction ability, and the use of adjusting instruments can help make up for these concerns.
In part 2 we will look at the factors of psychomotor aptitude, practice style, personal experience, and practice style. References are listed at the end of part 2.
About The Author
Dr. David Graber is in private practice in Parsippany, NJ. He teaches seminars on spinal and extremity adjusting, and is the chairperson of the ANJC Council on Technique and Clinical Excellence. His blog is ChiroExcellence and can be found at: drgraber.wordpress.com. He can be reached at: DrDavidGraber@gmail.com
(This is a revised article originally published in The New Jersey Chiropractor, Vol. 14, No.1,Winter 2018)