Chiropractic adjustment is like fine-tuning a piano. It requires
caring, skill and sensitivity.
The art and science of adjusting the spine requires a very high level of knowledge, skill, sensitivity and coordination on the part of the doctor. Yes, you can lay on your stomach and have monkey jump on you and your back will pop. But this is like getting a wrench, opening the lid of a piano, twisting away at all the tuning pins and calling yourself a piano tuner. Yes you can push, twist and pop your spine (a lot of people can even do it themselves), but this is many miles away from a corrective adjustment.
There are several steps in performing a specific and corrective spinal adjustment.
1. The subluxated vertebrae must be identified. A Subluxation produces a number of local effects such as neuro-motor and neuro-vascular changes that can be sensed by palpation (feeling) and by instrumentation. A Subluxation also creates kinetic changes in the spine which affect the ability of the vertebrae to move. These changes can be felt with skilled palpation – often I will also use light tapotement (tapping) as well wherein the condition of individual vertebrae will reverberate like a series of drum heads tuned to various tensions. I’m a musician and pianist (I actually attended my first two years of undergrad on a music scholarship) so I’ve developed an inherent sense of the “music” of the spine and how a well tuned spine should feel and sound.
2. Characterize the subluxation both in terms of static misalignment and in terms of loss of dynamic motion in the spine. This requires palpation skills of a very high order that can only be developed with years of practice. A patient recently asked me how I could so quickly find the problem. I said, “It’s like reading Braille.” I had a roommate in undergraduate school who was totally blind and it always amazed me how he could read those little bumps on the page. The misalignment associated with a vertebral subluxation typically consist of a combination of rotation, flexion/extension and/or lateral flexion misalignment. The degree and direction of the misalignment must be determined before and effective Adjustment can be made. This is determined using static palpation and motion palpation.
A word on x-rays. Some chiropractors use x-rays to visualize misalignments in the spine. The medical x-ray was actually introduced in Germany in 1895, the very same year as chiropractic was founded. Dr. Palmer (the founder of chiropractic) imported the fifth x-ray unit ever brought to the U.S. So x-rays and chiropractic have been together from the beginning. Since then x-ray technology has improved remarkably and the amount of radiation from modern machines is a fraction of what it was in the early days. While x-rays have been helpful in characterizing the static misalignment component of Subluxation they are not typically necessary when the doctor possesses excellent physical examination and palpation skills. We will only take x-rays if the individual history or condition make it advisable such as the possibility of underlying disease of fracture. There are chiropractors that insist that every new patient get x-rays. However, we order x-rays only in cases where it would also be medically advisable.
3. Determine the specific vector for correction. In physics, a vector is the combination of direction andmagnitude. The direction of the adjustment must be to reduce the combination of rotation, flexion/extension and lateral flexion misalignment that has occurred in the subluxated vertebra. This is not as simple as it sounds to get a single vector that will de-rotate, de-flex or de-extend and de-laterally flex the segment. This is an important thing that the “spinal manipulating” chiropractor or physical therapist most often fail to do. The subluxated vertebrae is naturally fixated and primarily resistant to moving into proper alignment. Movement into greater misalignment is actually easier than moving back into alignment. Therefore the non-specific spinal manipulation (whether it’s done by a therapist, your uncle or yourself) is 99% sure to drive the spine deeper into subluxation.
When you hear someone say, “I don’t need a chiropractor. I can pop my own neck” or “My wife can push on my back and pop it.” The answer is, “Yes, and every time you do you are subluxating the spine more and more.” Does it sometimes feel better for a little while? Yes, and here’s why in semi-technical language: The joint cavitation that occurs on forced movement of the spinal joints (that most often results in a “popping” sound) creates a barrage of proprioceptive (motion receptors) neural impulses that momentarily override the local nociceptors (pain receptors) creating a temporary sense of relief, but no actual correction. This is why many people seem to constantly need to pop their own neck and back. They’re giving themselves a little temporary relieve, but every time they do it they’re driving their spine in further Subluxation. A subluxation is accompanied by a high degree of fixation or resistance to movement in the direction of correction. A general, non-specific manipulation of a subluxated area of the spine will almost invariably send the spine into further subluxation.
The second part of the vector is the magnitude. There are several magnitudes with must be concerned with in adjusting the spine. One magnitude is the amplitude of the adjustment. A proper chiropractic adjustment has a short amplitude, typically done in a distance of half and inch or less. Spinal manipulation on the other hand (common among physical therapists, non-specific chiropractors and people who pop their own neck and back) is typically done with a large amplitude or long lever of movement. Large amplitude manipulation of the spine fails to isolate and correct the misalignment components of the subluxation. In fact, they most often make the subluxation worse. Correcting a subluxation requires a high level of specificity, not just random cracking. Large amplitude manipulation also carries a risk of injury. A properly done adjustment is extremely safe.
Another aspect of magnitude involved in producing the right vector is velocity. The most gentle and effective way to correct a Subluxation is with a high velocity low amplitude (HVLA) adjustment. The reason is that the body has a normal resistance to change. If the velocity of the adjustment is too slow the nervous system will have time to react and resist any external change. Therefore, the effect of the adjustment will actually be the opposite of that intended and the reaction of the nervous system will push the spine backward into further Subluxation. This often happens when a layperson (or an un-skilled practitioner) tries to “adjust” the spine.
An important aspect of velocity is acceleration. This is the amount of time it takes the adjustment to achieve peak velocity. The reason acceleration and velocity are important is a simple physics formula, F = M x A, which means that the amount of force generated is equal to the mass multiplied times the acceleration. Anyone who has ever done karate and tried to break a board understands that if you hit it too slowly all the force will recoil back at you and injure your hand. An proper adjustment should be nearly completely painless. Most of the painful adjustment that I’ve had (and I got a lot of bad adjustments from students when through chiropractic college) were because of poor adjustment direction and poor acceleration. The chiropractor simply did not have the combination of clinical skill to properly assess the Subluxation vector and the physical skills to produce adequate short-amplitude acceleration.
Another important factor in adjusting is what I refer to as rapport. This doesn’t mean having a nice personality and getting along nicely with the patient (even though this is true!). It means the ability to personally connect with the patient’s physiology. It involves a level of person empathy and ability to sense the patient’s level of stress/relaxation, comfort/discomfort, pain/relief. This is truly something that I think cannot be taught and some people either have this level of sensitivity or they do not.
So by now you see that being a good chiropractor and delivering a Vector Specific adjustment entails a great number of factors that must be mastered over years of practice. And behind all of this technical ability is the mind of the Chiropractor, in directing the adjustment with clear purpose and intention.
“The adjustment should always be painless.”
~ Dr. Takao Nakagawa, D.C.
My Chiropractic Sensei