Chiropractic Technique

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

Chiropractic Technique Articles

	Chiropractic Nimmo Receptor-Tonus Technique and McKenzie Self-Therapy Program in the Management of Adjacent Segment Disease: A Case Report J Chiropractic Medicine 2020 (Dec); 19 (4): 249–259 ~ FULL TEXT This report illuminates and informs the chiropractic management of a patient with Adjacent segment disease (ASD). After 3 weeks of therapy, VAS and ODI scores were improved. Furthermore, she discontinued her medication, pregabalin 75 mg 2 times a day, under her neurosurgeon's supervision because the outcomes were significant enough for the patient to discontinue her long-standing medical prescription.
	Vascular Ultrasound Measurements After Atlas Orthogonal Chiropractic Care in a Patient With Bow Hunter Syndrome J Chiropractic Medicine 2018 (Dec); 17 (4): 231–236 ~ FULL TEXT Bow hunter syndrome (BHS) is also known as bow hunter stroke and rotational vertebral artery syndrome. Bow hunter syndrome is a rare cause of vertebrobasilar insufficiency; the mechanism was first postulated in cadaveric studies of the early to mid–20th century. [1, 2] Sorensen coined the term in 1978 based on the symptoms occurring with the activity of archery. [3] Bow hunter syndrome is most commonly a result of a mechanical compression of the vertebral artery (VA), except for rare cases where compression results from intrinsic vascular problems such as atherosclerosis. [4] The resultant occlusion or stenosis of the VA occurs with head rotation and typically in the dominant VA. Because the occlusion is dynamic, the symptoms are typically transient, dependent on head position. The most commonly reported symptoms are syncope, near-syncope, drop attack, vertigo, dizziness, and impaired vision. Other less commonly reported symptoms include dysarthria, dysphasia, diplopia, nystagmus, numbness, paresthesia, nausea, headache, neck pain, arm pain, tinnitus, and ataxia. [4–6] Transient vision loss (TVL) and blindness have also been reported in some cases. [4, 5, 7–9] Bow hunter syndrome studies are limited to case studies and case series. The largest overview of BHS to date was published by Jost and Daily [7] in 2015, in which 126 cases were described and categorized and in which a variety of causes, sites of stenosis, and treatment regimens are described. The condition can result in permanent neurologic deficit if left undiagnosed. [10]
	Joint Manipulation: Toward a General Theory of High-Velocity, Low-Amplitude Thrust Techniques Journal of Chiropractic Humanities 2017 (Mar); 20 (1):   1–9 ~ FULL TEXT High-velocity, low-amplitude thrust (HVLAT) techniques are widely used in manual therapies and nearly always produce a “cracking” noise. This is considered a cavitation event [1, 2] for the metacarpophalangeal (MCP) joint and is produced by the sudden separation, or “gapping,” of the joint surfaces. In clinical practice, the force to do this is applied manually. It is assumed that the event is the same mechanism in both spinal and peripheral joints, as it involves the same types of structures. For example, similar characteristics were found for joint noises (ie, “cracks”) in both the MCP joint and the cervical apophysial joint. [3] In addition, it was found that gapping occurred in lumbar adjusting procedures. [4] Various terms have been used for the lesion that is treated with HVLAT. [5] In this paper, the term “joint dysfunction” will be used.
	The Influence of Curricular and Extracurricular Learning Activities on Students' Choice of Chiropractic Technique J Chiropractic Education 2016 (Mar);   30 (1):   30–36 ~ FULL TEXT Students (at Southern California University of Health Sciences) appear to have the same practice technique preferences as practicing chiropractors. The chiropractic technique curriculum and the students' experience with chiropractic practitioners seem to have the greatest influence on their choice of chiropractic technique for future practice. Extracurricular activities, including technique clubs and seminars, although well attended, showed a lesser influence on students' practice technique preferences.
	A Proposed Model With Possible Implications for Safety and Technique Adaptations for Chiropractic Spinal Manipulative Therapy for Infants and Children J Manipulative Physiol Ther 2015 (Nov); 38 (9): 713–726 ~ FULL TEXT The literature showed that tensile strength differences have been observed between pediatric and adult specimens. A preliminary model of care including pediatric SMT technique adaptation based on patient age is proposed, which may possibly contribute to further knowledge of safety and clinical implications for SMT for children and infants.
	Craniocervical Chiropractic Procedures - A Précis of Upper Cervical Chiropractic J Can Chiropr Assoc 2015 (Jun); 59 (2): 173–192 ~ FULL TEXT Presented here is a narrative review of upper cervical procedures intended to facilitate understanding and to increase knowledge of upper cervical chiropractic care. Safety, efficacy, common misconceptions, and research are discussed, allowing practitioners, chiropractic students, and the general public to make informed decisions regarding utilization and referrals for this distinctive type of chiropractic care.
	Validity of Palpation of the C1 Transverse Process: Comparison with a Radiographic Reference Standard J Can Chiropr Assoc 2015 (Jun); 59 (2): 91–100 ~ FULL TEXT Interexaminer agreement for radiometric analysis was "excellent." Stringent accuracy (marker placed ±4mm from the most lateral projection of the C1 TVP) = 57.1%; expansive accuracy (marker placed closer to contiguous structures) = 90.5%. Mean Absolute Deviation (MAD) = 4.34 (3.65, 5.03) mm; root-mean-squared error = 5.40mm.
	Chiropractic Treatment Approaches for Spinal Musculoskeletal Conditions: A Cross-sectional Survey Chiropractic & Manual Therapies 2014 (Oct 1); 22 (1): 33 ~ FULL TEXT This cross-sectional survey of 280 Australian chiropractors revealed that Diversified manipulative technique was their first choice of treatment for most of the included conditions, except for these 4 conditions; cervical disc syndrome with radiculopathy; cervical central stenosis; lumbar disc syndrome with radiculopathy, and lumbar central stenosis.
	Enhanced Learning of Manipulation Techniques Using Force-Sensing Table Technology (FSTT) Toronto: Higher Education Quality Council of Ontario (2014) ~ FULL TEXT (PDF file) In July 2011, the Higher Education Quality Council of Ontario (HEQCO) issued a Request for Proposals that focused on the innovative use of technology in the classroom. The goal was to provide funding to institutions to allow them to evaluate the effectiveness of pedagogical practices that aim to enhance the quality of student learning through the introduction and integration of new technologies. Based on a novel implementation of technology within a new skills simulation laboratory, the Canadian Memorial Chiropractic College (CMCC) submitted a successful application that allowed it to evaluate the system as a means of assessing manual skills development.
	Review Of Methods Used By Chiropractors To Determine The Site For Applying Manipulation Chiropractic & Manual Therapies 2013 (Oct 21); 21 (1): 36 ~ FULL TEXT A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care-methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine-such as skin conductance or thermography-tend not to be supported by the available evidence.
	Learning Spinal Manipulation: A Comparison of Two Teaching Models J Chiropractic Education 2011 (Fall); 25 (2): 125–131 ~ FULL TEXT The results revealed that students exposed to complete practice demonstrated lower time to peak force values, higher peak force, and a steeper rate of force production compared with students in the patient–doctor positioning scenario. A significant group by gender interaction was also noted for the time to peak force and rate of force production variables.
	Consensus Terminology for Stages of Care: Acute, Chronic, Recurrent, and Wellness J Manipulative Physiol Ther. 2010 (Jul); 33 (6): 458–463 ~ FULL TEXT As the chiropractic profession delineates its role in the emerging health care marketplace, it will become increasingly important that the scope of appropriate chiropractic care is clearly defined relative to overall patient case management. Therefore, the Council on Chiropractic Guidelines and Practice Parameters engaged in a multidisciplinary consensus process addressing the terminology related to "levels of care." You may also enjoy this review of this process by the ACA, titled: Chiropractic Reaches Consensus On Terminology For Stages Of Care.
	Technique Systems Used by Post-1980 Graduates of the Canadian Memorial Chiropractic College Practicing in Five Canadian Provinces: A Preliminary Survey J Can Chiropr Assoc. 2009 (Mar); 53 (1): 32–39 ~ FULL TEXT The purpose of this study was to survey 200 randomly selected post-1980 graduates of the Canadian Memorial Chiropractic College practicing in five Canadian provinces to determine which, if any, technique systems they sought out instruction in and/or are utilizing either primarily or secondarily for patient care. Using a systematic sampling approach, 83 eligible data sets were received. Respondents reported to have sought out instruction in a total of 187 technique systems other than Diversified technique. In addition, although 86% of respondents stated they primarily used Diversified technique in practice, they reportedly used 134 different technique systems secondarily for patient care. This calculates to an average of 2.27 different techniques used per respondent. Future studies should survey a larger percentage of practitioners to better assess the validity of these findings.
	The Efficiency of Multiple Impulse Therapy for Musculoskeletal Complaints J Manipulative Physiol Ther 2006 (Feb); 29 (2): 162 ~ FULL TEXT Response of patients in the study sample to multiple impulse therapy for symptoms of low back and neck pain appeared to be considerably faster than that obtained in 3 recent studies. There are more articles like this at the Instrument Adjusting Page
	Pilot Study of Patient Response to Multiple Impulse Therapy for Musculoskeletal Complaints J Manipulative Physiol Ther 2006 (Jan); 29 (1): 51 ~ FULL TEXT Patients expressed improvement in symptoms after the first visit (average improvement in subjective pain rating scale of 41%). Patient symptoms improved between the first and second visits for 70% of patients (average improvement in subjective pain scale for all patients was 58%). The majority of patients achieved complete resolution of symptoms between the third and fourth visits. Maximum benefit for patients across all symptoms required an average of 4.2 visits. The half-life for response to multiple impulse therapy for all symptoms was 17 to 26 days. The half-life for response to multiple impulse therapy using the PulStarFRAS for low back pain was 9 to 16 days.
	A Review of the Literature Pertaining to the Efficacy, Safety, Educational Requirements, Uses and Usage of Mechanical Adjusting Devices J Canadian Chiropractic Assoc 2004 (Mar); 48 (1–2): 74–88, 152–161 ~ FULL TEXT Part I      and      Part II   (Adobe Acrobat files) Over the past decade, mechanical adjusting devices (MADs) were a major source of debate within the Chiropractor's Association of Saskatchewan (CAS). Since Saskatchewan was the only jurisdiction in North America to prohibit the use of MADs, the CAS established a committee in 2001 to review the literature on MADs. The committee evaluated the literature on the efficacy, safety, and uses of moving stylus instruments within chiropractic practice, and the educational requirements for chiropractic practice.
	Upper-cervical Technique, Historically Considered J American Chiropractic Association 2003 (Mar) ~ FULL TEXT According to Dye [5] the upper-cervical concept was in the air at Palmer College in the late 1920s. B.J. Palmer introduced the concept of the primacy of the upper-cervical subluxation to his contemporaries in the early spring of 1930, [5] apparently emphasizing axis at first. By this time, he felt that this was the only place where interference with the neurological connection between the brain and the rest of the body was possible. Modern practitioners in the tradition of B.J. Palmer have included Kale [13–18] and Mears, as well as their adherents. Dr. Donald Mears, who passed away in 1991, developed his Mears Technique [19, 20] starting from the proposition that others of the HIO practitioners had inadequately identified primary occiput problems-that is, x-ray methods and adjustive approaches for thrusting upon the occiput, as compared with the atlas.
	Differential Compliance Instrument in the Treatment of Infantile Colic: A Report of Two Cases J Manipulative Physiol Ther 2002 (Jan); 25 (1): 58–62 ~ FULL TEXT A PulStar Function Recording and Analysis System (PulStar FRAS, Sense Technology, Inc, Pittsburgh, Penn) device was used to administer light impulses (approximately 1.7 joules, which produced a 3 to 4 lb force) at each segmental level throughout the dorsal spine, with probe tips spaced 2 cm apart straddling the spinous processes. Crying was reduced by 50% after a single session of instrumental adjusting in a 6-week old girl and after 4 sessions in a 9-week old boy, according to colic diaries kept by the mothers. Average hours of uninterrupted daily sleep increased from 3.5 to 6.5 hours after a single session.
	Name Techniques in Canada: Current Trends in Utilization Rates and Recommendations For Their Inclusion at the Canadian Memorial Chiropractic College J Can Chiropr Assoc 2000 (Sep); 44 (3): 157–168 ~ FULL TEXT Since its establishment in 1945, the Canadian Memorial Chiropractic College (CMCC) has predominately adhered to a Diversified model of chiropractic technique in the core curriculum; however, many students and graduates have voiced a desire for greater exposure to chiropractic techniques other than Diversified at CMCC. A course structure is presented that both exposes students to a plethora of different “Name techniques” and provides students with a forum to appraise them critically. The results of a student survey suggested that both of these learning objectives have been successfully met. In addition, an assignment was designed that enabled students to recommend which, if any, “Name techniques” should be included in the curriculum of the College.
	Relationship Between Techniques Taught and Practice Behavior: Education and Clinical Correlation J Manipulative Physiol Ther. 1999 (Jan); 22 (1): 29–31 ~ FULL TEXT Data from this research provide evidence that a relationship does exist between manual procedures taught in two different chiropractic colleges and the perceived use of those procedures in actual clinical practice. Implications of this relationship are discussed.
	Overview of the Blair Cervical Technique Council on Chiropractic Practice, Chandler, Arizona: October 2–3, 1995 ~ FULL TEXT Dr. William G. Blair began to develop his distinctive method for the analysis and correction of subluxations of the cervical spine soon after graduating from the Palmer School of Chiropractic and establishing his practice in Lubbock, Texas, in Late 1949. Trained in the classical Upper Cervical Specific (HIO) method, Dr. Blair soon became concerned with the potential effects of osseous asymmetry ("malformation," as he termed it) on the accuracy of the traditional spinographic analysis in producing a valid adjustive listing.

Chiropractic Technique References

	The About Chiropractic Adjusting Page A Chiro.Org article collection Review a variety of articles about chiropractic adjusting (aka spinal manipulation).
	Spinal Palpation A Chiro.Org article collection The Palpation page details how this clinical assessment tool has evolved over the years.
	Instrument Adjusting, a.k.a. Mechanically-assisted Adjustments A Chiro.Org article collection This page gathers articles discussing the use of mechanically-assisted instrument adjusting.
	The Pierce Technique A Chiro.Org review The Pierce Results System was developed by Vernon (Verne) Pierce, D.C., Sr. It is a biomechanical analysis of spine kinematics (or motion), utilizing “stress views” of the spine (flexion, extension, rotation, and/or lateral bending views where required) or videofluoroscopy (VF, or “moving x-ray” studies) to determine the loss of spinal function, which is at the core of the “vertebral subluxation complex”.
	Chiropractic Techniques The Job Analysis of Chiropractic 2000 This list contains the 15 techniques most frequently used by doctors of chiropractic (DCs), followed by a brief explanation of each one of these manipulative/adjustive procedures.
	The Art of Pioneer Chiropractic Technic By Richard C. Schafer, D.C., FICC and the ACAPress This paper strives to define certain general principles that underlie almost all efficient chiropractic articular adjustive technics. A review is offered regarding depth of drive, the articular snap, segmental distraction, timing, the advantages of placing the patient's spine in an oval posture, correct table height, and patient positioning objectives. The factor of time in the clinical approach and its underlying biomechanical principles of tissue viscoelasticity, fatigue, creep, and relaxation are considered. Also reviewed are the need to visualize the loading effects on articular cartilage, joint lubrication, action of the intra-articular synovial tabs, the articular planes, the classic types of contact, contact points and their options, securing the contact hand, and the direction of drive. Then is offered a rationale on adjustive velocity, types of adjustive thrusts, objective-oriented approaches, and some closing comments.
	Adjusting the Pediatric Spine Topics in Clinical Chiropractic 1997;   4 (4):   59–69 ~ FULL TEXT The subject of chiropractic care of children must by necessity include a discussion of the various techniques chiropractors use to address a subluxation. [1–2] The act of introducing a force into a spinal joint in an effort to restore mobility or alignment is termed an adjustment. This article discusses the technical aspects of adjusting the pediatric spine (ie, occiput to pelvis).
	The Art of the Chiropractic Adjustment By Richard C. Schafer, D.C., FICC and the ACAPress Part 1 Part 2 Part 3 Part 4 Part 5 Part 6 Part 7
	The Chiropractic Scope of Practice in the United States: A Cross-sectional Survey J Manipulative Physiol Ther. 2014 (Jul);   37 (6):   363–376 ~ FULL TEXT The scope of chiropractic practice in the United States has a high degree of variability. Scope of practice is dynamic, and gray areas are subject to interpretation by ever-changing board members. Although statutes may not address specific procedures, upon challenge, there may be a possibility of sanctions depending on interpretation.

Who Should Manipulate The Spine?

The World Health Organization (WHO) recently crafted and published the
WHO Guidelines on Basic Training and Safety in Chiropractic (FULL TEXT Adobe Acrobat 512KB) in consultation with the World Federation of Chiropractic, the Association of Chiropractic Colleges and various chiropractic, medical, osteopathic, and other groups. [1]

The Guidelines make it clear that chiropractic is a separate profession rather than a set of techniques that can be learned in short courses by other health professionals.   They also make it clear that medical doctors and other health professionals, in countries where the practice of chiropractic is not regulated by law, should undergo extensive training to re-qualify as chiropractors before claiming to offer chiropractic services.

In some countries there have been recent efforts by medical groups to provide short courses of approximately 200 hours (or less) in chiropractic technique.   The World Health Organization guidelines indicate that a medical graduate should a require an additional minimum of 1800 class hours, including 1000 hours of supervised clinical training, before claiming to offer chiropractic services. [2]

You will also enjoy this July 2004 review of the WHO Guidelines by the Chiropractic Report [3] and WHO's first Policy statement on Chiropractic in 2006. [4]

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REFERENCES:

1. World Health Organization (WHO)
   WHO Guidelines on Basic Training and Safety in Chiropractic
   Geneva, Switzerland: (November 2005)

2. An Announcement About This Guideline's Publication From The WHO
   

3. WHO Guidelines on Chiropractic Education and Practice
   Chiropractic Report ~ July 2004; 18 (4)
   

4. WHO’s First Policy Document on Chiropractic
   Chiropractic Report ~ January 2006; 20 (1)
   

5. Editorial Commentary:   The Need for Professional Regulation:
   Are German Orthopedic Surgeons Killing People With Chiropractic?

Chiropractic Technique Websites

   Activator Methods

   Applied Kinesiology

   Atlas Orthogonal Technique   ~ Upper Cervical

   Blair Technique Homepage   ~ Upper Cervical

   Chiropractic Biophysics   (CBP)

   Directional Non-Force Technique   (DNFT)

   Gonstead Technique

   Motion Palpation Institute

   National Upper Cervical Chiropractic Association   (NUCCA)   ~ Upper Cervical

   Orthospinology  ~ Upper Cervical

   Pierce Technique Page

   Pettibon Technique

   Sacro Occipital Research Society International, Inc. (SOT)

   Sacro Occipital Technique Organization (SOTO)

   Thompson Technique

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Since 8–01–1997

Updated 7-01-2022