The chiropractic adjustment isn’t just one thing: Part I

A patient I’ve known a long time came in recently with her husband. I’d never met him before, and he had no experience with chiropractic himself. He asked if he could watch, and asked how one would know if they needed a chiropractic adjustment. The first question was entirely up to the patient; I don’t mind an audience. The second is a question I get asked a lot.

There are two key ideas to answering it. The first has to do with the reason most of us access health care in the first place: we have a problem we can’t solve on our own. Most chiropractic patients come to us with neuroskeletal problems: back pain, neck pain, headaches, arm or leg tingling, etc. Sometimes it’s about decreased function. We see a lot of athletes this way; they feel they can perform better than they are. But that idea can also apply to non-athletes. As we age, people often gradually begin to feel stiffer. It may not be painful, but it can certainly interfere with your life. We can help.

The second key idea has to do with how chiropractors treat a given problem. I see a large number of acute disc herniations in my practice. The standard of care for herniations is a type of adjustment known as flexion distraction. It was pioneered in the sixties and seventies by a doctor in Indiana named Jim Cox. Dr. Cox believed so strongly in his idea that he developed eight generations of new equipment, and published numerous National Institutes of Health-funded studies demonstrating its effectiveness. He was so successful that surveys have found 60% of chiropractors have a version of the table he developed.

Flexion distraction looks nothing like what many envision chiropractic to be. The patient generally lays face down on an articulated table, where the lower half can be disengaged to move independently. This supports the patient’s weight so the chiropractor can control the body with one hand, while contacting the involved part of the spine specifically with the other. This has been proven to decrease the pressure within an injured disc by almost three hundred percent, allowing the herniated disc material to return to its proper position.

Another form of adjustment is orthopedic blocking. These are padded wedges placed under the body of the patient, usually the pelvis, face down or face up. Gravity then begins to manipulate the joints of the pelvis, known as the sacroiliac joints. The force of the adjustment can then be scaled up anywhere from the patient’s breathing alone providing the force, to using the blocks with a drop piece, to a direct thrust. Orthopedic blocks were another inspiration of genius developed by Dr. Major Dejarnette. A chiropractor, osteopath, and engineer, Dejarnette spent his life in chiropractic research and development. Orthopedic blocking is also specific to joint dysfunction, though it may be useful with certain disc cases.

These two are very gentle forms of manipulation. Key to their use is matching them to the right condition. Some disc problems really require a light touch, and flexion distraction is perfect. If a patient has osteoporosis, orthopedic blocking may be the best choice because the only forces are gravity and the patient’s own breathing. However, other conditions may actually require more force, more specifically more speed. I’ll deal with a form of adjusting for speed in the next installment.