MAKING EVERY ADJUSTMENT COUNT
I’ve organised a lot of seminars over quite a few years now (my first was in 1996) and as a result I have had the privilege of meeting every “type” of Chiropractor – and I have found that there is one constant trait that exists across all philosophies, techniques, practice management styles and scopes of practice – and that is a strong desire to provide the best possible therapeutic benefit from each and every “treatment”. Ignoring the very small segment of the profession that is more interested in the bottom line, than the spinal column – I know that each one of us hopes for and even expects that when we adjust someone, something good is going to happen for that person.
And that encounter can look quite different between practitioners. For example, it’s Monday morning and the first patient for the day is waiting, eagerly anticipating that they will be feeling “better” after their adjustment: Here are some possible generic scenarios:
1) The Chiropractor goes through their standard procedure of adjusting both sides of the neck, thrusts on a few thoracics, then rolls the patient onto both sides to loosen up the low Back.
2) The Chiropractor checks their notes from the last progress exam to see which segments had been determined to be needing adjustment for the next course of corrections, and then follows that recipe.
3) The Chiropractor palpates down the spine to find tight and tender points then proceeds to manipulate those symptomatic areas to improve the mechanical function of the spinal joints.
4) The Chiropractor uses some form of orthopaedic or neurological examination which can lead them to adjust anywhere between 6 and 12 subluxations on any given visit.
But there are some inherent weaknesses in the above approaches which must be reconciled if our goal is truly to deliver adjustments with that something extra:
1) If we don’t have a method to prioritise where someone really needs to be adjusted then should we call ourselves practitioners or technicians? One root of burnout is boredom: When every spine starts to look the same and when we start to diminish the value of each adjustment, then our sense of importance and passion also diminishes.
2) If we believe that adjustments initiate change, then shouldn’t the adjustments need to change through time? If a person’s spine and nervous system is healing, adapting and even evolving under our care, then why would today’s adjustment be the same as last month’s adjustment? And if someone’s life circumstances have altered since they started care, wouldn’t the pattern of Subluxation change to reflect this, and last week’s adjustment would now be inappropriate?
3) Chiropractors have long made the claim to be treating the cause. But if we treat based on symptoms, whether pain or tenderness, then don’t we make a mockery of this claim? If we claim to be removing interference from the nervous system, then shouldn’t we have some means of determining where that interference is, and how best to reduce that interference?
4) Most chiropractic techniques have talked about concepts such as primary and secondary subluxations, compensations, referral, distant effects from local interference, reflex projection. In other words not all Subluxations are created equal, and not all Subluxations need to be adjusted on every visit, because adjusting the “primary” subluxation will influence and reduce the connected secondary and compensatory malfunction. If we don’t have a method to differentiate between these types of Subluxations then won’t we be wasting some of our precious time?
Now consider a fifth option: On any given day, at the very moment that you are examining a spine, depending on the most recent physical, chemical and emotional stresses to your practice member’s nervous system, and superimposed over the long term accumulation of tension in their spinal system – there is one predominating subluxation, which if adjusted will produce bigger neurological changes than adjusting any other segment in the spine at that time. You would want to know how to differentially diagnose that segment wouldn’t you?
Watch Short Video Explaining The Concept of Primary Subluxations…
(If you can’t view this video try this link: http://www.screencast.com/t/YjliZjgwN )
This model has been developed during the research method design for a ground breaking, randomised, placebo controlled, prospective scientific project run in conjunction between Holder Research Institute, Turning Point Addiction Recovery facility, and the University of Miami School of Medicine’s famous Biostatistician Bob Duncan. This technique is today called Torque Release Technique and has been published in major journals such as Molecular Psychiatry, the Journal of Psychoactive Drugs, and Journal of Vertebral Subluxation Research, as well as being featured on the Discovery Health Channel.
Thankfully modern chiropractic can stand on the shoulders of its technique pioneering giants: Palmer, Thompson, DeJarnette, Van Rumpt, Logan, Toftness and more contemporary ground breakers like Epstein; and the development of TRT saw the best of the best being integrated to produce an amazingly streamlined and efficient means of determining which segment of the spine needs to be adjusted, with precise correctional vectors, and to confirm the success of a single adjustment or plot the objective improvement in indicators of subluxation through time.
Another gift from the research project was the Integrator – the first chiropractic instrument to be specifically designed and patented for the correction of Subluxations. What makes the Integrator stand alone is its ability to deliver a three-dimensional correction which includes all of the defining features of a Toggle Recoil adjustment – high speed, recoil, and torque. Plus it offers a feature that takes reproducibility and reliability to new levels – a preloading trigger that means that every adjustment delivers just the right amount of force and frequency.
Because of these breakthroughs TRT developed the reputation for being the twenty first century technique for Chiropractors to shift their practice model away from a mechanical and orthopaedic paradigm, towards a neurological and tonal application of our wonderful vitalistic philosophy.
And the consistent feedback from the hundreds of Chiropractors who have now completed TRT training is that it provides that missing piece in the technique puzzle – how to provide an adjustment which responds to the current physiological needs of the practice members’ nervous system, and how to generate big changes in state of wellbeing on each and every adjustment – physical, chemical and emotional.
2010 sees TRT in its 8th year of training Australian Chiropractors with Dr Nick Hodgson offering training programs in varied locations each year. Nick has organised numerous TRT training programs, has been personally mentored by the developer of TRT, Dr Jay Holder, and is one of Australia’s most experienced practitioners.
Click Here To See Upcoming Dates and Locations…
Tags: Adjusting Instrument, Adjustment, Chiropractic, Chiropractor, Integrator, Management Styles, Mechanical Function, Monday Morning, Neurological Examination, Orthopaedic, Philosophies, Practice Management, Primary Subluxation, Privilege, Progress Exam, Scenarios, Scopes, Spinal Column, Spinal Joints, Spine, Strong Desire, Subluxation, Subluxations, Tender Points, Therapeutic Benefit, Thrusts, Torque Release Technique, Trt
February 8th, 2010 at 3:04 am
Dear Doctor:
I took TRT last year in Detroit, MI with Dr Holder and Dr. Suzi
Tayor. Dr. Holder spent 95% of the entire seminar on theory
and 5% on technique. I never understood the adjusting
proceedure, even from the notes that were supplied. It
was a 1-2 pg copy of some possible listings that could come
up with not exact protocol sequence. I ordered your TRT manual
but still found it wanting in a clear format as to proper sequencing
and protocols. Is there any other instuctional (DVD,tape,
etc) that can help me LEARN how to do TRT? Thank you
Hi Dennis,
The USA basic training is primarily seminar with some demonstration and then you can attend an advanced track which is more hands-on which I would recommend is your next best step. We include more hands-on at the Australian program and also run advanced hands-on workshops which are entirely practical application. I’m surprised you didn’t find the instruction manual clear as it includes photos of contact points, and a very detailed flow chart of the protocol - I have had DCs attend a seminar after learning from the manual and they are usually very close with their application and just need some coaching and fine-tuning…
February 8th, 2010 at 12:22 pm
Looks & sounds interesting . Have you thought of doing an Adelaide seminar any time soon??
February 8th, 2010 at 6:04 pm
Hi Natasha
I am gradually working my way around the country and elsewhere - have done Melbourne, Sydney, Brisbane, Auckland, Johannesburg and this year will be in Perth. I’ll put Adelaide on next year’s hit list plus I also present to groups if they organise he event - happy to chat about this if you have a group of Chiropractors that would like to host me?
February 23rd, 2010 at 10:37 pm
I rather something based on evidence
February 23rd, 2010 at 10:38 pm
Did you know that Discovery Health Channel is peer reviewed and the “Wiped Out” documentary was about research published in the Molecular Psychiatry Journal, published by Nature.
The Health in Hand documentary was produced by York University and was probably the most objective investigation of chiropractic in this format?
Perhaps you should investigate the evidence before you conclude there is no evidence?
February 23rd, 2010 at 10:39 pm
I agree completely, however my issue is with subluxation based chiropractic and the out dated philosophy of the profession. wouldn’t a medical based model help the profession to become more mainstream in such a “prove it or lose it” society?
February 23rd, 2010 at 10:41 pm
So here are the questions
1) What is the philosophy of a “medical based model”?
2) Is it a fact that chiropractic philosophy is outdated, or is it just that you disagree with it based on your own beliefs/evidence?
3) If chiropractic was more “mainstream” what does that actually mean or look like? Who will be consulting the Chiropractor and what for?
4) What is it that we want to ”prove or lose”? Is it the cheapest most effective treatment for low back pain, the best way to improve basic daily functioning, the natural alternative to improve global quality of life? In order to accumulate evidence we have to know what question we are asking…
The reason I pose these questions is that you cannot define what you want by describing what you don’t want – we can’t say that we don’t want to be subluxation based chiropractic – we need to make a clear decision as to what we do want to be?
February 23rd, 2010 at 10:42 pm
Always love to have a good discussion, keeps the mind active and the passion of our profession alive!!
Understandably one can not define them selves by describing what we are not.
What we are is a specialist with our scope of practice being spine. Therefore one must be able to differential diagnose between the most simple of synovitus, annular tears to the most serious of neuroblastomas etc.
It is also important to know and understand outside our scope of practice or that, that we can not treat we must refer. As responsible first line health care practitioners.
Chiropractic ’subluxation’ to the best of my knowledge is not a proper diagnosis. It is a term with a specific meaning; a partially displaced joint, which has been turned into a vague myriad of conditions being complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.
It is similar to “joint listings” which have been proven to display poor intra and inter practitioner reliability.
However the adjustment is an amazing tool, we use a biomechanical system as a lever to send an ampliphied propioceptive burst to the brain to restore an aberent somatosensory image of a dysfunctional joint, in addition promoting decending inhibition to significantly reduce pain almost immediately. (BASIC SCIENCE RESEARCH RELATED TO CHIROPRACTIC SPINAL ADJUSTING: THE STATE OF THE ART AND RECOMMENDATIONS REVISITED, CRAMER ET AL 2006)
It needs to be promoted as such.
What is meant by mainstream is that chiropractic is fully integrated into the medical system. ie integration into hospitals etc
We a spinal specialist with our primary tools being that of non invasive physical medicine.
We diagnose conditions using orthopedic, biomechanical and neurological examinations.
We treat conditions within our scope of practice using a variety of manipulative, soft tissue and rehabilitative techniques and procedures.
February 23rd, 2010 at 10:43 pm
I completely respect your views and positions: Here is the challenge for the maturity of our profession – I do not totally agree with your description of our specialty and scope of practice, nor your definition of subluxation: There are areas of similarity and areas that I am not at all in agreement with you. SO – is there room in the profession’s description of itself for the both of us, and for a number of other colleagues who would further spread the definition one way or another?
There are two options:
1) The inclusive view – where all factions of the profession are mature enough to respect each others views AND each others evidence and come up with some kind of description that encompasses the diversity – difficult, most likely heated, possible?
2) The exclusive view – where we sit down and try to determine what we do agree on as the defining similarities between all of us, and then qualify the fringes as specialty interests, perhaps even requiring some degree of post graduate certification?
For example I am not interested in differentially diagnosing what the noxious nociceptive anatomical structure is in a person’s spine, which you may find nauseating to hear. But, I am very interested in the effect that the chiropractic adjustment has on neuroendocrine function and hence state of wellbeing, and brain function. While I have a “general practice” that may look very similar to yours from a number of viewpoints, there are also a bunch of people who seek me out for assistance with addictions, ADHD, depression, anxiety, compulsive disorders and the like, while I might imagine that you have people referred to you because of your skilled ability to diagnose and manage their spinal disorder that no-one else has helped?
Through all the years that I have participated in the growth and development of our profession the thing that has made me most distraught is not the opposing views and the honest and open discussion of these; but the dogma, anger, vindictiveness, even destructiveness with which some viewpoints can try to impose and dictate their agendas on others. (I’m not saying that I feel any of this from you but just sharing a disturbing truth that recurringly surfaces within our ranks)
It’s like the words from a Phil Collins song about war – “if we agree that we can disagree, we can stop all of this today”…