Modes of Care 6 Modes of Adjustive CareRECOMMENDATIONAdjusting procedures should be selected which are determined by the practitioner to be safe and effective for the individual patient. No mode of care should be used which has been demonstrated by critical scientific study and field experience to be unsafe or ineffective in the correction of vertebral subluxation.
Rating: Established
Evidence: E, L
Commentary
This chapter is concerned with the modes of adjustive care (techniques) associated with the correction of vertebral subluxation. The literature reveals many articles on adjusting modes. These articles include technique descriptions, various applications of techniques, and reliability studies usually assessing inter- and intra-examiner reliability. A number of review articles provide discussion of the modes of care. Available research data has been complemented with professional opinion, derived from two separate forums of chiropractic experts' The International Straight Chiropractic Consensus Conference, Chandler, Arizona (1992) and the Council on Chiropractic Practice Symposium on Chiropractic Techniques, Phoenix, Arizona, (1996), both of which served to validate procedures by common knowledge and usage.
The intent of this chapter is not to include nor exclude any particular technique, but rather to provide a guideline, drawing upon the commonality of various techniques, which contributes to the chiropractic objective of correcting vertebral subluxation. Any technique which does not espouse the correction of subluxation would be considered outside the scope of the Guidelines.
A list of descriptive terms and definitions related to chiropractic adjustive care as commonly practiced follows:
Adjustment: The correction of a vertebral subluxation.
Adjustic Thrust: The specific application of force to facilitate the correction of vertebral subluxation.
Adjusting Instruments: Fixed or hand-held mechanical instruments used to deliver a specific, controlled thrust to correct a vertebral subluxation.
Amplitude: Magnitude; greatness of size or depth.
Blocking Technique: The use of mechanical leverage, achieved through positioning of the spine or related structures, to facilitate the correction of vertebral subluxation.
Cleavage: The movement of one vertebra between two other vertebrae.
Concussion: An adjustic thrust produced by arrested momentum. Momentum is the result of weight (mass) in motion and also of speed. An adjustic concussion depends more on speed than mass.
High Velocity Thrust with Recoil: A controlled thrust delivered such that the time of impact with the vertebra coincides with the chiropractor's contact recoil, thus setting the vertebra in a specific directional motion.
Impulse: A sudden force directionally applied to correct a malpositioned joint.
Low Velocity Thrust with Recoil: A controlled thrust administered at low speed with a sudden pull-off by the practitioner, setting the segment in motion.
Low Velocity Thrust without Recoil: A controlled thrust administered at low speed coupled with a sustained contact on the segment adjusted.
Low Velocity Vectored Force without Recoil: A short or long duration (usually ranging from 1 to 20 seconds) contact with the segment being adjusted, with or without a graduation of force.
Manually Assisted Mechanical Thrust: A manually delivered specific thrust enhanced by a moving mechanism built into the adjusting table.
Manipulation: The taking of a joint past its passive range of motion into the paraphysiological space but not past the anatomic limit, accompanied by articular cavitation (Kirkaldy-Willis). It is not synonymous with chiropractic adjustment, which is applied to correct vertebral subluxation.
Multiple Impulse: Impulses delivered in rapid succession.
Recoil: The bouncing or springing back of an object when it strikes another object.
Tone: The normal degree of nerve tension.
Thrust: The act of putting a bony segment in motion using a directional force.
Toggle: A mechanical principle wherein two levers are hinged at an elbow giving mechanical advantage. Combinations of toggles may be used to multiply or strengthen mechanical advantage.
Toggle Recoil with Torque: A method of using the toggle with rotation (twist) as the toggle straightens, causing the adjusting contact to travel in a spiral path.
Torque: A rotational or twisting vector applied when adjusting certain vertebral subluxations.
Velocity: The speed with which a thrust is delivered.Conclusion
Considerable evidence substantiates the adjustment being administered for the purpose of correction of vertebral subluxation.(1-11) Studies regarding the different modes(4, 12-86) compare low force methods to those employing a high velocity thrust without recoil, and low velocity vectored force without recoil, high velocity thrust with recoil, low velocity thrust with and without recoil, manually and mechanically assisted thrusts, blocking techniques, and sustained force. These studies are often presented in the context of effects on various physical and physiological parameters.
Although providing useful information, the majority of these studies are limited by uncontrolled variables and lack of statistical power. They do, however, demonstrate that the application of various modes of adjustive care is accompanied by measurable changes in physical and physiological phenomena. The importance of this information, in terms of its linkage to processes used by the body in the correction of subluxation, will be assessed through continued research.
These guidelines consider(86) the modes of adjustive care in common usage, which adhere to one or more of the descriptive terms presented in this chapter, as appropriate for correction of subluxation. However, studies regarding their theoretical basis and efficacy are often conducted by advocates of (those practicing or instructing) the respective techniques. While the information attained in the numerous investigations is not in question, since many of the studies have not passed the scrutiny of peer and editorial review, it is suggested that the advocates of particular modes of adjustive care encourage research by chiropractic colleges, independent universities and other facilities to extend the level of credibility already achieved.
Continuing research and reliability studies are necessary to better understand and refine the underlying mechanisms of action common to the various modes of adjustive care. In addition, it is suggested that more observational and patient self-reporting studies be conducted which deal with quality of life assessments and overall "wellness," to demonstrate the pattern of health benefits which heretofore have been the purview of the patient and the practitioner. A conference sponsored by U.S. Department of Health and Human Services, Public Health Service Agency for Health Care Policy and Research, proposed many different approaches for studying the effects of treatments for which there is no direct evidence of health outcomes.(87)
The CCP recognizes that many subluxation-based chiropractors do not adhere, in totality, to the current hypothetical model thus far described. These practitioners consider two additional components. One is interference with the transmission of nonsynaptic neurological information which is homologous to the Palmer concept of mental impulse. The other limits the misalignment component of the subluxation to the vertebrae and their immediate articulations. While these practitioners may adhere to some concepts of other subluxation models, their practice objectives are based on correction of the vertebral subluxation as proposed by Palmer, which has recently been elaborated by Boone and Dobson.(88-90)
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