ABOUT CHIROPRACTIC ADJUSTING a.k.a.SPINAL MANIPULATION
 
   

About Chiropractic Adjusting

a.k.a.   Spinal Manipulation

This section was compiled by Frank M. Painter, D.C.
Make comments or suggestions to
  Frankp@chiro.org


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The Chiropractic Technique Page
           The Technique page contains articles about chiropractic techniques, as well as links to various named-technique websites.


   Instrument Adjusting, a.k.a. Mechanically-assisted Adjustments
           This page gathers articles discussing the use of mechanically-assisted instrument adjusting.


  
Chiropractic Subluxation and Neurology Articles
           This page contains a wide variety of articles about the Subluxation Complex, and it's impact on the nervous system and health.


  
A Replication of the Ernst Study
“Adverse Effects of Spinal Manipulation: A Systematic Review”

Chiropractic & Manual Therapies 2012 (Sep 21) ~ FULL TEXT

The number of errors or omissions in the 2007 Ernest paper, reduce the validity of the study and the reported conclusions. The omissions of potential risk factors and the timeline between the adverse event and SMT could be significant confounding factors. Greater care is also needed to distinguish between chiropractors and other health practitioners when reviewing the application of SMT and related adverse effects.


  
Does Facet Joint Inflammation Induce Radiculopathy? An Investigation Using
a Rat Model of Lumbar Facet Joint Inflammation

Spine 2007 (Feb 15);   32 (4):   406–412

The association between lumbar facet joint inflammation and radiculopathy was investigated using behavioral, histologic, and immunohistochemical testing in rats. Both mechanical and chemical factors have been identified as important for inducing radiculopathy. In lumbar spondylosis, facet joint osteophytes may contribute to nerve root compression, which may induce radiculopathy. Furthermore, inflammation may occur in the facet joint, as in other synovial joints. Inflamed synovium may thus release inflammatory cytokines and induce nerve root injury with subsequent radiculopathy. (In this study) when inflammation was induced in a facet joint, inflammatory reactions spread to nerve roots, and leg symptoms were induced by chemical factors. These results support the possibility that facet joint inflammation induces radiculopathy.


  
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).


  
DC’s Perform Most Manipulations and Receive Most Eduaction
           In their 1992 study, the RAND Corporation confirmed that chiropractors perform 94% of all spinal manipulation procedures in the U.S. with osteopaths delivering just 4% and general practitioners and orthopedic surgeons performing the remaining 2%. In light of the AHCPR's findings, we must be prepared for these figures to change as spinal manipulation becomes more accepted as a viable treatment of choice.


  
Increased Multiaxial Lumbar Motion Responses During Multiple-Impulse
Mechanical Force Manually Assisted Spinal Manipulation

Chiropractic & Osteopathy 2006 (Apr 6);   14 (1):   6 ~ FULL TEXT

Knowledge of the vertebral motion responses produced by impulse-type, instrument-based adjusting instruments provide biomechanical benchmarks that support the clinical rationale for patient treatment. Our results indicate that impulse-type adjusting instruments that deliver multiple impulse SMTs significantly increase multi-axial spinal motion. There are many more articles like this in the Instrument Adjusting Page.


  
A Revised Definition of Manipulation
           J Manipulative Physiol Ther 2005 (Jan);   28 (1): ~ FULL TEXT

           We write this commentary to address a problem that we feel exists in the description of chiropractic theory regarding the definition of spinal manipulation. We will first outline the background of the problem and then state the problem as it exists currently. We will then propose a revised definition to more accurately describe spinal manipulation.


  
An Investigation into the Validity of Cervical Spine Motion Palpation
Using Subjects with Congenital Block Vertebrae as a 'Gold Standard'

BMC Musculoskelet Disord 2004 (Jun 15);   5 (1):   19 ~ FULL TEXT

This study indicates that relatively inexperienced examiners are capable of correctly identifying inter-segmental fixations (CBV) in the cervical spine using 2 commonly employed motion palpation tests. The use of a 'gold standard' (CBV) in this study and the substantial agreement achieved lends support to the validity of motion palpation in detecting major spinal fixations in the cervical spine.


  
Degenerative Changes Following Spinal Fixation in a Small Animal Model
           J Manipulative Physiol Ther 2004 (Mar);   27 (3):   141–154

           Fixed segments had more degenerative changes than nonfixed segments for all Z joint parameters (ANOVA, P <.0001). Osteophyte formation and ASD were directly dependent on duration of fixation. These findings indicate that fixation (hypomobility) results in time-dependent degenerative changes of the zygapophysial joints. You may also enjoy reviewing the FCER-funded research project that led to the publication of this article.




  
Manual Healing Diversity and Other Challenges
to Chiropractic Integration

J Manipulative Physiol Ther 2000 (Mar);   23 (3):   202–207 ~ FULL TEXT

Chiropractic has made significant strides in establishing itself as a leading contender for integration in the emerging health care system.  However, recent articles in prominent medical journals illustrate key issues that must be resolved for chiropractic to fully establish itself within the new health care model.  Manual therapy diversity and the corollary question of whether chiropractic care should be defined solely in terms of the high velocity-low amplitude (HVLA) adjustment, are issues in need of urgent attention and analysis. Other problematic areas affecting chiropractic's integration into the health care mainstream include research methodology issues, treatment of visceral disorders, and professional relationships.


   Cavitation Emptor:   Tracking the Holy Grail of Manipulation
           Anthony Rosner, PhD

           From Roston and Haynes' classic force-displacement curves of the third metacarpophalangeal joint in 1947, [1] through Sandoz' application of this phenomenon to manipulation, [2] through the criteria established by Mierau, Cassidy, et al., in 1988 to operationally differentiate manipulations from mobilizations, [3] chiropractors have held the audible release to be a virtual hallmark (if not a holy grail) of a successful manipulation. Indeed, an elegant model proposed by Raymond Brodeur, one of FCER's Peter Bommarito Residency Award-holders, has suggested [4] that the cavitation process provides a simple means for initiating reflex patterns associated with a manipulation. [5-7]


  
Spinal Pain Syndromes:
Nociceptive, Neuropathic, and Psychologic Mechanisms

J Manipulative Physiol Ther 1999 (Sep);   22 (7):   458–472

Although the treatment of neuropathic pain is difficult, sufficient evidence in the literature demonstrates that the treatment of nociceptive pain should be multimodal and involve spinal manipulation, muscle lengthening/stretching, trigger point therapy, rehabilitation exercises, electrical modalities, a variety of nutritional factors, and mental/emotional support.


  
Somatic Dysfunction and the Phenomenon of Visceral Disease Simulation:
A Probable Explanation for the Apparent Effectiveness of Somatic Therapy
in Patients Presumed to be Suffering from True Visceral Disease

J Manipulative Physiol Ther 1995 (Jul-Aug);   18 (6):   379–397

The proper differential diagnosis of somatic vs. visceral dysfunction represents a challenge for both the medical and chiropractic physician. The afferent convergence mechanisms, which can create signs and symptoms that are virtually indistinguishable with respect to their somatic vs. visceral etiologies, need to be appreciated by all portal-of-entry health care providers, to insure timely referral of patients to the health specialist appropriate to their condition. Furthermore, it is not unreasonable that this somatic visceral-disease mimicry could very well account for the "cures" of presumed organ disease that have been observed over the years in response to various somatic therapies (e.g., spinal manipulation, acupuncture, Rolfing, Qi Gong, etc.) and may represent a common phenomenon that has led to "holistic" health care claims on the part of such clinical disciplines.


  
Reflex Effects of Subluxation: The Autonomic Nervous System
           J Manipulative Physiol Ther 2000 (Feb);   23 (2):   104–106

           Recent neuroscience research supports a neurophysiologic rationale for the concept that aberrant stimulation of spinal or paraspinal structures may lead to segmentally organized reflex responses of the autonomic nervous system, which in turn may alter visceral function.


  
Dysafferentation: A Novel Term to Describe the Neuropathophysiological Effects
of Joint Complex Dysfunction. A Look at Likely Mechanisms of Symptom Generation

J Manipulative Physiol Ther 1998 (May);   21 (4):   267–280 ~ FULL TEXT

Joint complex dysfunction should be included in the differential diagnosis of pain and visceral symptoms because joint complex dysfunction can often generate symptoms which are similar to those produced by true visceral disease. You may also enjoy this response from another chiropractic researcher.


  
The Effects of Mild Compression on Spinal Nerve Roots with Implications
for Models of Vertebral Subluxation and the Clinical Effects of Chiropractic Adjustment

Journal of Vertebral Subluxation Research 2001 (May);   4 (2):   1–13

There is evidence of nerve compression at the level of the intervertebral foramen (IVF) occurring anywhere from 15.4% to 78% of levels inspected. Most of the spines inspected were already prescreened to eliminate those that were definitely known to have nerve compression problems. Pressures as little as 10 mm Hg can alter the nerve root and dorsal root ganglion’s abilities to function normally. The concept that a vertebral subluxation can induce pressure increases at the level of the IVF is supported by the literature. This increase, though seemingly mild, is enough to alter nerve function. The garden hose theory or hard bone - soft nerve explanation of vertebral subluxation is considered by some to be archaic but appears to be a valid entity at least in the lower cervical spine. More research is needed to decipher the susceptibility to mild pressure increases throughout the spine.


   Biological Rationale for Possible Benefits of Spinal Manipulation
           Chapter X;   AHCPR Publication No. 98-N002:   December 1997

           Manipulation is a form of treatment that dates to antiquity and has been practiced in some form in most cultures since that time (Lomax, 1997; Anderson, 1992). One of the first theories related to manipulation might be the statement attributed to Hippocrates: "Look to the spine as the cause of disease." The theories of the early pioneers of chiropractic were firmly grounded in notions that had been widely held in the 1800s, particularly the idea of "spinal irritability" and its correlation with disease (Lomax, 1997; Terrett, 1987). Theories on the nature of the primary spinal disorder amenable to manipulation and on the mechanisms of action of spinal manipulation abound within chiropractic, osteopathy, physiotherapy, and manual medicine. The original chiropractic theory suggested that misaligned spinal vertebrae interfered with nerve function, ultimately resulting in altered physiology that could contribute to pain and disease. In recent decades, chiropractic theories about how mechanical spinal joint dysfunction might influence neurophysiology have undergone significant modification and reflect more contemporary views of physiology (Gatterman, 1995).



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