INSTRUMENT ADJUSTING
 
   

Instrument Adjusting

a.k.a. Mechanically-assisted Adjustments

This section was compiled by Frank M. Painter, D.C.
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The Chiropractic Technique Section
The Technique page contains articles about chiropractic techniques, as well as links to various named-technique websites.


The About Chiropractic Adjusting Page
Review a variety of articles about chiropractic adjusting (aka spinal manipulation).


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.


Three-dimensional Vertebral Motions Produced by Mechanical
Force Spinal Manipulation

J Manipulative Physiol Ther 2006 (Jul);   29 (6):   425436

Larger-magnitude, 3D intersegmental displacement and acceleration responses were observed for spinal manipulative thrusts delivered with Impulse at most force settings and always at the high force setting. Our results indicate that the force-time characteristics of impulsive-type adjusting instruments significantly affects spinal motion and suggests that instruments can and should be tuned to provide optimal force delivery.


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.


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.


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 Randomized Clinical Trial of Manual Versus Mechanical Force Manipulation
in the Treatment of Sacroiliac Joint Syndrome

J Manipulative Physiol Ther 2005 (Sep);   28 (7):   493501

Sixty patients with sacroiliac syndrome were randomized into two groups of 30 subjects. Each subject received 4 chiropractic adjustments over a 2-week period and was evaluated at 1-week follow-up. One group received side-posture, high-velocity, low-amplitude chiropractic adjustments; the other group received mechanical-force, manually-assisted chiropractic adjustments using an Adjusting Instrument. There was equal improvement in both groups.


Comparison of Mechanical Force
of Manually Assisted Chiropractic Adjusting Instruments

J Manipulative Physiol Ther 2005 (Jul);   28 (6):   414422

The minimum-to-maximum force excursion settings for the spring-loaded mechanical adjusting instruments produced similar minimum-to-maximum peak forces that were not appreciably different for most excursion settings. The electromechanical adjusting instruments produced short duration ( approximately 2-4 ms), with more linear minimum-to-maximum peak forces. The force-time profile of the electromechanical devices resulted in a more uniform and greater energy dynamic frequency response in comparison to the spring-loaded mechanical adjusting instruments.


A Review of the Literature Pertaining to the Efficacy, Safety, Educational
Requirements, Uses and Usage of Mechanical Adjusting Devices

Journal of Canadian Chiropractic Assoc 2004 (Mar);   48 (12):   7488, 152161

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.


Biomechanical and Neurophysiological Responses to Spinal Manipulation
in Patients With Lumbar Radiculopathy

J Manipulative Physiol Ther. 2004 (Jan);   27 (1):   115

Because spinal manipulation (SM) is a mechanical intervention, it is inherently logical to assume that its mechanisms of therapeutic benefit may lie in the mechanical properties of the applied force (mechanical mechanisms), the body's response to such force (mechanical or physiologic mechanisms), or a combination of these and other factors. Basic science research, including biomechanical and neurophysiological investigations of the body's response to SM, therefore, should assist researchers, educators, and clinicians to understand the mechanisms of SM, to more fully develop SM techniques, to better train clinicians, and ultimately attempt to minimize risks while achieving better results with patients.


Neuromechanical Characterization Of In Vivo Lumbar Spinal Manipulation.
Part II. Neurophysiological Response

J Manipulative Physiol Ther. 2003 (Nov);   26 (9):   579591

Spinal manipulative thrusts resulted in positive electromyographic (EMG) and compound action potential (CAP) responses that were typically characterized by a single voltage potential change lasting several milliseconds in duration. However, multiple EMG and CAP discharges were observed in numerous cases. The temporal relationship between the initiation of the mechanical thrust and the neurophysiologic response to internal and external spinal manipulative therapy (SMT) thrusts ranged from 2.4 to 18.1 ms and 2.4 to 28.6 ms for EMG and CAP responses, respectively. Neurophysiologic responses varied substantially between patients. Vertebral motions and resulting spinal nerve root and neuromuscular reflex responses appear to be temporally related to the applied force during SMT. These findings suggest that intersegmental motions produced by spinal manipulation may play a prominent role in eliciting physiologic responses.


PulStar Differential Compliance Spinal Instrument: A Randomized Interexaminer
and Intraexaminer Reliability Study

J Manipulative Physiol Ther 2003 (Oct);   26 (8):   493501

The PulStar mechanical adjusting device set to analysis mode appears to have good to excellent reliability when used by either an experienced or a novice (but trained) examiner. In addition, as a measure for resistance to a light thrust or spinal compliance, reliability was similarly good to excellent between the 2 doctors using the PulStar instrument.


The Minimum Energy Hypothesis: A Unified Model of Fixation Resolution
J Manipulative Physiol Ther 2002 (Feb);   25 (2):   105110

A unified theory of manipulative effectiveness is proposed that integrates the fixation and sensory tonus models of manipulation. The theory is based on the fact that the spine will assume a position of minimum internal energy when mechanical equilibrium is achieved. By using a simple mathematical model, it is shown that the fixation model and the sensory tonus models are 2 different aspects of the same theoretical construct. The Minimum Energy Hypothesis predicts that the spine will seek an optimal minimum energy configuration if the constraints preventing it from doing so are removed. Constraints are hypothesized to be joint fixations caused by inflammation in and about the spine and its sequella, muscle spasm, fibroadipose and scar tissue, and ultimately, degeneration. It is further hypothesized that the use of a computerized mechanical manipulative device may resolve such fixations, an example of which is radiographically demonstrable cervical hypolordosis.


Differential Compliance Instrument in the Treatment of Infantile Colic:
A Report of Two Cases

J Manipulative Physiol Ther 2002 (Jan);   25 (1):   5862

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.


Chiropractic Treatment of Postsurgical Neck Syndrome with Mechanical Force,
Manually Assisted Short-lever Spinal Adjustments

J Manipulative Physiol Ther 2001 (Nov);   24 (9):   589595

The patient was treated with conservative instrumental chiropractic manipulation, consisting of mechanical force, manually assisted short-lever spinal adjustments rendered with an Activator Adjusting Instrument (AAI) II. She comfortably tolerated the treatment and responded favorably to this therapy. All chronic symptoms had resolved within 30 days of instituting the chiropractic instrumental adjustments with an AAI. More interestingly, longitudinal examination over the next 2 years showed that the patient experienced no residual effects or further recurrences of her previous chronic problem after her initial course of chiropractic care.


A Pilot Randomized Clinical Trial on the Relative Effect of Instrumental (MFMA)
Versus Manual (HVLA) Manipulation in the Treatment of Cervical Spine Dysfunction

J Manipulative Physiol Ther 2001 (May);   24 (4):   260271

The objective range of motion measures showed statistically significant changes in the Instrument=adjusted (MFMA) group for left and right rotation and left and right lateral flexion from initial consultation to final consultations and for right rotation and right lateral flexion from initial consultation to 1-month follow-up. The HVLA group showed only the change in left rotation from initial to final consultations and from initial consultation to 1-month follow-up to be statistically significant.


Mechanical Force Spinal Manipulation Increases Trunk Muscle Strength Assessed
By Electromyography: A Comparative Clinical Trial

J Manipulative Physiol Ther. 2000 (Nov);   23 (9):   585595

The results of this preliminary clinical trial demonstrated that MFMA SMT results in a significant increase in sEMG erector spinae isometric MVC muscle output. These findings indicate that altered muscle function may be a potential short-term therapeutic effect of MFMA SMT, and they form a basis for a randomized, controlled clinical trial to further investigate acute and long-term changes in low back function.


Neurophysiologic Response to Intraoperative
Lumbosacral Spinal Manipulation

J Manipulative Physiol Ther. 2000 (Sep);   23 (7):   447457

During the active trials, mixed-nerve root action potentials were observed in response to both internal and external spinal manipulative thrusts. Differences in the amplitude and discharge frequency were noted in response to varying segmental contact points and force vectors, and similarities were noted for internally and externally applied spinal manipulative thrusts. Amplitudes of mixed-nerve root action potentials ranged from 200 to 2600 mV for internal thrusts and 800 to 3500 mV for external thrusts.


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


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