The Science and Art of the Chiropractic Adjustment
The Science and Art of the Chiropractic Adjustment
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 15 from RC’s best-selling book:
“Clinical Chiropractic: Upper Body Complaints”
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Chapter 15: The Science and Art of the Chiropractic Adjustment
THE SCIENCE OF ARTICULAR MOBILIZATION
Although adjunctive procedures have been recommended in this text, it should always be remembered that the articular adjustment is the core of chiropractic therapy. Ancillary procedures can condition tissues to receive and respond to articular therapy and enhance physiologic mechanisms, but, with rare exceptions, they should not be considered substitutes.
The sincere student of this manual will readily recognize that this author acknowledges the value of reflexology and numerous physiotherapeutic applications along with nutritional supplementation, counseling, “bloodless surgery,” and stardardized rehabilitative procedures. Yet, as explained previously, they all stand in the shadow of the basis for and the proper administration of the chiropractic adjustment. This chapter focuses on the need for the development of our unique art.
The author has witnessed several practitioners who have turned an adjunctive tool into a primary therapy exclusively. We see this at times with acupuncture, physiotherapy, therapeutic nutrition, psychotherapy, and those who have made the upper cervical spine or sacroiliac joints their master rather than a servant of the patient. Such a limited viewpoint of the scope of chiropractic health care, unfortunately, does a disservice to the practitioner, his or her patients, and the public. The fault for this misdirection must be placed on improper training. No logical person would forsake a primary therapy for an ancillary therapy if he or she had confidence and skill in its application.
Perfection of an art is a constantly expanding process. The quest of perfection in our profession is the basis of the diligent practice of chiropractic — to the extent of our creative imagination. This chapter will briefly define certain general underlying principles that underlie almost all chiropractic adjustive technics. Some may be new to the reader, yet their basis is as old as chiropractic itself.
Because of tradition and not semantics, the term technic is commonly used in the profession to describe a procedure used within a manual adjustive procedure. The word technique is used relative to other procedures. Regardless, a technic or technique is only a method, one method of many, that must be adapted to the situation at hand, clinical judgment, and personal preference. This is true for those technics described in this text or within any other book or seminar.
Clinical rules are not laws. They must frequently be amended for the particular situation and the individual making the application. For example, technics must be adapted to the size, strength, and skill of the doctor; the age, sex, health status, and pain tolerance of the patient; and the type of adjusting table used. Obviously, a doctor of short height treating an obese patient on a high table will find great difficulty in applying the same contact or technic that might be applied by a tall doctor treating a lean patient on a low table. The variables that can arise are too numerous to list, and each situation must be adapted to when encountered as conditions and personal skill permit.
The Factor of Time in the Clinical Approach
To produce a therapeutic adjustment, it is first necessary to evaluate the degree of joint motions and end plays present. Whatever corrective procedure is used, remember Hooke’s law: The stress applied to stretch or compress a tissue is proportional to the strain, or change in length thus produced, if the limit of elasticity of the tissue is not exceeded.
The goal of any therapy must be based on rational hypotheses. According to its founder, the primary objective of chiropractic therapy is to restore normal “tone” to the nervous system. Although some practitioners do this exclusively by “non-thrust” means (eg, the application of somatosomatic reflexes), the objectives are generally achieved by dynamic manual articular mobilization unless such a technic is contraindicated in a specific situation. Obviously, one would not apply a dynamic force over extremely porotic bone, a fracture, an abscess or a tubercular cyst, or a malignancy, for example. Nor would it be applied over acutely inflamed tissue or splinted muscles if the doctor expects the patient to return.
The author approaches the subject of chiropractic articular correction as a non-incisive surgical procedure, a chiurgical art. Correct application takes time. It takes time to assure proper patient positioning, assure that the intended line of drive is exactly parallel to a particular patient’s facet design, assure that the safest and most efficient and painless point of contact is selected, and assure that the proper impulse velocity and depth have been predetermined according to the circumstances at hand (eg, patient age, size, development, individual pain threshold, underlying pathophysiologic status, etc).
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