The art of chiropractic lies primarily in the adjusting techniques
that each chiropractor utilizes. Why do some chiropractors jump from technique
to technique?
By Jennifer LeClaire
There are many approaches to evaluating the effectiveness of chiropractic techniques.
Probably the two most prevalent are physiologic response or orthopedic re-alignment
of the spine. These two approaches have very different indicators of effectiveness.
The orthopedic approach to adjusting uses pre and post X-rays as the primary
indicator of the whether or not the doctor is successful in reaching his clinical
goals. Chiropractic Biophysics, Pettibon, Atlas Orthogonal, Pierce-Stillwagen,
Grostic are just a few of the techniques that employ an orthopedic approach
to chiropractic technique either on a segmental basis or on an entire spine
basis. B.E.S.T., Newtwork, Directional Nonforce Technique, Activator, Applied
Kinesiology, Sacro-Occipital Technique are examples of adjusting techniques
that use physiologic indicators.
It was the late 1990’s and Dr. Bruce Wong was busily adjusting 175 patients
each week at his Honolulu practice. Wong was content that he was helping his
patients down the pathway to lifelong health with a subluxation-based approach
to correction and maintenance.
Then it happened. One of Wong’s colleagues suggested that he take post-treatment
X-rays to determine just how much chiropractic care had improved his patients’
spinal alignment.
To Wong’s chagrin, when he compared pre-treatment and post-treatment X-rays
he determined an outcome that was far and away different than what he had hoped
for: His patients’ spines were in the same orthopedic configuration that
they were when they first walked into his office. That discovery opened up the
door to doubt about his techniques.
“My patients were symptomatically feeling better all along and they weren’t
complaining,” says Wong. “But I felt terrible and it shook my confidence
in the techniques I was using. I knew that something had to change if I was
going to live out my long-term care philosophy.”
Like Wong, many chiropractors reach a point in their career where they question
their skills and talents. The truth is that every chiropractic technique works.
However, it’s easy to forget that truth when business isn’t exactly
booming. The natural thing to do is question your performance and technique.
“Confidence in adjusting technique is pivotal for chiropractors and it
gets more important as the practice grows,” says Dr. C.J. Mertz, founder
and president of The Waiting List Practice, a chiropractic performance coaching
system practice in Austin, Texas. “In my travels across the country I
meet chiropractors that are adjusting 15 people a week because their confidence
levels are so low.”
How do you correct low confidence, faulty mindsets and stagnant practices? One
adjustment at a time. Experts say the first step in evaluating your technique
is to reexamine the foundations of your philosophy. With a firm footing, you
can take steps to ensure that you are competent in analysis. Then, and only
then, should you seek to refine your technique. These, say experts, are building
blocks to a successful practice.
Sometimes it’s not the chiropractor’s method of moving bones that
hinders success. Rather it’s a faulty mindset that stymies growth and
shatters confidence. These foundational cracks can be damaging to both patient
and practice.
Mertz says chiropractors that see less than 100 patients a week have a lot more
leeway than chiropractors that see 200 patients a week. By the time you get
to 300 patients a week, major adjustments in time management are absolutely
necessary, regardless of the actual technique. According to Mertz, some chiropractors
have inappropriately valued the adjustment based on the amount of time they
spend with the patient.
Treatment models are also part and parcel with technique. Mertz says if the
chiropractor is using his technique to address some sort of conditional situation,
such as headaches or backaches, then he is sending the wrong message to the
patient. The lynchpin of a successful long-term practice is a corrective care
wellness-based model.
Analyzing Patient Outcomes
While most techniques come with their own analysis, there is a distinctive difference
between technique and analysis that experts say should be noted. One technique
may require you to check leg lengths before you adjust, for example, another
may require a scope or scan. Mertz says chiropractic biophysics (CBT) helps
DCs take the guesswork out of technique evaluation by creating a universal analysis.
Simply stated, CBT analyzes posture. Chiropractors perform a complete spinal
exam with corresponding neurological and orthopedic testing, as well as digitized
postural analysis and spinal X-rays to determine if there are any structural
deficiencies in the spine that are preventing total wellness. Chiropractors
may also put the patient on bilateral weight scales to demonstrate how weight
is distributed on each side of the body.
“If the patient’s spine is neutral to gravity and his posture is
normal, then each scale will show the same weight,” Mertz says. “If
there’s some fault in the positioning of the patient’s spine or
posture, then you’ll see swings of up to 30 pounds heavy on one side.”
Mertz says this is the most powerful patient education tool because they can
see the problems and the improvements with their own eyes—and so can the
doctor.
“Recheck the patient every 12 visits and see how their posture is improving,”
Mertz says. “No matter what technique you are using, the bilateral weight
scale readings should improve. If the weight distribution is not improving,
then your technique isn’t effective.”
Grappling withTechniques
In its root beginnings, chiropractic had limited methodologies available to
gauge the effectiveness of adjusting techniques. Therefore, many belief systems
developed surrounding adjusting techniques that could not be measured by quantification
or qualification. B. J. Palmer’s theory was that since the external concussion
of forces would be greater than the internal resistance of the patient, a change
in the status of their subluxation would result.
“All techniques I am aware of in chiropractic today are certainly more
specific,” says Dr. Russ Pavkov, a coach with The Family Practice, a chiropractic
coaching firm in Marietta, Ga. “All techniques are therefore more productive.
What would make a doctor question his technique would be dependent on patient’s
results and the patient satisfaction level.”
Choosing a Technique
Diversified. Thompson. Gonstead. Activator. There are many different techniques
in the world of chiropractic—and experts continue to stress that they
all work. The art of selecting a technique that works for you lies in assessing
your own personal needs and strengths, including age, body type, psychomotor
skill level, muscle strength, whether you are a primarily analytical personality
who enjoys summative processes, or a personality-type that enjoys more formative
processes.
Of course, switching techniques should not be a knee-jerk reaction. Pavkov says
you should first go back to basics with the technique you are using: Check your
contact points. Make sure you are on the correct spinal segment. Look at your
line of drive in relationship to the bone above and the bone below on which
you are making the adjustment. And consider the patient variables, such as age,
sex and weight, that could render your technique less efficient.
“Ask a colleague what’s working for them or what you are doing or
not doing that could be different,” Pavkov says. “Take a refresher
seminar for your own technique. You could see things from a different perspective
that may just open your thinking to the understanding of body mechanics from
a different position. That new perspective could assist you in getting the right
type of adjustment on the patient at the right time.”
Pavkov says chiropractors may not realize they are using resources that are
incongruent with their core chiropractic belief of wellness. Other chiropractors
may have settled on a technique that is difficult to perform, too time-consuming,
or causes patient discomfort or chiropractor discomfort.
Moreover, some chiropractic schools are not focusing on subluxation, leaving
DCs insecure about how and what they are treating. Pavkov says resources like
the Insight Subluxation Station can help chiropractors read the spine and arrive
at the proper vertebral adjustment level.
Pavkov started his practice decades ago with a “pop and pray” technique
(one in which he used little or no outcome criteria to measure the effectiveness
of his adjusting technique) moved on to Thompson technique and then became expert
in the Activator method. He has learned from experience that the best results
come when chiropractors choose the technique that they are most comfortable
with and physically able to perform.
Part of his migration from Diversified to Activator was due to stress on his
back, neck and shoulders that made it difficult to bend over and adjust patients
on low tables. Much the same, different techniques could be better suited to
the patient’s needs.
“Technique is only part of practice success, but it plays a major role
in the overall practice success,” Pavkov. “A doctor must be able
to get results with his technique in order to have success with his patients.
When you have gained or even exceeded the expected results with a patient, then
your practice will be successful.”
What about Dr. Wong? Did the adjustments he made to his technique help his patients?
Overwhelmingly so. In fact, Wong’s story has a happy ending for his practice
and his patients. The changes he made to his analysis and techniques have led
his practice to explode. Wong treated 175 patients in a five and a half day
week back in 1997. Today he treats more than 1,000 patients in three days. And
that number continues to grow.
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