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Special Section: Analysis Equipment


Insights into Chiropractic Instrumentation: Achieving Clinical Certainty

By Christopher Kent, D.C., F.C.C.I.

A challenge facing chiropractors is determining when to adjust. When you recommend that a patient be checked three times a week, what is your basis for doing so? How do you measure patient progress? Are your examinations congruent with your philosophy and clinical objective?

Trying to apply examination procedures, such as medical orthopedic tests, which do not indicate the presence or correction of vertebral subluxations, has frustrated many doctors.

Although static and motion palpation are popular techniques, they are only as effective as the examiner is skilled. A review of the literature on the interexaminer reliability of motion palpation of the lumbar spine demonstrated marginal-to-no reliability. Even in the hands of skilled clinicians, palpatory findings are highly subjective and difficult to quantify.

For some patients, the concept of nerve interference may be difficult to understand. The confusion is compounded when the chiropractor claims to be subluxation based, but recommends care plans based on the presence or absence of symptoms.

The ideal clinical examination procedure:

  1. Provides objective measurements;
  2. Is completely non-invasive;
  3. Provides a reliable and valid assessment of the functional status of the nervous system;
  4. Provides a means of re-examination to track progress;
  5. Is time and cost effective;
  6. Uses protocols supported by peer-reviewed publications
  7. Is applicable to persons of all ages, including infants, toddlers, children, adolescents and adults;
  8. Facilitates patient education by providing easy-to-understand, tangible evidence
  9. Is suitable for spinal screening.


Five aspects of functional integrity, which are related to the analysis of vertebral subluxation, include:

  1. Static surface EMG (SEMG) measures the electrical activity in the muscles surrounding the spine. This test enables the chiropractor to objectively evaluate the innate response of the paraspinal muscles to gravity. Tonic muscle activity is assessed with static SEMG.
  2. Dynamic surface EMG allows the chiropractor to graph up to four channels of SEMG activity as the patient goes through ranges of motion. The result is an objective assessment of voluntary motion.
  3. Paraspinal Infrared Temperature analysis evaluates the integrity of the autonomic nervous system, which controls organs, glands and blood vessels. It allows the chiropractor to relate vertebral subluxation to autonomic function. The rolling thermal scanner allows the doctor to examine infants, children and adult patients in a single pass.
  4. Computerized inclinometry measures ranges of spinal motion. These measurements relate to the biomechanical component of vertebral subluxations.
  5. Pressure algometry evaluates sensory function by measuring the pressure/pain thresholds of tender regions along the spine.


Chiropractic adjustments alter paraspinal EMG readings

Research supports the use of this technology. Chiropractors have often observed dramatic palpatory changes in paraspinal muscles pre- and post-adjustment. Shambaugh conducted a study where surface electrodes were used to measure paraspinal EMG activity before and after chiropractic adjustment. Shambaugh concluded, “Results of this study show that significant changes in muscle electrical activity occur as a consequence of adjusting.” Similar findings were reported in a study conducted by the osteopathic profession. Ellestad’s group found that paraspinal EMG activity decreased in patients following osteopathic manipulation. Such changes were not observed in controls.

A study conducted at the NZCA School of Chiropractic in New Zealand involved chiropractic care provided by chiropractic interns in a teaching clinic. The equipment used was an Insight Subluxation Station. One or more adjusting procedures, including Palmer Upper Cervical, Diversified, Gonstead, and Thompson Terminal Point Technic were used. Baseline SEMG scans were performed prior to initiation of chiropractic care. Follow up SEMG scans were performed one week after the first adjustment, and four weeks after the first adjustment. The investigators concluded, “Under the conditions of this study, it is concluded that SEMG is an objective measure of change which can be used as an assessment of patient progress.”

Surface EMG has been accepted by courts of law
In their test, “Proving Medical Diagnosis and Prognosis,” Houts and Marmor state: “Properly used, the EMG scanning technique is far more persuasive in the courtroom than is a report of needle EMG. You can present the jury with mathematical, tangible physical evidence which they can see.” A memorandum in support of admission of EMG muscle scans which was filed in superior court, state of Washington, county of Spokane stated, “There is no legal basis for the exclusion of the EMG muscle scan when a proper foundation is laid for the introduction of such scientifically accepted testing. EMGs have been used for many years. Muscle scan testing has been admitted in numerous courts, including this court.”

Skin temperature analysis indicates sympathetic nervous system activity
Uematsu’s team determined normative values for skin temperature differentials in asymptomatic “normal” individuals. These authors stated: “These values can be used as a standard in assessment of sympathetic nerve function, and the degree of asymmetry is a quantifiable indicator of dysfunction...Deviations from the normal values will allow suspicion of neurological pathology to be quantitated and therefore can improve assessment and lead to proper clinical management.”

The Insight Subluxation Station is one of many quality analysis instruments used by chiropractors attending elite athletes, professional sports teams, and others demanding the best technology for chiropractic assessment. If you seek technical certainty, improved patient communication, and are committed to the vision of lifetime, subluxation-based wellness care, analysis equipment can help you raise your practice to a higher level.

BIBLIOGRAPHY
Bergstrom E, Courtis G: “An inter- and intra-examiner reliability study of motion palpation in lateral flexion in the seated position.” Euro J Chiro 1986;34:121.

Boline P, Keating J, Brist J, Denver G: “Inter-examiner reliability of palpatory examinations of the lumbar spine.” Am J Chiro Med 1988 1(1):5.

Cassidy J, Potter G: “Motion palpation of the lumbar spine.” JMPT 1979; 2(3):151.

Ellestad S, Nagle R, Boesler D, Kilmore M: “Electromyographic and skin resistance responses to osteopathic manipulative treatment for low back pain.” JAOA 88(8):991, 1988.

Gonella C, Paris S, Kutner M: “Reliability in evaluating passive intervertebral motion.” Phys Ther 1982; 62(4):436.

Houts M, Marmor L: “Proving Medical Diagnosis and Prognosis.” Matthew Bender, Times Mirror Books, 1989. 82A-20.

Johnson v Carbon No. 86-2-03806-4. Memorandum in support of admission of EMG muscle scans. Superior Court, State of Washington, County of Spokane.

Jull G, Bullock M: “A motion profile of the lumbar spine in an aging population assessed by manual examination.” Physiotherapy Practice 1987:3:70

Keating J: “Inter-examiner reliability of motion palpation of the lumbar spine: a review of the quantitative literature.” Proceedings of the Scientific Symposium on Spinal Biomechanics, International Chiropractors Association, May 19-21, 1989.

Kelly S, Boone WR: The clinical application of surface electromyography as an objective measure of patient progress: a pilot study. Journal of Vertebral Subluxation Research 1998;2(4):175.

Kent C, Gentempo P: Instrumentation and imaging in chiropractic: a centennial retrospective. Today's Chiropractic 1995;24(1):32.

Kent C: Surface electromyography in the assessment of changes in paraspinal muscle activity associated with vertebral subluxation: a review. Journal of Vertebral Subluxation Research 1997;1(3):15.

Kent C: Instrumentation and imaging. In: Masarsky C, Todres-Masarsky M: Somatovisceral Aspects of Chiropractic—An Evidence-based Approach. New York. Churchill-Livingstone. 2001.

Love R, Brodeur R: “Inter- and intra-examiner reliability of motion palpation for the thoracolumbar spine,” JMPT 1987 10(1):1.

Saur PM, Ensink FB, Frese K, et al: Lumbar range of motion: reliability and validity of the inclinometer technique in the clinical measurement of trunk flexibility. Spine 1996;21(11):1332.

Shambaugh P: “Changes in electrical activity in muscles resulting from chiropractic adjustment: a pilot study.” JMPT 10(6):300, 1987.

Uematsu S, Edwin DH, Jankel ER, et al: Quantification of thermal asymmetry. J Neurosurg 1988;69:552.

Whatmore GB, Kohi DR: Dysponesis: a neurophysiologic factor in functional disorders. Behav Sci 1968;13(2):102.

For Further Information
Contact Chiropractic Leadership Alliance, Inc. at 800-892-6463 or 201-368-9600.


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