The Art of the Heal: Pillars of Chiropractic Part two
Hello and welcome to my blog!
At Dr. Super’s House of Health, I try my best to treat every patient as the individual they are. This includes taking into consideration any contraindications to care they may have, technique restrictions, their ability to handle body or tissue work, and their preferences during treatment. Last week my blog post titled “Why Philosophy is Important in Medicine” described how chiropractic philosophy drives my clinical decision making and treatment choices as a physician. I also discussed what makes up the “Three Pillars of Chiropractic”: Philosophy, Art, and Science. This post explains what the “Art” portion of the three pillars entails. I’m going to briefly describe the connection to philosophy, the difference in physics and the forces involved, the application of the different adjusting techniques I use, and how they shape your chiropractic visit with me. Don’t mind me while I nerd out in this one!
When I went to chiropractic school I was terrified I was going to wind up learning how to do the same thing, day in and day out, working on nothing but back pain and headaches. Maybe I would get the occasional car accident victim with whiplash, or an athlete with a hip injury? I was nervous about getting bored. Did I make the right choice for my career? Does this chiropractic thing even work? I never went to a chiropractor growing up and knew next to nothing about this path I had chosen.
My anxiety quickly dissipated when my philosophy instructor, Dr. Victor Strang, explained some important philosophical debates within the chiropractic community. He described the differences in Upper Cervical Specific doctors, the almost cult-like following of Dr. Clarence Gonstead, the debates in pediatric research outside the “chiropractic bubble”, and flaws seen in “The Flying Sevens” doctors. I learned that there are manual adjusting techniques, instrument assisted techniques, and specified techniques performed on only one area of the body. Some techniques include detailed analysis, some require X-rays, and some require specialized equipment. Some techniques are contraindicated for certain patient populations or conditions, while others are considered safe for everyone. These technique choices are driven by different joint structures and debates on the best way to manipulate them, philosophical differences in when, why (or why not) or what to adjust, and differences in patient populations. I was so overwhelmed! That at least, was an improvement from boredom.
As I continued in the program, I also got to learn about the differences between chiropractors: straight practitioners, mixed-chiropractors, wellness docs vs symptom relief docs, manipulation techniques vs specific ones. Pediatric specialists, rehab specialists, sports chiropractic and intensive care docs. It seemed like there was a technique for everything and everyone. Techniques like Torque-Release Technique, Thompson, and Activator use combinations of speed and torque to increase force without using more mass (a classic play on mass x acceleration = force). Other techniques like Gonstead, Diversified, and Logan use different contact points and lever-pulley systems to gently adjust using specific lines of drive. Some techniques require high-velocity, low-amplitude forces (HVLA) while others use gentle set and holds (like NUCCA) or low-velocity, low-amplitude (LVLA) forces. Some techniques require different tables, scales, meters, or machines to perform pre and post checks. My favorite technique, Activator, uses a form of reflex testing to determine the position of a bone in space and adjust using an instrument. At the end of my career at Palmer I had been adjusted by 48 different people and almost as many techniques. I decided to choose to practice the techniques that worked best for me as a patient, for my body as a physician, and for my patients comfort.
By the time I graduated chiropractic school, there were 207 different chiropractic techniques that I was aware of. I regularly use Diversified, Sacro-occipital, Activator, Thompson, Webster’s, and Logan in my daily practice along with different extremity techniques. Less frequently I use Toggle, NIMMO, Gonstead, Cox-Flexion Distraction, Arthrostim, and Graston or other soft tissue techniques. That’s only twelve out of hundreds. I am constantly reading up on how to get more “tools for my toolbox” as I like to say. I would be considered a mixed- chiropractor who combines adjusting techniques and therapies. I also focus on certain populations such as pediatrics and athletes. I would also be considered an “old-fashioned” chiropractor who believes in the power of the adjustment (you bet your coccyx I do!).
Despite the limited number of techniques I use, I occasionally will get a “Wow, no one has done that before!”, or “This visit was completely different from last time!”. I also get the occasional “Well, my old chiropractor always did it this way”. I might be using the same technique, on the same vertebral segment as another doctor, but the application of force, precise torque, depth, and hold of the adjustment procedure can all vary. This means the outcome can vary as well. That’s one of the things that makes studying the science behind chiropractic so difficult; every practitioner is unique and adjusts differently (more on this next week!). The technique used and its proper application makes all the difference in patient comfort and treatment outcomes. So how do I teach my patients about different techniques?
I start by telling them that my job as a chiropractor is to correct their body’s structure in order to improve its function. Therefore, if I succeeded in changing your structure last week, then I would have to treat you differently this visit. Even if I did not succeed in changing their structure last visit, that doesn’t mean that their body hasn’t changed in some other manner since their last visit. Responding to the body’s adaptive powers requires a variety of techniques and treatments. On occasion, I will have technique restrictions where I have to modify contact points, torque, patient positioning, or try something completely new. Sometimes patients give me restrictions as well, “No popping noises”, “No twisting moves”, or “I don’t like being touched a lot”. I have techniques available for my patients to accommodate for all of this as best as I can.
I take my art form seriously and practice adjusting regularly, get adjusted regularly, and read chiropractic literature regularly. I have to practice the art of touch, of pressure, of reading the body. I listen to my hands when they tell me something hurts, when something has loss of tone, or too much tone.I listen to my hands and my innate intuition when it tells me when to adjust or when NOT to adjust. I feel for differences in vibration, pulses, temperature, skin drag, and fluid. I feel for stability, lack of stability, restriction, or hypermobility. This is all part of the “Art” of chiropractic. Everytime I get to treat a patient, I get to practice and improve my “Chiropractic Pillar of Art”. This makes how I treat my patient just as important to me as it is to them. We are both benefiting from and care about this partnership. We are both invested in this; me in learning more about the body and how it works and expresses itself through our nervous system, and my patient through learning about their body and its conglomerate of simultaneous processes that are all coordinating in a way that allows life and vitality to flow through them. It’s truly amazing to me that I get to explore this as a career and I can’t believe I ever thought I would be bored!
Feel Well and Do Good,
ADIO
Dr. Super