We do not "snap, crackle, or pop" the vertebral spine. In itself, this means nothing regarding making the right correction. This sound is only a physiological reaction to a force directed at a stressed joint. It can be done wrong by anyone and overdone by many, even the one trained in the technique. Often when anyone trains many different people in the art of adjusting, it should not be to anyone's surprise that the technique becomes different somewhere down the road.
Fortunately, chiropractors are given great training in making the manual adjustments with some schools giving more time and greater rigor in the art. Sherman College, for example, is thought of by many as one of these colleges where smaller classes and an emphasis placed on upper cervical techniques seem to help make this occur. Students are not allowed to adjust there until they have reached maturity and an understanding later in their coursework. This is not the case in some schools; therefore the discipline required for the art of adjusting becomes merely a club activity with too many immature students adjusting when they do not know what they are doing. They form bad habits that carry over.
There is little validity to believing that a chiropractor can hurt someone or that the techniques should be considered dangerous. It is fair, however, to be reasonably apprehensive about manual cervical adjustments. No one has complications when things are done right and people who are infirm are excluded from treatment. Establishing "infirmity", however, is subjective. Generally, manual techniques should exclude the very elderly, severely osteoporotic, fractures, hemangiomas, or stroke-likely patients. Those who could have a stroke are not labelled as such, and during any normal activity one could have a stroke. Rightly or wrongly, people tend to believe that in all cases, the more direct the action, the more likely the cause. The anatomy of the vertebral artery in the upper cervical complex allows for complete rotation without endangering the vessel. In all Dr. Katherine's adjustments, only the specific adjustment is to the bone and its articulation, not to the surrounding soft tissue, because of a much smaller instrument contact or as in the AO specific adjustment, next to no physical contact with no physical force.
Chiropractors pay very little for professional insurance, much less than any general family practice MD. In any case, we elected to adjust using instruments; thereby, we are the least likely to hurt any patient.
If a patient is sore and there is tenderness, the areas will be sensitive to the touch. The chiropractor did not create the soreness and it is likely that after any adjustment you may feel soreness and tenderness in the most chronic regions. You should not have any sharp pains that present as a result of the adjustment. Seldom are they created and may have been part of your presentation before the adjustments. Many patients present with only millimeters of tissue separating them from pain. They are a cough or sneeze away from no symptoms to symptoms. Dr. Sweat teaches that you do not adjust people unless they have negative symptoms; while others teach that you need to do so, to help the patient from having negative symptoms or for more preventative reasons. Insurers demand that "adjustments" must have "negative symptoms." You just cannot be too safe, but if you are a chiropractor, you adjust. You have to make that decision for yourself as a physician and with an understanding of the patient's condition as best as it can be determined.
You have to read the patient to see if they have the maturity to overcome the conditions that brought them to you and the resources and time to stay with the program. If they do not, it's better not to start.
Dr Katherine was a very good clinic manual adjustor using Toggle, Diversified, Gonstad and other traditional techniques, but she also saw the benefits of instrument adjusting early in her career. She took electives in instrument adjustment with Activator and Atlas Orthogonal work at Sherman College. Of course, she graduated from post graduate work in Atlas Orthogonal, the equivalent of 2 additional years of study to qualify for this additional degree granted program Board Certified through Sherman College. Additionally, she took an additional externship with Dr. Pierce, the founder of Advanced Atlas Orthogonal in St. Petersburg, FL.
All chiropractors have to demonstrate proficiency in the manual adjusting and pass Part IV National Board Examination. If you do not understand spinal biodynamics and the traditional manual adjustments, you cannot use an instrument effectively and creatively. With the instrument and this knowledge, you have greater accuracy, speed, and a smaller contact, The amount of force can be reduced for a better result.
Dr. Katherine has little to be concerned regarding showing the safety of instrument adjustment. There is no way that a patient can be hurt. The cervical rotation adjustment often sited as a concern to scare business away from chiropractors is never into play. Dr. Katherine does much range of motion work in combination to the adjustments and the patient in most cases notices immediate improvement. She seldom if ever has an atlas orthogonal adjustment not reduce the short leg syndrome and relieve the C2 nerve root showing the accuracy of the analysis and the precision of the Atlas adjustment.
Insurance does not use the term "adjustment". They use the term "manipulation" which disturbs most chiropractors because it is medical language associated with therapies and implies that it could be done by professionals who are not trained to the same rigors as chiropractors. This will not change. CMT codes refer to the Chiropractic Manipulative Therapy and have procedural codes describing the regions and number of adjustments performed. Also any extremity manipulation is similarly coded as CMT. The term "manipulation" is closely akin to activities associated with mobilization of the joint; however, to a chiropractor any measured and directional force into a joint for some correction is viewed as an adjustment. The area to be corrected is viewed as a subluxated joint (subluxation), one that is misaligned with nerve interference as characterized in the State definition of the chiropractic scope of practice. It is the physician's intent that determines the coding of the procedure, not the technique, nor the instrument. In Dr. Katherine's adjusting room, she could well perform 3 to 4 different codes without most patient's knowing. She will do what tests positively and needs to be done. It is evident that she works very hard on all patients equally. She spends more time and does not let you go until she is satisfied.
The subluxated vertebral joint degenerates more rapidly and will eventually desiccate as it reduces the height of the disc. This puts more compressed resistance upon the nerve roots. Dr. Suh in a NIH study showed that a dime's worth of pressure would reduce nerve function up to 60%. Sustained imbalance and abnormal pressure influence reflexive joint activity and any automatic organ system activity "wired" to that region. Certain motions are more resisted and the function becomes reduced. Strength is lost to some degree and even neurological sensations occur. The patient is more vulnerable to certain activities and more easily is hurt in accidents. Some misalignments are related to the loss of the lordotic curve in the lumbar and cervical spine or increased kyphosis (flexion) in the shoulder and mid back. Also an abnormal curvature in the spine when it is supposed to be straight can effect your development and influence how well you age and the integrity of all weight bearing joints. Abnormal head carriage and fixed joints in the cervical spine contribute to headaches and jaw problems. Improper birthing in hospitals contribute to infant cervical subluxation that can stay with the person through their life. Dr. Katherine believes that most health problems related to the spine were initiated by earlier traumas and influenced by a series of microtraumas associated with poor postures and stressful repetitive, jarring workplace activities. Also poor Western oriented nutrition contributes to poor cellular regeneration influencing bone, connective, and muscle tissues.
Because insurance views the adjustment as no more valued than any mobilization or therapeutic timed activity, it is devalued in the marketplace. This is very misleading as the art of the chiropractic adjustment can change ones entire health improving the mind/body communication system. Its value cannot be measured.
Some chiropractors refer to themselves as Straight and others as Mixers. There is any combination of descriptors used to describe the physician's philosophy of practice. Straight essentially means only the vertebral adjustment is performed. Most of these physicians do not accept insurance. Sherman College of Straight Chiropractic was formed to express this philosophy where graduates were encouraged to restrict their practice to include only the adjustment without supportive therapies. It is not so likely today to find a "straight" chiropractor. There may still exist a formal association of straight chiropractors with close ties to Sherman College. Many are seen as eccentric, and of course, it is difficult to practice without accepting insurance. Sherman College recently took out the term "straight" but the beliefs still linger. A mixer was a negative term they used to refer to physicians who used therapies, instruments, or whatever they did not use or understand. Dr. Katherine values the importance of an adjustment and the straight philosophy or else she would never have become Upper Cervical; however, she also knows that therapies can be helpful to a lesser degree closely akin to their marketplace value. It is only the chiropractic adjustment that is devalued, but she cannot change that and will continue to focus her practice on its expert delivery.
Holding the Adjustment
"How long do I need to be adjusted? I've seen other chiropractors, and they want to see me three times a week for months." These are the thoughts and sometimes the questions asked by all patients. A very close family friend, an osteopath, in family practice once stated that the chiropractic adjustment does not hold implying that it was therefore unnecessary and nonproductive. He, of course, has never seen a chiropractor and has no better idea of what we do than any new patient who also has never seen a chiropractor. And, of course, all chiropractors are not the same, any more than all medical doctors are all the same. "Why would I keep going when I still have the same problem?" This question is generally only asked by someone who does not either go long enough to improve or who just is unable to notice improvement to justify the obstacles in going. When one questions its value, one is only voicing what many people are thinking. This medical doctor does not have the opportunity to observe patients being adjusted and sees them improve and feel better. He is also personally unable to have a limitation or painful spinal condition and have it improve. In fact, I really do not know to what satisfaction he can find professionally when he is only managing conditions and prescribing drugs and referring to Specialists.. He is a wonderful, sensitive, and caring professional, but without any directly personal experience, he would never consider to recommend chiropractic. If one of his patients spoke of improvement seeing a chiropractor, he would quietly discount the patient's opinion, but he would sense their positive feelings, drop inquiries, and tell them to keep going. This may be why many of our patients do not ever tell their medical doctors about their positive experiences. They know when someone's not interested.
Somehow there exists this preconceived belief that seeing a chiropractor is only an occasional event whereas seeing your medical doctor on a regular basis is the American Way. "Medicare or Medicare for All" is very political and implies quality, acceptance, and security, but chiropractic care is not included. Everyone asks who is your "family doctor", as though this helps to define your personal stability and responsibility. A certain smaller segment of society are more suspect of those "bearing gifts" and view being "attached" to a family referring MD is akin to a greater marketing skem.
Logic has it that if you see a chiropractor and you "do not hold your adjustment" it is not a worthy activity; holding the adjustment was the goal. Since you move all the time, how is it even possible to "hold." In most all cases, the medical doctor diagnoses conditions, most of which are managed with medications and advice. The condition does not disappear; the symptoms come and go. Most bacterial and viral infections never leave the body. Why is it that a medical doctor continues to treat someone if they cannot be cured but are only managed? The same question applied to value chiropractic could be applied to medical care to determine its value.
We find it frustrating that no one seems to be applying these same doubts on prescribing drugs and only treating symptoms. In these cases, the people are being harmed and diluted yet somehow this has value. The answer is not simple; some people will not be able to hold an adjustment because of damaged ligamentous tissue and degeneration. Some segments lose the ability to move while others are hypermobile. The longer you are "out of adjustment" and more degeneration, the longer it takes for some improvement. Long term structural changes at more mature ages are not going to change on x-rays even with the best chiropractic intervention, but function and relief will improve.
Our belief is that the body wants to be balanced, and that it makes every effort to balance itself given certain limitations of matter. This activity is primarily neurological. Certain tendencies of misalignment can become life long challenges where the individuals always seem to be dealing with a certain vulnerability. Vertebral joints require mobility to maintain health; yet we do not get enough motion and stimulation to these joints. Also in the adjustment are other energies that go unrecognized in their ability to react with neuroreceptors and our body chemistry.
We see patients get better. They continue to come back for what they see as improvements. They send in friends and family who experience the same benefits. We do not see a patient for years only to learn later how grateful they are for the few adjustments they received that made them pain free. We never promised them these kind of results. Some people we have to see all the time because of the pain and degeneration they experience. They have seen every medical doctor imaginable, but come to our office for the only relief they can get. Often these patients are over 65 and they must pay us out of pocket for these services.
My only answer for this medical friend who I respect is that each person is different. They believe and attest to experiencing benefits. Sometimes we are just not sure why some get better while some do not, but most all people experience relief and improved measurable function. They cannot move their shoulder, and have seen physical therapists and orthopedists showing no improvement. We adjust them and do some deep tissue muscle work and they can move their shoulder. You tell me. It is not just in their feeble uneducated minds. We have lawyers, doctors, teachers, business owners, CPAs, and other professional discerning patients. Making it so they do not need drugs and avoiding surgery seem to be good things. Being able to return to work and to enjoy certain activities is what our patients talk about. Being able to be helped when no one else has been able to is impossible to share with someone else. Who would believe it?
If a patient does not experience some measurable improvement within the first third of their plan of care, it is rare and has me wonder if it is the right thing. Most plans of care need to be no longer than 12 visits. In most cases, they can be helped within the limitations of coverage when those limitations at least allow for a full plan of care. We really do not want to see anyone three times a week for months; we are not a factory. The more accurate and measured the adjustment, the less likely you need to continue to adjust. The longer you have been out of adjustment and the more unstable the segment, the longer it takes to improve and stabilize within the limits of matter. Certain patients have more vulnerable anomalous spinal presentations, such as genetically fused segments or scoliosis, or other atypical spinal conditions, all of which make it more difficult to stabilize the spine. Chiropractic science deals with the dynamic nature of the spine, not its static presentation, therefore making it more of a neurological activity. It performs only activities that are inherently considered "good for everyone" and the spinal health of everyone. More so our goal is to improve function, not to correct misalignment. Would you ask, when do you stop exercising; when did you get enough exercise to last you? It really is a question that does not apply. I guess the answer is when you personally do not value it anymore or whenever you do not have the resources or the creativity to substitute your own personal activities to maintain your best function. The adjustment is our main tool in professionally performing this service.
Most often when people ask this question about holding an adjustment or how often do I need to be adjusted, they are worried about money. They do not want to add on another expense. I understand this. They would be much better off eliminating many expenditures, but those activities that improve function and health should not be rationalized away. When a medical doctor asks the question, they are status conscious and overly protective of their flock. It is very difficult for them to value any health care professional not part of their referral network.
