Why should chiropractors learn low force adjusting? The techniques I have studied and the work I teach are all done manually, hands-on, and are based on palpation as our primary diagnostic tool. Are there potential advantages to a manual, palpation-based approach to low force adjusting?
When addressing neurological retraining, we're reminded of the importance of education and patient self-care. Are we teaching our patients how to move better, through basic exercise, spinal stabilization, and proper activities of daily living?
Many chiropractic techniques are dependent upon what I would call intuitive or innate guidance. We are using a "reflex" method of determining where to adjust, whether it's a leg check or a muscle test. I'm not knocking these methods, but unfortunately, if the doctor uses these tools to the exclusion of using his or her palpating hands, he or she never develops the subtle manual skills necessary to become really good at our art.
One of the benefits of palpation is that it has an incredibly broad learning ramp. This means that this is a tool that can lead to mastery, if applied consistently over many years. We have the opportunity of practice, our everyday opportunity to touch many people, and continually build our "database" of palpatory experience. There is so much information stored in the tissues of the body.
I believe, as do most of the respected teachers within international manual methods, that palpation with the hands is the key diagnostic skill for manipulation. This skill only develops if you use it, and if you seek to understand what you are feeling under your hands. I'll quote Karel Lewit, from Manipulative Therapy of the Locomotor System: "Eliciting the twitch sign in a trigger point illustrates another very important feature of palpation: it provokes a reaction in the patient's tissues, additional diagnostic information establishing a unique feedback relationship between two highly complex self-regulating systems, examiner and patient, which can be matched by no other instrument. This would satisfy any criteria of modern information theory, if it were reproducible and scientifically verifiable. We are thus faced with a paradoxical situation. The clinical method that provides the richest and most differentiated information is stigmatized as 'subjective' and therefore nonscientific, compared with sophisticated apparatuses that at best are but a poor copy of the nervous system, whereas palpation uses the human brain itself, and the sensing hands."
Unfortunately, studies that have looked at the reliability of palpation have shown a lack of reproducibility of findings between examiners. This does create a dilemma. I will not claim to have all the answers to the questions that these research results create for the field chiropractor. I will continue to practice based on palpation for all of the reasons outlined here and more, acknowledging that the signal to noise ratio for palpation is troubling. We always add tenderness as an important part of our palpation exam, as it adds the feedback quality mentioned by Lewit, and is the most reproducible palpation tool.
If we are working only with digital, off/on tools like muscle testing, leg checks, or the testing tool itself, once mastered, they do not require further learning. If all of my adjustments are done with an instrument, do my hands become more adept each time I do an adjustment? In palpation and in manual adjusting, there is an ongoing learning, a continual improvement of skills. Some of you may not feel you need more skills in this area; others may welcome the opportunity for the lifelong improvement of skills.
There is recent intriguing research about what happens to the brain in skill development. The essence of this research says, "Use it or lose it." MRIs of the brains of London taxi drivers, who must memorize the incredibly complex roads of the city, revealed that the drivers had larger posterior hippocampi compared to noncabbies. Violin players have greater development of the parts of their brains that control the fingering hand. If we palpate and pay attention, we can develop this skill, this connection between our brain and our eyes and our hands, to an incredible degree. Any of you who have seen a master at work in any field know this. Are you becoming a master of your own art, or are you satisfied to work at the journeyman level? There is an incredible combination of satisfaction and ongoing yearning that comes from climbing the difficult path to mastery.
There is much more to say and learn about improving our hand on clinical skills, and I'll address palpation and barriers more specifically in the next article of my series.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
