D.D. Palmer once said that chiropractic is a science, and adjusting, an art. We sometimes forget the pure artistry of adjusting. For those of you just beginning in school, it is like picking up a paintbrush for the first time. I'm sure we have all seen an instructor or doctor perform an adjustment and wonder how they make it look so easy. This month I would like to explore the adjustment and what we can do to improve skills in adjusting.
All art begins in the mind of its creator, therefore if adjusting is an art, it does not begin with our hands placed on the patient, but in our minds. The doctor must be able to visualize all the structures that are involved with the medium in which we as artists function, namely the human body in its entirety. Adjusting as an art form must always begin with a thorough understanding of human anatomy. This knowledge should include, but not be limited to the musculoskeletal system, biomechanics, neurology, and physiology. Diagnosis therefore is only a matter of applying one's anatomy.
Anatomical understanding cannot be overlooked because it forms the basis of our skill. Anatomy supplies the WHY (to provide normal joint movement); the WHERE (in joints that exhibit joint dysfunction); the HOW (using basic biomechanical principles to increase joint movement); and the HOW OFTEN (based on pathophysiology of joint structure and function). Anatomy also supplies an understanding of direction of joint movement, ability of joints to withstand an adjustive force, etc.
Adjusting as an art also requires practice and focus. Practice is essential for any skill and focus enhances our ability to see through our hands. Anyone, given enough leverage can create an adjustment. Art, on the other hand requires much more diligence and plain old work.
The following is a summary of those factors that will enhance our adjusting skills:
- knowledge of anatomy
- tissue sense -- obtained through practice and motion palpation
- timing, timing, and timing
- power -- seldom needed if 1-3 are utilized correctly
- direct the force into as small as area as possible, i.e., index or finger contacts when possible
- utilize proper body mechanics for yourself and your patient to direct the force where it is needed.
- be gentle, in other words, use only that amount of force necessary to move the joint
Terry Elder, DC
Winfield, Kansas Editor's Note:
Dr. Elder will be conducting his next Spine 1 seminar April 9-10 in Bridgeport, Connecticut, and a Spine 2 seminar April 16-17 in Toronto, Ontario, Canada. You may call 1-800-359-2289 to register.
