Chiropractic care is based on three main beliefs: 

• Your body has a natural and powerful ability to heal itself.
• Your nervous system is the main controlling system of the body.
• An interference with the nervous system can cause your body to malfunction or cause disease. 

Thus, the goal of a chiropractic adjustment is to remove the interference with the nervous system.  

Words Defined: Vertebral Subluxation

An interference of the nervous system due to a misalignment and/or abnormal motion of spinal vertebra which causes improper communication with associated organs, muscles and tissues of the body.

The International Chiropractor’s Association (ICA) states that the “chiropractic spinal adjustment is unique and singular to the chiropractic profession,” and that it “is characterized by a specific thrust applied to the vertebra utilizing parts of the vertebra and contiguous structures as levers to directionally correct articular malposition.” 

The adjustment will involve force to specific areas with therapeutic intent. This force is often done with the hand, but other instruments may be used. The force varies with your particular problem and the technique your chiropractor is using.

Why Have an Adjustment

Why would someone want a chiropractic adjustment? The real question is “Why wouldn’t you want a chiropractic adjustment?” 

Stat Fact   31 million Americans experience low-back pain at any given time. Low back pain is the main reason why people seek chiropractic care.

Chiropractic adjustments help your body to be healthy, rather than just “not sick.” Chiropractic fits in with exercise, good nutrition, positive mental attitude and rest as components to a wellness lifestyle. This is because chiropractic focuses on the proper alignment and function of the spine and nervous system, which controls

every aspect of how the rest of your body works.

Some people are crisis-oriented and wait until they can’t move before they take action on their issues. In fact, most often people seek chiropractic adjustment as a remedy for pain conditions, including: 

• Pain and stiffness in the neck, shoulders, back, arms, hands, chest, abdomen, hips, legs and feet
• Headaches
• Sciatica (pain caused by compression of a spinal nerve root in the lower back)
• Injuries such as whiplash and sports injuries
• Leg pain
• Nerve disorders
• Bursitis and Tendonitis (conditions involving inflammation of soft tissues).
• Repetitive strain disorders such as carpal tunnel
• Fibromyalgia (chronic muscle pain and stiffness)  Arthritis

Of course, chiropractic adjustments can help with these conditions, but you will be far better off if you have your spine checked out before you have pain.

Studies Show

High Patient Satisfaction with Chiropractic

The results of the published study summed it up best; “Based on the results of this survey, it seems that patients suffering from back and/or neck complaints experience chiropractic care as an effective means of resolving or ameliorating pain and functional impairments. Moreover, the patients surveyed demonstrated a high degree of satisfaction with the care they received. Numerous other studies have demonstrated that chiropractic is as effective, if not more effective, than conventional medical management of such complaints.”⁴

What to Expect During an Adjustment 

If you ask 1,000 patients to describe their experience with a chiropractic adjustment, you would likely hear 1,000 different answers. Why? There are so many different techniques for your chiropractor to choose from and each patient has different needs. 

You may be asked to sit up. You may be asked to lie down. You may be on a table that has adjustable head and foot rests. You may be tilted. And, depending on your subluxation, you may be put in a variety of positions over the course of your treatment. However, even with all the variations, there are some things you can expect when you go in for a chiropractic adjustment.

Depending on the reason for your visit, your chiropractor may make adjustments to joints in your back, neck, shoulder or some other part of your body. At your first visit your chiropractor will: 

• Take a health history
• Perform an exam, particularly on your spine
• Recommend diagnostic tests
• Based on these initial exams, your chiropractor will put together a treatment plan to suit your needs and treatment goals. 

Now it is time for the adjustment. Depending upon your affected area, your chiropractor will place you in a specific position for the adjustment. 

Each adjustment technique is different, but many involve the use of your chiropractor’s hands. He will use his hands to apply a controlled force to a joint. 

You may hear popping or cracking sounds as your chiropractor works your joints during the treatment session. Do not worry. When your vertebrae are adjusted, tiny pockets of gas are released from the joints, making a “popping” noise.

Because your chiropractor is concerned with the health of your entire body, he may recommend other treatments in addition to the adjustment, such as: 

• Heat and ice 
• Massage
• Stretching
• Electrical stimulation
• Rest
• Exercise
• Lifestyle counseling
• Dietary supplements

Adjusting techniques use minimal force and gentle pressure; therefore, you are unlikely to feel much discomfort. In fact, most patients report feeling relief, calmness and a sense of well-being. More than likely, you will also have increased mobility. 

Adjusting Techniques

A chiropractor goes to college for many years learning how to care for his patients. During college, he will learn many different adjusting techniques because each doctor and each patient is different. Patients come in different shapes and sizes just like doctors, and these factors have to be considered when coming up with a plan of action. In fact, different subluxations in the same patient are different, so different approaches may have to be taken.  

In the end, your chiropractor will choose the technique that most effectively corrects your subluxations with a minimum of force.

Every chiropractor employs different techniques in his office. Not every chiropractor will perform every kind of technique. However, there are techniques that are more standard than others. Here are just a few.

Activator Methods: This technique uses the Activator Adjusting Instrument instead of a by-hand adjustment. This gives consistent mechanical low-force, high-speed clicks to the body. Adjustments with the Activator are so quick that your muscles are less likely to resist, allowing for a more precise and accurate adjustment. Your chiropractor will know that it is working by performing a leg-

length analysis. Subluxation of the spinal bones causes a change in the length of your legs. As the subluxation is released, your legs will become even again.

Active Release Techniques (ART): ART is a soft tissue technique that involves movement-based massage. It treats problems with muscles, tendons, ligaments, fascia and nerves, often caused by overused muscles. Your chiropractor will use his hands to assess the texture, tightness and movement of muscles, fascia, tendons, ligaments and nerves. Tissues that are abnormal will then be treated with tension, along with movements your chiropractor asks you to make. ART has over 500 specific moves, allowing your chiropractor to correct your specific issues. 

Words Defined: Fascia

Strong connective tissue found throughout the body.

Bio-Geometric Integration (BGI): This approach isbased on the geometry of the human body. The body is made of a web of energy connections and sometimes these connections become faulty due to the misuse of your body. Understanding these connections allows your chiropractor to use light touches and gentle adjustments so that your body can release tension patterns. As these patterns are released, correct patterns can be established and your body can heal.

Blair Upper Cervical Technique: This is a system of analyzing and adjusting the upper cervical vertebrae of the

Stat Fact   The brain stem at the level of the atlas vertebrae consists of approximately ten billion nerve fibers.

spinal column. These vertebrae can misalign, interfering with the brain stem and spinal cord as they exit through the floor of the skull and into the neural canal. Most attention is given to the first two cervical vertebrae, the atlas and axis, because they move more freely in the spinal column and often become

misaligned. When they misalign,they interfere with the messages being sent to and from the brain to all parts of the body. The Blair technique uses neurological tests, x-rays and heat sensitive instruments to detect subluxations. 

Cox Flexion-Distraction:Flexion/distraction manipulation decompresses the disc by applying a gentle stretch to the lower spine. This is done through a series of repetitive, slow movements. This technique does not use quick force like many other methods. It is often used for people with disc problems and to mobilize joints. A special, adjustable table, known as the Cox table, is used for this technique.

Directional Non-Force Technique (DNFT): With this technique, a body challenge and a leg check are used to determine where subluxations are located. The body challenge consists of a gentle push against a structure in a specific direction. The leg check determines if the reactive leg has gotten shorter. If so, then the body challenge is positive and that structure is causing nerve interference.  Once the correct structure is identified, a light thumb pressure is delivered. At the same time, the correction of ribs, discs and ligaments is also performed. 

Diversified: Diversified is characterized by a high velocity, low amplitude thrust. Diversified is considered the most generic chiropractic manipulative technique.

Gonstead Technique: Gonstead, once a mechanical engineer, developed the idea that a subluxation in one area of the spine created changes in other areas. The Gonstead concept of chiropractic begins with the body’s structure and intervertebral discs. Balance within the body occurs when the pelvis, vertebrae and legs are level. The Gonstead technique focuses on unleveling, intervertebral misalignments, motion disturbances and nerve dysfunction. To determine which problems are occurring in your spine, a full spine x-ray is used. Additionally, palpations, visualization of motion, gait and inflammation, and skin temperature examinations are used. 

Kale Technique (Specific Chiropractic): This is agentle technique which uses a special adjusting table that helps adjust and stabilize the upper cervical region surrounding the brain stem.

Logan Basic Technique: This technique treats the muscles that control spinal balance in order to release tension. The chiropractor will examine your spine next to a plumb line, and then place pressure on a leverage spot on the sacral bone (tail bone) in the lower spine. This spot is held for 10 to 15 minutes while the chiropractor lightly rubs the back muscles with his other hand, coaxing them to release tension. You will also be required to lift your heel during this process.

Manipulation Under Anesthesia (MUA):  Manipulation under anesthesia uses a combination of specific shortlever leverage, passive stretches and maneuvers to break up fibrous adhesions and scar tissue around the spine and surrounding tissue. It is usually offered under general anesthesia, but can also been done with mild sedation or the injection of an anesthetic into specific tissues. This treatment is performed in a hospital or surgical center. 

(for more, see the end of this chapter)

NUCCA Technique: NUCCA stands for National Upper Cervical Association and is a specific technique practiced by only a small number of qualified chiropractors. A gentle touch and controlled contact on the first vertebrae in the neck, the atlas, is designed to restore balance to the spine. Pre-adjustment three-dimensional x-rays are used to determine the direction and degree of spinal misalignment and how to properly restore the spine to normal. 

Orthospinology Procedure:This procedure focuses on the atlas and axis in the neck. It is a precisely calculated adjustment and is usually not felt by the patient.  The calculations are complex and based on x-rays taken from three different directions. Depending upon the calculation, 1 to 7 pounds of force are delivered to the upper cervical spine using a hand-held or table mounted instrument while you lay on your side. 

The Palmer Method (Hole-in-one technique):  This technique was developed by B.J. Palmer, the father of chiropractic. He felt that the atlas and the axis were the cause of most problems with the spine. During this technique, you will be on your side with your head supported by an elevated headpiece. Your chiropractor will then place the heel of his hand immediately beneath your ear on one side, while gripping the wrist of that hand. He will then apply a sudden thrust against the side of the neck.

Thompson Terminal Point Technique (Thompson

Drop-Table Technique): This is a technique performed on a table in which cushions drop an inch or two when a thrust is applied to the spine. Your chiropractor will locate subluxations by checking leg length.

Toggle Recoil Technique: A toggle recoil adjustment is performed on the atlas and axis in the cervical vertebrae. A toggle is a sudden shallow thrust followed by quick withdrawal of your chiropractor’s hand. While thrusting, your chiropractor may add rotation. 

Results of a Chiropractic Adjustment

The effects of spinal adjustment vary depending on the method performed; however, all techniques have amazing benefits, such as:

• Decreased muscle tension 
• Reduced stress
• Relief of musculoskeletal pain  
• Increased range of joint motion 
• Changes in facet joint movements
• Increased pain tolerance 
• Increased muscle strength

Safety of Chiropractic Adjustments

The World Health Organization states that when “employed skillfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems.”⁵ Chiropractic is a safe, drugfree, non-invasive therapy.   

Studies Show Chiropractic Is Safe

This study looked at 19,722 chiropractic patients who had received chiropractic manipulation of the cervical spine. The researchers reviewed a total of 50,276 neck adjustments and looked to see if there were any serious side effects from the chiropractic care. Serious effects were defined as those needing hospitalization, the worsening of the symptoms or significant persistent disability. There were no reports of serious adverse events.⁶

More on Manipulation Under Anesthesia

Manipulation under anesthesia (MUA) is a procedure that is offered for acute and chronic conditions. This noninvasive procedure can be used for:

• Shortened muscles
• Fibrous adhesions
• Long term pain syndromes
• Neck pain
• Back pain
• Joint pain
• Muscle spasms
• Failed back surgery
• Traumatic torticollis
• RSD
• Chronic fibromyalgia
• Nerve entrapment
• Decreased spinal range of motion

Manipulation under anesthesia is considered safe and is used to treat ascending pain from the thoracic, cervical and even the lumbar spine as well as the pelvic and sacroiliac regions.¹ 

How Does Manipulation Under Anesthesia Work?

Manipulation under anesthesia uses a mixture of specific short lever spinal manipulations, passive stretches and concise articular and postural kinesthetic maneuvers in order to break down fibrous adhesions and scar tissue surrounding the spine and tissue.^.2

The three manipulation procedures can be given to patients under general anesthesia, during mild sedation or following the injection of anesthetic solutions into spinal tissues. Only licensed physicians/chiropractors who have specific training and certifications perform the manipulation treatments. Manipulation under anesthesia is typically done in a hospital or surgery center with a team approach.²

Who Is Included In the Team Approach?

• The anesthesiologist
• The main chiropractor/doctor who performs the manipulation under anesthesia
• The first assistant who is a certified chiropractor for manipulation under anesthesia Other assistants if necessary³  

Important Fact:

  Manipulation under anesthesia has been around   for more than 60 years, so it is not a new practice.  

Who Is a Candidate?

Certain neck, back and spinal conditions don’t respond well to conventional care. One theory of why conventional care doesn’t work for certain conditions is due to adhesions and scar tissue building up around spinal joints and nearby muscles. Due to tissue buildup and adhesions, chronic pain is caused.⁵

Many times, people undergo treatments such as physical therapy, epidural injections or back surgery that don’t address fibrous adhesions. Sometimes patients feel better for a brief amount of time, but pain frequently returns. 

Patients who have received nonsurgical care/treatments for around six to eight weeks are the patients typically selected for manipulation under anesthesia. MUA may be the right alternative to these treatments if they aren’t working. Before treatment, diagnostic testing should support the need for manipulation and eliminate questions of factors that can cause pain. 

In addition to MRI scans or CT scans, musculoskeletal sonograms or nerve conduction velocity tests can be used to support the need of treatment. Pregnant women, frail people, the elderly and the osteoporotic should not be treated with MUA due to fear of causing fracture of the shaft or proximal humerus.⁶

What Is the Purpose of Manipulation Under Anesthesia?

Manipulation under anesthesia is used to break up scar tissue around a joint that doesn’t have complete range of motion. For example, if a patient was to have a knee replacement and they aren’t receiving very much flexibility with movement after approximately six weeks, they could receive manipulation under anesthesia so that the doctor/chiropractor could gain improvement to the patient’s range of motion. MUA isn’t only for knee problems; it can

also be used for neck pain, back pain, joint pains, etc.

Does Insurance Cover This Procedure?

MUA is covered by most insurance companies, but the coverage is dependent on if this procedure is a necessity to the patient. Many examinations will determine the necessity of this treatment.