AJCC April 2000

When to Adjust?
by R. J. Hammett, D.C.

Dr. Hammett is a chiropractor in private practice in Kenosha, Wisconsin. After graduating from Life College in 1979, he completed several post-graduate programs in Physical Impairments, Diagnostic Imaging and Rehabilitation. He completed his Juris Doctor in 1995. He has written articles for several Journals and has lectured to numerous Chiropractic groups on the topics of Practice Management and Risk Prevention.

I have observed various chiropractors in their offices, and adjusting each other at seminars. It is obvious the pride each doctor brings to his/her individual art. After observing different chiropractors, a basic question comes to mind . . . how do you know when to adjust and when not to? Most chiropractors when asked this question, go on the defensive with questions like ' What do you mean? 'or 'Why do you ask? '

If asked by a colleague or by a patient, how do you simply state what you're doing and why? How do you answer your patients when they ask, 'How do you know when to adjust me or not to adjust me??'Most chiropractors relate their adjustments to symptoms whether it's conscious or unconscious. Most criteria in today's 'scientific'chiropractic community revolves around symptom control and ADLs (Activity of Daily Living), just ask any IME doctor.

Research into the components of a vertebral subluxation complex shows that symptoms provide clues to the place of the vertebral subluxation complex, but in and of themselves, they are the poorest way to detecting the real vertebral subluxation complex. I suggest that you use objective tests for each of the components of the vertebral subluxation complex to verify its existence.

First is postural analysis by computer. This is something you can easily show the third parties and patients. Second, bilateral and four-quadrant weight scales which is another way of showing evidence of vertebral subluxation complexes, computerized range of motion, SEMG, radiographics. . . both pre and post, skin temperature analysis, leg length analysis, and strength challenges noted pre and post adjusting.

The above objective tests are applied to each of the five components of the vertebral subluxation complex. It should be noted to the reader that palpation, orthopedic and neurological tests have not been included. The reason is that research to support the application of these tests to confirm or deny the presence of vertebral subluxation complexes is lacking or not available (Oh Mercy Me!). Now, before you orthos and neuros start screaming, I didn't say don't palpate or do neurological or orthopedic tests. Unfortunately, these have become a 'standard,'however, they do not allow the chiropractor precise and predictable assessment of when and when not to adjust a patient or when the vertebral subluxation complex is corrected. Show me a single leg raiser or Soto Hall test that tells me where and when to adjust. Watch fellow chiropractors at a seminar adjust each other. What pre and post adjustive assessment is that chiropractor doing? It ' s easy to tell if a chiropractor knows where and when to adjust. Look at their assessments and note if they were using any orthopedic or neurological tests to determine where to adjust. Do all the 'TESTS,'(the standard ones)! But know when and where to adjust, and when not to.

Use third party chiropractic tests to 'show'the presence or absence of the vertebral subluxation. It is critical to you, your patient and any third party person. Your daily chart notes should have a minimum of leg checks, postural analysis, range of motion tests, as well as subjectives. At every re-examination, you should recheck all of your findings. Show the patients the weight and balance, their pre/post posture picture, and occasional re-xrays if you're trying to achieve spinal correction.

It is one thing to have abnormal orthopedic/neurological tests, but is this how you base your care? Base your care on objective chiropractic analysis and adjust accordingly. Place your faith, not in ortho/neuro tests, but in your chiropractic evaluations.

Finally, a practice hint: How to show a short leg syndrome to your patient? Have them lie supine, relax and tell them to gently lift their head and look at their feet. Show them the difference, before and after the adjustment.

Till next time . . .