The Side of Adjustment Matters
Dear Editor:
With dismay, I have read various articles and papers recently suggesting it is not critically important that we be accurate in our chiropractic analysis.
Sure, it would be great to adjust the "correct side" of the vertebrae or even the correct level, if one can possibly find it, but the authors seem to be satisfied simply adjusting the area and putting motion into the spine! Based upon my 19 years of experience, much reading and researching, and numerous clinical seminars, I find this thinking seriously flawed.
We need to approach our chiropractic treatment of the patient with the utmost care, knowledge and specificity. As my analysis sharpens, based on my deepening knowledge of the body and how it functions, my results get better and better. I would like to share what I consider a powerful way to analyze and treat neuromusculoskeletal dysfunction.
I begin by using visual inspection of the patient in the prone position. Look for any obvious areas of decreased muscle tone adjacent to the spine in the lumbosacral, thoracic and cervical regions. View the patient from the foot and head of the table. Palpate using your fingers or even thumbs on either side of the entire spine, and take note of the areas of decreased muscle tone that you identified by your visual inspection. This will be visually and palpably indicated by a depression or hollowing in the area. When I palpate these areas, I press my thumbs down with equal pressure from P to A.
These areas, corresponding to segmental levels of multifidi muscle atrophy, require specific chiropractic adjustments, not the compensatory side where the muscles appear rounder and fuller. Those muscles are simply adapting and reacting to the weaker, inhibited side. This analysis of function just so happens to correlate with the Activator PD or short leg, due to the fact that when I make the necessary corrections, the PD/short leg lengthens/balances with the other leg, indicating muscle relaxation and normalization of tone.
After I have made the necessary corrections, I perform a quick weight-bearing scan of the areas I have just treated to get an appreciation of the patient's standing posture, often slightly flexed to visually draw out the muscle dysfunction. I then make any final adjustments and call it a day! Of course, the areas displaying multifidi atrophy need spinal stabilization exercises to strengthen and support the adjustment.
In this age of modernization and technology-based analysis, it's nice to know relatively simple principles and practice are very effective and reproducible. One simply needs due diligence and practice in order to become quite proficient. The human body reacts and responds in very intelligent and predictable ways to injury or chronic insult. Sometimes, if you step back and look intently at the patient, the ways to help them will be simpler than you think.
James Metzger, DC, CCSP
North Haven, Conn.