There's been a lot of discussion about instrument based adjusting as well as questions about which instrument to buy and which technique videos to get. So I thought I'd share with you all what I do with the Arthrostim.
Have you all heard of above-down, inside-out? (ADIO) It's the basis for chiropractic philosophy. That's not how the body works. It's not how the nervous system works. Impulses aren't generated in the brain. They're originated via the billions of nerve receptors that are distributed throughout the body - which sends afferent impulses to the brain. The brain then responds with efferent impulses to control & regulate the body function. So it's not above-down, inside-out. It's receptor-above-down-inside-out. You must stimulate a nerve receptor to get the process going.
First of all, you need to understand that an instrument adjustment is a NEUROLOGICAL correction. You aren't going to move a bone with an instrument - not to any appreciable degree. It's not a structural correction, it's neurological. You are going to be targeting specific nerve receptors (namely joint mechanoreceptors, muscle spindle fibers and golgi tendon organs). By stimulating these specialized nerve receptors, you can accomplish a number of clinical outcomes.
Pain (or nociception) is an afferent impulse which travels from the point of origin, through the dorsal column of the cord, synapses in the brain and is interpreted as pain in the cortex. Proprioception travels along the same pathway. By stimulating joint mechanoreceptors, you flood the "pipeline" with proprioception and by doing so competitively inhibit the nociceptive impulses. If you had 100% nociception, and then stimulated the mechanoreceptors and by doing so, you now have 50% nociception and 50% proprioception, you just cut the pain signal in half. That's pretty powerful. It's also how ALL chiropractic adjustments work. Because you are able to accomplish this neurological feat regardless of which technique you employ. Be it a traditional osseous manipulation (resulting in a cavitation), a drop or an instrument...they all function the same way. This mechanism also explains why when you smack your elbow in the doorway, and you instinctively rub the elbow, the pain goes away. Same mechanism. It's how Nimmo, ART, Graston, massage therapy, etc... ALL work to eliminate pain.
By the way, I need to address a pet peeve of mine. There is no such thing as "proprioceptors". There are joint mechanoreceptors that when stimulated produce proprioception. Not to nitpick, but given we all took and passed neurophysiology, it bothers me that so many people still refer to them as proprioceptors. Anyway...
So this brings us to a question. If you can get rid of pain by using 5 pounds of force, why use 50 pounds of force? Why crack somebody's neck if you can get them out of pain by zapping joint mechanoreceptors with an instrument - and get the same results?
When I was at Palmer, I was taught that thinks such as line of drive, line of correction, torque, roll-in, tissue pull, etc.. all were critical to get right if you wanted to correct the subluxation. However when I got into clinic and later on when I got into practice, I tried it both ways. And I found that I got the same results regardless if I was being ultra-specific or more general in my approach. I'm not advocating gross manipulation and just doing the flying 7 on everyone who walks in the door. In fact, I think less is more when it comes to adjustments. The fewer areas you adjust generally the better. By being economical with your adjustments, you can also zero in on which adjustments are effective and which ones aren't. Each patient reserves the right to have multiple problems. So when dealing with two or more issues, it also becomes important keep it simple and do the least amount possible. Not because of laziness, but due to trying to accomplish the best clinical result. I really don't think line of drive, line of correction etc.. matter. I don't really believe in the SEGMENTAL BONE OUT OF PLACE theory. I don't believe you can move one bone all by itself (not when it's connected to the one below and the one above by 9 common ligaments and 5 layers of muscle plus fascia and other connective tissues). It's like links in a chain. You can't pull on one link without pulling the whole chain along with it. Anyway...
If you remember from neurophysiology, there's a concept called facilitation. Hyperfacilitation generally means that there's less stimulation required to get the action potential to fire. In the simplest terms, the spinal segment is too "hot" and needs to be calmed down. The way to calm it down is by stimulating the neurology in that segment. When you zap the joint mechanoreceptor, it's like hitting the reset switch in the circuit breaker. It calms things down and evens the impulses out.
Not only should you adjust the fewest possible areas, you should also be mindful of how long to address each area. Most people who have an electronic adjusting instrument go overboard. You don't need to jackhammer the area for a whole minute. You only need about 2 seconds per region. That's enough to accomplish your goal - to stimulate the nerve receptor. Get in, hit it and get out. The arthrostim will continue to thrust so long as you hold down the trigger. The Impulse gun automatically shuts itself off after 2 seconds of thrusting. I spoke to Chris Colloca about this at a seminar. And he confirmed what I had been thinking about. That you don't need more than 2 seconds. His instrument has a built-in dummy switch that cuts you off. So if you have an arthrostim, just be mindful of how long you're treating.
Now hard should you adjust? An arthrostim has a floating stylus which recoils depending on how hard you press into the patient. You can set it up so they're receiving a fraction of an ounce of pressure. Or you can lean into it and drive nails. Colloca's instrument has 3 preset force settings (which are controlled via a 3-way toggle switch on the back of the instrument). You set it for how you want it, and pull the trigger. And it doesn't matter how hard you're pushing it into the patient... it's delivering the same amount of force with each thrust. Some doctors like that...others (like me) prefer to be able to dynamically control how much force you're using (based on real-time patient feedback). I think most people use too much force because they're so used to cranking on a joint and making it crack. You don't need to use very much force to stimulate a nerve receptor. Think about how little force is generated by an Activator....or even an Atlas Orthogonal machine. If you're leaning in and cranking on the patient each and every time, you need to re-think your approach. Use common sense here. For cervicals, you're going to want to use the lightest approach - for patient comfort. This is especially true for upper cervical areas. For thoracics, use a medium force. And for lumbo-sacral-pelvic areas, you can go heavier. For extremities, just think about the size of the area you're working on. For hands and feet, I'd use the same amount of force you'd use for cervicals. For elbows and knees, I'd use the same as you'd use for thoracics. And for shoulders and hips, I'd go somewhere between how much I'd use for thoracics to lumbars. Just start light and work your way up - depending on patient tolerance. Remember, when in doubt, go lighter.
There are three primary clinical outcomes I'm going for when using an instrument (in my case - I use the Arthrostim):
1. Pain relief
2. Restoration of normal, pain-free motion.
3. Posture correction
The way I address pain is to find the areas of pain by way of case history, palpation and provocative orthopedic tests. And then I zap the area of pain. It's that simple. I also am cognizant of referred pain caused by myofascial trigger points. (See Travel & Simmons and/or Nimmo Receptor Tonus Technique). I flood the brain with proprioception by zapping the joint mechanoreceptors.
The way I address range of motion is by targeting the muscle belly and/or muscle tendon while taking the patient through the range of motion. For example, if the patient cannot rotate his head to the right, I will have him rotate in both directions while using the arthrostim to stimulate the scalenes, SCM, suboccipitals, splenius, levalors, traps, etc... Typically within 1-3 sessions, I'll have 90 degrees in both directions.
How I address posture is via CBP methods. I do an analysis of their posture. And then when I see a postural problem, I put the patient in their mirror image, superstress them in that position, and zap the areas of the body which have the richest beds of joint mechanoreceptors (namely the atlas/axis area, the SI joints and the femur heads where they articulate in the acetabulum). That's pretty much how CBP works. Analyze their posture; put them in the mirror image; stimulate the nervous system.
Just like with ALL other chiropractic techniques, an instrument based adjustment is not going to fix everything. You have to get the patient stretching, exercising, eating right, sleeping right, pooping right, drinking plenty of water, paying attention to ergonomics, taking supplements, managing stress, thinking good thoughts, and all the other components of a wellness lifestyle.
Using an instrument confers many collateral benefits to you and your practice. There's zero risk of injuring a patient. There's no wear and tear on your body. There's no cracking of the neck (which does freak out a lot of people). It is congruent with chiropractic philosophy. It's good for sports injuries, MVA & WC injuries, and can be used for wellness & subluxation based care.
Does an instrument work 100% of the time? No. There will be times when it is necessary to get a little more aggressive. But doesn't it make sense to start with the instrument and work your way up - only when necessary? No adjusting technique works 100% of the time for 100% of the population. But I've found that the instrument will work with probably 90% of the patients who come in the door. Many of them actually get better results and enjoy the comfortable, low force approach.
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