Redefining Instrument Adjusting and Computerized Adjusting
Friday, October 22, 2010 at 8:36PM
Christopher J. Colloca, D.C.
CEO and Founder of Neuromechanical Innovations
Dr. Colloca is the CEO and Founder of Neuromechanical Innovations, a UL Listed and ISO 13485 medical device manufacturer of the patented Impulse® family of adjusting instruments currently in use in over 6,000 chiropractic offices in 42 countries around the world.
INTRODUCTION
Instrument adjusting is by far the fastest growing technique specialty in the chiropractic industry. The last National Board of Chiropractic Examiners survey reported that over 70% of chiropractors utilize instrument adjusting in their practice as one of an average five techniques they incorporate. But what comes to mind when you think of Instrument adjusting? Do you think of an esoteric chiropractic analysis that you couldn’t imagine yourself doing? Or, maybe you have visions of high priced computerized adjusting systems with no research to back them up? In a recent survey that we conducted, we identified these sentiments as primary concerns among chiropractors who hadn’t incorporated instrument adjusting in their practice. What would you change about Instrument adjusting for the betterment of your practice and the profession? That is exactly the question that I asked myself when developing the Impulse® family of adjusting instruments and Impulse Adjusting Technique®.
Having taught Instrument Adjusting to thousands of chiropractors throughout the US and around the world, I think I’ve fielded most every question on the subject. Unfortunately, instrument adjusting has historically been associated with esoteric chiropractic analyses within technique systems. Unquestionably, chiropractors have a right to be turned off by some of the instrument adjusting techniques. Some common negative feelings about instrument adjusting that we identified in our survey are listed below in Table 1.
|
Table 1. Negative sentiments about chiropractic instrument adjusting |
|
1. “I don’t think the instrument can move the vertebra like I can manually.” |
|
2. “Patients don’t feel the immediate result after an adjustment like they do with manual adjusting.” |
|
3. “Those instrument guys use whacky tests and look for leg lengths to change telling them where to adjust.” |
|
4. “There’s a new instrument adjusting guru teaching people that they adjust away emotional problems stemming from childhood by tapping on the skull. He even teaches chiropractors to adjust themselves.” |
|
5. “I like using the instrument, but it hurts my hands and wrists!” |
The sentiments seemed to grow even stronger when speaking of so-called computerized adjusting. Some felt that they have been harassed by salesmen trying to land the big sale, and others who actually did buy had felt swindled. Some negative connotations associated with computerized adjusting that we identified are listed in Table 2.
|
Table 2. Negative comments about computerized adjusting |
|
1. “It is cost prohibitive. They sell these things for $25,000 - $80,000!” |
|
2. “I bought it and I still can’t explain what the device measures. Even the owner of the company can’t explain what it does.” |
|
3. “There is no research validation for computerized adjusting.” |
|
4. “The ‘analysis’ they teach in their assessment is not enough pressure to measure through the fat and muscle of the patient, let alone the spine’s stiffness.” |
|
5. “There is no way they can locate the same vertebra for their pre-post analysis.” |
Redefining Instrument Adjusting
Surveys are powerful tools to identify customer’s feelings and consumer confidence. As a instrument adjusting manufacturer, of course we wanted to overcome each of these objections to restore consumer confidence and instrument adjusting utilization. Interestingly ten years ago, we began overcoming these very objectives in developing the Impulse Adjusting Instrument®, computerized adjusting (Impulse iQ®), and Impulse Adjusting Technique®. My aim was to redefine instrument adjusting and computerized adjusting in the minds and practices of chiropractors. We needed to create reliable and valid research-based adjusting instruments to combine with a logical chiropractic analysis to take the mysticism (whacky stuff) associated with instrument adjusting. Table 3 provides our response to the concerns that chiropractors had with instrument adjusting.
Instrument Development
Simply stated, instrument adjusting can be broken down into two components – the instrument itself, and the chiropractic analysis used to identify where and when to adjust with the instrument. First, we had to begin to answer the basic science questions of instrument adjusting. What forces should we use to adjust different regions of the body? How much preload should be applied? What frequency should the multiple-impulse thrusts be delivered? Using both human subjects and animal models, we measured these variables and published our results in scientific journals.
|
Table 3. Response to negative sentiments about chiropractic instrument adjusting |
|
|
Negative Sentiment |
Impulse® Response |
|
1. “I don’t think the instrument can move the vertebra like I can manually.” |
Research clearly demonstrates equivocal inter-segmental motion responses with impulsive chiropractic adjustments to manual thrusts. |
|
2. “Immediate results?” |
Because of the faster speed, tuned frequency, and larger force magnitude of the Impulse® devices, patients report more immediate results than with other spring loaded activation devices. |
|
3. “Whacky Tests” |
IAT does not incorporate any leg checks, isolation tests, or other esoteric tests |
|
4. “Esoteric adjustments and adjusting yourself” |
I don’t cut my own hair and I don’t advocate adjusting yourself. |
|
5. “The Instrument hurts my hands and wrists!” |
Impulse doesn’t have a spring activation system that slams back into your wrist and hand. Impulse® uses microchip technology to control the force of the adjustments. |
To perform the necessary biomechanical studies to answer these questions, we implanted stainless steel pins into the spinous processes to which we attached 3-D accelerometers. With this experimental setup, we were able to precisely quantify the spinal motion responses during chiropractic adjustments as well as differences in motion among those with disc degeneration, hyperactive muscle activity, and ligament injury. Through this research we validated our computerized adjusting protocols in a non-invasive method to measure dynamic spinal stiffness. We published our findings in the journal, Spine. To this extent, the Impulse Adjusting Instrument® was prospectively developed out of this research. Table 4 provides our answers to the concerns posed by chiropractors with respect to computerized adjusting.
Technique Development
After the instruments were invented, Impulse Adjusting Technique® (IAT) was developed. IAT was developed with an aim to incorporate logical and validated objective assessments into a technique analysis that was fast and easy to perform. We embraced the Centers for Medicare (CMS) Services mandated P.A.R.T. analysis in our own technique to keep chiropractors in compliance and increase their reimbursements at the same time. Easy to implement and combine into your current technique system, IAT is taught in most major US Cities and international hubs (see www.impulseseminars.com).
|
Table 4. Answers to computerized adjusting concerns |
|
|
Concern |
The Impulse iQ® Approach |
|
1. Cost |
Affordable pricing at a fraction of the cost of others |
|
2. Difficult to Explain |
The patented auto-sense technology® of Impulse iQ® monitors spinal motion and its frequency during the treatment. |
|
3. Validation |
Validation studies have been published in numerous scientific journals |
|
4. Analysis |
Stiffness measured during the actual adjustment; Accepted PART assessment utilized |
|
5. Test-Re-Test Reliability |
No pre-post analysis vs. adjustment modes used. Instead, Stiffness is measured in real-time during the adjustmen. |
We hope to have addressed the most common concerns that chiropractors have about instrument adjusting and in the decades to come will continue to improve computerized adjusting technology with the Impulse® family of adjusting instruments. To learn more about the Impulse system and for free educational downloads visit www.neuromechanical.com.
References
- Complete references for this article can be found online at www.neuromechanical.com or